Dear Therapist:

For many years I was in a relationship with a very challenging family member. 

There were very compelling reasons why I was unable to set appropriate limits in this relationship and therefore made the choice to just swallow, give in and avoid confrontations. 

It's quite a few years later now and even though I am a pretty positive person I started to feel worse about these very trying years. I realized that I need help processing this difficult period and B'H found a wonderful therapist to work with. 

The whole topic of therapy is new to me and I am wondering if it is normal that I am experiencing acute waves of anxiety and having difficulty sleeping and eating after just starting therapy? 

Is there a concept of feeling worse before feeling better when going to therapy?

Thank you so much for your weekly column, which I have been reading for many years and has helped me gain so much information!



As children, we all develop defense mechanisms to help us deal with emotions for which we are mentally unprepared. These emotions often include anxiety, sadness, shame, guilt, and feelings of worthlessness. We cannot “appropriately” process these feelings in childhood because we do not have the level of maturity, insight, and experience that comes with age. A young child who is continuously bombarded with messages telling them to be afraid—or that there is something wrong with them—does not have the mental fortitude to question, qualify, and challenge these thoughts; they therefore become beliefs.

If a child believes that they have a compelling reason to be anxious or to acknowledge their worthlessness, this can be extremely destructive. Therefore, the unconscious mind creates a defense against these beliefs. Some of the defenses with which many of us are familiar are repression, denial, and intellectualization. If a child’s unconscious mind refuses to allow these negative thoughts to reach the conscious mind, they do not need to deal with them.

Of course, these feelings do not disappear; they are simply covered up. As children, these defenses are often necessary in order for us to properly function. Ideally, however, they should be short-term in nature, slowly dissipating as we get older. In reality though, we all hold on to at least vestiges of these childhood defense mechanisms. Typically, the more strongly we need them in childhood, the harder they are to dispel when we no longer truly need them. As we grow older, these defense mechanisms can easily become coping skills.

As a short-term childhood strategy, unconscious defenses can be rather useful. As a long-term way of dealing with life, they can become catastrophic. For most of us, they simply become a part of the way in which we deal with hurtful emotions without causing us significant harm.

Although as adults we technically have the ability to better deal with negative emotions, we nonetheless tend to turn to our childhood defenses when a strong childhood emotion is triggered. The reason for this is twofold. Our emotional response has become habitual, and we no longer reflect on it. Also, the unconscious mid “convinces” us that there is as great a danger in confronting our emotions as there was in childhood. And each time that we utilize it, we further reinforce the use of the defense. This is the reason that we can experience a strong emotion in response to something, then wonder in the aftermath at its intensity.

I don’t know whether the problematic relationship to which you refer existed for you in childhood or in adulthood. In truth, this question is only academic. If in childhood, it may have contributed to your initial development of a defense. If in adulthood, the defense would already have been developed, and the relationship probably helped to reinforce it.

I don’t know what defense you used to help you deal with this relationship. It seems, however, that it began to break down, allowing negative feelings about the relationship to seep in. Once you began therapy, you more directly attacked the defense, thus allowing more of the initial emotion to surface. It sounds that you may struggling with a conflict between your conscious desire to directly address your emotions and a long-standing unconscious impulse to suppress these emotions. This could certainly lead to heightened emotions in the beginning phase of therapy.

Some people utilize childhood defenses all their lives with no significant ill effects. It seems likely, however, that you were going to deal with these, one way or another. The guidance of a skilled therapist can make the difference between a slow, difficult process and a relatively quick and painless one.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200


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