Why Do I Keep Regressing After I Make Therapeutic Progress?

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I am often asked by my clients some version of the following:

I don’t understand what is going on. I was making progress in therapy and feeling great. I thought that I finally had everything under control, and I could move on with my life. Then, for no reason, I suddenly regressed. It started a couple of days after our last session when I decided to go back to school and finish my degree. Suddenly, I started feeling all these emotions I couldn’t control. I was jumping out of my skin! I felt desperate so I went back to my old ways of distracting and soothing myself. I smoked a joint, ate a pint of ice cream, two pizzas, and had sex with a stranger. I feel like such a failure. What happened? Where did all that progress go?

James F. Masterson (1926–2010), a well-known personality disorder theorist, came up with a very useful explanation of why the above situation occurs. He said that progress in therapy, especially for people with personality disorders, is a circular process, not a linear one. Clients improve in therapy, restart their life, begin to make changes, and then suddenly regress. Rather than being a bad sign, this is normal.

The regression occurs when clients outrun their ability to emotionally support themselves. All it means is that they need to do more work on their underlying issues and unhealed traumas before they are ready to restart their progress towards their goals.

Masterson was a genius at noticing repeating cycles in psychotherapy, understanding what causes them, and explaining how to deal with them in a useful fashion.

What Is "The Triad”?

Masterson taught that in psychotherapy:

Self-activation leads to abandonment depression which leads to defense.

Masterson called this 3-part situation “The Personality Disorder Triad.” He developed it early in his career when he was working with clients with borderline personality disorders. As a result, he initially called it “The Borderline Triad.” This is the reason why he originally called the painful emotions that start to surface after self-activation the “abandonment depression.” Abandonment trauma was a central issue for his borderline clients.

Later, he realized that the same type of regression was an issue in the therapy of all of his clients with personality disorders, even ones where abandonment was not a major problem, such as clients with narcissistic personality disorder. But by that time, most Masterson-trained therapists were used to saying “abandonment depression” as shorthand for every painful feeling that starts to surface after the client starts to make progress in psychotherapy, so many psychotherapists continued to use it. I call it “The Triad” for short and find it also can apply to the therapy of people who are not diagnosed with a personality disorder.

I will break the parts down and explain what each one means.

Self-Activation: Self-activation is psychotherapy shorthand for a process in which clients start to identify their authentic likes and dislikes and become motivated to begin making some positive changes in their life.

Abandonment Depression: This is shorthand for all the painful feelings that have been buried and need to be worked on in psychotherapy—rage, grief, panic, helplessness, shame, hopelessness, emptiness, and so on.

When clients make progress in therapy, they start to self-activate and stop using their maladaptive coping mechanisms that distracted them from their underlying pain. Now, the unworked-through underlying traumatic feelings start to surface as the person moves toward being more authentic and going for what they want.

Defense: This stands for all the maladaptive coping mechanisms the person uses to deal with their underlying feelings. This can be anything from overeating, substance abuse, cutting, having sex with strangers, to picking fights.

Masterson-trained therapists are taught to expect the regressions associated with self-activation and deal with them.

An Illustration

Betty came to therapy because she felt very anxious and could not understand why her life was such a mess. She told me that when she had been a teacher, she had never realized how her job structured her life. She was able to get up in the morning and go to work and socializing with the other teachers provided her with a ready-made group of friends.

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Now she had taken early retirement due to some health issues but without the external pressure to get up for work and get showered and dressed, she seldom left her house. She slept most of the day and binge-watched television shows at night. She also found it hard to keep up the friendships from work without seeing the other teachers every day.

Betty came to therapy because she had gained a lot of weight, was depressed and lonely, and had no idea what she wanted to do with the rest of her life. She felt abandoned by the other teachers who had gradually stopped including her in their plans. That hurt her the most because she had assumed that they all would be friends for life.

As Betty made progress in therapy, she started to identify things that she might like to do and started to experiment with them. She signed up for classes and started to make new friends (Self-Activation).

After a particularly productive session, she left therapy happily anticipating a busy week. Instead, she found herself immobilized and unable to focus on her plans. She was very anxious and had a panic attack (Abandonment Depression). Instead of going out, she went back to sleeping all day, eating pints of ice cream, and binge-watching television (Defense).

Betty came to her next session and said: I feel awful. I hate myself. Therapy isn’t working. I might as well quit. Nothing is working out for me, and it never will!

I said: Slow down. Let’s talk about it. Do you remember your last session?

Betty: Not really. I just hate my life. And I hate myself.

I said: Well, I remember that you left quite enthused and had decided to take a jewelry-making class. Do you remember now?

Betty: Yes.

I said: Let’s go through your week together and try to figure out why your mood shifted so radically.

Analysis

In the above example, Betty’s self-activation lasted for a day or two, then old unworked-through negative issues started entering her consciousness in the form of panicky feelings. To soothe herself, she went back to her old defenses against feeling. Then she berated herself and felt like a total failure.

Betty came to the session in defense, feeling quite hopeless. She forgot about all her progress from the prior month.

I then interrupted Betty’s defensive acting out (as Masterson had taught us to do) and started to engage her again in the therapy process. She left the session restored and enthusiastic. I also told her that these ups and downs were an expected part of the process and that they would gradually diminish as we worked on her issues.

Summary

It is quite normal for clients to make some progress in therapy, start to self-activate, and then regress and go back to their old defenses. It is the therapist’s job to hold the memory of past successes, interrupt the use of the old maladaptive defenses, and help clients restart the therapeutic process. For some people with personality disorders, this may take up the entire first half of the therapy. As the old issues are worked through, clients’ moods stabilize, and the ups and downs gradually diminish. At that point, self-activation leads to satisfaction, not defense.

Based on a Quora post.

To find a therapist, please visit the Psychology Today Therapy Directory.