Thursday, 28 March 2013

Older, more experienced therapists cry more often in therapy

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comes from an ethics paper published in the 80s (56.5% of therapists said they'd cried in front of a client), and an unpublished qualitative study of ten psychodynamic psychotherapists for a doctoral thesis completed in the 90s.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

--Further reading--
When therapists have the hots for their clients
What should a therapist do if a client confesses to murder?
Successful therapists focus on their clients' strengths

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.


Anonymous said...

the word is extroverted (not extraverted)

Unknown said...

No, either spelling is correct and BPS house style is for extraverted. Sorry.

Anonymous said...

Well, that's a nice picture you got there.. :P

Roman Graff said...

wise words
makes you think

Roman Graff said...

next publication please
something about the aggression of patients
this may sound stupid
but this is the link
how to deal with it

annamanna said...

It means for me that older, more experienced therapist "can afford" the tears, can afford to show how deeply the situation touch them. It can be an important moment in the therapy.

Anonymous said...

In Latin, the word uses the "a"; however, English is not Latin, and the rules of origin languages do not apply; take "stadiums" and "stadia" as examples - in Latin, "stadia" is the correct plural, but the word "stadium" is considered a word IN English, not just a word FROM Latin, so standard pluralisation rules for English apply; the debate about "a" or "o" is irrelevant, since both may be deemed correct, though it is worth pointing out that the word with "a" was re-introduced by Jung, who wrote in German, not English; I think using the "a" may make it valid as a technical term, jargon if you like, but not necessarily one in common currency.

Anonymous said...

When I raised this question with my tutor recently, he reckoned that therapists who cried were associating their client's experience with something from their own lives or frames of reference, rather than staying within the client's. He didn't think it was useful. I challenged this assumption: I am not sure it would be human not to well up from time to time.

Having said that, my own therapist has welled up a couple of times and, though I don't at all resent it - in fact, I am touched that she is so into my story - I am aware that her emotions are out of sync with mine. Whenever it has happened, I have felt that she has been reacting from her own frame of reference to something that wasn't such a big deal within mine.

Anonymous said...

Myers Briggs also has it with extraverted as a personality preference.

Anonymous said...

This is just my personal opinion. I think it's unprofessional for the therapist to cry in a session.

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