The In-Between Phase of Treatment: When Clients Are Improving but Still Feel Distressed
In clinical practice, we often conceptualize progress in terms of symptom reduction, improved functioning, or goal attainment. However, there is a phase in treatment that can be more nuanced one that is frequently overlooked in both clinical discussion and client preparation.
This is the in-between phase: when clients are objectively improving, yet subjectively report feeling unsettled, disconnected, or off.
Understanding and normalizing this phase can be critical for both therapeutic alliance and treatment retention.
Clinical Presentation of the In-Between Phase
Clients in this stage may present with:
Reduced acute symptoms (fewer panic attacks, improved mood stability)
Increased insight and self-awareness
Greater behavioral control or use of coping strategies
Despite these gains, they may report:
A persistent sense of discomfort or unease
Frustration that they do not feel better despite progress
Confusion about their identity, relationships, or emotional responses
This can lead to discouragement or premature beliefs that therapy isn’t working.
Why This Phase Occurs
1. Increased Insight Without Full Integration
As clients develop awareness of maladaptive patterns, cognitive distortions, or relational dynamics, they often lose the protective buffer of unawareness. However, insight alone does not immediately translate into emotional resolution or behavioral consistency.
This gap between awareness and integration can feel destabilizing.
2. Disruption of Longstanding Coping Mechanisms
Many clients enter therapy with coping strategies that, while maladaptive, have served regulatory or protective functions (avoidance, emotional suppression, people-pleasing).
As these strategies are challenged or reduced, clients may temporarily experience increased emotional exposure without yet having fully internalized alternative coping mechanisms.
3. Identity Reconstruction
Therapeutic progress often involves shifts in identity, values, and relational boundaries. As clients begin to behave differently, they may experience a sense of unfamiliarity with themselves.
This can present as:
I don’t recognize myself anymore
I don’t know what I actually want
This reflects not regression, but restructuring.
4. Reduced Emotional Numbing
As clients become more emotionally present, they may experience a broader and more intense range of affect. While this is often a marker of progress, it can initially be perceived as increased distress.
Clinical Implications
Normalize the Experience
Explicitly naming this phase can reduce client anxiety and prevent misinterpretation of progress. Framing discomfort as part of the therapeutic process can support continued engagement.
Reinforce Process Over Outcome
Encourage clients to evaluate progress based on behavioral and cognitive shifts, not solely emotional relief. This helps recalibrate expectations around healing.
Support Integration
Interventions should focus on helping clients bridge the gap between insight and application. This may include:
Behavioral rehearsal
Values clarification
Gradual exposure to new relational patterns
Monitor for Discouragement or Dropout Risk
Clients in this phase may feel stuck or disillusioned. Regularly assessing motivation and reinforcing observed progress can help maintain engagement.
Discussion Questions for Clinicians
How do you conceptualize and explain this phase to clients in your practice?
What interventions have you found most effective in supporting integration during this stage?
Have you observed increased dropout risk during this phase, and how do you address it?
The “in-between” phase represents a critical point in treatment one that reflects movement rather than stagnation. While it may not present with immediate relief, it often signals that deeper cognitive, emotional, and behavioral shifts are underway.
Recognizing and addressing this phase intentionally can enhance both clinical outcomes and the client’s overall experience of therapy.