https://doi.org/10.4081/ripppo.2024.725
Crying in psychotherapy: an exploratory mixed-methods study on forms of emotional crying and associated therapeutic interventions
Submitted: September 20, 2023
Accepted: March 2, 2024
Published: April 17, 2024
Accepted: March 2, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Emotional tears can be interpreted as expressions of our deepest inner lives, and yet they have largely been ignored in psychotherapy research. This study addresses this gap. Based on grounded theory and using a sequential mixed-methods design, we examined the interaction between therapist and patient during episodes of crying in video-recorded psychotherapy sessions. This resulted in two rating systems: one differentiates forms of patient emotional crying, and the other categorizes therapeutic interventions associated with crying. In this sample, including 46 video sequences from 32 therapy sessions, both rating systems were found to be reliable. To identify potential interactional patterns, we examined the statistical correlation between the two systems through multiple linear regression analyses. We found that certain forms of crying were associated with specific therapeutic interventions. Despite methodological limitations, the study contributes to a subject of clinical relevance that is still in its beginnings. To our knowledge, this is the first study to examine therapeutic events in episodes of crying in a process-oriented and comprehensive way.
Barthelmäs, M., Kesberg, R., Hermann, A. & Keller, J. (2022). Five reasons to cry – FRC: a taxonomy for common antecedents of emotional crying. Motivation and Emotion, 46(3), 404-427. doi: 10.1007/s11031-022-09938-1.
DOI: https://doi.org/10.1007/s11031-022-09938-1
Blume-Marcovici, A. C., Stolberg, R. A., & Khademi, M. (2013). Do therapists cry in therapy? The role of experience and other factors in therapists’ tears. Psychotherapy, 50(2), 224-234. doi: 10.1037/a0031384.
DOI: https://doi.org/10.1037/a0031384
Bylsma, L. M., Gračanin, A., & Vingerhoets, A. J. J. M. (2021). A clinical practice review of crying research. Psychotherapy, 58(1), 133-149. doi: 10.1037/pst0000342.
DOI: https://doi.org/10.1037/pst0000342
Capps, K. L., Fiori, K., Mullin, A. S. J. & Hilsenroth, M. J. (2015). Patient crying in psychotherapy: Who cries and why?. Clinical Psychology and Psychotherapy, 22(3), 208-220. doi: 10.1002/cpp.1879.
DOI: https://doi.org/10.1002/cpp.1879
Capps Umphlet, K. L., Fiori, K. L., Mullin, A. S., Cain, L. A., & Hilsenroth, M. J. (2021). Patient crying during psychotherapy intake sessions: relationship to patient characteristics and early treatment process. Clinical Psychology & Psychotherapy, 28(6), 1482-1493. doi: 10.1002/cpp.2584.
DOI: https://doi.org/10.1002/cpp.2584
Cohen, J. (1988). Set correlation and contingency tables. Applied psychological measurement, 12(4), 425-434. doi: 10.1177/014662168801200410.
DOI: https://doi.org/10.1177/014662168801200410
Creswell, J. W. (2003). Research design: qualitative, quantitative, and mixed methods approaches (2. Aufl.). Sage Publications.
Creswell, J. W. (2015). A concise introduction to mixed methods research. Sage Publications.
Denckla, C. A., Fiori, K. L. & Vingerhoets, A. J. J. M. (2014). Development of the crying proneness scale: associations among crying proneness, empathy, attachment, and age. Journal of Personality Assessment, 96(6), 619-631. doi: 10.1080/00223891.2014.899498.
DOI: https://doi.org/10.1080/00223891.2014.899498
Fleiss, J. L. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76(5), 378-382. doi: 10.1037/h0031619.
DOI: https://doi.org/10.1037/h0031619
Frijda, N. H. (2012). Foreword. In A. J. J. M. Vingerhoets & R. R. Cornelius (Hrsg.), Adult crying: a biopsychosocial approach (S. XIII-XVII). Routledge. doi: 10.4324/9780203717493
DOI: https://doi.org/10.4324/9780203717493
Genova, F., Zingaretti, P., Gazzillo, F., Tanzilli, A., Lingiardi, V., Katz, M. & Hilsenroth, M. (2020). Patients’ crying experiences in psychotherapy and relationship with working alliance, therapeutic change and attachment styles. Psychotherapy, 58(1), 160-171. doi: 10.1037/pst0000339.
DOI: https://doi.org/10.1037/pst0000339
Gračanin, A., Bylsma, L. M. & Vingerhoets, A. J. J. M. (2018). Why only humans shed emotional tears. Human Nature, 29(2), 104-133. doi: 10.1007/s12110-018-9312-8.
DOI: https://doi.org/10.1007/s12110-018-9312-8
Gwet, K. L. (2014). Handbook of inter-rater reliability: the definitive guide to measuring the extent of agreement among raters. Advanced Analytics, LLC.
Hilsenroth, M. J., Blagys, M. D., Ackerman, S. J., Bonge, D. R., & Blais, M. A. (2005). Measuring psychodynamic-interpersonal and cognitive-behavioral techniques: development of the comparative psychotherapy process scale. Psychotherapy: Theory, Research, Practice, Training, 42(3), 340-356. doi: 10.1037/0033-3204.42.3.340.
DOI: https://doi.org/10.1037/0033-3204.42.3.340
Kast, V. (1982). Trauern. Phasen und chancen des psychischen prozesses. Kreuz Verlag. [Book in German].
Kast, V. (1988). A time to mourn: growing through the grief process. Daimon Verlag.
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 and Psychotherapy Research, 22(2), 439-457. doi: 10.1002/capr.12458.
DOI: https://doi.org/10.1002/capr.12458
Knox, S., Hill, C. E., Knowlton, G., Chui, H., Pruitt, N. & Tate, K. (2017). Crying in psychotherapy: the perspective of therapists and clients. Psychotherapy, 54(3), 292-306. doi: 10.1037/pst0000123.
DOI: https://doi.org/10.1037/pst0000123
Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155-163. doi: 10.1016/j.jcm.2016.02.012.
DOI: https://doi.org/10.1016/j.jcm.2016.02.012
Kübler-Ross, E. (1977). Interviews mit Sterbenden. Kreuz Verlag. [Book in German].
Kuckartz, U. (2014). Mixed methods: methodologie, forschungsdesign und analyseverfahren. Springer VS Wiesbaden. doi: 10.1007/978-3-531-93267-5. [Book in German].
DOI: https://doi.org/10.1007/978-3-531-93267-5
Landis, J. R. & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159-174. doi: 10.2307/2529310.
DOI: https://doi.org/10.2307/2529310
Levitt, H. M. (2020). Methodological integrity: establishing the fidelity and utility of your research. In H. M. Levitt, Reporting qualitative research in psychology: how to meet APA style journal article reporting standards (Revised Edition, pp. 29-41). American Psychological Association. doi: 10.1037/0000179-003.
DOI: https://doi.org/10.1037/0000179-003
Levitt, H. M. (2021). Essentials of critical-constructivist grounded theory research. American Psychological Association. doi: 10.1037/0000231-000.
DOI: https://doi.org/10.1037/0000231-000
Mey, G. & Mruck, K. (Hrsg.). (2010). Handbuch qualitative forschung in der psychologie. VS Verlag für Sozialwissenschaften. doi: 10.1007/978-3-531-92052-8. [Book in German].
DOI: https://doi.org/10.1007/978-3-531-92052-8
Meyer, V. (2009). Der körper als ein führer durch das tal der tränen. Psychotherapeut, 54(2), 139-144. doi: 10.1007/s00278-009-0660-z. [Article in German].
DOI: https://doi.org/10.1007/s00278-009-0660-z
Mills, C. K. & Wooster, A. D. (1987). Crying in the counselling situation. British Journal of Guidance and Counselling, 15(2), 125-130. doi: 10.1080/03069888700760161.
DOI: https://doi.org/10.1080/03069888700760161
Nelson, J. K. (2005). Seeing through tears. Crying and attachment. Routledge. doi: 10.4324/9780203955758.
DOI: https://doi.org/10.4324/9780203955758
Nichols, M. P. & Efran, J. S. (1985). Catharsis in psychotherapy: a new perspective. Psychotherapy: Theory, Research, Practice, Training, 22(1), 46-58. doi: 10.1037/h0088525.
DOI: https://doi.org/10.1037/h0088525
OPD Taskforce, (Ed.). (2008). Operationalized psychodynamic diagnosis OPD-2: manual of diagnosis and treatment planning. Hogrefe.
Perneger, T. V. (1998). What’s wrong with Bonferroni adjustments. Bmj, 316, 1236-1238. doi: 10.1136/bmj.316.7139.1236.
DOI: https://doi.org/10.1136/bmj.316.7139.1236
Rydé, K., Friedrichsen, M. & Strang, P. (2007). Crying: a force to balance emotions among cancer patients in palliative home care. Palliative & Supportive Care, 5(1), 51-59. doi: 10.1017/s1478951507070071.
DOI: https://doi.org/10.1017/S1478951507070071
Strauss, A., & Corbin, J. (1990). Basics of qualitative research. Sage Publications.
Strauss, A. & Corbin, J. M. (1997). Grounded theory in practice. Sage Publications.
‘t Lam, C., Vingerhoets, A. J. J. M. & Bylsma, L. (2018). Tears in therapy: a pilot study about experiences and perceptions of therapist and client crying. European Journal of Psychotherapy & Counselling, 20(2), 199-219. doi: 10.1080/13642537.2018.1459767.
DOI: https://doi.org/10.1080/13642537.2018.1459767
Vingerhoets, A. J. J. M. (2013). Why only humans weep: unravelling the mysteries of tears. Oxford University Press. doi: 10.1093/acprof:oso/9780198570240.001.0001.
DOI: https://doi.org/10.1093/acprof:oso/9780198570240.001.0001
Vingerhoets, A. J. J. M. & Bylsma, L. M. (2016). The riddle of human emotional crying: a challenge for emotion researchers. Emotion Review, 8(3), 207-217. doi: 10.1177/1754073915586226.
DOI: https://doi.org/10.1177/1754073915586226
Wirtz, M. A. & Caspar, F. (2002). Beurteilerübereinstimmung und Beurteilerreliabilität: Methoden zur Bestimmung und Verbesserung der Zuverlässigkeit von Einschätzungen mittels Kategoriensystemen und Ratingskalen. Hogrefe. [Article in German].
Zingaretti, P., Genova, F., Gazzillo, F. & Lingiardi, V. (2017). Patients’ crying experiences in psychotherapy: Relationship with the patient level of personality organization, clinician approach, and therapeutic alliance. Psychotherapy, 54(2), 159-166. doi: 10.1037/pst0000110.
DOI: https://doi.org/10.1037/pst0000110
How to Cite
Gutjahr, F., & Benecke, C. (2024). Crying in psychotherapy: an exploratory mixed-methods study on forms of emotional crying and associated therapeutic interventions. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(1). https://doi.org/10.4081/ripppo.2024.725
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