A talented therapist I know, one who I greatly respect, recently told me that he had gotten rid of all the Kleenex in his office. His thought—accurate and interesting—is that when a client wells up with tears, they might reach for a tissue so quickly that they circumvent or curtail their sadness. On the other side of the couch, if the partner grabs a Kleenex and hands it over to their crying partner, that might circumvent or curtail other ways of offering comfort. As in, “Tears call for tissues. Done.”

Thought-provoking and important. And true. I’m sure we can all think of times when this has been the case. And it goes without saying that as emotionally-focused therapists, we experience a lot of tears in our offices. So I’ve been thinking a lot about this. I did some research on crying (if you are interested, some of the top researchers include Lauren Bylsma, Ad Vingerhoets, Jonathan Rottenberg, and William Frey), and paid attention in a different way to tears and the use of tissues in my office these past few weeks. I’ve noticed that every client eventually wants a tissue, but at different points in their cry. If they don’t see the tissues and I don’t point them out, some hunt for one in their bags, others use their hands and even the hems of their shirts. At times, I noticed that what seemed to show up in the room first was my own impulse to point out the tissues. That was interesting too, as I am comfortable with tears, I invite and evoke them, and then I am comfortable leaning in and lingering. I don’t think that my tissue-impulse is about wanting to shut the tears down, and I can’t help but now wonder that maybe it is. I can now also see how it could land that way to my clients. Perhaps in my pointing out the tissues, some of my clients hear “Pull yourself together; clean yourself up.” So I am glad to pay attention to that impulse in myself and will continue to be curious about it.

Because Kleenex use is usually about catching or wiping away tears, I wondered whether there was any research on the physiological effect of leaving tears on our cheeks, i.e. whether the flow of tears down our cheeks–perhaps either the chemicals in the tears or the sensation of wetness on our skin–was healing or otherwise important to our brain. Unfortunately, I didn’t find any research on this. But I will keep an eye out for it because I wouldn’t be surprised. (I’m a runner, and there is interesting research out there about how smiling while you run actually makes you a more efficient runner.)

Regardless, tears are important and as EFT therapists, we not only welcome them but we evoke them, we stay with them, we cradle them. And when they well up, as EFT therapists we attend to and care for not only the personal impact of those tears but also the relational impact. How do tears affect the partner, the relationship? Tears can be a powerful signal to our partners, and can often elicit a desire to help, to soothe, and to caretake. But as we all know from the hours in our therapist’s chair, it often isn’t that simple; history and experience and especially trauma can bubble up and disrupt this instinct to come close to and to comfort someone who is crying.

This is just what the researchers have found, that it is complicated and that not all cries are cathartic. “Despite the popular idea that crying produces physical and mental benefits and the multiple theories developed to account for the cathartic effects of crying, empirical examinations of the effects of crying have actually yielded a mixed (and potentially confusing) set of results.”1 They go on to say that who you are, why you are crying, who sees you do it, and all the permutations of these pieces make a difference as to whether crying helps or hurts your emotional state.2

This makes sense right? We’ve all been with the client who cries and reports not feeling better; we’ve experienced the partner who doesn’t seem emotionally moved by the tears of a loved one, the partner who can’t move physically or emotionally closer and in fact, might move farther away in that moment. We can understand this in terms of the negative cycle, and we work to make sense of it in this way with and for our clients.

So, back to the tissues. Here is where I sit right now with the dilemma. I offer up my thoughts on this not as “right” but just as the way that feels good to me at this moment in time. I am really just thinking out loud here, and I would love to hear other people’s thoughts.

I think it is up to us, with each of our clients, to explore what the meaning of tears and of tissues is. I have pulled back with my offer of a tissue because even though it feels like a caring gesture on my part, I can also see how it could feel as if I was saying, “Wipe away your sadness.” I want my clients to know and to feel that my heart welcomes and honors their tears. And I don’t want to risk even a slight chance that my offering a tissue carries a negative message. So I no longer point out the boxes of tissues that sit patiently on either side of the couple. But I do have them there, and for now, I am going to keep them there. And I now use the reaching for a Kleenex—by either partner—as just another important moment to unpack and understand.

One of the fundamental tenets of EFT is to start where the client is. For me, to just get rid of the tissues altogether feels like I am not meeting the clients where they might be. I think many people want a tissue when they cry, and I don’t want to exacerbate someone’s discomfort or dysregulation by not having them available. If someone uses tissues as a way to protect themselves in some way, I don’t want to take that away from them; instead, I want to understand that protection, and to help them understand it.

And because I believe in being as transparent as possible with my clients, I am starting to wonder out loud with them about tears and tissues, and to share that I am thinking about this issue with all my clients. For instance, I might lean in and wonder, “When you reach for a tissue, are you trying to stop the tears? Help me with that moment for you.” Because there is important stuff—beliefs, values, fears — packed into that tiny moment.

We may have a client who is crying and who looks frantically around for a tissue at the first welling up. I want to be curious about that. I might wonder with them about what happens as they start to well up. In reaching for a tissue are they literally wanting to wipe the sadness away? Or perhaps the tissue helps them to hide in some way. Or maybe they are afraid of what they look like when they cry. Is the physical act of crying uncomfortable or even scary for them? I might ask, “Help me with what crying has been like in this relationship?”

With regard to the partner, I can certainly see that sometimes handing a tissue to their loved one precludes another, perhaps more comforting gesture—a hand on the knee, a hug. And at the same time, handing someone a tissue can be a very caring gesture too, a gesture we can unpack with them and help the partner to be explicit about. I might say, “I notice you just handed your husband a tissue. Can you help me with that moment? What was happening for you? What do you want your partner to know as you are handing him that tissue?” You can distill this down to the caretaking impulse and then create an enactment around that impulse. For instance, “Can you turn to your husband and let him know that you want to take care of him right now? And that when you handed him a tissue, that was what was in that gesture?”

Or, let’s say the client answers your gentle curiosity about what was happening in that tissue-handing moment with something you weren’t expecting (because we always have to be prepared for that!). Perhaps your client says “I handed him a tissue because I can’t stand when he cries.” Now you have something else really important to unpack and help make sense of.

Could you get all this information without tissues in your office? Absolutely. And maybe it is my own caretaking impulse that I am wrestling with. But those self-of-therapist issues are important to notice and wonder about (with yourself or with a supervisor) too.

We all know that there can be enormous value in a good cry. And let’s be honest; many (most?) of us might be at least a little uncomfortable with tears and snot and mascara all over our faces at some point during, or after, that cry. So I am keeping the tissues so that I can mine the value of the tears, while also trying to mitigate and understand any discomfort. And until there is research or at least anecdotal evidence in my own practice that leaving tears on our cheeks is important, I am going to have Kleenex and posit to my clients that there may be something beneficial in letting the tears linger without wiping them away, and would it be okay if we looked at that and noticed what comes up for them around this. Together. And with tissues if they need them.

As always, I would love to hear what you think. 🙂

  1.Bylsma, L. M., Vingerhoets, A. J., & Rottenberg, J. (2008). When is Crying Cathartic? An International Study. Journal of Social and Clinical Psychology, 27(10), 1165-1187. doi:10.1521/jscp.2008.27.10.1165.

2. Collier, L. (2014). Why We Cry, New research is opening eyes to the psychology of tears. American Psychological Association, 45(2), 47.Bylsma, L.M., Croon, M.A., Vingerhoets, A.J., Rottenberg, J. (2011). When and for whom does crying improve mood? A Daily Diary Study of 1004 Crying Episodes. Journal of Research and Personality, 45(4).