Is it normal to feel worse before you feel better in therapy?

For some people, yes. In a study of 192 women in trauma-focused therapy, a minority had a temporary rise in symptoms during treatment, roughly 15 to 29 percent depending on the approach. Even so, they still reached meaningful improvement by the end, and the bump did not lead to dropping out.

Does feeling worse mean the therapy is not working?

Not on its own. The research found that a short-term symptom increase did not predict a worse final result, and the people who felt it still improved. A temporary dip is common in trauma work. A low that keeps deepening is different, and it is worth raising with your care team.

How long does the dip after a session usually last?

The evidence here does not put a fixed number on it, and it varies from person to person. The study framed these increases as temporary and part of the active phase of trauma work, not lasting setbacks. If a low stretches on or feels hard to manage, your therapist can help you make sense of it.

The Wait

Why do I feel worse a few days after a session?

Short answer

Feeling worse for a few days after a session is common, and it usually does not mean therapy is failing. In trauma therapy research, a minority of people have a temporary symptom bump, and they still improve by the end. The dip often passes as you process the work.

The research

Larsen, S. E., Stirman, S. W., Smith, B. N., & Resick, P. A. (2016). Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behaviour Research and Therapy, volume 77, pages 68 to 77.

Sample 192 women in trauma-focused therapy for PTSD, pooled from two randomized trials

Published 2016

Journal Behaviour Research and Therapy

Sarah Larsen and her colleagues pooled data from 192 women receiving trauma-focused therapy for PTSD across two randomized trials. They tracked symptom scores through treatment and counted a reliable worsening as a jump of more than 6 points on a standard PTSD measure. A minority reached that mark, and the rate did not differ in a meaningful way by treatment: about 29 percent in cognitive processing therapy, 20 percent in prolonged exposure, and 15 percent in a version of cognitive processing therapy without a written trauma account. Most people did not have a reliable bump at all. The increases that did happen were not tied to dropping out of therapy, and the people who had them still reached clear, meaningful improvement by the end. The authors read this as evidence that trauma-focused therapy is safe and works, even when it stirs things up along the way.

Read the paper

What does this mean for you?

The gap right after a session can feel rough. You opened something hard, and now the feelings are still moving. This research suggests that a short rise in symptoms is a known part of trauma work for some people, not a sign that you are broken or that therapy went wrong.

Be clear about what this study can and cannot say. It followed women in structured trauma-focused therapy for PTSD, so the exact numbers may not match your own care or your own diagnosis. It measured worsening across the whole course of treatment, not only the days right after a single session. And most people in the study did not have a reliable bump at all. What it shows is steady and useful: when worsening did happen, it was temporary, it did not push people out of therapy, and it did not block their progress.

For you, the value is in the frame. A hard few days after a session is often the work continuing, not the work failing. It helps to be gentle with yourself, keep your usual supports close, and carry what you felt back to your next session. If the low feels heavy or does not lift, that is worth telling your care team, so they can walk through it with you.

The takeaway

Name it as normal. A dip in the days after a session is common and usually passes.
Stay gentle and supported. Rest, routine, and people you trust help you ride it out.
Bring it back. Tell your therapist what came up, since the after is part of the work.

Terms in this page

Afterglow Between-session support Grounding

This is the work Asendar™ was built for: staying with you in the tender days after a session, so a hard stretch feels less lonely and the insight is not lost. If you want a simple read on where you are starting from today, take your Mental Readiness Score.

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