Emotional crying, a unique human trait, is crucial to communicating emotions. Previous research has indicated that crying occurs in 15% to 30% of psychotherapy sessions, with a majority of patients (80%) reporting crying in at least one session during their treatment. This prevalence is not unexpected, given that psychotherapy is a context that often encourages and supports emotional expression and immediate experiences in the session. Some research in non-English speaking countries has suggested that clients who cried during therapy perceived their treatment as more successful. In this study, Katz and colleagues examined whether patients crying in therapy was associated with greater improvement and a stronger therapeutic alliance. They were also interested in whether patients’ attachment security provided some context for patients’ crying experiences. For example, compared to securely attached individuals, insecurely attached individuals tend to be more prone to be emotionally overwhelmed or emotionally distant. Katz and colleagues surveyed 124 adult patients who were currently in psychotherapy. Ninety-seven patients (78%) reported at least one instance of crying during treatment. Patients who cried were in therapy longer (average = 63.91 sessions, SD = 161.42) than those who never cried (average = 19.33 sessions, SD = 15.54). Those who cried reported crying in an average of 1.51 sessions (SD = 1.94) in the past four weeks, and 76.5% reported talking about the crying with their therapist. Patients who cried reported higher rates of improvement in therapy, that is, less tension, more control, and less depression. Patients reported that when therapists responded to their crying with greater compassion and understanding, they experienced better outcomes (r = .41 to .49) and a better therapeutic alliance (r = .45 to .65). Patients who cried felt that the bond with the therapist was more substantial and that they felt more confident that they would reach their therapy goals. Therapists’ responsiveness to patients’ crying was particularly important for clients who had an insecure attachment style. These patients believed their therapist understood them better after crying.
Practice Implications
It's not surprising that patient crying is ubiquitous in psychotherapy. Despite causing discomfort, crying, especially among insecurely attached patients, resulted in feeling better understood by their therapists when the crying was explored. Therapists should consider instances of patient crying in therapy as an important relational moment with the potential for positive as well as negative consequences. Therapists should actively and regularly dedicate time during therapy sessions to explore their patients’ experience of crying and its meaning. Although potentially challenging, such explorations have the potential to improve the therapeutic alliance, the bond between patient and therapist, the patient’s confidence in the therapy, and their outcomes. This proactive approach can lead to more engaged and effective therapeutic experiences for both the therapist and the patient.
Katz, M., Hilsenroth, M., Johnson, N., Budge, S., & Owen, J. (2024). “Window of opportunity”: Clients’ experiences of crying in psychotherapy and their relationship with change, the alliance, and attachment. Professional Psychology: Research and Practice. Advance online publication. https://dx.doi.org/10.1037/pro0000559.
To learn more about the Psychotherapy Practice Research Network, visit www.pprnet.ca.
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