When Therapy Feels Worse: A Progress and Safety Check-In Guide

Feeling worse after a therapy session does not, by itself, prove that treatment is helping or failing. It is a signal to review what changed, how it relates to your goals, and whether the current approach and therapeutic fit still make sense.

Treat feeling worse as a check-in signal, not a verdict

CAMH explains that some people feel worse at the start of therapy as difficult issues are brought to the surface. It also says that progress is better assessed against goals discussed with the therapist over time, rather than by assuming that one difficult reaction has a single meaning. 1

CAMH notes that discomfort can reflect several possibilities, including a poor fit, an approach that is not useful, a difficult issue being opened, or anxiety about speaking to someone new. Those possibilities cannot be distinguished from a general guide; bring the specific pattern to your therapist so you can review it together. 1

Next step: At the next safe opportunity, ask for time to review: I have felt more distressed after sessions. Can we revisit our goals, the approach, and what we should monitor together? 1

• Use a short check-in note to make the CAMH-recommended progress conversation concrete: what felt difficult, which therapy goal it relates to, how long the change lasted, and what you want the therapist to review with you. 1

Run a progress-and-fit review instead of guessing

CAMH says good treatment is based on a proper assessment and clear goals the client and therapist have discussed and decided on. When someone is unsure about progress, CAMH recommends discussing it with the therapist and scheduling time to evaluate how therapy is going. 1

A useful review keeps the decision shared rather than asking the reader to diagnose themselves or follow a fixed number of sessions. It can clarify whether the goals still fit, whether the current approach is useful, and whether another provider or referral should be discussed. 1

Next step: Ask for a defined progress review instead of relying only on how you feel immediately after one session. 1

• Bring four prompts: What goals did we agree on? What has changed or not changed? What are we doing to address those goals? What other approach, provider, or referral should we discuss if this is not working? 1

Keep the safety boundary visible

CAMH advises a person who is uncomfortable or unsure whether therapy is working to discuss those concerns with the therapist. It also says not to stay in therapy that is not working and notes that another provider or referral may be appropriate; a general article cannot prescribe a break for an individual. 1

A routine progress review is not crisis care. Government of Canada guidance says to call 9-1-1 for immediate danger and to call or text 9-8-8 if you or someone you know is thinking about suicide. 2

Next step: If you are in immediate danger, call 9-1-1. If you are thinking about suicide, call or text 9-8-8 now rather than waiting for an ordinary therapy appointment. 2

What to do next: Before the next routine appointment, write one sentence describing the change and ask for a scheduled review of goals, approach, and fit; if you are in immediate danger or thinking about suicide, call 9-1-1 or call or text 9-8-8 now. 1 2

• If you are safe enough to wait, use the check-in to discuss the plan and fit; if you are in immediate danger or may act on suicidal thoughts, use emergency or crisis support instead of waiting for a routine session. 1 2

If you are considering a different therapist or want to discuss therapeutic fit, you can review Ann James’s therapy services or book a consultation.

Research used in this guide

1. CAMH psychotherapy guidance — Centre for Addiction and Mental Health guidance on psychotherapy, treatment goals, progress, and fit. Retrieved 2026-07-18.
2. Government of Canada mental health crisis support — Government of Canada mental health crisis-support guidance. Retrieved 2026-07-18.

Frequently asked questions

Is feeling worse after a session proof that therapy is helping?

No. CAMH notes that difficult issues can make someone feel worse at the start, but it recommends reviewing progress against goals discussed with the therapist and scheduling evaluation when progress is unclear. Feeling worse alone does not identify the cause or determine the right next step.

How do I know whether to take a break or ask for a change in therapy?

A blog cannot make that treatment decision for an individual. CAMH recommends discussing concerns and progress with the therapist, and says a person does not have to stay with therapy that is not working; another provider or referral may be worth discussing. If safety is at risk, use crisis or emergency help instead of waiting for that review.