Sadness is an emotion we often associate with depression, grief, loss, change, and many other transitions occurring in our lives. When people experience sadness, they may describe a heaviness in their chest or a weighted vest slowing them down; cognitively sadness may be labeled as a mental fog or an absence from the present moment. When people come to therapy they can also disclose they feel blue, empty, down, stuck, hollow, heavy, lonely, withdrawn, or isolated. These words and descriptions are all good synonyms to the primary emotional state of sadness.

When working with patients in a therapeutic setting, sadness is often an emotion people want to avoid and keep out of one’s conscious awareness. On top of that, sadness is something we often associate with negativity and should not be experienced in our lives. When we disclose we are sad a space is created in which one is vulnerable, exposed, and invites a genuine response from most people asking, “What’s wrong?” or “I am sorry, is there something I can do to help?”.  In today’s culture, there seems to be little room for sadness or at least the open expression of it. Working with people in therapy, patients often talk about what others have, such as consumer products, certain job titles, different dating partners or more access to resources. The reality is such items or positions rarely bring about authentic happiness; instead they mute one’s sadness for the time being, before the next new version or opportunity comes along.

Sadness tells us we have or might lose something close to us. This could be a loved one who is dying, an upcoming retirement, or a child going off to college. In these moments, people try to hold onto a familiar experience they are so afraid to lose because the alternative of what life might or could be like can be difficult to imagine. During these moments, the job of the therapist is not to make the patient happy, ignore the sadness, or re-frame the emotion, it is to just sit with the sadness and experience it.

*Susan and I have been working together for about 2 years. She was an expert at hiding her sadness from others due to the fear of burdening them, dragging them down, and stealing their happiness. I think what stood out to me most about Susan was her notable change in affect from the waiting room to my office. A simple walk of about 50 feet, I would see a metamorphosis of a chatty smiling person in the waiting room to the one who often sank into my couch.

She made a big thud after sitting down in my office, “Ughhh, I can’t believe he did not call back!”. Susan was dating a man she met on a dating application for about six months on and off. “I thought things were going so well,” she uttered to me in a low and slow tone, “this happens all the time. I invest a lot of myself and things like this always fail.” When working with Susan, sadness was not the first thing that came to mind. My initial reaction was one more built out of curiosity. This seemed to be a pattern for her; engaging in relationships that seemed to stall out or simply stagnate. Then, like most cycles that often repeat themselves, she would find someone new to invest her energy in and the cycle would pick up again.

This time I decided to stay in her experience of what it was like to end this relationship. I said, “There seems to be a pattern here and I wonder if you have noticed anything?” She looked at me in a puzzled manner. “Yeah” she said, “All the men I date are the same.” I replied, “That may be true, but since they are not here in therapy, we cannot do much for them. I wonder what it would be like for you to share your internal experience with me about the pattern of not just this most recent relationship that has ended, but the last couple?” Susan and I had a good rapport at this time, so she trusted me, even if she thought I was off base.  I said, “I wonder if you cycle through these relationships as a way to distance yourself from your feelings.” I continued, “I know I would feel very sad, perhaps even angry, about being so vulnerable with this person then have them leave me.” I paused for some time to let what I said sink in. Sometimes as therapist we overcomplicate things with interpretations and interventions we hope that will bring about an epiphany for the patient. The reality is witnessing a patient’s truth, providing empathic support, and a safe holding environment goes much further than we therapists think.

Susan verbalized to me, “I do not think so.” I said to her, “That is fair. How about we try something different? Can you tell me what you feel in your chest or stomach when you think about this most recent relationship?” She paused for a moment and said to me, “I really can’t feel anything, but it feels kind of hollow and heavy.” I replied, “That feels like a lonely and hard place to be.” Susan then noted that this feeling is constant, almost like a fog that follows her around that obstructs her ability to see and feel. “I do not like this” she said, “this places makes me feel sad.” I sat in silence with her for a few moments, “what do you think your chest and stomach are trying to communicate to you?” She disclosed to me in a very soft tone, “that any place is better than this and no one will ever love a sad person.” This part of our session truly impacted me so I just decided to stay in this place with Susan to let her know that she is not alone. She started to tear up and broke eye contact with me and started gazing out the window as if her eyes wanted to not see what was in front of her. I continued, “I often experience if sadness cannot be expressed in the body, it will often stay in the eyes as a heaviness.” When her gaze returned to me, her eyes were red, puffy, and beginning to water.

Susan and I worked together for about another 6 months before we decided to end our work together. Last we spoke, she was still dating around and trying to find the right partner, but now she had more clarity into her choices and drives for picking certain partners. Ultimately therapy gives people insight into why people do the things they do. It is not meant to “fix” people or significantly change people’s personalities, but it gives us hope and perspective into our emotions, motivations, thoughts, and inhibitions. The point of therapy is not to get rid of sadness, loss, or change, but it is to accept it and gain insight into where these patterns come from. Sadness arises within us to make us realize that change, loss, and grief are inevitable, that it cannot be stopped. Sadness alerts us we need to pay attention to what is important in our lives and how those important people and things make us feel. It is not a bad or negative thing to be sad, however it can be negative if we try to suppress the sadness out of our awareness.

*Pseudo-name to protect confidentiality.