How often do therapists cry in therapy and does it matter? For a profession that trades in emotions, you’d think these questions would have been tackled before. But as Amy Blume-Marcovici and her colleagues point out in their new paper, the issue has been strangely neglected. There’s been plenty of research on crying medics, yet all we know about crying therapists comes from an ethics paper published in the 80s (56.5% of therapists said they’d cried in front of a client), and an unpublished qualitative study of ten psychodynamic psychotherapists for a doctoral thesis completed in the 90s.
From their survey of 684 US psychological therapists (75% were women; age range 22 to 85; 35% CBT, 23% eclectic with psychodynamic emphasis, 19% eclectic without psychodynamic emphasis) Blume-Marcovici’s group found that 72% of the sample had cried in therapy ever. Among these criers, 30% had cried in the last four weeks.
Looking at the correlates of being a therapist who cries in therapy, it was older, more experienced therapists and those with a psychodynamic approach, who were more likely to be criers. Surprisingly perhaps, female therapists were no more likely to cry in therapy than male therapists, despite the fact that they reported crying more often in daily life than the men.
This mismatch between crying in everyday life and crying in therapy was a consistent theme. Older therapists too cried less often in daily life than younger therapists, despite more crying with clients. Also, whereas crying in daily life is typically associated with negative emotion, in therapy it was associated not just with the therapists experiencing sadness (reported by 75% during their last therapy cry), but also with “feeling touched” (63%), warmth (33%), gratitude (15%) and joy (12%). “This suggests that tears that occur in the therapy situation are different in nature than tears shed in daily life,” the researchers said. However, it’s worth noting that, at their last time of crying in therapy, the therapists believed their clients were experiencing negative emotions like sadness, grief and powerlessness.
Therapist personality was only weakly related to crying, with openness being the most relevant trait. More agreeable and extraverted therapists also showed a tendency towards crying more. The personality questionnaire used in this study was extremely brief, so it’s tricky to read too much into these results. Ditto for therapist empathy, which showed an association with crying tendency, but not frequency or proneness, possibly due to the limitations of the empathy scale that was used.
This research provides no objective data on the effect on clients of having a crying therapist. However, the therapists’ belief was that their crying was either inconsequential (53.5%) or that it had changed their relationship with their client for the better (45.7%). Less than one per cent felt it had harmed their client. Referring to the literature on therapist self-disclosure, the researchers speculated that perhaps therapist crying has a positive impact when the therapist-client relationship is already strong, but can threaten that relationship when it is weak or negative.
Blume-Marcovici and her colleagues called for more research on this neglected topic, and particularly for future studies to investigate the effect of therapist crying on client outcomes. They said their initial results are “meaningful” because they challenge the idea that “therapist crying in therapy is occurring due to the therapist being overwhelmed by intense negative emotions that arise in therapy, and instead signals a moment of potentially positive emotional connection, even if amid painful negative affect.”
Blume-Marcovici, A., Stolberg, R., and Khademi, M. (2013). Do Therapists Cry in Therapy? The Role of Experience and Other Factors in Therapists’ Tears. Psychotherapy DOI: 10.1037/a0031384