Crying in psychotherapy

Crying is a common occurrence during psychotherapy sessions. However, only over the past 10 years have researchers begun to systematically investigate crying in psychotherapy using clinical samples. Such evidence can help to inform clinical practice on how best to approach instances of crying in the therapeutic setting as well as to address specific client needs. A study by Katz et al., published in Professional Psychology: Research and Practice, uses the largest U.S. sample to date to investigate clients’ specific crying experiences in therapy and their relation to outcome, the therapeutic relationship, and client attachment styles.

Results of the study demonstrate that the association of client crying events in therapy with outcome and the therapeutic relationship is not necessarily about quantity (i.e., the number of crying episodes) but rather about the quality of that experience (i.e., the way these crying episodes are both emotionally and cognitively experienced or processed with the therapist). These findings remain significant even when controlling for the therapeutic alliance or attachment security.

The data also reinforce the accumulating evidence for the importance of responding to crying events with compassion and support, as well as using an episode of crying as a valuable source of information about the therapeutic relationship. That is, how the crying experience is perceived or internalized by the client is strongly linked with their experience of the strength or weakness of the therapeutic relationship. Crying events thus have the potential to deepen the therapeutic relationship, reflect the existing bond in treatment, or both. In addition, although clients reporting less secure attachment reported greater discomfort during crying events, they also expressed greater confidence that their therapist understood them better after they cried.

The clinical implications of the study are clear: Therapists, when faced with a crying client, should slow down, explore the crying experience more fully, and avoid quickly moving past the tears. Therapists should help clients express and explore the feelings behind and the reason for these tears, as well as the potential new information that conversations about the crying event can reveal. After the crying is explored, therapists should process what it was like for the client to share these tears with them in the moment and their experience of doing so in the therapeutic space.

Additionally, the authors suggest revisiting crying episodes in the following session (e.g., “I wonder if you’ve had any further thoughts about your tears from last session?”). It is also important to recognize the unique role that crying in therapy may play for insecurely attached patients, given that the experience can be both challenging and uniquely rewarding.

In sum, clients’ crying events provide a window of opportunity for therapists to deepen the working alliance and promote improvement in therapy.

This article is in the Clinical Psychology topic area.

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://doi.org/10.1037/pro0000559

Michael Katz, PhD, received his PhD in clinical psychology from the Derner School of Psychology at Adelphi University. He is an assistant professor in the clinical psychology program at Long Island University Post. His primary areas of professional interest include crying in psychotherapy, variations in psychotherapy techniques, the relationship between therapy technique and treatment process and outcome, and psychotherapy for grief. Contact Katz.

Mark J. Hilsenrothopens in new window, PhD, received his PhD in clinical psychology from the University of Tennessee and completed his clinical internship at The Cambridge Hospital/Harvard Medical School. He is a professor of psychology at the Derner School of Psychology at Adelphi University and the primary investigator of the Adelphi University Psychotherapy Project. He served as the editor of the APA Division 29 journal Psychotherapy from 2011 to 2020, and his areas of professional interest include personality assessment, training and supervision, and psychotherapy process and treatment outcomes. Contact Hilsenroth.

Natassia Johnsonopens in new window, PhD, earned her PhD in clinical psychology from the Derner School of Psychology at Adelphi University. She is currently in private practice at DNJ Psychology and an adjunct clinical associate professor at Fielding Graduate University. Her areas of professional interest include psychodynamic, interpersonal, and relational psychotherapy; attachment styles; and family dynamics. Contact Johnson.

Stephanie L. Budge, PhD, received her PhD in counseling psychology from the University of Wisconsin–Madison. She is an associate professor in the Department of Counseling Psychology and the director of the Advancing Health Equity and Diversity program in the Collaborative Center for Health Equity at the University of Wisconsin–Madison. Her areas of professional interest include improving access to mental health care for transgender and nonbinary communities, well-being for LGBTQ populations, and psychotherapy process and outcomes. Contact Budge.

Jesse Owen, PhD, earned his PhD at the University of Denver. He is a full professor at the University of Denver and studies psychotherapy processes and outcomes, with a focus on multicultural orientation and therapist effects. He also serves as the senior research advisor at SonderMind and is the current editor of the journal Psychotherapy. Contact Owen.