Ep 7. Feeling Worse After EMDR Therapy? It Might Mean It's Working

You might feel worse before you feel better. You've probably heard it. And honestly, I used to think it was kind of a tacky way to prime people, so that if shit hit the fan they'd assume it was just part of the process.

But after years of doing exclusive trauma therapy, I can give you the honest take. You can absolutely feel worse before you feel better. That part is true. But there's an important caveat: you can feel worse without actually getting worse. That distinction matters.

This episode breaks down the two main reasons people feel worse after starting trauma therapy, and why both of them are usually signs that the work is doing exactly what it's supposed to.

If you're in EMDR or trauma therapy and you're starting to wonder whether it's making things harder, this one's for you. Particularly if you've been thinking about cancelling your next appointment.

• Read the Transcript

  Have you heard this before? You might feel worse before you feel better. I always thought this line was kind of a tacky way that we prime people, to sort of set an expectation that if shit hits the fan at any point and they feel worse, that it's all just part of the process and nothing to panic about, because often it isn't.

  But after doing exclusive trauma therapy for many years now, I can actually give you the honest take on this. You can absolutely feel worse before you feel better. That is true and totally legit. But there are some important caveats within that statement. Number one being that I'm saying feel worse, not get worse. That is an important distinction.

  Hello, I'm Helen Billows and this is the Trauma Nerd Podcast. I'm a registered psychologist, EMDR therapist and supervisor, and I run a trauma-focused private practice in Adelaide, South Australia.

  Today I'm touching on what is actually happening when trauma therapy gets challenging. In my opinion, there are two primary reasons people feel worse after starting trauma therapy. Note, not everybody does feel worse after starting trauma therapy, but the people that do — these are the two main reasons why.

  I think hard experiences are much easier to tolerate when we have an understanding of what's occurring. We can generally cope much better. We expect it, and we have a sense of control about the situation. So I hope that having this knowledge will help you view challenge in trauma therapy, and specifically EMDR, as a green flag, not necessarily a red one.

  When you come to trauma therapy, what we're doing is bringing up the thing that you don't want to think about. We are intentionally activating it, bringing it in the room, talking about it, looking at it, and working with it.

  Now put that into context with the fact that your brain's very natural and automatic response to trauma is to avoid it. Whether that's suppressing, burying, minimising, maybe telling yourself it wasn't that bad, but it actually was. And yes, that is a form of avoidance. Your brain has avoided this as a coping strategy because you have to keep living a life. You have to function with this thing in your brain. So your brain's way of dealing with that is shove it aside, put it away.

  Your brain's been very intentionally keeping this out of your conscious awareness, and then you come to therapy and very intentionally bring it into conscious awareness. When we compare avoiding to working with, of course that feels worse in the moment. Avoiding it, you're not feeling it as much. You probably are in different ways, but not so directly. You might have been avoiding it for years, maybe even decades, and now we're in the room with it and we're bringing it up and talking about it.

  So obviously that feels worse than avoiding it. But here is the question: did it actually get worse? No. You felt worse because you actually felt it. Maybe that's the first time ever, or maybe it's just the first time in a long time, but you have stopped avoiding and you've started feeling. That's not a deterioration. That's just feeling what was already there.

  Whatever you are making contact with has been sitting there the whole time. Probably longer than you realise. Trauma therapy is not creating that or generating that. It's just surfacing what's there. We're not creating a problem, we're just bringing it up and engaging with it.

  We do that in a very intentional and purposeful way, and we try to make you as comfortable as possible, but no, it's not going to feel good, because that's the whole point. It doesn't feel good, which is why we're working with it. This is where we really emphasise the idea of short-term pain for long-term gain. A short-term challenge with the awareness that this is going to benefit me in the long term.

  I don't go to the dentist super excited, like yay, I'm getting a root canal. I go to the dentist like, man, this is going to suck and it's really important for my health, so I'm just going to do it. Trauma therapy: good analogy. Not getting too thrilled.

  The second reason is what I call the dust on the mirror effect. This is a Buddhist analogy I have shamelessly repurposed for clinical purposes. So thank you to whoever came up with it originally.

  Here is the idea. Imagine you are grabbing a dusty mirror from your brain, the dust on the mirror being the trauma or the pain — the painful experience, whatever we're working with. When we engage with it, when we start working with it, we're making an attempt to clear it, to resolve it. So in this analogy, we're grabbing that dusty mirror. And what do we do to try to clear a dusty mirror? We go, whew. We try to blow the dust off.

  And what is the first thing that will happen when you try to blow the dust off a dusty mirror? The dust is going to hit you in the face.

  So in this analogy, the dust is the painful realisations and emotions that come from unravelling experiences of abuse, neglect, and mistreatment. It's the pain that arises when you see the truth clearly and sometimes for the very first time.

  Let me give you a concrete example from what I see in my therapy room. Say growing up your feelings were consistently dismissed, ignored, or maybe even mocked, made fun of. Maybe you got told you were too much, too sensitive, that you made mountains out of molehills.

  You adapted to that environment to try to protect yourself. You stopped letting it out. You stopped being authentic. You learned to keep a stiff upper lip, to not reveal your true feelings and to pretend to be okay when you weren't. Over time, that is going to establish some core beliefs. Things like: I'm too much. There's something wrong with me. My feelings are not important.

  Then you do a few sessions of EMDR and something shifts. This isn't an intellectual lightbulb moment. It's not just a thought you have in your head, though that'll probably accompany it. It'll be a deep, felt internal recognition of truth. Something like: my feelings were always normal. The only abnormal thing in that situation was how my feelings were responded to. And if there was something wrong with anybody, it was the people who told me these things. There's nothing wrong with me, and there never has been.

  When you have lived your whole life believing the opposite of that — the trauma version of that — hello, dust. And what is the dust composed of? Probably grief. Grief for the child who believed that false version. Grief for the adult who's held onto painful beliefs about themselves that should have never been there in the first place.

  A really common one is also anger. Anger towards the people whose behaviour led you to believe things that were never true about yourself and were never yours to carry.

  That is obviously not a pleasant experience, but it is a necessary step on the path to resolution. Because we hit that dust moment, and we do keep going. That's not the endpoint. That's probably a halfway point. We keep going. And you know what's on the other side of the dust? The mirror. And what the mirror is composed of is truth, clarity, and the version of you that knows on a deep felt level that your feelings are normal, that you are normal, that there is nothing wrong with you, that you are okay as you are, and that in fact you are good.

  So that is not getting worse. It might feel much worse temporarily, but I would emphatically argue that that is getting much better. That is one of the most significant moments of progress a person can experience in therapy. And in fact, it's very exciting, though painful.

  These kinds of experiences, the dust and the avoidance, in my experience, the beginning of these is when people sometimes start to get a bit freaked out and they're at risk of bailing or ghosting their therapist. AKA me.

  The thing about that is the worst thing you can do when you're hitting these experiences is to stop. A, because if you keep going, it's going to get so much better. And B, because if you're driving at night through a dark, scary tunnel, what's the worst thing you could possibly do? Stop. I don't want to stop in the tunnel. In fact, I'm probably going to accelerate to get through it, to get out of the tunnel.

  So that's the advice. We keep going. We don't stop when it gets challenging, particularly when there are indicators that these circumstances are what is actually occurring, because these are indicators of progress. We want to keep going. We even want to accelerate a bit.

  My biggest advice is if you're getting a bit antsy about what's happening in therapy or EMDR, please talk to your therapist about it before you discontinue. Not to say that nobody's forcing you to continue, but you don't want to react to something challenging. You don't want to be impulsive about it. You want to respond thoughtfully, and your therapist can probably help you make that decision in a way that's in your best interest.

  If you're sitting with some anxiety about whether trauma therapy or EMDR might make things worse, that is something I'm going to dedicate a whole episode to, because I think there's actually a bit to talk about on this. But I'll give you the too-long-didn't-read version, because the research on this in my opinion is very reassuring. I think more reassuring than many clinicians are aware of.

  Fairly recent studies with over 1,700 participants show that legitimate, genuine clinical deterioration from trauma therapy is exceptionally rare. And in some cases, fascinatingly, the people who didn't receive treatment deteriorated more than those who did. Meaning the people who were waiting for the treatment did worse than the people who did EMDR.

  So the research positions EMDR as a really safe therapy. It's very low risk to actually cause a problem or make you worse. I think the biggest risk is just staying the same. That's probably the more common outcome, that you don't improve, but you're no worse off.

  Coming back to this idea of feeling worse before you feel better. Remember that your body has been carrying whatever you're working with for a long time. Probably longer than you realise, because there are probably roots of it that go further back than you're aware of.

  The fact that things are moving, even if it's challenging, and even if it's making you really want to cancel your next therapy appointment, is not necessarily a problem. Sometimes it means you're healing.

  Thank you so much for listening. If this resonated, share it with somebody. Subscribe to the podcast, comment, review. Everything helps. And as always, send me your questions through the inquiry form at helenbillows.com.

  Take care, and I'll see you next time.