November 2024

Question from the followers:

How should a psychotherapist react to a client that cries during a therapy session? 

In therapy, I find it incredibly normal for clients to cry and welcome the full range of their emotional expression. As a therapist, I will often use humor to build rapport and establish a sense of safety through a lighthearted approach. ​

Psychotherapy is an emotionally vulnerable space where people experience a range of feelings and cathartic expressions including crying during the session.  Often, crying in session can trigger (or even expose) deeper and more complex issues including negative thoughts or judgements about crying, helplessness, feelings of shame, embarrassment, or beliefs about one’s right to cry.  

One of the most common phrases I use to joke with my clients when they cry is, ​

“Why do you think I got
​ into this profession? 
​To make grown people cry.”   ​

The manner in which a therapist reacts to a client that cries during the session may be dependent upon the context in which it occurs. As with any other behavior presented in therapy, when a client cries during the session the triggers, antecedents, and motivations are taken into account. A therapist may observe first then offer assistance later.

​People cry in their therapy sessions for a variety of reasons: to express sadness, relief, joy, resistance, and pain. Whether a psychotherapist be in session with a child, adult, or couple, a client who cries in a therapy session should be validated and the behavior should be normalized as natural part of the therapeutic process.

In grad school, I was taught that even a small gesture, such as offering a box of tissues to a client who is crying, may have many other perceived implications than simply acknowledging the behavior. For example, while many people may perceive offering a box of tissue as an act of empathy- for a client in emotional duress it can be perceived as an attempt to control or dispel the behavior; in plain words, the client may see it as the psychotherapist telling them to stop crying.

It's important to consider that a psychotherapist offering a box of tissues to a crying client can interrupt their cathartic expression or serve as a distraction to processing their present experience. While offering a box of tissues can come across as a consoling (that’s also assuming our clients want to be consoled), the behavior of offering a solution to our client crying can reinforce helplessness.

Generally, if a client is crying and I notice that they begin frantically searching for Kleenex or are wiping themselves with their hands or clothes, I will slightly motion in the direction the box of tissue or move it within their reach. 

I will often ask my clients,
“What's going on for you in this moment?”
or, “Tell me about your tears.”

In terms of how a psychotherapist should acknowledge a client crying during a therapy session, I would suggest a proactive rather than a reactive approach.  There are several environmental cues that can signal how a client's can express and manage their feelings during a therapy session, including by providing access to therapeutic tools like kleenex to more adequately cope.  Just like other coping skills taught in session, when a therapist responds to a client crying during session encouraging they should be reinforcing autonomy and self-directed coping.   

​As a psychotherapist in practice for the last 12 years, I would suggest keeping a box of tissues fully stocked, in visible site…and if you're a child therapist, be prepared to use your shirt.

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If you or someone you love is struggling with their mental health and would benefit from working with a  licensed therapist please visit www.TherapywithRaquel.com for more information. Raquel Buchanan is a licensed marriage and family therapist in California.