“I Feel Worse in Therapy Than I Did Before” – Why a Crisis Can Be the Beginning of Real Change

The decision to begin addiction treatment is often accompanied by the hope that, from that moment onwards, everything will start to improve. A person entering a treatment centre stops using substances, finds themselves in a safe environment and receives professional support. Their family may therefore expect to see calmness, gratitude and a visible transformation quite quickly.

Sometimes, however, the opposite happens.

Sadness, irritability, anger, anxiety, insomnia, emptiness or doubts about the purpose of treatment may begin to emerge. The person in therapy may say:

“I have felt even worse since I came here.”

“At least before, I could stop myself from thinking about all of this.”

“Therapy is only reopening old wounds.”

“I no longer know who I am or why I should keep trying.”
 

For the person in treatment, this can be frightening. For their loved ones, it can be difficult to understand. If treatment is supposed to help, why does the person appear to be suffering even more?

There is no simple answer. A crisis during therapy does not always mean that something is going wrong. Sometimes, for the first time in many years, the person is beginning to feel their emotions fully, recognise the consequences of their choices and face problems that were previously suppressed by drugs or alcohol.

This does not mean, however, that every form of distress should simply be endured or treated as a necessary stage of recovery. A crisis must be noticed, named and discussed with a professional. Therapy should never involve coping with suffering entirely alone.
 

The Substance Served a Purpose for Many Years

Drugs or alcohol are not merely substances on which the body becomes dependent. Over time, they may begin to fulfil a range of psychological functions.

They can help a person avoid thinking about a painful past. They may suppress anxiety, create a temporary sense of confidence, make social contact feel easier or help someone fall asleep. They may numb guilt, fill an emotional void or provide an escape from loneliness, shame or a deeply rooted belief that one is worthless.

Of course, the relief is temporary, while the price paid for it becomes increasingly severe. Health problems, conflict, dishonesty, loss of trust, debt, violence, high-risk behaviour and repeated unsuccessful attempts to stop may all follow.

Despite this, the substance may still be experienced as the quickest way of regulating emotions.
 

Addiction is a complex disorder that affects not only behaviour, but also brain function, motivation and the ability to control impulses. This is why simply deciding, “From today, I will never use again,” is often not enough.

When the substance is removed, the emotions, memories and difficulties do not disappear. The person is left facing them without the anaesthetic they previously relied upon.

This is often when they begin to feel that treatment has made everything even more difficult.
 

Stopping Substance Use Does Not Automatically Resolve the Problems Beneath the Addiction

For many years, a person may have focused on one overriding objective: obtaining the substance, taking it, surviving its effects, concealing the consequences and managing until the next opportunity to use.

Life gradually becomes organised around the addiction. Everything else moves into the background.

Once drugs or alcohol are removed, what had previously been hidden may become visible:

• difficulty recognising and expressing emotions,
• fear of rejection,
• low self-esteem,
• family conflict,
• unresolved grief,
• experiences of violence or neglect,
• loneliness,
• mental health difficulties,
• an inability to build safe and stable relationships,
• shame relating to behaviour during active addiction.
   

For some people, addiction coexists with depression, anxiety disorders, post-traumatic stress disorder or other mental health conditions. Substances may intensify these symptoms, but people may also use drugs or alcohol in an attempt to relieve psychological distress on their own.

For this reason, mental health difficulties and addiction should be identified and treated in a way that takes both areas into account.

Therapy does not create these problems. It often makes it possible to see them clearly for the first time without the effects of the substance.
 

Why Can Talking About Yourself Be Painful?

During therapy, a person begins to speak about matters they may have avoided for years. They examine their behaviour, defence mechanisms, relationships and the consequences of addiction.

They may realise that they have spent years blaming everyone around them. They may see, perhaps for the first time, the pain experienced by their children, partner or parents. They may recognise that some memories have been suppressed, distorted or repeatedly justified.

These discoveries can be deeply painful.

Psychotherapy is intended to help people recognise and change difficult emotions, thoughts and behaviours. However, looking directly at painful issues may initially increase emotional tension.

Some people may therefore feel worse for a period of time before they begin to notice improvement. This experience should be discussed with a therapist rather than concealed.

It can be compared to a person opening a room into which they have thrown everything they were unable to deal with for many years. When the door is finally opened, the first thing they see is disorder. This does not mean that opening the door was a mistake. It means that the process of putting things in order has only just begun.
 

A Crisis in Personal Identity

Over time, addiction can become part of a person’s identity.

They may stop thinking of themselves as a parent, employee, friend, partner or someone with interests and plans. Instead, they begin to see themselves mainly through the substance, the problems it causes and a succession of failures.

Once the substance has been removed, a difficult question may arise:

“Who am I if I no longer use?”

Not everyone is able to answer this immediately.

The old life was destructive, but it was familiar. The person knew where to obtain the substance, whom to meet and how to survive another day. The new life is healthier, but unfamiliar. It requires the person to relearn ordinary life from the beginning.

They may need to learn again how to communicate, apologise, accept criticism, plan their day, rest, tolerate boredom and complete responsibilities without an immediate reward.

This may provoke resistance, fear and anger.
 

Guilt May Only Emerge in Sobriety

During active addiction, a person often avoids acknowledging the full extent of the harm they have caused. They may minimise it, deny it or seek explanations that protect them from responsibility.

They may say:

“Everyone is exaggerating.”

“I have not hurt anyone.”

“It is my business.”

“If my family behaved differently, I would not have to use.”

Such statements can be deeply painful for loved ones. However, they may also be part of the psychological mechanisms that allow the person to continue using without completely destroying their image of themselves.

During therapy, these mechanisms begin to weaken. For the first time, the person may clearly recognise how much they have lost and how their behaviour has affected others.

Guilt begins to appear.

Guilt itself does not have to be harmful. It can lead to responsibility, reparation and behavioural change. The difficulty begins when guilt turns into shame that defines the whole person:

“I did something wrong” becomes “I am a bad person.”

“I hurt people” becomes “I do not deserve another chance.”

“I have a problem” becomes “I am the problem.”

Therapy helps a person separate responsibility from self-destruction. They are not expected to deny what they have done. They are expected to learn how to accept the consequences without deciding that their life no longer has value.
 

Anger Towards Therapists and Rules May Be Part of Resistance to Change

A therapeutic centre has rules. Each day has a structure, residents have responsibilities, attend sessions, discuss their behaviour and receive feedback from others.

For someone who has become accustomed to avoiding responsibility, this can be extremely difficult.

It may feel easier to think:

“The therapists have something against me.”

“No one here understands me.”

“These rules are pointless.”

“I am not like the other people here.”

“I can manage on my own.”

Not every criticism of therapy is a defence mechanism. A person in treatment has the right to ask questions, express doubts, communicate their boundaries and report behaviour that feels inappropriate or harmful.

At the same time, anger may arise precisely when therapy touches upon an important issue. Confronting one’s own behaviour can feel like an attack, particularly when a person has spent years protecting themselves from shame through denial, blaming others or escaping from difficult emotions.
 

Not Every Deterioration Is a Positive Sign

The statement that “sometimes you need to feel worse before you feel better” must never be used to justify everything.

Suffering in itself is not therapeutic. Nor is it the purpose of treatment.

Warning signs may include:

• a sustained and significant deterioration in mental health,
• increasing hopelessness,
• thoughts of self-harm or suicide,
• severe psychotic symptoms, such as hallucinations or delusions,
• loss of contact with reality,
• extreme agitation or an inability to function,
• feeling humiliated, intimidated or abused during therapy,
• being unable to report concerns safely,
• serious symptoms being ignored by staff,
• a sudden deterioration in physical health.
   

These signs should not be dismissed as ordinary resistance or an attempt to avoid therapy. They require prompt discussion with a professional, a proper assessment and, in some cases, psychiatric or medical consultation.

In situations involving an immediate threat to life or health in Poland, emergency services should be contacted by calling 112, or the person should attend the nearest accident and emergency department.

A person experiencing an acute mental health crisis may also attend a psychiatric hospital without a referral. The decision regarding admission is made by a doctor following an assessment.

Free, round-the-clock support is also available in Poland:

• 800 70 2222 – Support Centre for Adults Experiencing a Mental Health Crisis,
• 116 123 – emotional support helpline for adults,
• 116 111 – helpline for children and young people,
• 112 – emergency number in situations involving an immediate threat to life or health.
   

How Can a Constructive Crisis Be Distinguished from a Dangerous Deterioration?

A constructive crisis does not have to be mild. It may involve sadness, crying, tension, anger and doubt. At the same time, the person remains in contact with their therapist, is able to speak about what they are experiencing and gradually begins to understand where their emotions come from.

Despite the difficulty, there may still be signs of movement:

“I am beginning to understand why I escaped into drugs.”

“I can see what I did to my family.”

“I do not yet know how to live differently, but I want to learn.”

“I am frightened, but for the first time I am speaking about it honestly.”

“This is difficult, but I do not want to return to my old life.”
 

A dangerous deterioration is more likely to involve increasing disorganisation, complete withdrawal from others, loss of hope, life-threatening behaviour or the conviction that there is no possible way forward.

The boundary is not always obvious. A person in therapy does not have to decide alone whether their condition is “normal”. They should speak to a therapist, doctor or another trusted member of the treatment team.
 

What Can Someone Do When They Feel Worse in Therapy?

The most important step is not to pretend that everything is fine.

It may help to say clearly:

“My condition has been getting worse over the past few days.”

“I cannot calm down after talking about my past.”

“I feel that therapy is becoming too much for me.”

“I am afraid I will leave treatment or return to using.”

“I need help understanding what is happening to me.”

These statements are not a sign of weakness. They are an expression of responsibility.

Together with a therapist, the person may consider:

• what specifically triggered the deterioration,
• which thoughts appear most often,
• what physical sensations are present,
• whether there are cravings for the substance,
• which situations increase emotional tension,
• what provides even a small sense of relief,
• whether psychiatric consultation is needed,
• who can provide support outside formal therapy sessions.
   

It is also important to maintain a basic daily routine: regular meals, adequate rest, physical activity suited to the person’s abilities, participation in treatment and contact with others.

These actions do not resolve deeper problems, but they can reduce chaos and help restore a sense of stability.
 

Why Is the Therapeutic Community Important During a Crisis?

In a treatment centre, recovery does not take place only during individual sessions with a professional. Daily contact with other people who are also dealing with addiction plays an important role.

A person may recognise their own patterns in someone else’s story. They may hear for the first time that they are not the only person experiencing emptiness, shame, anger or fear about the future.
 

The group does not remove suffering, but it can ensure that the person does not have to face it alone.

Support from people with direct experience of recovery is based on mutual understanding, respect and the belief that change is possible. It can help people remain engaged in recovery and apply therapeutic skills to everyday life.

Within the therapeutic community, a resident not only receives support. Over time, they may also become a source of support for someone who has only just begun treatment. This can help rebuild self-worth and the belief that they still have something valuable to offer.
 

How Should the Family Respond?

Loved ones often fall into one of two extremes.

The first is to minimise the problem:

“Do not exaggerate. You are in a good place.”

“Everyone has problems.”

“You just need to pull yourself together and finish the programme.”

The second is to attempt an immediate rescue:

“If you feel this bad, we will bring you home.”

“You do not have to stay there.”

“We will come and sort everything out.”

Neither response is always helpful.

The family should not ignore the person’s distress, but they should also avoid making sudden decisions based solely on an emotional telephone conversation.

They might say:

“I can hear that you are suffering. Have you told your therapist?”

“I do not want to minimise what you are feeling. Please speak to someone from the treatment team.”

“We are here for you, but we will not make a decision about ending treatment without speaking to a professional.”

“The fact that this is difficult does not mean you cannot cope. But you do not have to cope alone.”

The family’s role is not to conduct therapy from a distance. Their task is to support contact with professionals, encourage honesty and avoid reinforcing decisions made in the middle of a temporary crisis.
 

Genuine Improvement Does Not Always Look Like Feeling Better

Families may judge the effectiveness of treatment according to the person’s mood. Yet someone who appears calm and cheerful is not always making a genuine change. They may be avoiding difficult subjects, adapting only superficially or saying what others expect to hear.

By contrast, a person who is sad or experiencing a crisis may be doing significant internal work.

Progress may also be reflected in less obvious changes:

• greater honesty,
• accepting responsibility,
• asking for help,
• naming emotions,
• remaining in therapy despite the urge to leave,
• accepting feedback without immediately becoming aggressive,
• recognising the needs of others,
• giving up manipulation,
• rebuilding daily responsibilities,
• learning to tolerate emotional tension without using substances.
   

Recovery is not a single moment or a simple transition from illness to feeling well. It is a process of change that includes health, independence, relationships, everyday functioning and the creation of a meaningful life.
 

A Crisis Is Not a Failure

A crisis during therapy may mean that old ways of coping are no longer working, while new ones are not yet strong enough.

It is an uncomfortable and painful place between the old life and the new one.

The person may no longer want to return to addiction, but may not yet know how to function without it. They may no longer believe all of their previous excuses, yet still not know how to accept responsibility without falling into destructive shame. They are beginning to see the truth, but may not yet have the strength to carry it calmly.

This is precisely why therapy is needed.

Not so that a person will never again feel fear, sadness or anger, but so that they can learn to experience these emotions without escaping into substances, dishonesty, aggression or isolation.

Real change does not always begin with relief. Sometimes it begins at the moment when a person stops running away from what they truly feel.
 

Addiction Treatment at the MONAR Centre in Kębliny

When a person says, “I feel worse in therapy than I did before,” it does not necessarily mean that they should give up. It may indicate that they have reached the problems from which the substance protected them for many years.

They should not, however, face this experience alone.

At the MONAR Centre in Kębliny, recovery takes place with the support of professionals and the therapeutic community. Treatment is not limited to stopping drug use. It helps people gradually recognise their emotions, understand the mechanisms of addiction, identify difficulties in relationships and become aware of situations that may increase the risk of relapse.

A crisis can become the beginning of change when it is recognised, addressed safely and used as an opportunity to understand oneself more fully.

The most important step does not always sound like:

“I feel better now.”

Sometimes it sounds like:

“This is extremely difficult, but this time I will not run away. I will ask for help.”