Yeah, okay, I’ve shed some tears.
Every few weeks a client will dive into a past trauma, or realize a life-changing insight, or we'll have some meaningful moment of connection and suddenly my vision gets a little blurry. The tears don’t often spill over my lower lid, but there’s certainly some hydro activity going on. Enough to be considered Kleenex-worthy. And that’s fine by me.
But some therapists resist emotional expression, and some clients don’t like weepy therapists. Or so we thought.
In graduate school I was never taught about my own tears. Some instructors encouraged maintaining an unaffected strength as our clients expressed their emotions. Other professors encouraged us to engage empathically, which invariably means we might feel what clients feel and experience what they experience. I recall group supervision meetings where my fellow trainees would admit to crying in session as if they were confessing to a misdemeanor. Are we supposed to be neutral and detached? Or are our tears a beneficial, empathic, rapport-building expression? Might we be showing weakness or codependence with our clients? Would our clients still respect our skill and intelligence if we showed our emotional side?
To my educators’ defense, they may have neglected to mention it because crying isn’t a technique. It isn’t part of manualized treatment. You’re not going to find a chapter in a CBT text devoted to the Therapist Waterworks Intervention (TWI™). It’s simply a by-product of the empathic, relational connection between therapist and client that can't really be taught or forced. It’s part of the human side of the interaction that our clients can’t get from a self-help book or a pill. It's gonna happen, whether they teach it or not. So what do we know about therapists crying in session?
Before now, not much. I was honored to interview Amy Blume-Marcovici, a recent graduate from Alliant International University and lead author of a groundbreaking study in the APA journal Psychotherapy on therapist tears. It’s groundbreaking because for some mysterious reason, it’s barely been studied.
Blume-Marcovici and her colleagues surveyed 684 US therapists (75% women, aged 22-85, 35% CBT, 23% eclectic/psychodynamic, 19% eclectic/non-psychodynamic) about their crying habits in session. They found that older, more experienced therapists and those with a psychodynamic approach tended to cry more. Females were no more likely to cry than males. The weepers reported they experienced their last in-session cry due to sadness (75%), “feeling touched” (63%), warmth (33%), gratitude (15%) and joy (12%). According to the researchers these findings challenge the idea that therapists cry "due to the therapist being overwhelmed by intense negative emotions that arise in therapy, and instead signals a moment of potentially positive emotional connection, even if amid painful negative affect."
Dr. Blume-Marcovici took a few moments to share her thoughts on this under-researched element of the therapeutic interaction. Grab a hanky and read on:
Ryan Howes: Why have therapists shied away from crying in therapy?
Amy Blume-Marcovici: Actually, I'm not sure that they have! It turns out that 72% of therapists cry and those who do cry in 7% (on average) of therapy sessions. Prior research done on client crying has estimated that clients cry in 21% of therapy sessions (Trezza, 1988) - which means therapists report crying nearly a third as often as clients. It is important to note, however, that these estimates do not take into account intensity or duration of crying and it is likely that therapists "tear up" more often while clients actually shed tears.
However, your question gets at an important issue: the subject of therapists' crying is one that has not been discussed, much less researched. The majority of therapists report that their training did not include how to deal with therapist crying in therapy, and a significant number of therapists reported that they felt unprepared when they cried.
RH: What has been the client's experience of their therapists' crying? Is it a humanizing gesture or does it show weakness?
ABM: A limitation of our research is that we only surveyed therapists, and no research has yet studied clients' experiences of therapist crying. However, several of our participants spontaneously included comments about their own experiences of having their therapist cry when they were therapy clients and in each of these cases, the experience of therapist's tears was positive for the client.
From the perspective of the therapists we surveyed, therapists felt that their tears had some important positive impacts on their clients -- 82% believed therapist crying led to the client feeling that the therapist genuinely cares about him/her, 72% that the client would feel the relationship was more authentic, and 61% that therapist tears would give the client permission to feel and express emotion. On the other hand, 69% of therapists expressed concern that therapist crying would cause the client to be concerned that the therapist would not be able to handle the client's emotion, 64% were worried that the client would feel burdened by the therapist's emotion and 56% thought that therapist tears could cause a role reversal in which the client would feel he/she would have to care for the therapist.
RH: Did therapists believe their crying was a weakness to be hidden or an asset to the therapy?
ABM: When we asked therapists how they felt their crying impacted the relationship, almost half of the time, the therapists reported that their relationship with their client improved due to their tears. The other half of the time there was no change in the relationship. In less than 1% of the time did therapist crying harm the relationship. Overall, more respondents noted the potential positive consequences of therapists' tears than they did negative consequences.
RH: How did you become interested in the topic?
ABM: I am fascinated by the ways in which subtle and nuanced expression of emotion by the therapist - such as therapist tearing up or crying - may impact the therapy process, and how therapists and clients can work together to make such "human" moments in therapy helpful and productive. In short, I am very curious about the ways in which "being human" as therapists can help our clients accept their own (human) selves.
RH: Bottom line -- do you think clients benefit from therapists who cry, or is it a non-issue?
ABM: I certainly do not think a therapist needs to cry to be helpful to their client, and based on our research, it does not appear that a therapist needs to hide his/her tears in order to be helpful, either. In this way, whether or not therapist crying is beneficial, appropriate or harmful is likely related to the unique dynamics between the therapist and client. For some therapists, it may never feel comfortable to cry in therapy. Likewise, for some clients, having a therapist cry may be very off-putting or upsetting. On the other hand, as our research showed, some therapists do cry in therapy (even with regularity), feel comfortable doing so and, from their perspective, feel that it can have a positive impact on the treatment relationship.
Let’s begin the next phase of Dr. Blume-Marcovici's research, kind readers. Has your therapist cried in session? How did you experience it? Did it improve your relationship or create more distance? Express yourself freely in the comments section.