Sunday, February 6, 2011

Why Weep?

Online discussion forms can be an interesting place. Take for example a thread of discussion about an older gentleman who was weeping in therapy. The psychotherapist posted the question "what do you make of weeping in a case of an [older] gentleman with major depression who has been seen in therapy [a handful of times]?

The range of responses are interesting. The original poster commented that in many years of clinical experience, they have never seen a person with major depression weep. Others have pondered if there is some sort of unexpressed grief, while many others talked about us living in a culture where men don't cry. Others have questioned if there is some sort of underlying medical disorder that is causing the weeping. The most useful comment is the most recent: "Have you thought about asking the patient why they are crying?"

My first thought is that I think every psychotherapist needs to think twice about having discussion about current patients anywhere on the internet. The second thought of the psychotherapist should always be "no, I'm not going to discuss this online." Supervision is great, peer supervision is great. Internet discussions with strangers about patients is nothing more than gossip. We owe our patients more than that. In fact, our ethics require us to offer our clients more than that.

My second thought is that if you are a patient, ask you psychotherapist about their privacy policy. Ask them directly if they discuss their work with anyone else. Most skilled and competent psychotherapists seek out some sort of supervision (with a peer, with a more experienced mentor) at various points in their career. This is perfectly acceptable. In asking how they talk about you with other's, ask if they have a policy about discussion on the internet. If you aren't comfortable with their policy, discuss it with your therapist until you are either comfortable or decide that you want a different therapist.

My third thought is about weeping. What a ridiculous question. Did you know one of the first things that comes up on a search of 'weeping' is a site that lists 52 medical causes for weeping. Have we really turned a normal human emotion and behavior into a disorder? Really?


  1. Thank you for giving such a well thought out, sensitive, incisive response to this question. I couldn't agree more with you on every point you have made. I think what struck me first & foremost is the absurdity of the question itself. What is so unusual about someone crying in therapy, let alone someone who is depressed?! I wanted to applaud the person whose comment was to ask the client. Not to have addressed the situation with the client in the therapy situation also strikes me as absured...& it was also a missed theraputic moment. Reflecting "I see you are crying." and a simple statement like "Tell me about your tears." or "What are your tears trying to say/express?" could have enriched the therapy session in a myriad of ways. All of this confirms my belief that good therapy is an art...&, unfortunately, not every psychologist is an artist.

  2. It's always a good question is psychology and art, is psychology a science, is psychology a science that requires are, or is it an art that requires science? Or is it something else?