Many people considering therapy wonder, “How does it actually work? Will I feel better right away?” These are natural questions, especially when facing emotional pain that has been buried for years. Therapy isn’t a quick fix—it’s a process that involves facing difficult emotions, understanding past wounds, and learning how to move forward in a healthier way. But despite the challenges, therapy can be profoundly healing and transformative.
What Happens in Therapy?
At its core, therapy is a guided conversation between you and a trained professional. It provides a safe space to talk openly about your struggles, fears, and hopes without fear of judgment. Therapists use different approaches, such as Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, and Humanistic Therapy, depending on your needs and personal history.
Therapy typically involves:
- Exploration of Thoughts and Emotions – You’ll discuss your thoughts, feelings, and experiences to gain insight into your emotional patterns.
- Processing Past Trauma or Pain – Many people come to therapy because of unresolved past experiences that continue to impact them. Addressing these wounds can be painful but is a necessary step toward healing.
- Developing Coping Strategies – Therapy teaches tools for managing stress, anxiety, and negative thought patterns.
- Behavioral Changes – Over time, therapy helps shift unhelpful behaviors and build healthier habits.
Why Therapy Feels Difficult at Times
Many people expect therapy to feel good right away, but the truth is that therapy can sometimes feel worse before it feels better. This is because therapy asks you to confront emotions that you may have suppressed for years.
It’s natural to feel like therapy “isn’t working” when painful memories resurface or when discussing emotions feels overwhelming. However, this discomfort is often a sign that therapy is doing exactly what it’s supposed to—helping you face and process what you’ve been avoiding.
A study in Psychotherapy Research (Swift et al., 2017) found that therapy can involve phases of distress before improvement occurs. This is often referred to as the “therapeutic dip,” where people feel emotionally raw before experiencing breakthroughs in their mental health.
The Science Behind Why Therapy Works
Numerous studies have confirmed the effectiveness of therapy across various mental health conditions.
1. Therapy Changes the Brain
Research using neuroimaging has shown that therapy can rewire neural pathways in the brain. A study in Molecular Psychiatry (Goldapple et al., 2004) found that CBT led to changes in brain activity similar to those seen with antidepressant medication, particularly in areas related to emotion regulation.
2. Therapy Strengthens Emotional Processing
Processing emotions in therapy activates parts of the brain responsible for emotional regulation, such as the prefrontal cortex and amygdala (Messina et al., 2013). Over time, this helps people respond to emotional triggers in healthier ways.
3. Therapeutic Relationships Foster Healing
A strong bond between a therapist and client—known as the “therapeutic alliance”—is one of the biggest predictors of success in therapy (Horvath & Luborsky, 1993). Feeling heard, validated, and supported by a therapist creates the safety needed to explore difficult emotions.
The Breakthrough Moments in Therapy
Despite its challenges, therapy often leads to profound moments of insight and emotional release. These breakthroughs might look like:
- Finally understanding why certain patterns keep repeating in your life.
- Realizing that past trauma does not define your future.
- Feeling a weight lifted after expressing emotions you’ve suppressed for years.
- Learning how to set boundaries and prioritize your own needs.
How Long Does Therapy Take to Work?
There’s no one-size-fits-all answer to this question. Some people experience positive changes within a few sessions, while others may need months or even years of therapy to work through deep-seated trauma. A review in World Psychiatry (Leichsenring & Rabung, 2008) found that short-term therapy (12-20 sessions) can be effective for many mental health issues, but long-term therapy tends to yield even greater benefits for more complex emotional struggles.
When Therapy Feels Stuck: What to Do
If you feel like therapy isn’t working, don’t be discouraged. Healing isn’t linear—it has ups and downs. Some things to consider:
- Be Honest with Your Therapist – If you’re feeling stuck, tell your therapist. They can adjust their approach or help you identify barriers.
- Give It Time – Emotional progress doesn’t happen overnight. Some changes are subtle but meaningful.
- Reevaluate Your Goals – Therapy works best when you have clear goals. Are you working on what truly matters to you?
- Consider a Different Approach – If a particular therapy style isn’t working, a different approach or therapist may be a better fit.
Conclusion
Therapy is a challenging but deeply rewarding process. It requires facing emotions you’ve avoided, working through past pain, and learning new ways to handle life’s difficulties. While therapy can feel hard, that difficulty is often a sign of growth. With patience and commitment, therapy has the power to heal, transform, and guide you toward a more fulfilling life.
- Goldapple, K., Segal, Z., Garson, C., et al. (2004). Modulation of cortical-limbic pathways in major depression: Treatment-specific effects of cognitive-behavioral therapy. Molecular Psychiatry, 9(5), 581–588.
- Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573.
- Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy. World Psychiatry, 7(2), 96–98.
- Messina, I., Sambin, M., Palmieri, A., & Viviani, R. (2013). Neural correlates of psychotherapy in anxiety and depression: A meta-analysis. Psychiatry Research: Neuroimaging, 213(2), 118–126.
- Swift, J. K., Callahan, J. L., & Vollmer, B. M. (2017). Preferences. Psychotherapy Research, 27(1), 1–14.
