The can of worms

Why does it get worse before it gets better? 

It’s a big question, especially when it comes to therapy. It’s one that might put some people off, especially if things feel "settled" in their lives at the moment. Some might even argue that when things do feel calm, it’s actually one of the best times to begin therapy. But why rock the boat? 

In his insightful book The Body Keeps the Score, Bessel Van der Kolk delves into how experiences, particularly traumatic ones, are stored in our bodies. We form our understanding of the world based on previous experiences, and our brains create neural pathways that shape how we respond to similar situations. But those responses, while useful at one point, may no longer be necessary—especially when it comes to trauma. 

For example, imagine a child who grew up in a violent environment. Over time, they may have learned to respond to loud noises and raised voices by hiding, a protective strategy that helped them stay safe in that environment. However, if they later move into a home where these things don’t pose a threat this instinct to hide may no longer serve them. In fact, it can start interfering with their daily life, such as when they hear a car backfire or people cheering at a sports game they feel conditioned to need to hide. 

In therapy, this behaviour would be addressed. The child would be helped to understand why the coping strategy is no longer needed. Relational work would also help them feel safe, gradually reducing the urge to hide. But, for that to happen, the fear at the root of the response must first be confronted. This can be a difficult and unsettling process, as facing that fear tends to make the symptoms feel worse before they get better. 

One of the most challenging aspects of healing is that we have to confront our pain in order to move beyond it. As we face it, the pain begins to lose its power over us, and with time, it can no longer control our responses. It’s a daunting but empowering process. 

Therapy works by gently stretching the "window of tolerance"—the space within which a person can process emotions and experiences without becoming overwhelmed. The goal isn’t to push someone into full exposure to their trauma all at once, but to work at their pace, gradually exploring and processing their past experiences. It’s like opening a can of worms. At first, the worms might wriggle around a bit, making the situation feel messier. But with patience, the worms eventually settle, and the process starts to make sense. This might look like things getting worse before they get better, but it’s a natural part of healing. 

Wiggly worms