A qualitative study of psychotherapists’ in-session tears.

Abstract

There is little empirical research on the topic of psychotherapists crying with or in front of clients (Blume-Marcovici, 2017); however, therapists crying in therapy appears to happen more frequently than previously believed (t' Lam, Vingerhoets, & Bylsma, 2018). Although many clients believe that crying in session improves their relationship with their therapist (Zingaretti, Genova, Gazzillo, & Lingiardi, 2017), it is unclear how therapists' tears impact the psychotherapy process. For example, as some research has suggested that tearful individuals may be seen as less competent (van de Ven, Meijs, & Vingerhoets, 2017), it is possible that therapist tears are potential detriment to psychotherapy. However, therapists' tears might also have a positive effect on the therapeutic relationship if they are seen as evidence of therapist genuineness. To more deeply understand therapists' experiences of crying during a psychotherapy session, 8 practicing psychotherapists of varying theoretical orientations were interviewed using Consensual Qualitative Research (Hill, 2012;Hill et al., 2005;Hill, Thompson, & Williams, 1997). Overall, the therapists had a consistent positive perception of the consequences of their own tears, both on therapy in general as well as on the client-therapist relationship. However, they also acknowledged a lack of training in how to manage their own tears in session, confirming previous results (Blume-Marcovici, Stolberg, & Khademi, 2013) and suggesting that psychotherapists may not be fully prepared to manage tears in counseling. Implications for psychotherapists as well as directions for future research are discussed. Clinical Impact StatementQuestion: How do psychotherapists understand the role, function, and consequences of crying in session with clients? Findings: Psychotherapists generally reported that their tears were positive and helped deepen the therapeutic relationship, though they also expressed concerns about countertransference and a lack of training about crying in therapy. Meaning: In making decisions about when to cry or to suppress their tears, psychotherapists will need to assess on a case-by-case basis whether their tears, as a form of self-disclosure, are in the best service of the client and will enhance the therapeutic process or detract from it. Next Steps: Future research will be needed to help us better understand the impact of therapist tears on clients and therapeutic outcomes.

A clinical practice review of crying research.

“…Finally, occasionally the therapists reported that their crying was meant as a model for the patient how to handle grief or as an aid to accelerate the therapeutic process of a patient (’t Lam et al, 2018). Positive effects of therapist tears were found by Morgan and Nutt Williams (2020), who showed that, overall, the therapists had a consistent positive perception of the consequences of their own tears, both on therapy in general as well as on the patient–therapist relationship.…”

“…Whether therapist tears are appropriate and helpful in the clinical context likely depends on several factors, including the therapist–patient rapport, the psychotherapeutic orientation, and whether the therapist tears would augment or distract from the therapy. Indeed, as advised by Morgan and Nutt Williams (2020, p. 1), In making decisions about when to cry or to suppress their tears, psychotherapists will need to assess on a case-by-case basis whether their tears, as a form of self-disclosure, are in the best service of the patient and will enhance the therapeutic process or detract from it.…”

“…As we reviewed, qualitative findings of patient and therapist reports suggest that discussion of therapist tears may be beneficial; indeed, Knox and colleagues (2017) explicitly recommends for such discussions to occur. For example, Morgan and Nutt Williams (2020) suggest based on case examples that statements such as “I feel for your story” or “I feel this for you” may be an appropriate way to discuss therapist tears with a patient. An example of how to address therapist tears is illustrated in the following text: It is also recommended to discuss how to handle both therapist and patient tears in supervision with trainees.…”

“…Similarly, empirically supported psychotherapeutic approaches also offer little guidance on how to address crying in the context of psychotherapy, particularly therapist tears. Indeed, therapists often report a lack of formal training or guidance on how to manage their tears in psychotherapy (Blume-Marcovici, Stolberg, & Khademi, 2013, 2015; Labott, 2001; Morgan & Nutt Williams, 2020). Therefore, although our insights have significantly improved in the past few decades, we still have limited knowledge of this behavior.…”

The Matter of Tears: Translucent Entanglements With/In Counselling Encounters

“…doctor-patient; nurse-patient; therapist-client) (Blume-Marcovici, Stolberg & Khademi 2013;2015;Lutz 1999). Indeed, while recent studies have found between 72% (Blume- Marcovici et al 2013) and 87% (t ' Lam, Vingerhoets, & Bylsma 2018) of therapists report having cried in therapy, there are less than a handful of studies on this topic (Knox, Hill, Knowlton, Chui, Pruitt & Tate 2017;Morgan & Nutt Williams 2020). Findings from this small body of work have primarily focused on the therapeutic context of tears (e.g.…”