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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 “caused”.

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 OK”: how do they know? I’ve heard therapists tell clients “there’s no need to cry now”: 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 that”, giving you the opportunity to normalise the crying (eg: “many people who come here cry: that’s why we have the tissues”) 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 crying”).

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.