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:

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.

29 Responses

  1. 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?

  2. 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.

  3. 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.

  4. 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.

  5. 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 his article on ethical use of touch in psychotherapy. Thanks for listening.

  6. 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.

  7. 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?

  8. 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.

  9. 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!)

  10. 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.

    1. Personally, I have been through a year of counselling. I have found that when I am very upset and cry, my counsellor does respond or do anything, instead she respects the moment and gives me a period of time in which I can cry and be silent as much as I need to be (this without feeling awkward from Counsellor and Client point of view) and waits until I lift my head again. If I say a few words then she responds, otherwise she usually asks very softly “what are your deep thoughts?” Or “Is there anything you feel the courage to share?” – this is amazing!…
      Also, I must admit, I don’t always agree with the policy of ‘no touch’. Reason being, touch is something I personally feel is necessary at times, even if it is just a simple soft gesture of holding a hand or a hand on the Clients shoulder/back. This must however be okay with the client and therefore the Counsellor must know the Client well enough (situations, feelings etc.)

  11. 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)!

  12. 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.

  13. 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…

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Why not just establish during the first couple of sessions with the client what their comfort level is with being touched?

  21. I wondered in all this talk of crying why the therapist wouldn’t be seeing the release of emotions as necessary to the healing process. Terrence Real actively encourages and attempts to elicit emotional release in therapy and engages the client to give full vent to his/her feelings. When I was with my last therapist (which wasn’t long), I found myself crying fully as I related a past abusive encounter with my mother, and as I always found crying in front of anyone embarrassing and shaming, I wanted only to feel accepted and my emotional release encouraged. I wanted someone who wasn’t afraid to actively engage me, not someone passively sitting across from me offering me a tissue.

  22. this is such an interesting topic could not resist, I have cried with my client it was diffiult not to. However, based on what I have been taught it is usually not a a good idea to touch clients while crying as the reason for crying could be revealed at the end of the episode. Touching breaks that moment in time when the client is experiencing something emotionally and at times it could be a breakthrough that the therapist has been waiting for.

  23. I don’t understand most of you people. I’m 100% in accordance with brandirose though..if I didn’t know better i would think I left that comment. Same thing for me, my T is a great guy, funny, intelligent, easy to get alon with, very compassionate, patient, and understanding, but I would just FREAk if he touched me or even got up from his chair if I had a crying fit. We’re trying to work towards me exeperincing emotions in sessions because I don’t cry often at all but if I do the tissues are right there in front of me on a small table..much closer to me than to him. I mean, really, what’s all this talk about handing the client a tissue? Just put the tissue box next to them. Duh. It’s not rocket science. I’ve noticed lately everytime I sit down he adjusts the table and pushes the tissue box closer to me. While this actually irritates me and it irritates me that the damn box is always there because to me it’s just a screaming challenge to not cry, I’d rather the tissues be handy to me in case it does happen then have him have to hand one to me in the moment.

  24. Never offer a client a tissue!! That’s right – offering a tissue says to the client – “I’m uncomfortable with your crying – please put back your ego defenses and regulate yourself”
    Have tissues handy – and the client will regulate himself or herself when they are ready.

  25. My therapist hands me a tissue when I cry, because if she didn’t I wouldn’t take one, even though they are right next to me. When I first cried in a session, she asked me if I wanted her to sit next to me on the sofa and whether I wanted touch.

    1. Honestly speaking, I haven’t cried once yet in a session at Counselling. However, I would dislike it if I was handed a tissue by my counsellor because it would most likely interupt my moment of crying (which I hate!), but neither would I be comfortable with seeing the tissue box there because that to me is a hint that you’re expected to cry or may urge you to unexpectedly.
      As well as, I would only appreciate touch if it was a simple gesture during a very good moment or a very subtle sad moment where you just need a little something extra.

  26. I could really use a good cry on someone’s shoulder. It’s a comfort thing. I haven’t been able to cry in therapy, but just the past 2 days I’ve been in tears at home. I hate being alone when I cry. I’m a single mom so it’s not easy having no one to talk to.

    I like the approach my psychologist used with me so I don’t want to give up with her. She can read emotion even if I try not to show it. Says it’s not always going to be comfortable so I’m wondering if she is thinking of ways to get me to experience emotions

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