Patients often say they feel worse during the beginning stages of therapy. "This occurs because our natural inclination in dealing with negative feelings is to avoid them," says William C. Sanderson, PhD, professor of psychology at Hofstra University in Hempstead, N.Y.
Therapy is hard work
A lot of people are surprised to find how much work is expected of them outside of therapy sessions. You may be asked to track thoughts, do assigned reading, and make specific behavior changes. "If you don't do what I suggest outside of sessions, it's like joining the gym but never working out. There's no lasting benefit," says Sanderson.
Others are uncomfortable with silences and don't know how to fill them. "There's a concept in therapy: Talk about whatever you think about, whatever comes to mind. But that's hard to do," says Tracey Lipsig Kite, MSW, a licensed therapist in Evanston, Ill. "It doesn't have a normal frame of reference. We don't do that with other people. It's really just weird. People aren't used to it."
Projecting is normal
One unexpected byproduct of therapy is intense emotions about the therapist. In other words a patient may have past emotional attachments surface that are projected (transferred) onto the therapist. The desired outcome is to work through the transference. This means the projections are discussed in therapy and not acted out. Acting them out would foster confusion and other problems.
This is normal, says Gary Seeman, PhD, a psychologist in San Francisco. "Primitive, childlike sectors of the mind can be activated during the therapy, and these intense emotions should become grist for the mill," he says.
However, strict boundaries must be observed. Therapists are prohibited from sexual or even social relationships with a patient.