The costs of therapy no one talks about

Therapist in session

We all know the benefits about psychotherapy, but what are the trade-offs?

“Therapy isn’t Radio. We don’t need to constantly fill the air with sounds. Sometimes, when it’s quiet, surprising things happen.”

— Mary Pipher

There is no questions that psychotherapy holds tremendous value for those who are able to pursue it. If you Google scientific articles on the benefits of psychotherapy, the evidence on its effectiveness is plentiful. However, very seldom do people talk about the costs of psychotherapy. As with most things in life, if not all, there is always a trade-off. As a psychologist, I have become well-aware of the costs of therapy, which have been revealed to me in both my professional and personal experiences. I believe the following to be costs of therapy that form part of almost all psychotherapeutic journeys, regardless of the main reason for starting therapy.

1. An overwhelming internal focus

Embarking on a therapeutic journey will mean you will start to – or continue to – have a higher sense of self-awareness. You will learn how to notice the ways in which you feel, think, and behave. This internal focus will escalate with time and become more autonomous to a point where, at times, it may get quite overwhelming. Particularly if you start to notice patterns in your ways of thinking and behaving. It is important to address any fixations on certain patterns directly in therapy in order to help you make sense of these, and move forward. Nevertheless, when you start therapy for the first time, you are bound to notice things about yourself you have never noticed before. You will be more tuned into your inner world, and depending what the content of your inner world is – it can become quite overwhelming. 

2. You can never unsee things

Combined with a higher level of self-awareness, therapy also makes you see things for what they really are. In simple terms, you will remove the rose-coloured glasses that you’ve been looking through all your life and actually see the world for how it truly is. Generally we have started using the rose-coloured glasses (i.e., our coping mechanisms) to help us deal with very difficult situations, or to keep our idealised picture of someone we really love, because seeing them as they truly are would just be too painful. Or we learned how to engage in denial and other cognitive distortions and defense mechanisms so we could regulate our own emotional experiences to what was really going on around us and inside of us. In therapy, you will identify things about your personal relationships. You will gain insights in therapy about the ones you love. Things you did not notice before. Things that may be hurtful to you. You will start to see things which you will not be able to unsee. Once you’ve made a particular realisation, you cannot rewind and undo it. This realisation – of both others and yourself – can hurt, really hurt! I always say, the toughest thing in therapy is not learning who you are, it is accepting what you find. 

3. Old ways of coping no longer work

Through therapy you will gain deep insight into your own maladaptive coping mechanisms or defense strategies. The strategies that you adopted as a child or adolescent which helped you get through life. These strategies served you at some stage in your life. They were beneficial. However, over time, these intended short-term, healthy coping mechanisms became long-term and maladaptive. But, once you’ve been able to identify these maladaptive strategies, and managed to replace them with healthier ones, you will no longer be able to escape the suppressed pain, anger, sadness, or whatever it is that these coping mechanisms have helped you escape. You can no longer use your projection, denial, suppression, sublimation, or regression to manage your emotional states. You will be faced with having to deal with these deeply uncomfortable emotions in their raw state.  

4. A new fear of going back to square one

Once you’ve witnessed your own progress and experienced all the benefits that accompanies therapy, there is this part of you that now fears that once you stop your therapeutic journey that you will end up back at where you started. You fear falling back into old patterns of behaviour. You fear losing the trust you’ve developed in yourself. You fear that you will stop growing, stop learning, stop progressing. This will be particularly true for those personality types that score high on perfectionism and ambitiousness, as they are motivated by moving forward and fear decline. It is important to remember that therapy is a marathon, it requires periods of intense work and then periods of longer rest and recovery. Also, we are all human. Our “old patterns” of behaviour are still wired somewhere in our brain and they may be triggered. That’s ok and normal. You cannot control this, but you can always control where your attention goes and what you do with those triggers. Even if you do end up falling back into old patterns of behaviour, you have not failed, you will never be back at square one! This is just an indication that more work is required. 

5. You will be tired, like a lot

Childhood trauma sends your central nervous system into fight or flight mode, and it can stay there for years. However, once you’ve worked through your childhood trauma(s) – both the big “Ts” and the small “Ts” – your central nervous system will be more regulated. You will experience a sense of safety and calmness. Your body is now no longer in fight or flight mode. As this happens, you will feel utterly exhausted. You would want to sleep a lot. You will struggle with fatigue. This is all very normal and expected, but not an enjoyable consequence. Particularly if you feel you now have so many dreams to accomplish and things to do. Things which you most likely have held yourself back from. But now, you feel so without energy and oomph. This is can be really difficult at times, but something that needs acknowledgment and a whole lot of self-compassion. 

These are just some of the main costs to therapy that I have found over the years of practice and that I feel are often not discussed. However, it is important to remember that as with anything worthwhile in life, progress in therapy will not come easy, but the personal growth and richness that you will experience in your life will be invaluable and immeasurable.  

If you have ever wondered about certain aspects around therapeutic process, feel free to drop me a question below or reach out via my other social media platforms:




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