My client is crying
Trainees (and clients) need to know that crying is common in therapy. Experienced therapists need to remember that crying may be common in therapy, but that crying in front of a stranger is probably a rare experience for any given client: you may now be relaxed about the situation, but they aren’t!
Every trainee dreads this moment: your client is crying. You probably are unaccustomed to strangers crying in your presence. The fear is that their distress is your fault, that you weren’t sufficiently sensitive or supportive: now you have to manage the situation you’ve “causedâ€.
More experienced therapists will have seen literally hundreds of clients cry. You know that people in therapy will cry for a variety of reasons, usually unrelated to the therapist. Knowing how common crying is, you’ve evolved your own set of responses. You’ve probably forgotten how awkward you used to feel…and how awkward the client still feels.
Professional role and therapeutic orientation will influence your response to a crying client. Phsyiotherapists will respond differently than psychologists: cognitive therapists will consider different factors than psychoanalysts. There are, however, some basic steps you can take which can make the situation more comfortable for everyone involved.
How should I react?
When a client begins crying, be it a single tear or a flood, you may have some idea why or you may be puzzled. Unless you are certain of the reason, some responses are to be avoided. I’ve heard therapists tell clients “it’s OKâ€: how do they know? I’ve heard therapists tell clients “there’s no need to cry nowâ€: again, what makes them so sure? I’ve seen one therapist cross the room and put an arm around a crying client to comfort them: with no idea as to why the client was crying, this physical contact might well have been a reminder of the physical or emotional trauma (eg: childhood sexual abuse) underlying the client’s distress; equally, the physical contact could have been construed as evidence of affection or attraction by a client with confused feelings about their therapist.
The single most normalising response that you can make to a crying client is to offer a box of tissues. This is an active, supportive gesture on your part, maintains your engagement with the client and gives them a small physical distraction from their distressing thoughts. The client then has permission to busy themself with wiping their eyes while you are now free to relax until they have finished and can restart the conversation.
How should I prepare?
Most therapists’ attempt to normalise crying are blown with inadequate preparation: if it’s so normal for people to cry, then how come you weren’t ready for it? Before any session, ensure:
- you have some ordinary tissues: a client who feels guilty for crying (eg: wasting your time) will feel even more guilty if they feel that their “silliness†is using up hospital supplies; moreover, having clearly identifiable tissues prevents you from inadvertently offering the client a handful of, say, surgical gloves (as one of my supervisors once did!)
- the tissues aren’t wholly inappropriate to the situation: a drug company promoted their antidepressant medication with free boxes of tissues; each box was a bright yellow cube with a smiley on each face; each tissue was also covered in smiley faces. How comfortable would you feel offering these to someone recently bereaved?
- the tissues are near the client, so that it is clear they’re not your personal supply (I have hay fever so do a lot of sneezing in the summer, but I have my own stash of hankerchiefs separate from the clients tissues
- the tissues aren’t so far away from you that you can’t reach across and proffer the box as a further invitation: most people are intimidated by clinical settings and psychological clients are likely to be unassertive, so explicit permission may be necessary before the client will use the tissues.
- there is an an easily accessed waste basket obviously for the client’s use (ie: not a clinical waste bin) so that the client doesn’t sit with a growing handful of soggy tissues.
What should I do or say?
I prefer to think of crying as communication. In conversation, the person who is speaking has the floor. I therefore treat a crying client as a speaking client and wait for them to indicate (by eye contact or other means) that I have permission to speak.
If you take this path, the client’s most probable first comment will be either “I’m being silly†or “I hadn’t meant to do thatâ€, giving you the opportunity to normalise the crying (eg: “many people who come here cry: that’s why we have the tissuesâ€) and to establish the client’s perspective on their reaction, according to your therapeutic approach (eg: “I wonder what went through your mind just as you started cryingâ€).
How should I continue the session?
I once heard of a counselling room with two doors: one in from the waiting room and one out to a recovery room in which a distressed or exhausted client could sit for a while (maybe even for most of the nest session) and compose themself before venturing back into the outside world. This sounded ideal, and is therefore unlikely to be encountered in most therapy settings.
If your client cries, consider ending the session a couple of minutes earlier than planned. This allows the client some time to compose themselves before heading back through the waiting room and out into the world. This strategy has possible benefits for you and for your clients.
15% of the variation in therapeutic outcome is due to clients’ hopes and expectations (the placebo effect). If your next client sees your previous client stagger out of your consulting room looking like they’ve just been beaten up, how positive do you suppose their expectations are going to be?
Appearance is a crucial part of impression formation and, generally, we like to look our best in public (or, if not our best, at least not puffy eyed, red-nosed and perhaps with smeared makeup). Permitting the client a couple of minutes at the end of the session to compose themself and (where necessary) fix their make up prevents any reassuring or relaxing effects of your session evaporating in a haze of embarrassment as the client rushes out of your room through the waiting room and into the nearest washroom (assuming they know where it is). This in turn maximises the chances that the client will return for another appointment, if necessary.
Jun 06 at 11:16
I often hand people tissues and then inform them to take ther time and give them a couple of mintutes composure, however others I speak to talk through the crying, any comments on which may be more appropriate?
Jun 06 at 18:32
Some people may be unable to speak for crying. If in any doubt, I’d ask the client to tell me when they feel ready to continue.
Dec 10 at 17:05
Interesting discussion about crying. I also would tend to offer a client a tissue if they were crying. However, I also bear in mind the advice of a tutor when I was training. The manner in which the tissue is offered is open to interpretation by the client. One possible interpretation (by an already distressed and embarrassed client) is: “Dry your tears now please – and don’t be spilling any more”! I find a gesture towards the tissue box with the words “There are some tissues here, if you would like one” provides a compromise.
Dec 11 at 06:12
I usually say that we expect people to cry: that’s why we have the tissues. I’d like to think that leaving the tissues near to the client implies that it is OK to cry again, but maybe that message needs to be more explicit.
Mar 13 at 03:49
I think that when a client is crying it’s helpful to stay in Self. Self is defined as a state of calm, copmpassion, curiosity, and other qualities.
Jan 19 at 01:35
The writer will probably never see this response, but anyway!! I cannot believe how narrowly this topic is looked at in traditional talk-only psychotherapy. Offering a box of tissues as a way to connect with your client?? The goal being to re-start the conversation? Offers them a distraction from their distressing thoughts?? Granted, in many situations this may be the best tactic, but also, maybe it’s time you all realized that some people really need a major cry as a time of healing, not just catharsis, but true inner healing.
I went through years and years of therapy with a couple different therapists, both whom I really truly liked and respected, but in front of whom I could never really truly cry because of the lack of touch factor. There were a number of times I was very deeply in despair over this issue, and the therapeutic community is really missing the boat here. When I had my first child, I went through a time of real grieving over some things that happened in my childhood, I could self-analyze it all very well, but what I truly, truly needed was another person who could see my pain, allow me to go through it with them present AND able to offer some physical contact, arm around shoulders, a shoulder to cry on , literally! Not just talk!!
I never really got over this and able to put it behind me until I went to a body-psychotherapist who uses the body as a vehicle for understanding what we need to do, in this case , a very deep, long cry with connection offered through touch. It should not have taken all those years, I hesitate to say how many, of pain and struggle trying to get this across to a regular therapist and get the simple help I needed. Yes, I know you will say there are too many dangers and landmines (I first accidentally spelled that “landminds” ) with physical contact. All that can be clarified, and if you’re willing to take the time, read at drzur.com his article on ethical use of touch in psychotherapy. Thanks for listening.
Jan 19 at 01:40
I can’t remember what even led me to this site, but once I saw this entry, had to respond. I truly wish the therapeutic community would take a good, hard, compassionate look at the issue of touch in therapy, and not just reason it away.
Mar 10 at 23:50
I find your obsession with the practical minutiae of tissues a little disturbing. Do you think that having the right amount of tissues, the right type of tissues to hand is really going to ease your discomfort or that of your client?
Mar 30 at 21:52
Having to leave a crying client in order to hunt for tissues or offering tissues with smiley faces could make a difficult time worse. A well prepared consulting room should enable client and therapist to spend the time in session focussing on what really matters.
May 21 at 14:46
This is really interesting, especially the comment about the touch factor. My therapist is waiting for me to cry, as am I (though as a bolshy git I’m not inclined to ‘perform’ for my therapist). I find it really frustrating that she does not touch me and I (assume that I) cannot touch her. If we could touch, maybe we might make some contact.
(The tissues, in either consulting room we use, are not even in a position for her to reach, so I would have to get them myself – interesting thought, that!)
Aug 30 at 01:06
It is mind-boggling how far apart the therapists and clients are on this (and probably most) subjects. A discussion about how to hand the tissues or whether to hand the tissues or what kind of tissues (seriously). How about another discussion around what would happen if the therapist were to (gasp!) touch the client when handing him/her the box of tissues. Surely that must have all sorts of interesting implications and would provide much fodder for therapist discussion. Perhaps one day soon we could have robots to perform the therapy work. That would solve all the problems of the therapy world.
Aug 31 at 07:27
The gap may not be as great as it would appear, but clients usually don’t risk being sued for inappropriate touching. An article on touch in therapy is a good & popular idea: a series is on the way. Unfortunately, so are a number of programmes to deliver computerised therapy without human involvement. Be careful of what you wish for (even in jest)!
Jul 29 at 23:20
I want to cry in front of my therapist but I would only do it if she sat next to me and was close. It is to lonely crying by yourself and being watched.
Sep 15 at 06:37
I have cried with a client ..this has really opened up the Humanistic side of therapy and was instrumental in an alcoholic”s complete recovery. he needed me to be human…
Nov 16 at 16:07
clearly everyone is different. i appreciated the thoughtful discussion of tissues, and as a client if a therapist touched me i would want to bolt. i am grateful that touching is not part of therapy.
Nov 23 at 02:50
Personally, I”d be very wary of a therapist who actually *expects* me to cry. It indicates that they think low of me. Yes, it”s good having a box of tissues in the office, but I see them as an “in emergencies only” kind of thing, for situations when I can”t help but cry, like when talking about a dead relative that I miss a lot. In other situations, I”d much rather talk out my issues in a rational manner. If I need to cry, I”ll do it in my own home, with “Cat”s in the Cradle” playing in the background. Crying in front of a therapist is one of the most objectifying experiences. You sit there feeling weak and vulnerable, while the therapist watches you. If I ever cried during therapy, I would absolutely insist on him/her turning around.
Jan 05 at 20:54
When one is crying uncontrollably and are finally in a process of accepting the grief of an event, isn”t it worse to touch them? I pose this question to both professional and the closest friends who wish to be available for support. Is it better to allow them to have this crying episode uninterrupted? At some point, if you are sitting close enough to them, and they are ready to bring themselves out of it, won”t they reach for you? That has been my experience.
Aside from the issues of perception of the client/provider relationship, touching them seems to interrupt the necessary process of finally bottoming out that is needed to move forward in the grieving process.
I would be grateful for feedback about this posting.
Jan 31 at 23:45
Hmmm…Deanna I think the big thing is that clients think about everything, why it happened or didn”t happened, what it felt like…
So I think that therapist should talk about touch early on, ask the client what they need in the moment or tell the client that you aren”t a touchy feely person or are uncomfortable with it.
I think people vary on what they need when they are crying and I think crying is such a sad thing..and who wants to be observed like a rat in a box. I personally on the other side have had times when I have wanted touch, especially when I was really, really crying an ocean. I think that if a client knows your boundaries and or knows they can reach out to you or ask to be touched then that is good. Clients don”t know that they can reach out to you, sometimes therapist seem so not human, so distant, so by the script.
talk it out with the client especially if you think they are going to need a good cry…let them have the autonomy to indicate what they need and or indicate when they don”t know what they need. Most of all be there, be human, and think about what you would need in that moment, what do you feel is the best thing to do, what do you feel intuitively you should do…being human one would have such ideas…
As a clinician I use this as my process and I ask them if I can hug them. I don”t shrink away from their touch (unless that is a part of the process, i.e. working with a sex offender) and at times its just a human sense that a person needs to know you are there, not just hear your voice or see your shadow across the room
Touching can move the grieving process forward too..and it changes the perception that grief is done alone, is disgraceful or shameful. Of course if the client has an aversion to touch that could stop the process or if the client does not have an attachment to the therapist.
Feb 23 at 01:46
Perhaps one can just be in presence with the client who cries. Offering perhaps a reflection such as, “Yes, this is very difficult…”
One need not “do” anything… Crying is natural… I agree with the remark above of “Counseling” in that there is no need to distract the client from such feelings. Indeed, their cathartic release may in part benefit the client.
Mar 18 at 02:53
I don”t cry in therapy, though I know it”s an option if I allow myself that vulnerability. There are tissue on a table next to the couch were I sit. My therapist sits on the other side of the room. There would be no reason for him to hand the tissue to me and he would have to invade my space to reach them. I would NOT be happy if he touched me for any reason. I like him. He is a nice, funny kind of guy and I find him pleasant to be around. I don”t like the real humanistic approaches (no offense intended) and I feel better knowing there is a strong dividing line between patient and client. If a therapist cried with me in the room. I would leave and I would definitely look for a new therapist. My personal belief is that it is inappropriate.