Patients’ experiences of clinicians’ crying during psychotherapy for eating disorders.

Abstract

Many psychotherapists cry in therapy sessions. Those clinicians who do cry see it as likely to have a positive impact on the therapy or to have no impact, and therapist personality characteristics have not shown reliable associations to crying in therapy. However, it is not known how patients experience therapists' crying, or whether the patient's view of the therapist's characteristics is related to that experience. This study used an online survey, recruiting 202 patients with eating disorders, 188 of whom had received therapy for an eating disorder, and 105 of whom had experienced a therapist crying. Retrospective data from those 105 individuals indicated that therapists' crying tended to be seen positively, but that perception was influenced by the patients' perceptions of the demeanor of their therapist and their understanding of the meaning of the crying. While they need to be extended to other disorders, these findings suggest that therapists' crying needs to be understood in the context of the therapist's perceived characteristics and demeanor, rather than being assumed by therapists to be positive or to have no impact on the therapy.Keywords: Psychotherapy; therapist; patient; crying IMPACT OF CLINICIANS' CRYING 3 Patients' Experiences of Clinicians' Crying during Psychotherapy for Eating DisordersPsychotherapy has a tradition of focusing on the inner world of the patient. However, the inner world of the therapist is also important, as it interacts with that of the patient. Such interaction appears in many forms in the literature, including constructs such as transference/countertransference and the therapeutic alliance. Therefore, regardless of therapeutic orientation, it is important to consider the therapist's reactions to the client during the session (e.g., Gelso & Hayes, 2007;Gilbert & Leahy, 2007;Summers & Barber, 2010).This study addresses one specific reaction -the therapist crying in the session, and the impact of that experience on the patient.Emotional experience in the therapy session and how it can disrupt therapy if unattended are key elements of therapists' reactions. This concept is not limited to the psychodynamic construct of countertransference. For example, Waller (2009) has hypothesised that cognitive-behavioral therapists who experience higher levels of anxiety are less likely to implement core behavioral techniques, making them less effective.Following a series of small-scale reports in the literature, Blume-Marcovici, Stolberg and Khademi (2013) surveyed a large number of psychologists and trainees (N = 684) regarding one specific emotional marker -the therapist crying in therapy. In this relatively diverse group of clinicians, using a variety of therapeutic approaches with a wide range of patients, they reported that over 70% of the therapists reported ever having cried in therapy (with 30% having done so in the past four weeks). Pope, Tabachnick and Keith-Spiegel (1987) found a slightly lower lifetime rate for therapists' crying (56.5%), but these findings represent a ...

Patients’ crying experiences in psychotherapy: Relationship with the patient level of personality organization, clinician approach, and therapeutic alliance.

“…The second contains questions about crying in general life, and derives questions from the Adult Crying Inventory—Short Form (Vingerhoets, 2001)—a validated measure that describes the frequency, proneness, and influence on mood of crying behavior. The third section, which specifically focuses on crying during therapy sessions, was developed on the basis of items from two prior surveys of therapists’ crying behavior during psychotherapy (Blume-Marcovici, Stolberg, & Khademi, 2013; Tritt, Kelly, & Waller, 2015). It is composed of 21 items: 9 items explore the frequency of crying episodes in therapy within different time periods (from the last session, last 4 weeks, over the last year, etc.…”

Crying in psychotherapy: The perspective of therapists and clients.

“…In 55% of these experiences, therapists thought that clients were aware of the crying, and those therapists who discussed their crying with their clients reported improved rapport as a result of the crying. Tritt, Kelly, and Waller (2015) surveyed 105 clients with eating disorders whose therapists had cried in therapy. Such crying was generally experienced positively, but clients more often reported a positive impact of crying (greater respect of clients for therapists, increased likelihood of clients expressing emotion, and greater likelihood that clients would engage in therapy in the future) when therapists had a positive demeanor (happiness, firmness, and con-sistency) rather than a negative demeanor (bored, anxious, and angry).…”

A qualitative study of psychotherapists’ in-session tears.

“…Some studies have examined clients tears in therapy (Capps et al, 2015; Robinson et al, 2015; Zingaretti et al, 2017), but few have studied the clients’ perspective on therapist tears. In one of the few recent studies taking this perspective, Tritt et al (2015) surveyed 202 clients with eating disorders who reported that over half of their therapists had cried at least once in session. Those who had experienced a therapist crying found the experience generally positive; however, their perception of the crying event was impacted by their understanding of the meaning of the therapist’s tears.…”

“…Despite the comprehensiveness of the three studies done by Blume-Marcovici et al (2013, 2015, 2016) and by Knox et al (2017), we still know relatively little about psychotherapists’ in-session tears. In addition, of the research done, the majority of responses have been collected through surveys (Tritt, Kelly, & Waller, 2015), presenting a number of limitations for understanding the meaning of the data. In regard to the one study that was qualitative in nature (Knox et al, 2017), participants were made up of exclusively doctoral students, leaving significant gaps in understanding psychotherapists’ tears with more experienced therapists.…”