Do Things Really Get Worse Before They Get Better?

Do Things Really Get Worse Before They Get Better? I did a consultation the other day - something many of our practitioners offer for free to people considering one-to-one sessions. I asked the client whether they’d had any previous therapeutic intervention. They told me they’d been offered counselling and cognitive behavioural therapy (CBT) through the NHS. When I asked how it had gone, they said they hadn’t achieved the outcome they were hoping for. In fact, their symptoms had worsened. This client was living with obsessive-compulsive disorder (OCD) and several behaviours that had developed around it. After twelve sessions of prescribed counselling, they found themselves feeling worse - not better. When I asked at what point they realised things weren’t improving, they said it was around the third or fourth session, when their symptoms suddenly ramped up. When they raised this with the therapist, they were told, “Sometimes things get worse before they get better.” And in that moment, I caught myself thinking: that old chestnut. When ‘Getting Worse’ Isn’t Just a Fob-Off It’s a phrase you hear often enough that it risks sounding like a convenient excuse for poor results. But later, I found myself reflecting on it. I wondered: Is there truth in that statement? Can it really be the case that, in the context of therapy or talk-based change work, things must worsen before they can improve? Or does that idea risk letting us miss important warning signs that something isn’t working? Here’s what I found when I started to dig a little deeper. Research into counselling and other talk-based therapies shows mixed results. Many people do experience what’s sometimes called a “therapeutic dip” - a temporary worsening of symptoms early in therapy. This can happen when a person begins confronting painful memories or dismantling defences that have been keeping difficult feelings locked away. In short, the conscious mind knows that change is necessary, but the unconscious mind resists - especially if the old patterns were still meeting some deep emotional need. So, the unconscious ramps up those old behaviours, almost like a psychological hoarding response: “I’d better grab as much of this coping mechanism as I can before it’s taken away.” This can make symptoms intensify before easing off. But studies also show that this isn’t inevitable - and it doesn’t happen to everyone. In fact, many people experience “sudden gains” early in therapy instead. So, the idea that things must get worse before they get better simply isn’t backed by consistent evidence. When the Wobble Signals Progress So, if feeling worse isn’t a guaranteed sign of progress, when is it meaningful? If the distress appears in the context of self-awareness, emotional release, or deep reflection, it may indicate that something important has surfaced. When counselling or other talk-based therapies reach the root of an issue, it can temporarily shake stability. That’s when the old and new versions of the self are negotiating - when conscious and unconscious minds are learning to work together again. But if symptoms continue to worsen without relief or clarity, that’s not “the process.” That’s a message to pause, review, and explore what might be missing from the approach. In other words, not every wobble means growth - but every wobble means information. The Balance Between Challenge and Care At People Building, whilst NLP isn’t counselling, it shares a similar foundation in conversation-led change work. Both rely on self-reflection, trust, and collaboration. That means we sometimes help clients explore uncomfortable territory - but we also emphasise safety, readiness, and pacing. For practitioners and clients alike, the art lies in knowing the difference between productive discomfort and genuine distress. The first can lead to insight and transformation. The second can lead to shutdown. Progress in talk-based therapy should feel challenging, but not punishing. It should stir emotions, but not strip away your stability. So yes, sometimes things do get worse before they get better - but not always. The real indicator of success isn’t how messy things feel midway through. It’s whether the process leads you to a place of greater self-understanding, calm, and control. And that’s what change work, in all its forms, is really about. by Gemma Bailey (with the help of Ai) https://www.peoplebuilding.co.uk/franchise