Why Therapy Gets Hard Before It Gets Better: Understanding ACEs and the Drop-Off

Over the past few decades, research has increasingly pointed to something many people have long felt but couldn’t quite name: our early experiences shape us in profound and lasting ways.

This is captured in what is known as Adverse Childhood Experiences (ACEs)—a set of 10 categories of early life stressors, including abuse, neglect, and household dysfunction.

The original Adverse Childhood Experiences Study, conducted by Vincent Felitti and Robert Anda in collaboration with the Centers for Disease Control and Prevention and Kaiser Permanente, found that individuals with higher ACE scores face significantly increased risks for a range of health outcomes.

One of the most striking findings:

Individuals with 4 or more ACEs have a dramatically increased likelihood of developing substance use issues in adulthood.

But substance use is just one expression.

The ACE framework identifies 10 categories of early life adversity that occur before the age of 18. These are grouped into three main areas: abuse, neglect, and household challenges.

1. Abuse

• Emotional abuse

• Physical abuse

• Sexual abuse

2. Neglect

• Emotional neglect (feeling unloved, unsupported)

• Physical neglect (lack of basic care such as food, safety, supervision)

3. Household Challenges

• Exposure to domestic violence (e.g., one parent harming another)

• Household substance use

• Household mental illness or suicide attempt

• Parental separation or divorce

• Incarceration of a household member

Each category counts as one point, for a total possible score of 10.

It’s important to note:

• ACEs are not about comparison—one person’s “2” is not another person’s “2”

• The score doesn’t capture severity, frequency, or protective factors

• And most importantly, an ACE score is not a life sentence

What it does offer is a lens:

a way to understand how early experiences may still be shaping present-day patterns.

How ACEs Show Up in Adulthood

ACEs don’t disappear—they adapt.

They often show up as:

• negative automatic thoughts (“I’m not enough,” “I’ll be abandoned”)

• self-sabotaging patterns

• chronic guilt or shame

• difficulty trusting others

• emotional reactivity or numbness

These are not character flaws.
They are adaptations to early environments.

The Good News: These Patterns Are Treatable

Once we can clearly identify how early experiences are showing up in the present, we can begin to work with them.

Evidence-based approaches such as:

• trauma-focused CBT

• EMDR

• somatic and attachment-informed therapies

can help process these patterns and gradually bring people back toward a more regulated baseline.

This body of work has been further expanded by researchers and clinicians like Bessel van der Kolk (author of The Body Keeps the Score), whose work has helped translate the impact of trauma into both science and clinical practice.

So Why Do People Drop Out of Therapy?

Despite growing awareness, many people begin therapy… and then stop.

Not because it isn’t working.
But often because it is.

In my clinical experience working as a psychotherapist in the Ottawa community, one of the most common reasons for drop-off is this:

Therapy often feels worse before it feels better.

A Different Way to Understand Therapy

Therapy is not always immediately relieving.

In fact, it can feel more like treating a stubborn wart.

If you’ve ever had one on your foot or hand, you’ll know the process:

• the wart is shaved down to the skin so the blood vessels are visible

• then liquid nitrogen is applied to it

• when you return next week, the wart has regrown, in an even more irregular shape

• however, the process keeps getting repeated…

• until one day you wake up and it has fallen off.

• Simply…gone.

What This Means for You

If you’ve started therapy and found yourself thinking:

• “This is too much”

• “I feel worse, not better”

• “Maybe this isn’t working”

You’re not alone.

And it doesn’t necessarily mean therapy is failing.

It may mean:

you’ve reached the part where real change begins.

The Takeaway

ACEs help us understand why certain patterns exist.
Therapy helps us change how they continue.

But that process requires:

• time (weeks to months, not days)

• consistency (weekly, biweekly)

• and a willingness to move through discomfort (imagine physical workout)

Not because something is wrong with you—
but because something happened to you.

And with the right support, those patterns can shift.

When “Access to Justice” Doesn’t Feel Accessible: A Woman of Colour at the Landlord and Tenant Board

There is a particular kind of exhaustion that comes from entering a system that, on paper, is designed to protect you — only to leave feeling unheard inside it.

As a woman of colour, and as a healthcare professional trained to observe patterns in human behaviour and systems, I have spent a great deal of time reflecting on an experience I recently had at the Landlord and Tenant Board in Ontario.

I walked into the hearing believing that, regardless of outcome, I would at minimum be allowed to speak, explain my position, and participate meaningfully in the process. Instead, I left feeling silenced.

The adjudicator — occupying a significant position of institutional authority — controlled the interaction in a manner that felt deeply dismissive and unequal. Attempts to clarify or provide context were cut off. I was not given the same space to articulate my concerns that I observed being afforded elsewhere in the process. Whether intentional or not, the impact was profound: I left feeling small, emotionally dysregulated, and acutely aware of how power operates inside institutional spaces.

To be clear, systemic racism is not always overt. In fact, most of the time, it is subtle.

It is not someone using a slur.

It is being interrupted more frequently.
It is your emotional responses being interpreted as irrational rather than human.
It is being perceived as “difficult” for advocating for yourself.
It is watching professionalism and authority attach more naturally to certain bodies than others.

Research in Canada has repeatedly shown that women of colour experience institutions differently — including healthcare, courts, housing systems, and workplaces. Not always through explicit hostility, but often through credibility gaps, tone policing, unequal assumptions, and reduced psychological safety.

And this matters because access to justice is not simply about whether someone is technically allowed into the room. It is also about whether they are meaningfully heard once they get there.

One of the most psychologically destabilizing parts of these experiences is that they are so easy to deny. Each individual interaction, in isolation, may appear minor. But cumulatively, they create an unmistakable pattern: a felt sense that your voice carries less weight.

As women of colour, many of us learn to second-guess ourselves in these spaces:
“Am I overreacting?”
“Maybe I’m being too sensitive.”
“Maybe this is just how the system works.”

But acknowledging the possibility of systemic bias does not make someone irrational or divisive. It makes them observant.

I am not writing this piece because I believe every negative interaction is racism. I am writing it because too many women of colour quietly carry these experiences alone, often while trying to remain composed enough to still be perceived as credible.

The emotional labour of navigating institutions while simultaneously managing how one is perceived inside them is real. And until we are willing to speak honestly about that reality, “access to justice” will continue to feel unequal for many Canadians.

What stayed with me after the hearing was not only the emotional experience of feeling dismissed, but the practical reality that followed. In order to seek a review of the decision, I was required to invest approximately $1,200 in filing costs and paralegal assistance — a significant amount for many Ontarians already navigating housing instability and institutional stress.

The review process ultimately resulted in corrections to the original decision. While I recognize that procedural systems are designed to allow for reconsideration and human error, the experience left me reflecting on a difficult question: how many individuals lack the financial, emotional, or psychological resources to continue advocating for themselves after initially feeling unheard?

For marginalized individuals, particularly women of colour, the burden of repeatedly proving one’s credibility inside institutional systems can become its own form of exhaustion.

My Experience with Chronic Pain: Minding The Way to Relief

For a long time, I lived with debilitating chronic back pain. I couldn’t sit still. My body was constantly tense, and I relied heavily on massage therapy just to get through the day.

Like many people, I explored a wide range of treatments—medications, stretching, yoga, swimming, and other physical approaches. While some offered temporary relief, the pain always returned.

What I didn’t fully understand at the time was how deeply my mind and body were connected.

Through therapy, I began to notice something I had never paid attention to before: the constant stream of automatic thoughts running through my mind. Self-critical, anxious, and often harsh—these thoughts were so frequent they felt almost invisible, like blinking.

But my body was responding to them.

That constant internal pressure showed up physically as muscle tension, tightness, and pain.

In therapy, I started to slow this process down. I learned to identify these thoughts in real time and gently challenge them. Using approaches like Eye Movement Desensitization and Reprocessing (EMDR), I was able to process not just the thoughts themselves, but the experiences and patterns behind them.

Over time, something shifted.

As my internal dialogue became less critical and more balanced, my body began to soften. The tension reduced. The pain that once felt constant started to ease.

An important part of maintaining this progress was to become mindful of my mental “real estate” - what is occupying it, what effects it negatively or positively, is it fair to me that this is what is there today, etc.

This experience shaped how I understand chronic pain today.

While physical treatments can be important, for many individuals, pain is also deeply influenced by emotional and psychological factors. Addressing both can be a meaningful part of recovery.

If you’re living with chronic pain, you’re not alone—and there may be more than one pathway toward relief.