What If They Get Worse?

This continues our series exploring the human realities of therapeutic practice. Today we examine one of the most anxiety-provoking aspects of our work: the fear that we might inadvertently cause harm.

The 5 AM Wake-Up Call

It's 5 AM and you're wide awake, replaying yesterday's session with Emma. She'd been making steady progress with her anxiety, but today she seemed more agitated than usual. She mentioned having "dark thoughts" and when you explored this, she clammed up and ended the session early.

Now you're lying in bed, your mind racing: What if I pushed too hard? What if those "dark thoughts" were suicidal ideation and I missed it? What if she doesn't come back next week? What if she hurts herself and it's my fault?

This is the fear that haunts many therapists: What if our interventions, our questions, our presence somehow makes things worse for our clients?

The Unspoken Truths of Being a Therapist: When You're Not Sure You're Helping.

The Question That Haunts Us

Every experienced therapist knows this moment intimately. You're sitting with a client you genuinely care about—someone you've been seeing for weeks, perhaps months. You've drawn from your training, applied your best clinical skills, offered thoughtful interventions. Yet something feels stuck. Progress seems elusive, and you find yourself wondering:

"Am I actually helping this person?"