Please Pass The Kleenex

By Jeff Levy

Last week in the graduate social work class I am teaching, we had a conversation arise about whether it was acceptable to offer a client a box of Kleenex when they are crying.  One supervisor had told a student not to offer Kleenex because in an implicit way, it conveyed that crying was not ok, or at a minimum, the crying should stop. Another student shared she had received the opposite instruction, and that the offering of Kleenex displayed an empathic connection.  So many considerations for the small act of pushing a Kleenex box closer to a client.

Every time I teach a graduate course in social work, the topic of crying during sessions comes up.  In most instances, however, it’s not about what to do when clients cry that people want to talk about.  My students, and many of the therapists I supervise or with whom I consult, want to know what to do when they are crying—or how to handle it if a time arises when they find themselves crying in front of a client or with a client.

Some have been told that it isn’t professional to cry in front of a client, even if you are responding to something sad a client has shared.  Others have been told that crying in response to a client’s pain demonstrates empathy and deepens the therapeutic relationship.  Typically, when I am asked this question, I rely on an age-old, universally accepted response when there is no “right” answer.  “It depends,” I say.  And I am met with looks of frustration and confusion.

It Depends

Gabe was a Gulf War veteran and had found his way to me through a friend who is also a therapist.  I was recommended because of my background in trauma work and Gabe had certainly experienced his share of trauma.   He sought me out, however, not to discuss his experiences in the Gulf War, but to explore the domestic violence he witnessed and endured as a child.  Gabe described himself as a “tough guy” who “wasn’t fazed by much,” but after returning from the war, he was thinking more and more about his childhood.

In the process of describing his history, he also talked about having adopted a cat upon his return from the war.  He didn’t have time to care for a dog, which would have been his first choice, but he had always wanted a cat as a child and decided this was his time to adopt.  Mary became a part of his family soon after he returned to the states.  Mary, it turned out, was a 16 year old tabby that had spent most of her life on the streets.

Several years after adopting Mary, Gabe told me he had walked downstairs from his bedroom one morning and found her dead, curled up on one of his living room chairs.  He said it looked like she had just gone to sleep; that she had a quiet and peaceful death.  As he was sharing this with me, I could feel tears streaming down my face.  At that moment, I couldn’t stop and I couldn’t talk.  When I had quieted a bit, Gabe looked at me with compassion and said:  “Jeff……that wasn’t about Mary, was it?”

His question allowed both of us to chuckle for a moment, and then I shared with him that I had just experienced a loss in my family and was still grieving.  I didn’t tell him that it was my mother who had died, and that her death had not been quiet or peaceful.  Even in the moment, I knew his description of his pet’s death triggered my feelings about the way my mother had died.  I even had images flash into my head about her last minutes.  Even with this awareness, I wasn’t able to stop the flush of emotion and flooding of tears.  I asked him how it felt for him to see me have the reaction I did.

He was quiet for a moment before speaking.  “I don’t know,” he paused.  “I think I was a little shocked at first, but then there was something about your reaction that almost felt good….not that I wanted you to cry,” he qualified.  We spoke about it for several minutes, and then returned to his loss—and then to other losses he experienced both as a child and while deployed.  Despite my crying (well—my sobbing) being an unanticipated response to Gabe’s loss, there was something about him seeing my vulnerability and my lack of control that I believe gave him permission to move more deeply into his experiences of trauma and loss.

It Still Depends

My experience with Andy took a different turn.   Andy was in therapy to deal with relationship issues, and in the course of our therapy, we began to talk about the extreme neglect and physical abuse he experienced as a child.  While he shared stories of abuse with little emotion, I felt my eyes swell as he described a particularly brutal experience.

We had been doing an activity in which Andy and I were sitting on the floor, with a large piece of craft paper and crayons in front of him.  I had asked him to draw the floor plan of the home in which most of his abuse occurred.  As he drew the floor plan and walked me from room to room, he shared stories of the abuse he had endured.  The combination of sitting on the floor, drawing with crayons, and talking about childhood experiences made his descriptions more vivid though he still had no visible emotional reaction.

When Andy saw my eyes, he immediately looked away.   “I can’t look at you,” he explained.  “When I saw your eyes and the expression on your face, it made me think about just how awful my childhood was.  I’m not ready to go there yet.”   I listened carefully as Andy explained further, until he eventually asked if my eyes were dry.  “Yes,” I said.  “They are.  When the time feels right though, maybe we can talk more about how difficult it is for you to acknowledge those really painful times.”  “Maybe,” I asked, “when you’re ready we can explore how those experiences might impact your relationships today.”

Andy nodded almost imperceptibly while he crumpled the paper and placed the crayons back in their box.  “Maybe,” he said quietly.  “But not now.”

We Can’t Always Predict When We’ll Cry

We can spend hours debating whether or not crying with a client is appropriate. There are times when we notice a reaction swelling and find ways to calm ourselves before the reaction overcomes us.  Other times, however, crying just happens.

We’re human and we have responses to people’s pain, and even more so when another’s pain resonates strongly with our own.  Hopefully, as therapists, we’re aware when this is happening, but even with awareness, there are moments when our tears will escape our eyes.  At these times, the question isn’t “do we cry or don’t we?”.  The more reasonable question is probably:  “What do we do when we cry?”

With both of the people I’ve described, my tears gave me more information about each client and about myself. Had I not cried with Gabe, we may not have talked about the losses he experienced earlier in his life, or it may have taken longer for Gabe to allow himself to be this vulnerable. And with Andy, had I not cried, I might not have understood just how difficult it was for him to acknowledge his experiences of abuse. In both instances, I learned how allowing, acknowledging, and being transparent about my vulnerability enhances the potential to strengthen relationships.

We’re fooling ourselves if we think we can create rules about when we can cry and when we can’t.  We can, however, think about how we can talk about our own tears in a way that enhances the therapeutic relationship and moves our process forward. I’m convinced that shared vulnerability—shared humanity—is a strong catalyst for connection and for change.

As for offering Kleenex when tears arise, I try to have two boxes close at hand: one next to me and one next to my client.

So take a good look at my face.  You’ll see my smile looks out of place. Yeah, look a little bit closer and it’s easy to trace, the tracks of my tears
—Smokey Robinson

By Jeff Levy, LCSW, CTRS

Published on December 17, 2017