I’m one of those people who believes crying is the most effective way a patient can both (a) release emotion and purge buried hurt and pain; and (2) connect with others, especially in a therapeutic setting. The irony here is that I’m also one of those people who has a great deal of difficulty crying in front of others, including therapists. I feel like tears are expected of me, and that tends to inhibit me even more. I don’t like feeling like I have to “perform.” However, alone, I have retrained myself to cry and now can do so quite easily. That’s been a huge breakthrough for me. It’s doing it in front of anyone else where I run into issues.
Most people with NPD (not so much BPD–who tend to be cryers anyway–and people with PTSD/C-PTSD could go either way) probably find it difficult or even impossible to cry in therapy–after all, being too vulnerable is what a person with NPD fears the most, and yet it’s that very vulnerability that led to their need for an “invulnerable” false self in the first place. Narcissists started life so sensitive that they had no natural defense mechanisms at all, so an elaborate false one was built to obscure the too-sensitive true self. Sadly, many narcissists are so far gone into their narcissism they will never be able to access their true self or even become self-aware enough to realize the TS still exists, even if in an undeveloped, atrophied state that never sees the light of day.
I found several excellent articles about crying in therapy, and what crying actually means (the answers are surprising). Many therapists today, especially behavioral or short-term therapists (which insurance companies prefer because these therapies cost them less to cover), don’t encourage crying because they think it means the patient has been unnecessarily triggered. But in psychodynamic therapy (of which “reparenting” is one form of this), in which patients are encouraged to experience and release emotions and painful incidents from their past, crying is encouraged and usually signals an important breakthrough. Psychodynamic therapy is the type most effective (and most often used) with people with NPD when CBT (a type of behavioral mindfulness training) isn’t used, and it requires a highly empathic therapist who can effectively mirror (reparent) the narcissistic patient (without offering supply) and make it “okay” for them to experience their true emotions, which includes crying their pain out.
But I can’t cry!
This article from Psychology Today, How to Cry in Therapy, gives some tips on how a patient can get the waterworks going. I haven’t tried most of these, but others may find them helpful. These techniques can be used both in and outside therapy.
Two more excellent articles about crying come from The Psychotherapy Networker:
Therapeutic Crying: In Praise of Therapy’s Best Kept Secret. Crying is actually the healing phase that comes following a period of extreme stress (either pleasant or unpleasant), after the stresser has been resolved. The tears, rather than being “sad” or “happy,” actually signal a relaxation and sudden release of tension that follows that. Both tears of grief and tears of joy arise from this sudden release of tension/hypervigilance/fight-or-flight response and a transition to healing (examples would be crying after a close brush with death has passed, a very sick relative finally passes away; or watching your child get married or graduate.) It’s why sometimes being offered kind words or a hug can get the tears flowing.
Up goes the white flag.
Crying can also be a physiological “white flag of surrender”–when you finally acknowledge, even in the midst of a crisis, that you can do nothing more to resolve it, and find yourself dissolving into tears. Its evolutionary purpose is to draw others to you to comfort you. Empathic types are sensitive to these signals and will be the first to offer comfort or help, but highly manipulative people (with cognitive or “cold” empathy) are drawn to this kind of “helpless” crying too, so it’s wise to be vigilant of who comes along to help.
Another article from The Psychotherapy Networker, Why We Cry: A Clinician’s Guide, is another excellent article that explains why crying (especially deep crying) is so beneficial.
Should touching a patient be involved?
According to the comments under these articles, the jury’s out on whether it’s best for therapist to give the patient space and simply offer a box of tissues (some find this gesture condescending though), or if it’s okay for the therapist to actually physically hold or touch the patient. I think whether touch is involved or not depends on the individual and how comfortable they are with physical contact or having that sort of connection with a therapist. In all cases, it’s probably best for the therapist to ask the patient first if it’s okay to give them a hug or pat them on the back or offer any other kind of physical contact, no matter how slight. There’s even a waiver a therapist can have a patient sign to allow “limited touch” which can avoid potential lawsuits for sexual abuse or harassment.
What about when the therapist cries?
Related to the above, it’s surprisingly common for therapists to cry with their patients and it’s not unethical or even considered unprofessional s long as it’s not overdone. In fact, nearly three quarters of therapists have at least “teared up” in a session, sometimes even when the patient isn’t crying! It would seem the most empathic therapists (who were probably drawn to this profession because they’re empaths) would be the most likely to cry with their patients (or go home and cry afterwards, as many do). Many patients prefer their therapists to remain dry eyed because it makes them seem more “in control” as far as the patient is concerned, while others welcome a therapist’s tears because it makes them feel like the therapist “really cares about me.”