Ohio Counseling Conversations
Ohio Counseling Conversations
Let's Unpack That #1: The Tissue Issue
Counselors Victoria Frazier and Marisa Cargilll tackle "the tissue issue," unpacking the subtle yet significant implications of how counselors handle tissues when clients cry. They explore opposing perspectives about whether handing tissues to crying clients is supportive or potentially disruptive to emotional processing as well as how:
- More traditional counseling approaches advise against handing tissues to avoid implying clients should stop crying
- Offering tissues can sometimes be a show of support and acknowledgment of difficult emotions
- Different approaches may be needed based on the individual client and therapeutic relationship
- In telehealth settings, counselors can adapt by suggesting clients keep tissues nearby
- Using tissues as grounding tools or placing them within client's reach offers a middle-ground approach
- Many clients apologize for crying, revealing societal messages that tears are unwelcome
- Counselors can normalize emotional expression by explicitly stating therapy is a safe space for tears
- Sometimes gentle humor helps clients feel comfortable with their emotional expression
- Quality tissues matter – "one-ply tissue is just not going to cut it"
- The "tissue issue" reflects deeper values about how therapists create warmth and authenticity in sessions
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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee
·Hosted by Marisa Cargill & Victoria Frazier
·Pre-Production & Coordination by Kailey Bradley, Marisa Cargill, Victoria Frazier, Linda Marcel-Rene & Kendra Thornton
·Editing by Leah Wood & Marisa Cargill
·Original music selections by Elijah Satoru Wood
Welcome to let's Unpack that a short-form segment from Ohio Counseling Conversations, where we dig into the topics, tools and truths that shape our work as counselors. Whether it's a trending issue, a clinical insight or something we've all been thinking about, we're here to process it together.
Speaker 2:Welcome to the first episode of let's Unpack that. My name is Victoria Frazier and I'm Marissa Gargiel, and today we're unpacking the tissue issue. One of my favorite things to explain to people who aren't as familiar with the counseling space is how long we can talk about tissues where the tissue box is. If we should be allowed to touch the tissue box, I feel like it can go on for hours, like I could talk about it forever. It's it seems so like simple and it seems like day one kind of stuff. But I think when you're practicing intentionally, like it matters so much how you're showing up to the space, yeah, and like how we interact with our clients is so important, and it's like I feel like the basis of everything that we do, like right. If that is off, they're not going to get what they need out of our sessions and so, like I don't know, I think baby counselors get in their head about it, and then I think older counselors have such strong opinions about what they should and shouldn't do.
Speaker 1:Oh, yeah, I've seen it even on TikTok, like people saying, well, I learned this in grad school, but like, is that like? And some people think it's the greatest thing I ever learned, but uh, they're, it's highly debated right. Yeah, and I feel like it's highly debated right.
Speaker 2:Yeah, and I feel like it's hard to understand if you're not someone who is providing, like doing this kind of work, like why it matters so much. So like I feel like the general consensus we all are presented when we're in grad school is like do not touch the tissue box.
Speaker 1:Don't hand the tissue, no Right. But the implication from that message is because it's like you're saying, stop crying. Like you're okay, like sort of the way, like parents, like traditionally not all parents right, but like where we feel like you're fine, you're okay, like dust it off, like it's fine. Or like don're fine, you're okay, like dust it off, like it's fine. Or like don't cause a scene.
Speaker 2:Yeah, yeah, Like it's too much and like we always want clients to feel comfortable, right, Because it's like this is the place for big feelings.
Speaker 1:And so Does the tissue say they're not welcome.
Speaker 2:Yes, or that they have like a time limit on them, like they need to only last for so long, like you cried enough now. Yeah, everyone's favorite thing to hear, that's enough.
Speaker 1:Yeah, yeah, and that like it can derail people from sort of sitting with that feeling or exploring that feeling a bit more by like offering it. That's kind of the don't hand the tissue conversation, the hands off side of the equation.
Speaker 2:And I think it was one of my first moments where I was like I don't know that I fully can get on board with this in grad school. Like I think sometimes clients need us to show up in different ways, like depending on who they are and how their journey has been, like I don't know. I think sometimes, like handing the tissue can be showing up in more of a physical way and it can kind of say like hey, I see what's going on and I recognize that this is hard for you, and it can be kind of like a show of support. I don't know that I've ever given someone a tissue and they've like shut down entirely.
Speaker 2:Yeah, I also think I'm pretty careful with who I'm doing that with.
Speaker 1:Yeah, so knowing like your client is an important part of the equation too of is this disruptive or supportive kind of um, yeah, like that? There can be some positive reasons to do that. It's been a minute for me.
Speaker 2:I work solely in telehealth, so I don't have the opportunity to hand the tissue in this space, but I think when in those spaces that sometimes it's also like acknowledging their feelings by doing it and offering it. Yeah, I mean like would you ever say, like do you need a tissue? Or like do you?
Speaker 1:ever offer permission to like go grab one. Oh yeah, all the time. I think, depending on, maybe, what the modality I might be using is in like with a particular client, I might even sort of encourage that they assure they have some nearby uh, like when working with like EMDR, because it can get heavy at times. I say, like you know, having grounding um objects nearby is helpful, but also might be helpful to have tissues nearby, depending on what comes up for us, right?
Speaker 2:That's interesting. I never thought about it being dependent on modality.
Speaker 1:You know, I don't think it needs to be. I think, especially because there's maybe some expectation that can get you know, um heavy in a multitude of ways, it's just an even more important like, I guess, preparation tool, and I don't think that that, though exclusively exists. With just that modality, I think we can say, especially in an informed consent type way of like, hey, telehealth is here and I want you to feel really comfortable, and so that for some people might look like having tissues nearby.
Speaker 2:Yeah, oh, that's such a good point as like a grounding tool too.
Speaker 1:Yeah, yeah, I also like, I feel like I was probably Switzerland when I was working in person with students and clients too, because I would make sure that they were always within arm's reach of my client so that they were accessible. I could honor their autonomy if they wanted a tissue, but I didn't have to be the one that handed it to them, but they knew they were there. Like that, they were always accessible.
Speaker 2:I feel like that's a good like middle ground is having them within arm's reach and letting them know that they're there, maybe during like one of their first appointments, and then it's. It's a little subtler to be like you can just point it. Sometimes I just point yeah, and like a gentle point, not an aggressive point.
Speaker 1:Yeah, I think I have plenty of people in telehealth who are like I need to grab something and I'm like go for it, right. You know, like um I I don't try to interrupt what their needs are. If they feel like that's something that they need to and it's not nearby Like yeah, do what feels um authentic in that moment for you. But I get like why handing it might also be like useful and like I see you right.
Speaker 2:Yeah, I think it's hard, like when you first meet a client, to know how they're going to react. I would say that maybe for SESH, we're not like throwing tissues at people, but if, like in the past, they've said like I feel really alone when I cry or like I don't like to cry in front of people, it can be like a supportive measure, like you're kind of lifting them up and being like hey, I get you. I also think and this might also be kind of controversial Like sometimes clients make me cry a little bit.
Speaker 2:Like I'm never incapable of engaging with them, but sometimes, like I leak a little bit and I think it can be a good opportunity to like model self-care by you getting your own tissue.
Speaker 1:And, yeah, I sort of honor that with myself by having tissues nearby so that, if that happens, I am able to utilize that.
Speaker 1:Sometimes it's helpful to bring that into the conversation to show that we're feeling with, and sometimes it may not feel appropriate, right, and a lot of that is dependent on that relationship that you have with the client, things that they've shared with you.
Speaker 1:I find myself maybe like this expands beyond just the tissue issue, of just normalizing that this is a safe place for tears, Because, whether it's societally, generationally, familial, there's often the message that tears are not welcome and I try to clarify, like it's not my goal to make you cry, right, but like, if you do happen to cry or tears happen to come up in session, that maybe those emotions and those feelings are asking to be felt and normalized, that like that's okay and that, like this is this, is a safe place to do that. And you know it's never like something you need to feel apologetic for, because I get a lot of people who apologize for crying right, like as if they've done something wrong, and so I just sort of say, like this is one place that, like you should never have to feel like it's a, you know an apology for crying Like this is full on permitted. You have permission to do that here, no matter the explanation.
Speaker 2:Yeah, I have lots of clients who apologize when they start crying and obviously, like that is a good, like go-to response like this is where we come to feel, um, very Nicole Kidman, like heartbreak feels good in a place like this at the AMC theaters.
Speaker 2:Um, I I also think sometimes like, if clients are like so uncomfortable, it can be like a opportunity for humor in the session, like I always, like sometimes, I'll say like I love when people cry, like you're not going to bother me. I say like I don't like show up to work ready, like excited for it, but I think it shows a lot of trust in session. I think it shows that, like you're showing up authentically as yourself, you're letting yourself like take up a lot of space, because I feel like a lot, of, a lot of my clients I work with a lot of kids and teens. Um, especially like my anxious teen girls try to make themselves so small and they never want to bother people, and so it's like I I always point out I'm like, hey, this is the biggest you've ever been in here and I can't wait until you like take up the whole room. Like this is not something to be embarrassed about.
Speaker 2:I'm not saying you can't feel embarrassed because like they should feel how they feel Right.
Speaker 1:Validating that, yeah, yeah. When you have those kinds of situations, tori, like what um, or how do you handle the tissue issue there?
Speaker 2:issue there Some. That's such a good question. So like I think that I would probably do a point with that, like when we're feeling nuts not to get too specific, but like I feel like I'd be like, and just so you know they're still over there Um, or sometimes I'll, I'll say like I just put a fresh box out so like don't be afraid to get in there, there's plenty left. I think, especially when we're feeling like small and we should be hiding about it, it's nice to bring like some lightness to it If that's something the client enjoys. I know that most of my clients we love to laugh and like gossip and so usually that's kind of I'm not the most like serious, like lab Cody clipboard, kind of girl in session, um, if you can't tell me everything about me, and so, um, I usually kind of like fall back on my like laugh, laugh, moments of laughter.
Speaker 1:Yeah, yeah, like bringing levity to the session.
Speaker 2:Yeah, because sometimes they are like really big feelings that need to be felt deeply, and sometimes it's just like this is a byproduct of the situation that we're in and it's not the worst thing, I think. Ultimately it really like it's no one's favorite answer, like I feel like whenever you ask a question in grad school and you get this answer, you're kind of like OK, but like it really depends. It depends on the client, it depends on the therapeutic relationship. I also think sometimes you can hand the tissue with the intention of it being a message of like hey, it's like if we're getting close to the end of a session, sometimes I'll use the tissue as like a way to be like here's this. I don't want you to feel rushed, but also like yeah, we are, we do have a schedule to keep Time here.
Speaker 1:Yeah, I had a professor in my dog program who would not let us use it depends as an answer.
Speaker 1:That because essentially we know that it depends Right, that because essentially we know that it depends right.
Speaker 1:Like that that's the obvious and easy choice. But like taking a side or or a stance, um, was kind of the purpose of like well, what do you feel more of about this? Or like more so like trying to help us with understanding maybe our own orientation to some of these topics. It was a theories course, so like, especially like the theoretical orientations and personalizing that some of the way. But in reality and in practice we know that like having it depends as an answer is sort of more aligned with like how we navigate clinical decision making, because it does depend on the client, the relationship, maybe even not just like the client, like therapeutic modalities or interventions, but like the modality of like how we meet, how you know in person, is it like within, even like a couple's or family dynamic, like who's in the room, that there's all of these other like elements that are going to help us sort of land on the best decision for the person who may or may not need the tissue.
Speaker 2:Yeah, yeah, it's so funny, like, like I said at the beginning, like it seems like a very simple issue, but then, when you really take some time to think about it, there's so many mitigating factors and we have to make so many little decisions throughout a session that, like all of them can kind of come together into, like, does this person need a tissue right now? Yeah, yeah, yeah, yeah. Well, um, I also think like to your point about like, how we're practicing. So much of counseling is so evidence-based and we're really focused on, like, what the data says, but also there's like a personal touch and an art form to it as well, of like, maybe you're very anti-tissue and that's how you present to your clients and um, so, yeah, as much as it depends. It's kind of a cop-out answer yeah, yeah it does.
Speaker 1:It's like the blend of maybe the evidence as well as like how we feel as humans and how we want to show up authentically as counselors, like Like um, I I oftentimes will try to like elaborate on things, so I I love giving an example, um to help make it make sense for people, right, like metaphors or any kind of example, um, sometimes even like riddled with some self-disclosure, so they understand. It's like this happens to everyone. It's like I'm a counselor and I know a lot of things about how, like air quotes, we're supposed to maybe navigate things in like mature and healthy ways and like I still fall short, right, like I still mess up. I'm not perfect, um, but one of the things I think I often will talk about, especially in like environment and creating spaces, I talk about like how I want people to feel when they see my picture on the screen that I don't like have like a green screen background because that feels impersonal to me and I I try to make it look warm here and so that like they feel comfortable in the ways that I have control over the same way I would if they were sitting in my office physically, but that we can create that and if I want to provide warmth to my clients.
Speaker 1:Sometimes the tissue is a good move. Right Like that shows who I am and we can also say how we want them to interpret that gesture. Right Like I'm not telling you to stop, I just want you to have this in case you need it. Right Like we don't always have to say like just the action is interpreted without any context. Right Like I think of informed consent as like, yes, it's a formal part of like what we do, but we can inform people like I'm narrating as I'm doing this. Right Like this is the intention and that's modeling in some ways too of like just healthy communication oh yeah, absolutely.
Speaker 2:And I I love what you said about creating warmth and like comfort, because and this is my final point but if you're handing me a one ply tissue, it's just not going to cut it. It's just not going to cut it. I need, I need, I need a puffs plus lotion something not not sponsored, but like I need a quality tissue, not an ad don't get it twisted but I need a substantial tissue in my counseling space as a client and as a counselor that I can rely on. That, I know, is my, my, my old faithful. One day I'm going to get one of those like grandmother tissue caddies, you know, like when they put the little thing over the box. I feel like that's going to be my brand when I grow up.
Speaker 1:There are so many cool ones. Got a hot one down they might show up on your algorithm now, but there are many cool um examples. I've seen plenty.
Speaker 2:I could get so into like a tissue algorithm, a tissue box.
Speaker 1:I hope that we're not creating that space for everyone, but if we are, you'll have to send us some of your favorites.
Speaker 2:Yeah, oh, my gosh, please. Well, as much as I genuinely could keep talking about this for probably a couple hours, that, I think, is going to wrap up our inaugural episode of let's Unpack that. Make sure you're subscribed so you never miss an update. If you have questions, feedback or a topic you'd like us to unpack, be sure to drop us a line.
Speaker 1:You can send us a text or connect with our socials in the show notes. Thanks for joining us for let's Unpack that brought to you by Ohio Counseling Conversations and the Ohio Counseling Association. If it sparks something for you, share it with a colleague or drop us a line. We'd love to keep the conversation going. Thanks for listening and until next time we encourage you to keep unpacking the big stuff, one conversation at a time. You