Presence, Boundaries, and Clinical Responsibility

A clinical reflection for practitioners

Crying Is Not a Treatment Goal

In recent years, a certain idea has become popular in therapeutic spaces:

“If a patient cries, it means something is released.
They will feel better afterward.”

This statement sounds compassionate.
Sometimes, it even appears to be true.

But in clinical practice, this belief is incomplete — and occasionally unsafe.

Crying is not a treatment goal.
And emotional expression alone is not a measure of therapeutic success.

A Brief Clinical Moment

A young patient presented with lumbar and leg pain, accompanied by visible anxiety and emotional instability.

After a brief midline abdominal stimulation below the umbilicus,
within two minutes, she began to cry intensely.

Recognizing the change in her system,
the needle was immediately removed.
Manual contact replaced stimulation.
The focus returned to containment, not expression.

Once the patient stabilized, treatment resumed locally on the iliopsoas region —
the original reason for consultation.

The session ended safely.
The patient left calm.

This moment raised a familiar but essential question:

What does it mean when a patient cries — and what is the therapist’s role at that moment?

Not All Crying Is the Same

In clinical reality, there are different types of crying, and they do not carry the same meaning.

1. Integrative Crying

• The patient remains present

• Breathing stays continuous

• The body does not collapse or dissociate

• Afterward, the system feels calmer and more stable

This type of crying reflects integration, not discharge.

2. Reactive Crying

• Often sudden

• Frequently triggered by opening systemic regulatory zones

• The patient may report feeling “lighter” afterward

• But symptoms often rebound hours or days later

This represents a temporary autonomic shift, not structural regulation.

 

3. Overload or Flooding

• Emotional loss of control

• Disrupted breathing

• Bodily trembling or dissociation

• The therapist’s own system becomes affected

This is not therapeutic release.
It is a system exceeding its capacity.

The Risk of “Crying Together”

Some therapists believe that crying with a patient demonstrates empathy.

In practice, this can create a critical problem:

When both therapist and patient enter the same emotional wave,
the system loses its reference point.

Empathy is not emotional synchronization.
It is stable presence without losing position.

In moments of emotional intensity,
someone must remain anchored.

That role belongs to the therapist.

Presence Is Not Emotional Participation

Clinical presence means:

• Staying regulated when the patient cannot

• Maintaining breathing continuity

• Holding structure without suppressing emotion

It does not require sharing the same emotional expression.

In fact, joining emotional overwhelm often amplifies instability rather than resolving it.

A Simple Clinical Principle

This principle guides every responsible intervention:

If the system cannot remain present,
expression is not therapeutic.

Crying becomes meaningful only when it occurs within a container that can hold it.

Knowing When to Stop Is Part of Treatment

Stopping a technique is not failure.

Removing a needle, changing contact, or returning to local work
is often the most therapeutic decision available.

Professional maturity is not measured by how much emotion is elicited,
but by how well safety and regulation are maintained.

Redefining Empathy

Empathy in clinical work means:

I feel you — but I do not become you.
I stay here — so you do not have to fall apart.

This is not distance.
This is responsibility.

Closing Reflection

Emotional expression has its place.
But therapy is not theater, and healing is not measured by intensity.

I do not cry with my patients.
Not because I do not feel —
but because someone must stay steady.

For vulnerable systems,
stability is kindness.

And sometimes, the most compassionate act
is simply staying steady when someone else cannot.