Is it ever right for a therapist to cry?
Ask most people about their idea of a therapy session and it will probably be a dispassionate professional sitting quietly taking notes as a patient pours out their darkest secrets - possibly on the analyst's couch. The patient may even break down in tears.
Suggest that it was the therapist who cried during a session and many might dismiss the notion. But recent research has discovered that as many as three-quarters of therapists may have wiped away a tear when listening to their patients.
The study was carried out by Amy Blume-Marcovici, a clinical psychologist at Alliant University in San Diego in the United States.
She found herself with tears in her eyes during a therapy session with a female patient.
"I worried mostly that I had harmed her, or that she would feel 'can this person handle what I'm talking about?' And then I also worried that I'd been unprofessional."
In her study Blume-Marcovici says it's not a case of therapists sobbing: "Most often this was people describing themselves as 'tearing up'… for the large majority the tears were beyond their control. Most of the time they did not regret their tears and they said that their client was not aware of their tears."
The therapists who took part in the survey encompassed beginners through to the most experienced.
Among those who admitted to crying, 30% had done so in the last four weeks. So crying is not a rare occurrence.
Even though women cry more in daily life, it wasn't reflected in the therapists' reporting of their own tears. Men cried just as often as women. Blume-Marcovici suggests that women might "hold back tears" more than men, to control how they behave in the sessions.
Susie (not her real name), who herself underwent therapy is horrified at the thought of therapists crying.
She saw a therapist in her 30s because an abusive childhood made her into "an angry control freak" that needed careful handling.
"If my therapist had cried I'd have never returned. I needed a therapist who was in control of their emotions… at the start I needed to feel that my therapist was a superhuman who could fix me, so seeing any wavering would have demolished my confidence in them. I was terrified of my own emotions and I think I would have felt enormous guilt that I had made them sad."
Simon Wessely, a professor of psychological medicine at the Institute of Psychiatry at King's College London agrees.
"You're supposed to be a professional," he says. "It's perfectly okay to empathise with people when they're in distress. But there's a big difference between that and then bursting into tears.
"You could also say for example, what you just told me made me feel angry and to prove that I'm now going to slap you. That wouldn't be very good, would it? I don't like the idea that at some point the patient might push the box of tissues back to you."
What makes a therapist cry?
In the therapy sessions patients are at their lowest ebb, often recounting tales which are distressing to listen to.
Consultant clinical psychologist Gillian Colville knows this only too well. She helps to support the families of very sick children in paediatric intensive care at St George's Hospital in London.
Some of her patients are in deep distress after a child has died.
"I glisten," she admits. "Certain things that people say - you can't fail to be moved by."
It's happened a couple of times recently and the clients noticed. "One caught their breath and changed the subject… the other continued what they were saying. But I don't do it on purpose, I wouldn't know how to."
In the American survey just over half of those who cried believed it didn't have an effect on their client and close to a half thought it had changed their relationship for the better. Less than one per cent felt it had harmed their client.
Amy Blume-Marcovici noted that older, more experienced therapists were more likely to cry. She suggests that this could be because they are more comfortable with expressing their emotions.
Gillian Colville uses professional support at work to cope with the pressures. She says she sometimes cries during sessions with her supervisor. "I do weep… a child dying is unutterably sad. I would be worried if I wasn't moved, but I have to take note and look after myself too."
Susie said she would have been distressed if her therapist had cried during her sessions but confesses: "Now, as a relatively sane person, I can see that there's actually nothing wrong with a therapist crying, because they are human."