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Nothing in his neat shirt and carefully knotted tie suggested that he was overwhelmed by crises. At work, he was known as a decisive leader. At home, he was the person his wife and children relied on.

Yet a few months earlier, after a particularly stressful day, he had spent nearly an hour sitting alone in his car in the basement of his apartment building, unable to bring himself to go upstairs.

“I don’t know who will talk to me if I go home,” he told Dr. Tran Thi Hong Thu, former deputy director of Mai Huong Day-Treatment Psychiatric Hospital in Hanoi, during a therapy session.

For most of the session, he spoke about work: failed projects, financial pressures and difficult decisions he had to make. But when Thu asked how he himself was feeling, he lowered his head. “I was taught from a young age to be strong, so I’m not used to talking about being exhausted,” he said quietly.

Thu then asked him when he had last eaten a meal without worrying about anything. He paused before replying: “I don’t remember.”

For years, his meals had been interrupted by work calls, while problems continued to follow him home. Sometimes his son wanted to tell him about school, but he would ask the boy to wait until the next day because he was busy. By the time he was free, his son no longer wanted to share.

“Now when I get home, he avoids me and doesn’t want to sit with me,” the man said before suddenly breaking down in tears.

After examining and talking with him, Thu diagnosed him with depression. She said the underlying problem was not simply his workload but years of suppressing his emotions, which had gradually distanced him from his own family.

Hoang Quoc Lan of the Mental Health Care Center at Phuong Dong General Hospital has witnessed many similar moments during his years of clinical work.

He has seen students cry under the weight of exams and family expectations, pregnant women devastated by discovering their husbands’ infidelity, and young women break down while recalling sexual abuse that had haunted them for years.

One case he remembers involved a 40-year-old woman who became pregnant through in vitro fertilization after she and her husband had spent 15 years undergoing infertility treatment. The pregnancy represented years of money, effort and hope for the entire family.

But during the first months of pregnancy, she discovered that her husband was having an affair.

The shock left her unable to sleep properly or eat normally, and she became visibly thin and exhausted. Her sense of betrayal was compounded by fear that her distress might harm the unborn child.

During her first therapy session, she initially remained silent. As the therapist gently asked open-ended questions, she suddenly covered her face with her hands and began sobbing. “I thought having a child would make us happy,” she repeatedly said. “How did things come to this?”

Research cited by the U.S. National Institutes of Health and the American Psychological Association indicates that crying occurs in around 15-30% of psychotherapy sessions, while about 86% of patients report having cried at least once during treatment.

Experts say tears can play an important role in therapy by bringing hidden emotions and the deeper causes of psychological distress to the surface, allowing therapists and patients to better understand and address them.

Thu describes crying as a distinct form of communication in the consulting room. When a patient cries, what triggers the tears and even an inability to cry can all carry different psychological meanings.

Tears can reveal how much emotion someone has been suppressing, she said.

Crying is also a natural response when the brain finally senses that it is safe to stop holding everything in. Rather than immediately trying to stop a patient from crying, therapists need to listen and understand what the tears are expressing and what kind of support the person needs.

Some patients enter therapy appearing composed and answering questions rationally, only to burst into tears when asked something as simple as, “Have you been feeling tired lately?”

According to Thu, such reactions may indicate that a person has spent too long suppressing distress without having a safe place to be vulnerable. In these situations, crying can function like a release valve after emotional pressure has accumulated for months or even years.

Patients often say, “I didn’t mean to cry,” which can itself show how deeply their emotions have been buried.

Tears can also stem from feelings of worthlessness. People with depression may cry while saying things such as, “There’s nothing I can do,” “I only make everyone suffer,” or “No one would care if I disappeared.”

In such cases, the crying may reflect intense self-blame, diminished self-worth and hopelessness.

People who have experienced abuse, sexual assault or major trauma may react differently. Some can recount traumatic events with little visible emotion, only to suddenly break down when recalling a smell, a song, the sound of children or a particular phrase once used by their abuser.

Therapists may interpret these reactions as signs that traumatic memories have not yet been fully processed.

The manner in which someone cries can also provide clues about their psychological state.

Intense, uncontrollable crying may occur in people experiencing acute stress, anxiety disorders, panic attacks or recent psychological shock.

Quiet, restrained tears are often seen in those who believe they must always appear strong. Others may appear to cry without producing tears, which can sometimes occur in severe depression or after prolonged trauma, when emotions have become numb and difficult to express.

Experts also caution against the common assumption that frequent crying necessarily means a mental health condition is severe.

In some cases, therapists are more concerned when patients describe deeply painful experiences without any emotional response, discuss suicidal thoughts in a flat tone, or laugh while recounting trauma.

Such reactions may suggest that emotions have become disconnected from the experience or that the person has reached such profound despair that they can no longer express what they feel.

The nature of crying can also change as therapy progresses.

Early in treatment, patients may cry from fear, confusion or helplessness. Later, they may cry after realizing how long they have been suffering.

In the final stages, some shed tears of relief after learning to forgive themselves, setting boundaries, saying “no” to unreasonable demands or recognizing that they deserve care and affection.

For therapists, these changes can indicate that patients are gradually reconnecting with their emotions and recovering.

Experts recommend seeking professional evaluation when crying becomes frequent or prolonged, occurs without an apparent reason, or when a person instead feels emotionally numb.

Such symptoms are particularly concerning when accompanied by insomnia, persistent low mood, loss of interest in everyday life or recurring negative thoughts.