Do you use humour in therapy?
The traditional advice is to avoid it if you can.
Freud famously thought part of humour is either a sexual or aggressive. It's just a mask for unconscious desires that society condones.
And we're all aware that humour can have a cruel quality. Ridicule and teasing are both forms of aggression, designed to wound and assert a sense of superiority.
Gallows humour too is well known.
Forensic anthropologist Sue Black writes of the humour her team use as they excavate the remains of massacres, atrocities from the Kosovo war. Bodies and unexploded devices all piled into one.
Humour, in this instance, is cathartic. A counterbalance to daily horrors. Its usage makes horrific situations bearable and builds trust when the pain of the unthinkable is shared.
Unsuitable for therapy then, where the pain is usually all on one side, and where aggression is avoided.
But hang on a minute….
Are we never to use humour in the therapy room?
And if so, why is it that that sometimes laughing with a client seems so natural?
Why is it that it just feels right?
Freud and psychoanalysis cast a long shadow over contemporary therapy.
The sheer scale of everything that he got right means it's hard to reject what he got wrong.
Moreover, we can all remember a time where we may have overstepped the mark. When we cracked a joke, and the receiver couldn't see the point. In times like this, we ask:
And humour can cause a sense of shame or even disgust in us. It may touch a more profound reality or truth that we don't want to acknowledge.
Plenty of therapists see humour as potentially dangerous and destructive.
For one, as humour is often used to defend against anxiety, the client may well start to mock his symptoms and avoid help.
For another, the therapist's use of humour may confuse the patient, restricting their range of responses. They are then unable to express their negative emotions.
At its most extreme, the therapist's use of humour is exhibitionist — a seductive form of transference that amounts to little more than the wooing of the client.
In a new study, humour in therapy associated with client recovery. Published in the American Journal of Psychotherapy, the authors note that fun is inescapable in life. It's present in every relationship between humans. And it's present in the therapy relationship too.
Humorous statements about their situation, their silliness or unsound mind, are a staple of every therapist's office.
I often have clients joke about me "sorting their head out."
The therapy process, current progress, and the strangeness of the counselling relationship can all become the butt of a joke.
Importantly, when therapists write, they are open about their frequent use of humour. Almost all report benefits, even while highlighting risks.
Yet clinical studies are rare.
In this study, 11 psychiatric clients, along with their therapists, completed surveys about humour.
These took place during individual out-patient therapy sessions. The clients had attended at least ten meetings, and the research included both men and women with a variety of diagnoses.
The researchers found the use of humour during therapy sessions linked to higher ratings of therapeutic effectiveness.
Clients who described more incidences of humour during therapy were also more likely to report greater pleasure in therapy sessions and report a stronger therapeutic alliance.
The conclusions were strong.
Besides the therapy alliance or reframing the client's view of the world, humour is another interaction between client and therapists that nurtures therapy efficacy.
All research includes limitations.
This study found the well-known negative association between humour and depression: if clients are more depressed, their production and enjoyment of fun decreases.
But it failed to find the evidence that humour was associated with clients lowering of depressive symptoms. This failure may be due to a flaw in the way the study was conducted.
More importantly, while approximately 15% of the variability of humour relates to therapy effectiveness, the study does not indicate the direction of causality.
It could be that humorous clients are more likely to get better. Or that the presence of humour is an indicator of therapy success. Good therapists cause the healing that makes humour possible.
Still, if humour in sessions does boost effectiveness, then therapists could include more humorous interventions.
At the very least, it is something to take into account.
No doubt, like other therapeutic tools, humour can heal, but it can also harm. What is critical is the preservation of the alliance with the client. And that the use of fun never comes at the expense of empathy toward the client.
At all times, the clients must know their therapist profoundly understands their suffering.
How do you feel about humour now?
As you reflect on your practice, can you recall times where you've used it and times when you haven't? What lay behind those choices?
And can you recall clients with whom laughing and joking was a natural part of your interaction?
A single study with all its limitations isn't conclusive evidence.
Nevertheless, it's worth considering whether the weight of the psychoanalytical tradition has influenced you more than you think, and whether it's worth considering this alternative.
The old approach says there's no place for humour in therapy, that the dangers are too severe, that it constricts clients or becomes a mask for their anxiety.
But this research paints a different picture.
Humour is useful in therapy.
It should never be at the expense of empathy, respect, and understanding. It should never be a glib approach to suffering.
But it can have benefits for clients, leading to better outcomes.
It seems there is some truth to the old saying:
I'm a qualified mindfulness teacher pursuing my doctorate in counselling and psychotherapy. My goal is to blend mindfulness with therapy to help therapists expand their inner peace as they develop their practices.
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