Therapy is hard work, whether you are trying to overcome an anxiety disorder, relationship issue or a trauma memory. Often, we find that our issues are connected to some stuff that we keep deep down, and we won’t know that it will resurface until it does, unexpectedly.

I’ve worked with some people who experience strong physical reactions during therapy, including wanting to throw up. This might happen even if we are talking about something seemingly benign to the client. The topic can unexpectedly link back to strong realizations, or difficult memories, and these experiences can be very powerful, intense and activating. I have even experienced this kind of intense activation myself during my own therapy sessions.
If this has happened to you, you might have felt overwhelmed in the moment, as if you have been caught off guard. This turns on your fight/flight response and you might unconsciously and instinctively respond accordingly.
Here are 5 signs that you are activated during a session.
1. You feel tense.
Your jaw might be clenched and your breath turns shallow. You might have hunched shoulders or other tight muscles.
2. You feel irritable.
You might feel some anger, resentment or irritation. This might even be directed towards your therapist. These are signs that your body has gone into fight mode, as it has gone into brace or defense.
3. You feel ready to run.
You would like the ground to swallow you up. You would like to end the session here and leave. You’re fidgety and restless. You scan the door, and your brain gets super creative at generating every excuse to cut the session short.
4. You feel anxious.
You’re overwhelmed, overstimulated and you might feel the impulse to cry. These are signs that your body has gone into flight mode, as it interprets danger and wants to get you out.
5. You feel numb.
You’ve hit a wall and can’t see a way through it. You might even be feeling checked out, and might find yourself staring into space or out a window. This could be a sign that your body has gone into a freeze state, as your body knows that it is there, but your mind can always go somewhere else.
I hope that you have a skilled therapist who will be able to detect these changes in your body and face. Even if you yourself don’t notice these changes in state, your therapist might. A good therapist will be able to notice this and invite you to talk about it.
However sometimes we are really good at hiding how we feel. Especially if you have spent years adapting to these states of being in your everyday functioning. In this case, it might take a while after you have gone to therapy, for them to notice these patterns.
What you can do about it.
These moments in therapy are uncomfortable. As mentioned in a previous blog post, use your emotions as cues, to let you know if you are on the right track or not. This will help you bridge the gap between your mind and body.
If you spot these changes in emotions or physical sensations before your therapist does, tell them. If you feel so angry and irritable that you could even punch the wall, tell them. If you feel like you could barf, tell them. If you feel uncomfortable in any way, tell them. There are a number of reasons why this could be happening but your therapist is there to be able to help you make sense of your patterns, learn skills to regulate yourself, learn skills to be kinder to yourself, and be an example of how people could respond to you expressing yourself.
For example, if you feel angry towards your therapist, tell them. They should listen to you, take on the feedback and work with you on how to make the experience feel safer for you.
Literature suggests that the relationship is the most important thing when it comes to therapy and its ability to help you make any positive progress (Ardito & Rabellino, 2011). When you find the relationship tough, or the approach is not working for you, you have an opportunity to see the problem for what it is, and work towards overcoming it. My supervisor once taught me that the way we are towards our therapist often mirrors the way we are in other relationships. Therefore, you would be doing your relationships a huge favour by working on the one with your therapist, as long as your therapist is also working on the relationship with you too (Slay-Westbrook, 2017)!
Sometimes it feels safer to write down our thoughts and feelings of our experience of therapy before we say them out loud. I encourage everyone I see, to keep a journal in general.
If you'd like a tool specific to counselling, I have created a journal especially for your therapy experience, called the Counselling Companion. It has a schedule, and prompts to record your goals, intentions for your sessions and reflections following up to 20 sessions. Buy it here.
References
Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270.
Slay-Westbrook, S. (2017). Respect-focused therapy : Honoring clients through the therapeutic relationship and process. Routledge.
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