Crying in therapy

I like studies that ask an interesting question. In this case, the question involves the impacts of crying in therapy. Katz, Hilsenroth, Johnson, Budge & Owen (2024) published “’Window of Opportunity’: Clients’ experiences of crying in psychotherapy and their relationship with change, the alliance, and attachment” in Professional Psychology: Research and Practice.  Here are the edited abstract and impact statements:

In psychotherapy, emotional tears occur frequently but have received limited attention. We set out to replicate and extend findings of previous studies conducted in Italy (Genova et al., 2021) and Israel (Katz et al., 2022) with U.S. clients. We hypothesized that positive crying experiences would be associated with improvement and stronger alliance, as well as that insecurely attached patients would tend to view crying as more intense but also more meaningful. One hundred twenty-four patients completed an online survey about crying in therapy as well as measures assessing therapeutic change, working alliance, and attachment. Findings revealed that postcrying positive feelings were linked with greater reported improvement. Several crying experiences were related to both change and alliance. All significant relationships between crying experiences and change remained significant after partialing the effects of attachment, and all but one remained significant after partialing the effects of the alliance. Participants who cried in therapy reported greater improvement compared to those who denied crying in therapy. Despite greater discomfort, less securely attached clients tended to report feeling better understood by their therapists after crying. These findings replicate and extend previous international studies in a U.S. sample, providing support for their cross-cultural relevance and previous evidence that clients’ crying experiences are related to both change and alliance. In conclusion, we suggest that therapists conceptualize instances of crying in therapy as a sensitive relational moment with potential positive or negative consequences, dedicate time to exploring experiences around crying, and specifically process crying experiences of insecurely attached patients. 

This study demonstrates that patients’ crying experiences in psychotherapy are linked with reported treatment change and the working alliance. In addition, those who endorse higher levels of insecure attachment tend to be more sensitive to how crying in therapy is experienced but also tend to find value in relation to being understood by their therapist. These findings are particularly important for psychotherapists in considering strategies for responding to crying in psychotherapy as well as the value of exploring crying’s experience and meaning with the client. 

It’s based on an on-line survey with a relatively small sample but the findings are intriguing. As a non-therapist, I would want additional information about how to define “positive crying experience.” As more therapy takes place remotely, it may be especially important to examine the specific features of the therapy experience that lead to successful outcomes.