This is a very hard time for the patient, after making the giant leap of asking for treatment, now they have to go back in time and communicate why they need it.


Do you have a friend who has started therapy and since their first appointment have seemed to go downhill? Maybe they started self-harming again or their symptoms have started to spike? Don’t worry! This is normal. I know it sounds almost unbelievable that the start of treatment can actually make a patient worse but mental health treatment is very different from any type of physical health treatment, especially therapy. The start of treatment is very emotional for people because it brings up past trauma, negative emotions, and can result in racing thoughts. You basically sit with your therapist for an hour and talk about your problems, therefore, remembering everything that’s happened within the last week or month that you need help fixing. It can be hard to go back in time and try to move on but it’s vital for the therapist to understand your history and where your fears come from because it helps them choose the direction of treatment you need. The beginning of treatment is usually the hardest because of this recalling nature and people tend to have a hard time going home and leaving the appointment at the office.

What can I do to help?

Be there for your friend, family member, or yourself if you are the one struggling. This is a very hard time for the patient, after making the giant leap of asking for treatment, now they have to go back in time and communicate why they need it. When I started outpatient therapy I booked off the entire day after therapy because I was just too emotionally drained to continue my day. After a couple years I can now go to therapy and leave without an issue (most of the time), but in the beginning, I simply couldn’t do it, and that’s ok. Take some time to perform some self-care after your appointments, try to have someone at the house with you so you’re not alone with your thoughts, treat yourself after a therapy appointment, there are several ways to ground yourself after a heavy appointment.

Has self-harm increased?

This is normal, especially for people with a personality or anxiety disorder. Old coping strategies (such as self-harm) come flooding back into your head after an appointment because of classical conditioning, you experience the emotions you felt at the time you were struggling so an automatic response comes back to help you numb that pain. Many people who overdose are victim to classical conditioning because their bodies try to stay at homeostasis and when in a drug-induced environment they receive environmental cues that increase certain chemicals in the body that lead to a lower tolerance level.

Another common experience of increased self-harm when starting therapy is when the patient starts to self-harm a couple days before the appointment. This mentality is usually when the patient is trying to show/prove how much they are struggling to both themselves and the therapist. It’s a cry for help as well as a physical sign as to their suffering. This is something that should be discussed with the therapist by the patient. If a therapist challenges the person on thoughts of self-harm and suicide by pointing out they haven’t acted on it (which happens more often than you’d think) it can lead to dangerous consequences. If a therapist doesn’t listen to the patient with care and compassion they can misunderstand their suffering and not be empathetic to the patient. Treatment teams are a collaboration and if your team is struggling than it is probably time to find a new therapist. At the beginning of treatment this can be hard to understand/do because you don’t want to hurt the therapist’s feelings but remember if continued in a dysfunctional team the treatment can end up being useless and if you’re uncomfortable than the therapist probably is too. Finding the right therapist can take years but once you find the right team treatment becomes so much smoother and can actually be enjoyable.


This may make treatment look a little scary but I want to point out that it is 100% worth it. Treatment isn’t meant to be easy, it’s not linear, it’s hard and can take a lot out of you but the consequences of dismissing treatment can be so much worse. Not only will your quality of life decrease if you avoid treatment, you can end up in dangerous situations, or even dead. But if you accept treatment you can start the road to recovery and start to create the life you’ve always wanted. Treatment is crucial for people who suffer from mental illness and the first few months can be tough, but stick with it and I promise you it’ll be worth it.


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