Key Points
Rationale
Crying is a uniquely human emotional expression that occurs frequently inpsychotherapy, estimated to happen in 15-30% of sessions (Blume-Marcovici et al., 2017; Bylsma et al., 2021).
Over 80% of clients report crying at least once during therapy (Genova et al., 2021; Katz et al., 2022). However, the phenomenon of client crying in therapy has received limited empirical attention until recently.
Previous research has begun to examine relationships between crying in therapy and treatment variables like therapeutic change, the working alliance, and client attachment styles.
Studies in Italy (Genova et al., 2021) and Israel (Katz et al., 2022) found associations between positive crying experiences and greater reported improvement and alliance. There is also evidence thatattachment stylesmay influence how clients experience crying in therapy (Katz et al., 2022).
This research provides an initial framework for understanding how crying experiences, change, alliance, and attachment are interrelated in the therapeutic context.
Method
Clients completed an online survey about crying experiences in therapy as well as measures assessing therapeutic change, working alliance, and attachment style.
The survey took approximately 20 minutes to complete.
Descriptive statistics, bivariate correlations, partial correlations, t-tests, andchi-square testswere conducted using SPSS Version 20.
Sample
124 clients currently in psychotherapy participated.
The average age was 30.33 years (SD= 11.1). 69% identified as cisgender female, 22% as cisgender male, and 9% as other gender identities. 69% identified as non-Hispanic White, with other racial/ethnic groups represented in smaller percentages. 68% identified as heterosexual, with various other sexual orientations represented.
Measures
Results
Additional findings:
Insight
This study provides robust evidence for a direct relationship between how clients experience crying in therapy and therapeutic change, even when controlling for alliance and attachment security.
This suggests that crying episodes may be particularly impactful for insecurely attached clients, despite initial discomfort.
The gender differences found in crying tendencies (with women more likely to cry in therapy than men) warrant further investigation. Future research could explore how gender roles and socialization impact crying in therapy and its therapeutic effects.
Cross-cultural comparisonsof crying in therapy remain an important area for future study. While this U.S. sample largely replicated findings from Italian and Israeli samples, nuanced cultural differences may exist in how crying is experienced and interpreted in therapy.
Strengths
Limitations
Implications
The results suggest that therapists should conceptualize client crying as a sensitive relational moment with potential for both positive and negative consequences. When clients cry, therapists are encouraged to:
For insecurely attached clients, crying may be particularly uncomfortable but also uniquely valuable. Therapists should be attuned to attachment styles and provide extra support and processing around crying experiences for these clients.
The gender differences in crying tendencies highlight the need for therapists to be aware of potential societal and cultural factors influencing crying in therapy. Male clients or those from cultures where emotional expression is less encouraged may need additional support to feel comfortable crying in sessions.
Overall, the study supports the idea that crying in therapy can be a “window of opportunity” for deepening the therapeutic process and promoting change.
By skillfully navigating these moments, therapists can leverage the transformative potential of emotional expression in therapy.
References
Primary reference
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
Other references
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model.Journal of Personality and Social Psychology, 61(2), 226-244.
Blume-Marcovici, A. C., Stolberg, R. A., Khademi, M., Mackie, A., & ‘t Lam, C. (2017). Tracking our tears: Research on therapist crying in therapy. In A. C. Blume-Marcovici (Ed.),When therapists cry: Reflections on therapists’ tears in therapy(pp. 23-39). Routledge.
Bylsma, L. M., Gračanin, A., & Vingerhoets, A. J. J. M. (2021). A clinical practice review of crying research.Psychotherapy, 58(1), 133-149.
Genova, F., Zingaretti, P., Gazzillo, F., Tanzilli, A., Lingiardi, V., Katz, M., & Hilsenroth, M. (2021). Patients’ crying experiences in psychotherapy and relationship with working alliance, therapeutic change and attachment styles.Psychotherapy, 58(1), 160-171.
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the Working Alliance Inventory.Psychotherapy Research, 16(1), 12-25.
Katz, M., Ziv-Beiman, S., Rokah, N., & Hilsenroth, M. (2022). Crying in psychotherapy among Israeli patients and its relation to the working alliance, therapeutic change and attachment style.Counselling & Psychotherapy Research, 22(2), 439-457.
Watson, J. C., Greenberg, L. S., Rice, L. N., & Gordon, L. (1998).Client task specific change measure-revised[Unpublished manual]. University of Toronto, Ontario Institute for Studies in Education, Department of Adult Education and Counselling Psychology.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
