Nearly every clinician has experienced an intense emotion during a client session. Perhaps it was grief as a client described the death of her 5-year-old son. Maybe it was anger triggered by the client who consistently shows up late.
Literature abounds on how to help patients express their thoughts and feelings, but there's a dearth of research on how therapists can best articulate their own emotions in client sessions, says Auburn University counseling psychology professor Annette S. Kluck, PhD.
"People are looking for some kind of guidance as to 'should I or shouldn't I' express it?" she says. Deciding whether or not to disclose emotions such as anger or sadness with clients depends on many factors, including the amount of time left in the session, the client's emotional state and the therapist's clinical assessment as to how the patient will handle the emotion says Melba Vasquez, PhD, a psychologist in independent practice in Austin, Texas, and member of APA's Board of Directors.
Some clinicians believe that a therapist should never express anger or grief in front of a client. Yet, says University of Iowa's John S. Westefeld, PhD, many psychologists agree that the therapist who expresses emotion with a client models integrity, encourages more open communication and often reinforces a client's instincts, all helpful therapeutic tools.
"It's important to be yourself and to be genuine," Westefeld says.
But before you let your anger or tears flow, here are tips on showing emotion in a way that's therapeutically beneficial:
Assess where your emotion is coming from. Sometimes, one's emotions may not be related to a client but connected to issues you are dealing with in your own life. If that's the case, Kluck says, take some time to tackle those issues, either by discussing them with a colleague or seeking therapy.
"Check out what's leading to these feelings so that what you need to get taken care of outside of being a therapist gets taken care of outside of being a therapist," Kluck says.
Consider the client's well-being. If your emotions are not coming from any sort of counter-transference, your No. 1 priority should be to determine how expressing anger or sadness may affect the client, experts say. In the case of anger, says University of Minnesota counseling psychologist Caroline Burke, PhD, if it is expressed before the client fully trusts you and understands that you're communicating this emotion for the benefit of the therapeutic relationship and the therapeutic work, it may do more harm than good.
"If it's not a trusting relationship, then they may go away confused, hurt and unable to talk about it or unsure if they even have permission to talk about it with their therapist," Burke says.
The same may be true if a therapist expresses sadness during a client session, says Westefeld. If tears are shed before a strong client-therapist relationship has been established, a client may feel like they're in the position of having to rescue the therapist. It's also important to assess whether the emotion you're having is appropriate for the situation, Westefeld notes.
"If the client were relaying something that was kind of difficult but not hugely emotional and that triggered [your crying], I think that would be a problem," he says.
Bite your tongue. There is a right way and wrong way to express emotions should you decide to do so, says Kluck. It must be done in a way that benefits the client therapeutically.
"If it's going to involve some sort of sharp comment, you're probably not there yet," Kluck says. Burke says that sometimes, if a client has said something mean to her, she thinks first about the status of their therapeutic relationship and how expressing her feelings of anger might affect it. In certain situations—such as when a client is having a bad day or when she believes she may not be able to share her thoughts in a constructive and helpful manner and instead worries she'll speak sharply toward the client—she'll let the instance slide.
"If I'm uncertain at all, I let it go," Burke says. "If it's a pattern for the client, they'll bring it up again."
Burke also advises psychologists to verbalize their anger in a calm and clear manner—and rarely. If it seems as though you're often feeling anger toward a particular client, it's important to check your counter-transference toward the client, seek consultation, and perhaps—as a last resort—refer him to another professional, she says.
Discuss your emotional reaction with the client. Once you've expressed your anger or sadness, discuss your reaction with the client, rather than just moving on to other matters, Burke and Westefeld say. This clears up any concerns the client may have and keeps the lines of communication open. Talking through your emotions can also be a good model for clients and might encourage them to take time to understand their own emotions moving forward, Burke says. Plus, it just makes sense, Westefeld notes.
"It wouldn't feel appropriate to me to shed some tears and then not in some way talk about what just happened and ask how the client feels about it," Westefeld says.
Farber, B.A. (2006). Self-disclosure in psychotherapy. New York: Guilford Press.
Fremont, S. & Anderson, W. (1988) Investigation of factors involved in therapists' annoyance with clients. Professional Psychology, Research and Practice, 19 (3) 330–335.
Pope, K. and Tabachnic, B. (1993). Therapists' anger, hate, fear, and sexual feelings: national survey of therapist responses, client characteristics, critical events, formal complaints, and training. Professional Psychology, Research and Practice, 24 (2) 142–152.