title: Patient Crying in Psychotherapy: Who Cries and Why?
abstract: OBJECTIVE
  The aim of the present study is to further the understanding of who cries in therapy and the relation of technique with crying behaviour in therapy.
  
  
  METHODS
  Psychological assessment feedback sessions, prior to the initiation of formal therapy for 52 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics and the process of the session were collected at the time of the session. Therapist's interventions were recorded verbatim and independently rated.
  
  
  RESULTS
  The number of times a patient cried during their session correlated negatively with global assessment of functioning scores and positively with measures of borderline personality disorder pathology as well as a measure of severity of childhood sexual abuse. Patients' crying behaviour demonstrated significant negative correlations with the overall experience of the session (bad/good), smoothness and positivity. Group differences between criers and non-criers reflected these trends as well. No significant correlations or group differences were found with regard to patient-rated or therapist-rated alliance as it relates to crying behaviour. Analysis indicates that therapist intervention prior to patient crying most often encouraged the exploration and expression of difficult affect, new perspectives on key issues or the patient's fantasies and wishes.
  
  
  CONCLUSIONS
  Our study addresses a significant gap in the clinical literature on crying. Crying behaviour seems to be related to certain clinical variables and has a negative impact on patient experience of the session in which they cry, although the alliance remained unaffected.
  
  
  CONCLUSIONS
  Small sample, outpatients with mild/moderate psychopathology and graduate trainees provided therapy.
  
  
  CONCLUSIONS
  Patients with greater problems in emotional dysregulation, borderline personality disorder symptoms and greater severity of childhood sexual abuse are more likely to display greater affective intensity during the beginning of treatment. Results suggest that the alliance may remain strong despite patients experiencing a session in which they cried as difficult. Therapeutic interventions that focus on affect, new understanding of old patterns and patient fantasies with outpatient clinical populations appeared to be associated with crying in session.
authors: Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA.
authors: Kristen L
authors: KL
authors: Capps
authors: Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA.
authors: Katherine
authors: K
authors: Fiori
authors: Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA.
authors: Anthony S J
authors: AS
authors: Mullin
authors: Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA.
authors: Mark J
authors: MJ
authors: Hilsenroth
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy; D002650:Child Abuse, Sexual / Q000523:psychology / Q000628:therapy; D003448:Crying; D005260:Female; D006801:Humans; D008297:Male; D010552:Personality Assessment; D010817:Physician-Patient Relations; D013811:Psychotherapeutic Processes; D064889:Psychotherapy, Psychodynamic; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: affect expression; affect regulation; borderline personality disorder; crying; therapeutic alliance