Really Good Tissues

When I was in graduate school they told me that you shouldn't hand people the tissues when they're crying because you want them to know that it's okay to do that, cry, and if you hand over the tissues then you're giving the message that you want them to stop.

I thought that was powerful but dumb, because you could hand over the tissues, which might make some people more comfortable, blowing their noses into a tissue, as opposed to say, on a sleeve, and you say,
"This is not to tell you to stop crying, cry away, please. Crying is good for you. In moderation, obviously, to a degree, for sure, but with me, it's always good."

We've joked about me wanting a sponsor for the blog, mainly Puffs or Kleenex.

But who has time to really pursue this? I did go after one of the tissue companies, actually, maybe both, and remember a resounding rejection. Life hurts, is the truth.

Generally, when I shop, it's a guerrilla mission, no time to go through all of the aisles. I know, however, when I'm getting low on tissues at the office, that this will be on my grocery list-- KLEENEX.

Because Kleenex is another word for tissues, right?

As a c0-parent of five, and a person who likes to eat, I save a few cents if possible, buy the generics. So the cart fills up with generic tissues, off-brands if they look okay, especially if they come in a pretty box. You have to buy in bulk if you're a therapist because they go, as we say, in a good week. A good week is a good cry or fifteen.

Anyway, in over the years, very occasionally, someone will say,
"You need better tissues. Buy Kleenex or Puffs. People don't want to think they're using up all of your tissues."
Pretty amazing, but it happens, and of course I say thank you for the advice, because you have to thank a person for asserting, for trying to get the needs met.

I might even say, "Thanks, I don't hear this much, but I'm not going to take it personally." This makes the event an intervention. People take way too much personally and it gets them into trouble emotionally. Something to talk about.

"No problem, Glad to oblige," my clientele will say. People are nice like this.

So this morning I go to the grocery store, and buy several brands of tissues thinking, "We'll give this a whirl, see which one really is the best, which is the best for the money, which makes a person feel worse, might make a person think, My life is so bad, I even get a cheap therapist! Everything is bad! I'm born under a dark star.

We'll see what happens.



Lou said…
On a recovery blog we were just talking about the crying that goes on at AA/NA/AlAnon meetings. Mostly one's first 2-3 meetings are all crying. For some, it is the first time they have acknowledged their feelings. Anyway, we were joking how you can tell the veterans in the program--they are reaching for their purses and the kleenex before the first tear falls.

I don't mind the brand, but I don't like being handed a bunched up wad of tissue.
Anonymous said…
I've had allergies for over 3 decades and what kleenex I encounter can make it better or worse. I always go towards the Puffs ultra because they're heavy enough that if I blow they don't disintegrate and leave me with a hand full of funky yuck. Also the lotion ones are hideous! They grease your face and make white heads pop up then you have to blow and have a sore face from the acne attack. My husband has joked that I slit the side of the box and slide it out and put it in my purse (inside of a zip lock bag so the white fuzzy degeneration doesn't coat the inside of my purse and things nearby.) Its embarrassing to catch a whiff of perfume or deodorant and suddenly have your nose become a literally a dripping faucet that you can't do anything but grab something to catch it before it hits the dog, couch, floor. I've often wondered if the connection between my emotions and being unable to express them at times ends up triggering all this wetness and watering eyes becomes a deluge that feels out of control. Have any of your patients gone through therapy and dealt with their issues and had less allergy problems after?
Anonymous said…
Your post compels me to confess... before my second visit with my therapist, I loaded my purse with kleenex. Her industrial/hospital tissues were just too thin and scratchy.
Syd said…
I have to say that I don't like it when those in Al-Anon are reaching for the tissues before the crying even starts. It seems too...well...controlling to me. Like they know who is going to cry and that the person needs to be taken care of. Too needy or something. Obviously I have a hang up over the tissue thing.
Meansomething said…
Hee hee hee! I was amazed by what you were told in graduate school. I think of handing over the tissues as being a gesture of kindness and comfort, as saying "It's OK that you are crying, and I want you to be comfortable and be able to take care of your runny nose while you cry." It never would have occurred to me before this that anyone would interpret the gesture as meaning, "Please get control of yourself right now before you get any more disgusting." Of course, the student always apologizes and I always tell them it's okay, that nearly everyone has cried in front of a teacher at some point, including me, who cries at the drop of a hat.
CiCi said…
I agree that sometimes handing someone a tissue interrupts the flow as it were. I have been in recovery meetings where peoples heads are swiveling around and the attention is on "where the hell are the tissues" and not being a good listener. Thank goodness I'm not the therapist and I don't have the responsibility of deciding when the appropriate time is to hand over the tissues, but my therapist does not do the tissue thing.
Not ever. There is a box around and I can see it and if I want it I get up and get it. And soft tissues too. Things hurt enough and I don't want a scratchy tissue making my nose hurt more.
Alice Hates You said…
As someone who has just started therapy for the first time ever, I can tell you the first thing I noticed when I walked into my first appointment was the box of kleenex next to my seat. I didn't notice the brand, nor did I care. When the tears began, my therapist casually said "there's some kleenex right there if you need it," which was a nice way of inviting me to help myself.

But the tears just kept coming and coming, and I couldn't help feeling embarrassed. And you know what helped me feel most "invited" to cry? When I had gone through my 4th kleenex, she grabbed the waste basket under her desk to put in front of me so I didn't have to keep the ball of snotty tissues in my lap. That waste basket was 2/3 FULL of used tissues, and that was the best assurance ever. It reminded me "hey...this is what she does. This is what I'm here for."

I think it's a similar idea to why coffee shops put some change into the tip jar before setting it out on the counter. It shows people that others have been there before you, and please follow suit.

So my suggestion is to leave the waste basket out next to the kleenex, so your clients can see they're not alone.
nashbabe said…
I like this one. Made me stop to think about the Puffs at the table next to my chair in her office, and the wastebasket placed very conveniently next to the chair. It IS important, and no, I don't want people handing me tissues. At least in one place in my life, I want to be able to cry without people stopping me, out of embarrassment, or their own guilt, or awkwardness, or whatever. I have a lot of stuff that I'm carrying around and I'll bet a lot of we patients do. At least give me ONE place where I can cry without having to worry about it.
Elizabeth said…

I think this is like everything else, there's an art to it, to figuring out what a particular person needs.

I have a therapist friend I see once in a while. I went to him after my grandmother died. I was a mess. I had taken care of her for so long and was finding it impossible to go from that to grieving. I hadn't cried -- in all the weeks of horror leading up to her death I had not cried once.

I was telling him all the gory details and kept pulling myself together and then finally I was getting to the edge again and he handed me the tissues.

It was almost an instruction. Like, "Here, c'mon. It's time."

I burst into sobs. Really, I think the entire therapy was in that moment of handing me the tissues.

Although I can't say that I remember what brand they were. :)
Anonymous said…
I've often wondered about what my gush of tears does to my T. He sits there and never makes a move to hand me tissues (there is usually a box beside my chair)but if I look for them and they are not there but on a nearby computer desk, he immediately jumps up and grabs the box to hand to me.

My skin is not only dry, but sensitive. At times, I've had 3 hours sessions and if I've cried a lot, my face will naturally be chapped, but the few times he's had scratchy tissues, my cheeks looked and felt like I'd used sand paper on them. So, yeah, it makes a difference.
Wait. What? said…
Aha! This is why he set that tissue down in a different spot the second visit, I was not close enough the last visit to get it myself without rising!!!

And I think it was the generic brand, but I can't begrudge him that, I have HMO after all!
My therapist has the tissues right on the arm of the couch when you come in, with a waste basket next to the couch. If I know I'm not going to need the tissues I move them to the side table.

I do prefer name brand, that are soft and substantial. It makes me think the therapist cares.

I've had three cats die in the last two years, so I've used lots of tissues at our vets office. They are all the cheap, institutional, sandpaper tissues. It's awful. I'm a blubbering mess when I hear my cat is sick, then when I bring them in to die. And then my nose is raw too.
Lisa said…
Wow, I'm known to hand over the tissues when I see it coming. I always use off brand. It has never been mentioned to me, but now I want to experiment!
Kerro said…
I have never understood why therapists insist on buying the cheapest, thinnest, scratchiest tissues around... given their line of work. Please, for the sake of my skin, buy the soft ones with aloe vera!

As for not passing the tissues, I think that's just heartless.

Wendy said…
My therapist has the box right next to the chair, but the dang trash can is across the room so I sit there with a ball of tissue in the trash until she sees that - and hands me the trash can. Then as we leave, she takes the trash can with her and empties it in the little kitchenette they have. I've always felt slightly insulted by this, like she has to dispose of the smelly trash before the next person comes... Who knew I wasn't the only one having tissue issues... Get the softest tissue, makes us feel loved!
Serendipity said…
Interesting, the connection between "issues" and allergies. I think that they're parallel - allergies are overreactions to perceived dangers, and so are anxieties (especially phobias, OCD, etc).
Ally said…
I feel very taken care of when my therapist pulls the top tissue part-way out of the box and holds the box out for me to take it.

Yesterday I used 5, or was it 6, tissues during our session. I think it was just about the most I have used in her office. Amazing given that I was talking the entire time about how much progress I have made in the 2+ years since I started seeing her.

So now as I am reflecting on the session, the number of tissues in contrast to the topic is a symbol of how I need to delve deeper.
therapydoc said…
Okay. I'm with you all on this. I'm not even putting out the cheaper brands anymore. Only the good stuff for my patients from now on.

I think my disconnect comes from having allergies, too, all year long, pretty much. So the type of tissue never matters to me. ANY tissue is a good tissue.

As for the waste basket, well, that's a no-brainer. That has to be within reach. And yeah, they fill up.
Lisa said…
I know at CR (Celebrate Recovery) a rule is that you are not allowed to hand Kleenex (you are right, I don't even use the word tissue) to someone who is crying. It is cathartic and healing, and it is considered distracting to do this.

My t keeps the Kleenex on the side table. I've never paid attention to the brand, but they are soft and do not hurt when you are wiping away the tears. I definitely have noticed that. The cheap ones feel like wool.. not really a comforting feeling. Believe me, my school provides those for the classrooms and the kids end up using their sleeves half the time. Much softer.
blogbehave said…
A cheap therapist or a therapist who is modeling one way to be wise with her money? Money management is an important skill that keeps the system in good working order, no?
Anonymous said…
Wow, I found your blog about an hour agao and have been reading back through old posts ever since. I feel like I can learn a lot from you and your readers. I am in my first job after receing my MSW where I am doing direct one-on-one counseling with patients by myself. I have a supervisor who I am supposed to be working closely with, but things are so crazy that us new folks are kind of left to sink or swim on our own. I felt like I should give some sort of intro, but the real reason I chose to comment now is that all this talk of tissues and crying reminds me of a situation with a patient that I'm unsire how to deal with. It's embarassing to say as it's not a deep therapeutic issue, but more of an every day situation that is leaving me uncomfortable and unsure of myself. One of my patients almost always has a major sneezing fit during our sessions. This started at our first session in March and has continued since. There is always a box of tissues within her reach, but as an effort to do something I generally say bless you after the first couple of sneezes and offer her the box, which she always takes. This sounds crazy, but after that I don't know what to do. She either is sneezing so unconrollablly that she can't even get in a thank you, or, which is often worse, can begin to engage again, but the starts sneezing and the process starts again. I feel uncomfortable just sitting and looking at her until she's done. It also feels uncomfortable to continue talking when I know whe can't possiblyh process what I say. On a couple of occasions I asked if she wanted to step out and get some water. She declined both offers and then I felt like it may have seeemed like I wanted her to leave. Anyway, I feel like I'm probbably making too much of this, but it's making me soubt that I have what it takes to be a good therapist if I get flustered by sneezing. Any words of wisdom would be much appreciated!
therapydoc said…
How interesting! It almost seems as if the stress of talking brings on an allergic response. If it were me, that's what I would address. Good luck, anon, and don't give up so fast. I tell young therapists that they know, with an MSW, much much more than the people they're seeing, which is why they have licensure (assuming they do) to do the work. But as you see, it's always interesting.
Anonymous said…
"It almost seems as if the stress of talking brings on an allergic response."
That is very interesting. prospect. I will definitely bring this up. Now I just need to find a way to sit through the sneezing and be comfotmable. Thanks fir the quick response.


I've been at this business for 41 years and have never had anyone complain or comment on they type of tissues.

A couple of times I ran out of tissues and had to hand out napkins and paper towels.

Of course I'm a male. Maybe clients are more likely to complain to a female about the quality of tissues.

At any rate, my sense is that if this is what the client is complaining about, talking about, either they have a personality disorder, or its time to end therapy. :-)

All the best,

David Markham
therapydoc said…
Thanks David, or it could be they've been holding back and finally feel comfortable enough to hand out some constructive criticism. I like that explanation best, makes me feel I've done a good job empowering, teaching assertiveness.
SeekingJustice said…
And what if I never cried at the therapist. For almost 2 years I had once a week session but never needed a tissue. Is there something wrong with me? I just think that crying is very private thing and I don't like to share with anyone, even the therapist.
porcini66 said…
Not much of a crier - didn't get me anywhere when I was a kid, so....

Anyway, as to what type of tissue?? Hmmm...I appreciate the soft ones, of course. But I am not offended with the scratchy ones. I guess that I am pretty flexible as far as that goes. I will say the in my T's office, the tissues are on the desk and the wastebasket just by the chair. Uber convenient. I didn't use a lot of tissues in my T's office. I DO know that it was a breakthrough moment for me when he inadvertently said something that hurt my feelings terribly. Cut me to the quick. I confronted him later that day and coldly told him how much he had hurt me. Wasn't going to SHOW him that though. I was always taught you don't show people how you feel, no matter WHAT. At the last moment, I gathered all of my meager courage and choked out that I felt utterly BETRAYED by what he had said. My head was throbbing, the veins in my neck hurt from the pressure, my eyes felt that they would explode, my heart was pounding and my palms slick with sweat. That one word came from the very core of me, the depths of me - buried in an abcess of bile and frustration. It is the one time I have let him see my true hurt. And yes, I was glad the tissues were in reach because to have him have to stop and reach for them and offer them to me would have broken that moment - that one word, that one moment, authored a time of healing for me.

I needed to get my own tissue that time, for certain.
Hi TherapyDoc:

As I mentioned in an earlier post, I have been at this business a long time, over 41 years, and one of the dumbest moves I have ever seen an administration take was at Park Ridge Mental Health Center back in the 80s where as a cost cutting move they informed therapists that the agency would no longer be providing tissues, the therapists would have to provide their own.

The mutiny was quite a thing of beauty to behold if you have once ounce of rebelliousness in your blood.

This decree was quickly rescinded and tissues were restored to the budget but they were the cheap, single layer scratchy type.

I don't remember any therapists complaining about the quality of the tissues only that they be provided by the agency as a necessary tool of the trade.

It is interesting how so simple a thing as tissues can stimulate so many comments and discussion.

I currently purchased the ones with Aloe which I don't like because I can't clean my glasses with them so I'm going back to the regular. I am a Kleenex man myself.

All the best,

David Markham
therapydoc said…
Seeking Justice, I almost, but chickened out, was going to tell people that most people actually DON'T cry. We get you to squirt out a few tears if that makes you feel better, but no, you don't have to cry. Therapy is often an intellectual exercise, a thoughtful examination of problems and history. It can be fun, to tell you the truth.

Wow, right out of a movie, PORCINI.
Great stuff, thanks for sharing.

Oh, DAVID, we get a lot of mileage out of very little. It's fun. I stay away from the ones that smudge up the glasses, for sure.
Anonymous said…
I never did cry in therapy - I suddenly feel as though I didn't get my money's worth. Interpret THAT as you will!

My therapist thought it was strange. I felt stranger that she wanted me to cry, though I do understand her reasons intellectually. It was just awkard is all. Sorry, I'll try harder next time? Heh.
Anonymous said…
OK just saw your response right above mine.

Good. Maybe my therapist just felt like since nothing else was working maybe a good cry would work.
therapydoc said…
Maybe! Why not ask?
Cheryl said…
I've been in & out of therapy for almost 2 decades. I'm on my 8th shrink. I can only remember crying once. Seeking Justice, it's not just you. I'm not a cryer either. As a kid at the end of summer camp most kids would be crying and I never did. Couldn't even wrap my head around why people did. Just depends on who you are I guess.

And TD, I agree with you that therapy is indeed a very intellectual exercise. With my previous shrink, I never got anything out of the actual sessions. I always needed to chew things around in my head for a bit first...
Cheryl said…
Oh, and I don't even know where the tissues are in her office. Been going to this one for 2 years. Shows how much I'm not a cryer. Her office is small...
therapydoc said…
Yeah, now. I'm pretty sure it catches up with most everyone.
blognut said…
Good grief! People have a lot to say about tissues.

Me? I was just going to say that I thought this post was funny. Now I'm not even sure I was supposed to think it was funny.

But I do. And if people complain about your tissues, tell them they have a choice and are welcome to use their sleeves. Case closed.

therapydoc said…
It was a lot funnier before I edited it to make sure no one takes me wrong.
Tissue etiquette? You'd be surprised how many clients say to me "what, no couch?"

We were told in grad school to not use couches because of all the therapists that slept with their clients.

I guess the point is expectations, and you can't always plan for those with every client.

By the way, David, loved the story about the therapist revolt. You gotta fight for your right to have tissues!
porcini66 said…
Perhaps it is the anonymity of the web that allows us to wax so poetic about...tissues.

Or, perhaps, and more likely in my opinion, this is the stuff of great conversations. An interesting person can make even tissues fun to talk about. I sometimes wish that more folk would practice the art of conversation, though. I think that is one reason I love my T so much (in a safe way - no panic...). He and I can talk for hours about "stuff". Not always STUFF, but just mundane things, too. I sometimes feel like conversation gets more and more shallow with each decade while the texters and twitterites and chatters and IMer's of the world deepen the meaning of every emoticon. :)

Definitely NOT meant as a slur to you TD - I know that you tweet and there is a lot of GOOD stuff out there too...

I think it's great that this much content is generated with a tissue post. And, it lightens the mood a bit in a worrisome world. Thanks TD, for what you do!
Tues@11 said…
Wow, after more than 2 years of therapy and never having my therapist offer me a tissue you mean to tell me she learned that in graduate school? Gosh, and I thought she was just a cold hearted u know what. Guess I owe her an apology. TD, your blog is the best!
Emy said…
I remember a really, really long time ago you wrote it wouldn't be unusual for a healthy person to cry every day. Or that it was good maybe. (At least, I'm PRETTY sure you said that. It's entirely possible I'm making it all up.)

I'm not sure I've even cried on a monthly basis, so I found the comment a bit shocking. Still do.

My other random comment...just another thing that stuck with me regarding 6th grade US History teacher had a friend who'd lost her husband and never quite recovered. She said she cried so often that the tears ate into her skin and wore tracks down her face. I'm not sure I ever quite believed it but it was a powerful image.
Nainja said…
I also liked this post about the tissues very much. I never thought that it might be an issue. And I liked the idea that somebody might think that he is born under a black star because his therapist is buying cheap tissue 

Anyway, I cried a lot during therapy and used a lot of tissues and once my therapist started to cry too. That was rather surprising and besides worried me slightly. I wasn’t sure if she had some problems too, which I certainly couldn’t have dealt with or if she was just touched by what I was sobbing about. It turned out to be the latter and I found it rather sweet. It’s the only thing I can remember from that session actually, no idea what we were talking about.
Jew Wishes said…
I love this post! :)

Pass the tissues, please.
Hm.. I make people cry a lot, and my tissues suck. Note to self, get better tissues.
Mark said…
Too funny. Interesting also, never thought about have tissues available VS handing tissues to the person. I will keep this in mind next time I am in this situation.
April_optimist said…
Interesting. Why not simply have a box of tissues right next to where clients sit so the tissues are always there? And yeah, crying is important.
therapydoc said…
TUES, it's possible she was in my class. Who knows?

EMY, I do think it's good to squirt out a couple of tears everyday. Shows you're in touch with your fellow miserable creatures, if nothing else. So yes, you read it here.

NAINJA, we're just human, so if a therapist cries a little, it's probably an empathy thing. It can get really sad around here.

JEW WISH AND MIDWIFE, for sure, more tissues, less wear and tear on the sleeve.

Right, MARK. And APRIL, I have boxes, like, everywhere. Thanks!
Anonymous said…
This comment has been removed by a blog administrator.
therapydoc said…
Anon, let's not do this. Please?
Anonymous said…
Apologies from the "comment removed" anon ... I didn't really think it was an offensive comment, though I (obviously) thought the one referenced was at least marginally inappropriate. Maybe it's professional humor. I think that might be the genesis of people on the patient side sometimes feeling patronized. I have a loved one in therapy, and I think the sort of blunt "making fun" might leave him disinclined to trust, be vulnerable, worried about expressing something "trivial" or loosing esteem in the eyes of his therapist. That is all. No ill-will intended.
Ella said…
Box next to me today ran out. Mock horror expressed, another box was fetched.
They are the institutional Kleenex-brand. We have them at my job too. They are OK, esp. for a few tears. It's an HMO, I have low expectations.
At home I am exclusively on lotion tissues, need them for my tender nose. In my room I need to be able to blow my nose for real. Bought plain Kleenex for the other rooms, though, it was on sale for cheap.
BTC, (remember her?) recently took a poll on empty vs. not empty trash can at the therapists office. Most voted that they DO NOT like to see evidence of the other clients in the form of crumpled tissues, coffee cups, cigarette packs, etc. Alice Hates You comment is the opposite, very interesting!!
Anonymous said…
This tissue post is interesting. There were two interesting moments that involved tissues and my therapist: each involved a lack of tissues that was somehow troubling for me and that stands out for me. And one also overlaps with the issue that the relatively new therapist wrote about several posts back.

During one session, I had begun crying but not too severely. I thought that I could use a tissue to wipe the tears from my face, and I turned to the table beside the chair I was in: that was usually where the tissue box sat. But there was no box there. So I said, "do you have any tissues?" thinking that my therapist had a box somewhere in the office that she could get relatively quickly.

She smiled and said, "No," and then paused and said, "Uh...I could go get a box from one of the other offices"; she shares an office suite with several other therapists. The thought of her getting up and leaving to get a box of tissues just seemed like a big interruption, so I said, "no, that's o.k." And I just let the tears evaporate.

But after leaving the office, I pondered how strange it was that she didn't have tissues when she had always had them in the past. It seemed odd for me to think that maybe she was behind in her shopping and hadn't stocked up, and I felt strangely not provided for.

The second incident relates to sneezing, specifically my therapist's sneezing. I don't remember her sneezing too often, but when she did, I don't think that I noticed much because they were probably just some average sneezes.

However, one time I remember her sneezing, and it was the kind of sneeze that gets stuck a bit but then comes out suddenly with a massive force. It sort of took me by surprise, as I was in the middle of talking, so I said "bless you," probably in a surprised voice, and then I saw that she was looking around for a tissue. She usually had a box of tissues on a table next to me, and then another box on a table next to her.

Well, my box was there, but hers was not. So she took a glance at the table, and I saw her do it, because she had to turn her head to do it. And there were no tissues there, so instead of blowing her nose, which is what I'm sure she sought the tissue for, she sniffled loudly (I mean loudly; it had been quite a sneeze), and then, finally remembered that I had said "bless you" a while back, so turned her attention back to me, smiled, and said "thank you."

And the session had to end just a minute or so later, and after I left, I started thinking "why didn't I hand her a tissue from the box next to me?" I felt strangely self centered as though I had just returned to my usual talking instead of doing something considerate like handing her a tissue when it was blatantly obvious she was looking for one. I tried to console myself by telling myself that I had at least politely acknowledged her sneeze, but then I thought that the much more helpful thing would have been the tissue and that "bless you" after a sneeze was possibly the most useless phrase in the world.

So ... perhaps the newly minted MSW should not feel too pessimistic about getting flustered by sneezing. Maybe sneezing and therapy are sometimes an awkward combination.

I'm no therapist; I've only had therapy. But I wonder if the newly minted MSW could just say to the client, "I've noticed that you have been having some sneezing fits during our sessions. In the previous sessions, I have been waiting until you feel ready to continue talking after the sneezing subsides. Is that approach alright with you? Or is there something else that you would prefer for me to do?"

Anyway, I can always write forever about anything, so now would be a great time to stop.
Unknown said…
Hey people, we are not just therapists and patients, we are people sitting with other people in a room together.

It is good manners to have decent tissues available.

It is good manners to say "Bless you" when someone sneezes.

It is good manners to have the tissues easily accessible to the patient.

It is good manners to hand them to the patient if you are closer to the box than they are.

Come on! Part of therapy is modeling healthy relationships between two people.

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