Thank you to everyone who responded to our November Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
November Quandary: Sometimes I feel therapy getting a little bit dry. I consider myself a funny person, but I don’t know if it’s appropriate to showcase my sense of humor in the midst of clients’ clinical issues. Is there a way for me to bring play and humor into the work? How else are people using play and humor in therapy?
1) Create Energy
Playfulness and humor are energy, as important to therapy as empathy and attunement. I encourage clinicians to find any opportunity to be funny—even in the very first session! There are often opportunities to crack a self-deprecating joke or make an absurd analogy to accentuate how bizarre life can sometimes feel. In that way, you wake up the client’s nervous system, connecting with them and allowing them to see who you really are.
Humor can also encourage clients to bring out their positive, joyful energy. One 13-year-old client who was very defensive once called me and my therapy stupid. “Hey!” I responded. “My boss pays me a lot of money to be stupid!” Another teenager kept cracking his knuckles in sessions. I asked him “Hey, what other cool tricks can you do? Are you double jointed? Can you touch your tongue to your nose? Wiggle your ears? Curl your tongue?” He demonstrated every trick he knew, and we compared skills.
Another time, a young depressed client sat slumped on my couch, leaning her head on the armrest. She was so still I could barely sense her breathing. Then, I suddenly got the idea to take a craft feather from my supply closet and placed it on the armrest in front of her nose. I told her I wanted to see if her breath could make the whispy ends of the feather move. For a moment, the feather was still. Then, she started breathing so the feather began to jiggle and vibrate. Finally, she gave a stronger breath through her nostrils and the feather glided off the armrest. I grabbed it in the air and blew it back to her, but she wouldn’t catch it—it was too much effort for her. “That’s okay, I said, I’ll just blow it back toward you and see if it can land on the armrest.” The feather flew and landed on her knee, and another time in her hair. It made us both smile, and the deadness in the session began to dissipate.
You can feel the dynamic shift when humor and playfulness is used skillfully. Along the way, don’t forget the gift of repair: if your joke or funny gesture is ill-timed, falls flat, or the client finds it offensive, take responsibility and apologize for your misstep. In this way, you’re showing attunement and caring for your client.
Dafna Lender, LCSW
2) Trust Your Clinical Radar
Laughter is therapeutic. Teaching clients to find play and humor in their lives should be an unofficial treatment goal we all aspire to. It builds rapport, helps clients reframe what’s going on in their lives, and frankly, provides some lighthearted moments of relief from the weight of heavy sessions.
If you think the work is getting dry, it’s likely your clients do too, and injecting some humor is a great place to start. Of course, as with most things, balance is important. While I’m certain you have some fantastic material in mind, you probably don’t want to transform into a one-person standup comedy act overnight. And you certainly don’t want to undermine the therapeutic process or unintentionally make light of someone’s suffering (I lean toward drier humor, so it’s especially important that I be mindful of this). Trust your own clinical radar to tell you when it’s okay to offer a lighthearted quip, share a funny meme, or share something funny that happened to you—and invite your clients to do the same! The opportunities are there.
Early in my career, I was in session with an adolescent when my stomach growled. Loudly. As in you’d think I hadn’t eaten for days loud. When she heard it, my client stopped talking, looked out the window and back and me, and said, “Did a motorcycle just go by?” For a split second I considered jumping on the unexpected option of blaming the sound of my internal organs on an imaginary passerby, but instead I burst out laughing and said, “No, that was definitely my stomach. Apparently it’s time to eat!” She, too, burst out laughing, and then we spent the next few minutes telling embarrassing stories from our lives. When we did circle back to what she had been talking about before my stomach rudely interrupted her, her perspective of the situation was a bit more open, which aligned nicely with one of her goals to “stop being so closed off.” Go figure.
Helping clients find pockets of joy in their lives is part of what we do. It also increases their (and our) ability to tolerate the not-so-joyous parts of the journey. Take a chance and try it! No one ever said therapy has to be doom and gloom all the time.
Kate Sample, MA, LPC
Eau Claire, WI
3) Create a New Therapy for Each Client
I believe that showing up in therapy means bringing your whole self: your brain, your heart, your experience, and even your sense of humor. I certainly bring humor into the room when appropriate as a way of building rapport, humanizing the work, and occasionally taking a breather from heavy topics. But as it is with many other components of therapy, like self-disclosure, it should be both tailored to each client and used in the service of treatment.
For example, if a client asks about a late receipt, I might make a self-deprecating statement that I need to reprimand my business manager (I do my own books), showing an acknowledgment of my oversight and my willingness to chuckle about it. Most of the humor is generated from the relationship itself. A client once became very angry with me on a day I was wearing a bright blue shirt, which became known as “The Blue Shirt Session.” Going forward, whenever the client became angry, we talked about their anger in terms of the blue shirt: “I’m only baby-blue-shirt angry about that” or “your facial expression is telling me it's a navy blue shirt day.” This was always followed with a chuckle and an acknowledgement that we have a relationship and a history, and that makes it easier to discuss difficult topics.
As Irvin Yalom says, “create a new therapy for each patient.” For some, humor will be a helpful way for them to relax, share difficult material, and build a bond with the therapist. For others, humor is a way to minimize or sidestep the work they came to do, and for their therapy we may need to push past the urge to crack a joke and sit with less comfortable feelings. In my role as their therapist, it’s up to my clinical judgment to determine which is the best course.
Having said that, I would also want to explore what you mean by therapy “getting a little bit dry,” as humor may not be the remedy. Are you saying that the conversations are too intellectual, lacking emotion? Perhaps you or your clients are tiptoeing around emotional issues and staying in the safer realm of logic and reason. Are you creating a dry environment because your approach is clinically detached and aloof? Are you finding it difficult to bring warmth and empathy into the sessions?
Humor can break the ice and introduce a lighter element to the therapy, but it can also take us further away from some of the more painful growth that is necessary in our work. The remedy for therapy getting dry may be asking yourself (or the client) if there’s something you’re afraid to bring up in the session. I wouldn’t want to give a green light to use humor in sessions if it only serves as a distraction from the meaningful work you both may be avoiding. That would still be dry work, only with a laugh track.
Ryan Howes, PhD
4) Create New Possibilities
Many therapists are tentative about adding humor and play into the therapy session. As a play therapist working with individuals, groups, and families, I’ve come to appreciate play and humor as necessary tools for assessment, problem solving, and increasing intimacy.
In my social skills groups for children, I use a drama therapy approach called Playback Theatre. Visuals are important when working with children, so I use puppets or dolls, which are of various genders and races. I also like to use storytelling. With kids who are impulsive, for instance (impulsivity being very common in children with regulatory issues), I tell the story of “The Impulsive Dragon.” It includes exaggeration, which is something children love. It also creates distancing from the problem, and adds humor. An excerpt goes like this: “On Dragon’s first birthday, Tommy tried to get Dragon to light his own birthday candle. Sadly, the entire cake got burned, along with Tommy’s eyebrows.” To problem solve, I might ask a young client, “What do you think Dragon can do instead of becoming impulsive?”
I’ve also found that using play and humor with families creates more intimacy. I recently worked with a family that had seen several other therapists, but nothing had worked. In our early sessions, the feeling in the room was stifling, and trying to get them to engage in conversation extremely difficult. But once I added play and humor into the session, asking the family to work together to construct and go through an obstacle course, engagement and bonding soon followed. Now, I let them take turns choosing games, like charades and Pictionary. Both led to laughter and tears. Today, they show more physical closeness, holding hands and hugging. The fighting at home has decreased remarkably.
You can also use play and humor in couples therapy. Play is an essential ingredient for improving intimacy. To discover a couple’s preferred “play language,” I ask “How do you play together, whether it’s board games, jumping waves at the beach, picnicking in a meadow, rock climbing, or bobsledding?” Discussing a couple’s sex life can create tension, but I’ve found that adding humor can decrease it and show that I’m comfortable with the subject. For instance, I recently told a couple about a former client whose husband ordered a sex toy for her, and when it arrived, she nearly passed out from the size of it. Of course, both play and humor have to be used therapeutically, with sensitivity and proper timing. But in a world where pandemics, global warming, and isolation are affecting us all, I’ve found humor to be an excellent way to ease the tension in the room and open the door to new possibilities.
Charla Cunningham, LMFT, RDT
5) A Balm for Hard Times
I find that humor comes up naturally in sessions. Recently, I had a client ask “What else could possibly go wrong?” while shaking their head negatively. I quickly added with a smile, “Take it back! Never ask that question out loud. It’s the ugly cousin to ‘this can’t possibly get worse.’”
I sometimes share humorous stories about myself with clients. In October, I informed my clients we’d need to use telehealth for a few weeks since I’d been thrown from a golf cart and fractured my pelvis in two places. I told them that when the ER doctor informed me there was no dysplasia, I responded with “Good thing! Now you won’t have to put me down!”
Often, life intrudes in ways that makes the daily walk difficult, and humor is sometimes the only thing that can help us refocus and remember that sometimes you’ve got to chop wood and carry water. Translation: even when something bad happens, we still need to do the laundry, wash the dishes, and make dinner.
I once worked with a young man in his 20s who informed me in the first session that he’d been diagnosed with Asperger’s, and wanted us to focus our sessions on expanding his social IQ so he could get a girlfriend. One day, I got a call from him while he was at his ophthalmologist’s office. Evidently, his blood pressure had become so dangerously high that he was unable to see out of one of his eyes. The doctor wanted him to go to the ER immediately, but my client was refusing. Taking a line from the Arnold Schwarzenegger move Kindergarten Cop, I said in my best thick Austrian accent, “What if it’s a toomah?”
The staff freaked out, but my client began hysterically laughing.
After he settled down, I followed up by asking whether he could just get it checked out, just so we wouldn’t have to worry. He took my advice and went to the hospital, and I know it’s partly because I made him laugh first. As it turned out, they discovered he’d had a pituitary brain tumor (you can’t make this stuff up!). A few months after surgery, he met a wonderful partner and got married.
Personally, I say use humor whenever it feels like a good fit. It helps all of us make it through the hard parts.
Starlene Kelley, LCSW, CADC
Next Month’s Quandary: I’ve heard a lot of grief specialists talking about helping clients finding meaning after loss. But sometimes loss feels meaningless, like all of these COVID deaths, and I’m not sure what to think or feel about it. What’s helped other therapists? And how do I work with my clients around this?
Photo © iStock/SanneBerg
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