Therapy is not a painkiller
There's a moment that happens in many first sessions. A client sits down, and somewhere in the conversation — sometimes spoken, sometimes just in how they're sitting — there's a question underneath everything else: how long until this stops hurting?
It's a completely understandable question. But I think it often comes from an assumption worth gently questioning: that therapy is something you take, like a painkiller for a headache, and after a while the pain just goes away. I get why we think this way. It's been shaped by years of "diagnose and treat" thinking about health, and more recently, by an industry that sells therapy the way it sells everything else: fast, easy, guaranteed to work.
Why we expect quick fixes
For a long time, we've tended to think about distress the way we think about physical illness: symptoms, diagnosis, treatment, cure. That way of thinking has done a lot of good, and it's helped many people feel less ashamed of struggling. But I'd say it's also shaped what we expect from therapy. James Davies makes a similar point in Sedated: How Modern Capitalism Created Our Mental Health Crisis. He argues it's often easier, and more profitable, to treat distress as something wrong with the individual than to look at the harder, messier reasons someone might be struggling. On top of that, I think we're all a bit trained by instant-delivery culture to expect things to be sorted quickly. But in my experience, distress doesn't tend to show up on a schedule, and it doesn't tend to leave on one either.
Why a real relationship matters more than a slick app
I think this "quick fix" idea has been made stronger by therapy apps and platforms, where you can scroll through therapist profiles and switch to someone new with a couple of taps. Elizabeth Cotton's book UberTherapy: The New Business of Mental Health talks about how this can quietly teach us that any one therapist is easy to replace.
I think that undersells something important: the relationship between you and your therapist is one of the things research keeps coming back to as genuinely mattering. A large study by Flückiger and colleagues (2012), which looked at 190 separate pieces of research, found that a good working relationship between client and therapist was linked to better outcomes, and this held up no matter what type of therapy was used or how it was delivered. To me, that relationship isn't a nice extra alongside "the real work." In a lot of the evidence, it looks more like the work itself. That's something worth being mindful of, if you're choosing a therapist the way you'd choose a takeaway delivery.
Why progress isn't a straight line (and hard to measure)
Even with a good relationship in place, therapy rarely moves forward in a neat, steady line. This is because so much of what affects your week has nothing to do with the therapy room. A relationship ending, a health scare, money worries. None of that is something a therapist can control, however skilled they are.
This is part of why I'm a little wary of the phrase "evidence-based," especially when it's used mostly as a selling point. A lot of that evidence comes from a type of study borrowed from medicine, designed to test one thing at a time, in a very controlled way. Great for testing a pill, trickier for something as human as therapy. In my view, neither clients nor therapists behave like standardised ingredients in a trial. Two people with the same diagnosis can have completely different life stories, and two therapists using "the same" approach still bring their own personalities and ways of relating to it. Interestingly, that same 2012 study found that the researcher's own enthusiasm for a particular approach affected the results of the study more than the approach itself did. To me, that's a good reminder that even careful research is still shaped by people.
Feeling worse can be part of getting better
In my experience, therapy can sometimes stir up more anxiety or sadness before things start to feel easier. Frank and Frank's classic book on psychotherapy describes how people often come to therapy feeling worn down, having already tried everything else they know to cope. Early therapy can involve gently making contact with feelings that have been pushed aside for a long time, precisely because they're hard to face.
I'm not the only one who notices this. Writing for BACP, therapist Amy Bojanowski-Bubb describes the same thing: people often expect therapy to make them feel better straight away, but progress is rarely a straight line, and it's common to feel stuck or to circle back to the same themes before things shift. If a client starts crying in week four after holding it together in week one, I wouldn't read that as things going backwards. More often, it means they've started to feel safe enough to stop holding everything so tightly. To me, that's not a sign something's wrong; it's often a sign the work is actually happening.
In conclusion
I don't think therapy is a painkiller, and I don't think it should try to be one. In my experience, it tends to be slower and less predictable than we're used to in most areas of life. This is not because anything's gone wrong, but because real change rarely happens on demand. What the research points to, for me, isn't a faster technique; it's the quality of the relationship you build with your therapist, and a willingness to keep going even when it doesn't feel like relief right away. In the words of Irvin D. Yalom, “It’s the relationship that heals, the relationship that heals, the relationship that heals”.
That's harder to promise in a few words on a website. But it's the most honest description I can give of what tends to actually help.