Thursday, March 5, 2009

Is it OK for Therapists to Cry (with Patients)?

No. That was easy. Here’s why:

• It blurs the line of the doctor-patient relationship, potentially putting the patient in a very awkward position. Does patient now need to comfort therapist? Of course not, but the patient might not be able to discern that, especially in their emotional turmoil, and this is a question they will inevitably be asking themselves.

• Not crying during a distressing session is a demonstration to the patient that intense emotions can be managed and tolerated without becoming overruled by them.

• For the sake of the therapist, it is not healthy to be getting caught up in patient’s problems on a regular basis.

• It de-stabilises a therapeutic alliance. If doctor is emotionally shaken at one declaration by patient, patient might be more reluctant to share other information, whether they are uncomfortable with doctor’s crying or because they don’t want to upset doctor.

An exception occurs when the therapist makes an effort to not become emotionally caught up with the patient, but is physically unable to prevent tears (however, if this happens frequently, I would say there is an issue with the therapist). Crying is like sneezing; you might not be able to stop it (sometimes you can), but you can at least minimise its display. I myself have been deeply, and sadly, moved by some patient’s stories, and I have cried. But I did not cry in the presence of that person, because it was not about me, it was about them.


  1. From the other side of the therapy room, I must respectfully disagree. I think if something truly awful is expressed, it is only natural to sometimes tear up. I may have misunderstood what you meant, but I think you said it is necessary to be stoic (NOT your words) in order to maintain the alliance. I think being stoic in some situations could greatly damage the alliance - "hearted bastard."

    I don't remember ever sobbing, so maybe we aren't so far apart in what we are saying.

    Best wishes,
    Mike Miller, PhD

  2. I don’t disagree with you; there are times when it will only be natural to cry. The idea is not so much one of stoicism, but of an exampled display of managing emotions without becoming overwhelmed by them.

  3. Yes, a big difference between a few tears and sobbing. A few tears at something truly awful being expressed means your shrink is human. Heavy sobbing means your shrink needs to get his or her own shrink.