Many patients wonder how treatment will be like in mental health care. Can you expect improvement in a straight line up from the start of the treatment?


Improvement usually goes more in a wave movement (ten Broeke, 2004). Seen over the entire treatment, the goal is of course to reduce your symptoms and make you feel better. But often changes occur with ups and downs; sometimes you may feel that you are taking two steps forward and one step back. This may have to do with awareness and confrontation with what you previously avoided.

Awareness of your complaints and your behavior

You are going through several phases during treatment. The first phase starts with an intake interview, after which you may already feel a little better because you were able to tell your story and because your concerns were heard (ten Broeke, 2004). Also, you may have received confidence and hope that you can change your complaints.

This is followed by a phase that promotes awareness; you get information about your complaints, you register how often you suffer from your complaints (and you may notice that you are gloomy or anxious much more often than you thought and you may find this unsettling). That can be confronting and make you feel less good. You are more aware of what is not going well, but you still have few tools to get moving and change something (ten Broeke, 2004). This, of course, is not a nice feeling.

Yet becoming aware of what is going on is a sign that you have begun to confront your complaints so that you can do something about them.

Addressing complaints during treatment

When you are more aware of what is going wrong at the moment and how your behavior may sustain your symptoms, you can try to do things differently or changes your think about situations, your professional will be there to help you along the way.

You get tips and tricks to work with, for example by confronting fearful situations that you have avoided before, you become more active again while you previously had the tendency to withdraw. You can also learn to challenge your negative thoughts and become more realistic to start feeling better. And that too can go in waves, with trial and error.

Your development during a treatment is therefore on average not a straight, rising line, but rather a wavy movement. Being aware of this and knowing that this is “normal” can help you to put things into perspective when things go less well. Have faith that you are on the right track and that you will get there. Keep going!


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Saskia Schawo

Hi, I am Saskia and I work as a psychologist with patients with anxiety and mood disorders. I do this at the Digital poli Haaglanden and Parnassia Groep Zoetermeer. I mainly work with cognitive behavioral therapy techniques and interpersonal therapy. In addition to my work, I am a PhD student at Erasmus University. In my free time I draw and paint, I surf every now and then and I do pilates.

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