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The Tissue Box and My Observations

by Holly Walker, LPC-S

A counselor friend of mine said she dubbed her client seating area as “the crying couch” and I’ve referred to the loveseat in my own office as that many times over. One of the most vulnerable moments in therapy is when a person sheds tears while sharing their hurts, regrets, guilt, shame, and other emotions. It never ceases to be moving in those quiet meaningful moments. I’ve observed many clients over the years, who have different reactions to the emotion and vulnerability, and I bring it down to the observations of the tissue box.

Most, if not all, therapists keep a fresh box of tissues out in the open and available to clients at all times. It’s as vital to the therapy room as water is to grass. I keep one tissue box open and in plain view and one in reserves because I never know when the last tissue will be removed from the box. You may be wondering where I’m going with all this and so let me get to the point. Although I have not done official research and am not claiming to be correct in my observations, I have noticed a few themes over the years connecting vulnerability and the tissue box and wanted to share them with you.

Grab and hug it- Some clients like to kick off their shoes, curl up on the couch, and immediately reach for and hold the tissue box like a teddy bear. It’s a source of comfort in a safe space where crying (or not) is allowed. For some, they may not feel able to express raw emotion outside the therapy room and this is their time to be able to do so. For others, they may be emotional in life and it comes naturally in therapy.

Take out 5 at a time- For many, one tissue just will not do. Three, four, or five at one time is what’s desired and that’s what they do. They might blow their nose and throw them away all at once and in one big wad or might use one at a time but feel better having several in reserve. It seems the knowledge of having several tissues on hand is taking care of business, being ready, and prepared in the event that crying happens. Either way, whether they use them all at once or one at a time, the preparedness and ability to cry and be vulnerable means so much.

Use only 1 then another- Based on my very un-scientific research/ observations, this seems to be the most common or popular theme, which is taking one tissue at a time and using it until there’s not a dry spot on it! It may be folded neatly into a square and dabbed under the eyes or gently swiped under the nose, but until every little spot on that tissue has been used and is practically shredded or in a teeny tiny unusable square, the person will not reach for another one. I will sometimes say, “you are welcome to use more than one tissue if you’d like” and that usually brings a little smile and acknowledgement of drenching the one being used. I wonder if this client is harboring anxiety and feeling tense by not daring reaching for another tissue.

Only use 1- This grouping is related to the “use only 1 then another” except when suggested they reach for another, I get an immediate, “no, I’m fine.” Sometimes emotion catches a person off guard as they are sharing and have an emotional reaction to something being said and felt. I don’t push them in getting more than one tissue or suggest it further because I want that client to learn to self-sooth, tend to their own needs, and I respect their autonomy to decide for themselves. However, I also see it as a sign of holding on to uncomfortable feelings and not fully allowing themselves (yet) to be vulnerable or self-aware.

Never touch it- Some folks would not touch that tissue box with a ten foot pole, no matter how wet their cheeks have become from crying or how stuffed up their nose becomes as a result of emotion expressed as crying. Those who took a while to recognize emotions inside of them or have a first-time breakthrough after more than a few sessions oftentimes have a difficult time reaching for that tissue box, even with a gentle acknowledgement that the box is there for the taking. It’s as if they realize they’ve become vulnerable and it’s a little too scary to take the action of using a tissue and admit outwardly that they’ve become emotional. I believe they will reach for the tissue when ready and only they know when that time is.

Bring their own- Some clients bring their own tissue(s) and reach right into their pocket or purse as they sit down and never even glance at the tissue box in the room. They come ready to talk and be emotional and don’t think twice about it. It’s great to be self-sufficient but knowing you have back up in the room in that tissue box can be helpful and comforting, too.

As any person moves through the process of therapy, what a beautiful experience it is (or can be!) towards self-awareness, acceptance, vulnerability, and learning to care for and love oneself. While my tissue box observations are only that, observations, I do equate that to someone’s personal journey and path towards healing. May you find strength in vulnerability and wisdom in humility on your own path in life.

If you have questions or would like to reach me, you may contact me via email at or anyone at The Balanced Life, LLC at

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