As therapists we deal with some difficult situations and clients who have been through bad experiences. Sometimes, naturally enough, they cry when they are telling us about it. Sometimes we feel like crying too, but is that the best response? I’ve been looking at this issue this month and have some ideas.
What is crying?
Jay Efran (2012) says, ‘Physiologically speaking, emotional tears are elicited when a person’s system shifts rapidly from sympathetic to parasympathetic activity—from a state of high tension to a period of recalibration and recovery.’ [1]
It’s usually triggered by an emotionally significant event but this sudden shift from tension to recovery can be triggered by many different experiences, which is why we cry when we’re happy as well as when we’re sad, and why it can happen after rather than during a precipitating event – while things are still happening we’re still in a state of high tension and too busy with problem-solving to respond with tears.
So, in that sense, tears can be an indicator that the client has processed some strong feeling and is starting to move on, or that they are stepping away from an unresolved problem, at least for now, to get some thinking space; according to Efron, a bit like ‘sleeping on a problem’.
Clients who cry out of trance
As hypnotherapists, we have two different levels of communicating with clients – in and out of trance. All done with clean language, empathy and so on, before anyone puts up their hand, but still, they do have their differences. So, if your client crises in the ‘chatting’ part of the session, what’s your best response?
- Don’t overwhelm the client with your own response, immediately jump in with questions about why they are crying, or try to interrupt the tears – give them quiet and space in which to experience the emotional and physiological shift and to start to process it. Remain empathetic and focused on them until they start to get calmer.
- Help this process by validating their feelings. Make a practical move like offering tissues, by all means, then reassure them it’s OK to cry as much as they like, to allow the feelings to be expressed. Reassure them that it’s a normal and reasonable response - that many others sitting in that chair have cried before now, and no doubt will do so in the future.
- Once the tearful episode seems to be passing, you can gently explore the thoughts and feelings that led to it beginning.
Clients who cry in trance
To be honest, I would deal with this in a very similar way to clients who cry out of trance.
- Let it happen, don’t leap in there with questions or try to talk the client out of it.
- Especially if you find yourself reacting emotionally, take a few deep breaths until you can sound calm. Reassure the client their response is completely normal and that they can let it happen harmlessly, safely and naturally until they are comfortable again. Give them a tissue if they seem to need it.
- If the crying doesn’t pass in a reasonable time (but don’t rush it) or escalates to the point that the client seems ‘stuck’ there are a number of options you could consider: take the client to their peaceful place, reassure them that they are perfectly safe, give suggestions to help the feelings pass.
- As the crying passes, you can use clean language questions to explore what thoughts triggered the reaction and start to reframe or resolve the issues. It can be a good idea to work in the past tense at this stage to disassociate the client from the triggers.
At the end of any session where there has been crying in trance, awakening should always be done with lots of positive suggestions about feeling good, calm and relaxed when they open their eyes.
Should you cry with them?
I’m not suggesting here that you should make yourself cry, or put on any sort of act. But a study in 2013 (Blume-Marcovi etc al) found that 72% of psychologists and their trainees had cried with their patients. [2] So, if you find yourself tearing up, should you try to hold it in or express it? Sometimes the answer to that will depend on your theoretical orientation, of course, and how much of yourself you prefer to reveal to a client, but if you have no guidelines at present, where can you find them?
Often, therapists crying in therapy is not a topic we like to talk about much. We might feel we should be ‘strong’ enough to resist, or to keep separate from the client’s distress, but Nadine Kaslow, professor and chief psychologist at the Emory University School of Medicine, [3] believes that it’s a sign of humanity, and that gentle or restrained crying (as opposed to sobbing or hysterics) can help a client open up and accept their own feelings.
There is very little evidence about what clients do think when their therapist cries, but what there is indicates that their response might depend on the context and on the level of rapport you have with them. For example, Tritt et al (2015) [4] said that if the clients already had a positive view of their therapist, they were likely to be OK with them crying and want to continue therapy. If they already had a negative view of the therapist, or if the therapist’s crying interrupted the session, then they were more likely to view it as a problem.
With that in mind, it doesn’t seem as if there is a ‘one size fits all’ answer to this one, but if your rapport with your client is good and your crying is restrained, it will probably do no harm, and may even allow your client to see you as more empathetic.
If your crying is obvious to the client anyway, you might be better off addressing the situation directly – start by asking how they are interpreting your reaction, or how they are feeling about it.
If you always cry with the same client, or when addressing the same type of issue, then you need to apply some reflective practice. Are transference or countertransference at play? Is the situation tapping into issues of your own that need to be addressed? Should you consider referring this particular client on? Supervision is a good place to explore this.
References
[1] Efran, Jay. (2012). What to Do When Your Client Cries. www.psychotherapynetworker.org [online] Available at: https://www.psychotherapynetworker.org/blog/details/983/what-to-do-when-your-client-cries.
[2] Blume-Marcovi, A., Stolberg, R. A., & Khademi, M. (2013) Do therapists cry in therapy? The role of experience and other factors in therapists’ tears. Psychotherapy, [online] 50(2), pp.224–234. Available at: https://societyforpsychotherapy.org/wp-content/uploads/2014/06/Blume-Marcovici-et-al-20131.pdf [Accessed 23 Jul. 2020].
[3] Kaslow cited in Collier, Lorna. (2016). Is it OK to cry? American Psychological Society website. [online] Available at: https://www.apa.org/gradpsych/2016/01/therapy-tears [Accessed 5 Dec. 2020].
[4] Tritt, A., Kelly, J., & Waller, G. (2015). Patients’ experiences of clinicians’ crying during psychotherapy for eating disorders. Psychotherapy, 52(3), 373–380. Available at: https://doi.org/10.1037/a0038711 [Accessed 5 Dec. 2020].
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Thanks for this Debbie. It's a well -reasoned and compassionate article towards both the client and therapist. Also, confmed my feelings about crying as a therapist - which has happened on occassions.
ReplyDeleteI think we all do at times. Thanks for your comment.
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