You've Got to Be Kidding


You've Got to Be Kidding

The Power of Humor in Therapy

By Martha Straus, Kevin McKenzie

May/June 2022


This is certainly not a funny time on the planet. Arguably, it’s way too soon to even try to laugh about all we’ve gone through and continue to endure. As therapists, we likely have a particularly acute awareness of how bad things are; most of us are up to our burning eyeballs in urgent referrals and relentless suffering. How twisted does someone have to be to find any of this misery a source of amusement?

And yet, in most of our consulting rooms, on most days, we all share brief and transformative moments with distressed clients in which we’re grinning, chuckling, laughing, and even guffawing together. These moments often appear to be outside the work—the goals, objectives, outcome measures—of psychotherapy. Most of us don’t plan to have a mood-lifting, deeply connective giggle with our clients. In fact, a great thing about laughing together in therapy is that it surprises us. Good therapy is a mix of science and magic; a shared laugh is gloriously unquantifiable. Maybe it’s our little guildy—um, guilty—secret that there is, in fact, this much laughter in therapy.

When we know we just had a great session that so unexpectedly and delightfully moved to a new level, we might try to tell someone about it. In vain, we provide sufficient context for how this amazing thing happened, carefully offering a whole huge backstory—we want to be sure the listener understands we were being kind, that no clients were harmed in the burst of positive affect, and that it really, truly was a funny exchange. But like most magic, it vanishes under close scrutiny; our discourse saps the energy from the moment, and we may well wish we hadn’t even mentioned it. Better to keep it our secret that therapy can be this much fun.

Therapy humor is certainly not something taught in graduate school or explained much in supervision. Indeed, perhaps ironically, it’s the topic of surprisingly dull workshops and articles. Many of us may have also learned the hard way that laughing with clients can cause awful ruptures. We might have been cautioned about bringing humor into therapy lest it be used as “a dangerous weapon” of therapist power and aggression, a handy escape from the work at hand, a disconnection from relationship, or the discharge of beginner jitters. At worst, clients may feel that they—and their pain—are being laughed at.

But, mindful of the perils, our gentle willingness to look at suffering from a different angle—even with levity—offers us a potent therapy tool. Indeed, there’s voluminous and consistent literature on the many health and relational benefits of shared humor. Studies show that it elevates mood and reduces stress, anxiety, obsessional thinking, and depression. Laughter boosts our immune systems, lowers blood pressure, and improves brain functioning. It enhances bonding: people who laugh together maintain more eye contact, speak more openly, feel closer, and become more self-compassionate. Research on the specific benefits of humor in therapy concludes that it increases trust, deflates shame, improves self-esteem, opens the possibility of a new perspective that can help clients get unstuck—and can be truly cathartic.

In short, shared laughter can truly transform the hard work of treatment, providing a unique and specific opportunity for connection that analyst Daniel Stern calls a “now moment,” a nonlinear leap that moves the therapy and the relationship forward. Even just a knowing amused catch of the eye can suddenly open up a roomier space for exploring together.

Of course, humor in therapy takes many shapes and forms, all utterly dependent on the unique dynamics of each therapy relationship. In the intersubjective dances that we choreograph with clients, we can only hope to be limber enough to move together in a spontaneous twist or dip. How do you stretch to get ready for “a moment of meeting” as Stern calls it, that might very well transform how it feels to be together? Here are five ideas.

Mindful of the perils, our gentle willingness to look at suffering from a different angle—even with levity—offers us a potent therapy tool.

Humor during Intakes Bolsters Connection and Informs Diagnosis

Research supports that a little levity in the first session or two can play an important role in breaking the ice and making the conversation flow a little more easily. It can even be diagnostic. Our clients’ openness to seeing some aspect of their dilemma through a more humorous lens is an indicator of their level of metacognitive capacity, their relative investment in a particular story about their predicament, and perhaps their current access to alternative solutions.

In that nod toward irreverence or absurdity, we find a window into the degree to which despair, hopelessness, and general stuckness define a client’s relationship to their presenting problems. Can they join in a divergent narrative? Can they take their foot off the gas long enough to smile? It bodes well for the therapy if they can: humor and creative problem-solving go hand in hand. To laugh, you need to be able to imagine an alternative reality, read between the lines, and juxtapose contradictory ideas. You have to be a little creative to even begin to imagine that things might be different. By contrast, when our clients come in unable or unwilling to laugh, we know we’re beginning the journey together in a more relentless darkness.

For example, I (Kevin) often wisecrack my way through the first part of the intake interview. Starting with the administrivia, itself a great displacement object to divert us, I insert a joke here and there, like “I bet you didn’t expect to initial this much—you’d think you were signing for a mortgage,” and I take note of their reaction. Do they respond at all? If so, with a smirk, a chuckle, or a laugh? Afterward, do I sense a shift in them that’s more relaxed or tense? Can they warm to me and recognize small absurdities alongside the more serious inquiries about their circumstances? I don’t keep it up if they seem uncomfortable with my quips.

The answers to these questions tell me a great deal about both where the person is now and how we might best proceed together. If their laughter is heartier than the joke merits—I’m funny, but I’m no comedian—I attend more closely to their interpersonal style. Perhaps they feel a need to ingratiate. Maybe they’re too anxious or dysregulated right now. Or perhaps they’re interpreting it on a different level than I intended. If they don’t respond at all, that’s good data too, and I become less witty and more subdued for a time. My intent is to connect, not to overwhelm.

Still, it’s important for a client to see what therapy might feel like with me. My empathic engagement almost always includes space for enjoyment and pleasure in being together. I see this as a kind of service, too. A first session that includes a bit of humor offers a small window into how this relationship might develop in the weeks to come.

Can clients take their foot off the gas long enough to smile? It bodes well for the therapy if they can: humor and creative problem-solving go hand in hand.

Humor Develops Bonds of Attachment

Just as much as crying, shared laughter is an attachment language. Though therapists usually engage more knowingly with tears, the exchange of brighter affect is another kind of invitation to the dance of intimacy. Our mutual joy creates a condition of belonging and worth. Even with a shared chuckle, the space between therapist and client moves from top-down to side-by-side. In the moment of a good laugh, no one is more powerful.

Indeed, the best humor in therapy is co-created. Clients don’t just need to laugh at our jokes; we’d be on the standup circuit if that were the goal. Rather, our mission includes getting to know how their brand of humor might further enrich our work together. And clients have many ways of sharing their humor with us, each perhaps conveying a different agenda for their strategies in navigating relationships. In letting loose their wit, we get a glimpse of how they deploy humor to manage connection. Are they defending against something? Are they trying to regulate themselves? Are they pushing away or pulling close? How does it register in us and create shared meaning when clients intend to be funny—or discover that they are?

I (Marti) have known Elana for a few years. She struggles with the legacy of trauma, including incapacitating anxiety and angry outbursts that have cost her friendships and jobs. She’s wired tightly, and her body usually goes into panic mode well before her brain can engage and assess the situation. But, happily, her capacity for reflective functioning and sense of humor have developed in tandem these past months. Our use of humor in sessions allows her to coregulate in real time; now she can hear and calm herself, recognizing the funny elements in a given conundrum.

Here’s a small example from last week. Elana has begun fretting over every element of her bachelorette party, even though other people are organizing it. In particular, she’s worried that her bridesmaids will drink so much they’ll puke and ruin the festivities—and she definitely doesn’t want to spend the evening holding their hair back over a toilet. Because we’re working on her developing a more pleasantly forthright communication style, I ask how she intends to tell them this. My question slows her tirade, and she pauses before saying, “I think I’m gonna put hair ties in their party bags, so they can take care of it themselves.”

I start giggling, and she joins right in. “Brilliant solution,” I say. “And very generous.” We laugh some more. Problem solved.

Humor Provides a New Perspective

When we assume that our education, expertise, and confidence confer advantage upon us, we may miss the chance to play with narratives of who we are and what clients need from us in the therapy relationship. Sometimes humor can turn our own meaning-making system upside down, instantly changing power dynamics in surprising and amusing ways. Like everything else, positionality is usually a serious matter in the consulting room. But what if this, too, has aspects that are absurdly funny?

My (Marti’s) private practice is in a somewhat shabby—I call it comfortable—office in rural New England, and I love it. My new client Steph was a tough-on-the-outside lifelong New Yorker. Just a few weeks before we first met, she’d moved to a nearby log house at the end of a dirt road, arriving in a borrowed car with only a suitcase of books, an ecstatic dog, and about $150 in her wallet. In quick succession, she’d lost her job, primary relationship, and apartment in the city. Luckily, she’d retained some caring friends, one of whom had helped her land a quirky gig in which she’d live for free and be the personal chef for a wealthy couple in a town with a population of 1,400— “fewer people than on my frigging block in Brooklyn.”

Some might see this experience as a great adventure, a sabbatical from the city, a chance to regroup. But for Steph, the whole situation was just a further descent into a new circle of hell. She saw the “green exile” that I’ve chosen to call home as a relentless parade of bumpkins driving to the dump in their Subarus and trying to get her to go to the church for gelatinous chicken-pot-pie suppers.

Of course, it’s common for struggling clients to worry if their therapists will be able to help them, but Steph worried more than many because, on top of the barge of pain she was towing, she was reasonably certain I’d be a rube who wouldn’t be able to keep up or tolerate her urban-sized rage and despair. How could I possibly understand the depth of the loss she’d experienced when she’d had to abandon the city that she loved?

Steph’s suffering was palpable from the start, and there was little doubt that we had plenty to work on to help her regroup. Winding up our first session, I offered some empathic pablum about how I recognized the challenge of adjusting to cultural differences between the city and the country. She blew a loud and unceremonious raspberry in response, her eyes settling on my prize collection of crumbling birds’ nests before scoffing, “Culture?!”

At that moment, I saw the whole absurd scene through her eyes and couldn’t hold back my laughter. I then noticed surprise and curiosity in her face. My evident delight was, in equal force, unexpected for her. We looked at each other straight on, maybe for the first time that hour—and she nodded a kind of acknowledgment that seemed to mean, Hmm. You might be able to keep up after all.

Okay, I thought, she’ll be back for round two.

Though it was a few weeks before we shared a real laugh, the rhythm of our sessions—so often full of agonizing grief, traumatic loss, and resentment—invariably veered from time to time into moments for pleasure in being together, different as we were. Like someone swimming underwater for too long, Steph would come up for air, look me in the eye, and elaborate on something comically wrong with living in the boonies, making it clear she was, once again, grounded enough to play with me. In the midst of her confusion and pain, she and I could entertain the ridiculous elements of this experience, and, in those moments, she was less alone.

“Mud season? Are you effing kidding me?” “Porcupine quills? How is this my life?” “I was going to apologize for being late, but do you people take slow-driving lessons?”

Our mutual enjoyment of satire bridged the “cultural” divide. Hard work and humor together helped to pull Steph out of her isolated sorrow and toward a plan for how to move forward in her life. A year later, she moved back to Brooklyn.

Are they defending against something? Are they trying to regulate themselves? Are they pushing away or pulling close?

Humor Helps Anxious Clients Get Unstuck

Therapists are treating unprecedented levels of anxiety right now. Our anxious clients are buried in fear about the future, whether they’re focused on a single worry or something more overwhelming and global. In all its guises, and no matter how reality-based it may be, this constant worrying is exhausting and painful.

This doesn’t sound very funny at all. But fear and humor are a bit diametrical if we think about it. Fear only scares us when we take it seriously. Our mind plays tricks: we believe what we think and feel, despite compelling evidence to the contrary. The anxious mind has an answer for that, too. It inattends to the evidence; it asks “what if” to a degree that rivals that of the most precocious toddlers; it requires absolute certainty or it won’t relent. By contrast, humor requires the suspension of serious belief. It doesn’t so much argue the evidence as render it irrelevant.

I (Kevin) have been seeing more clients with OCD and health anxiety lately, including Nick, who came in one day distraught over finding a dead mouse behind his refrigerator. We explored how he’d mustered the courage to even stay in his home when we both knew that he’d rather have burned the place down. And I applauded his efforts as he walked me through the precautions he’d taken to deal with the mess (rubber cleaning gloves and a fair amount of bleach), the skills he used (grounding and breathing), and the support he sought (friends make the fear less powerful). Still, he remained significantly distraught over the ordeal.

I asked him about this agitation, now several days later, and he reminded me that the OCD and health anxiety wasn’t letting him forget how bad it was. He relayed to me the extensive research he’d conducted into diseases carried by dead rodents. Armed with the Mayo Clinic, the CDC, and WebMD, he’d (over)estimated his odds of having caught a deadly disease from the mouse. He established a timeline, compiled a checklist of symptoms to look out for, and set an alert on his phone to let him know when he’d finally be in the clear. As he described these measures, his anxiety became palpable, even over Zoom. He was convinced that it was only a matter of time before he became ill. I knew it would be impossible to convince him that he’d probably be okay, so I moved sideways.

With a deadpan expression, a twinkle in my eye, and a slight inflection of sarcasm, I replied, “Yeah, that makes sense.”

He burst out laughing. “I know! It’s ridiculous! What am I doing? Ugh.” We chuckled a bit together.

With a small bit of playfulness, I challenged Nick’s anxious thoughts and snapped him back to a level of insight and metacognition that he’d lost for the last few days. The real work could begin again.

I’m not recommending sarcasm as a go-to treatment for OCD, especially in the absence of a strong therapeutic alliance. But in this case, humor advanced the therapy because it was already part of our dance. My client knew we were on the same team, and if I were mocking anything, it was the anxiety. In this regard, my reply not only resurrected his metacognitive capacities, but served as an emotional regulatory function. My right brain assured his that he was okay—and he believed it, in both his right and left brains. Then and only then could the anxiety ease its grasp.

Creative Wordplay Makes It Easier to Talk about Tough Stuff

Because therapy with adults tends to be based in language, some of the funniest and most playful exchanges involve creative use of words themselves. Amusing metaphors, saying one thing and meaning your mother, and gentle witticisms help the therapeutic relationship become deeper and more dimensional.

In theory, our work and language reside firmly in the land of metaphor: all the therapeutic paradigms rely on it to translate complex ideas, so that they become less daunting or stressful. In practice, a good metaphor can go a long way—if you don’t overdo it—to help clients gain a safe distance from upsetting material. It provides a new perspective that can help them relate to aspects of themselves differently and get unstuck from constricting stories about relationships. A good metaphor can be useful and profound—it can also be quite funny.

The most compelling metaphors unlock the creative part of the brain. We suspend our white-knuckled grip on things as they seem and enter a playful, imagined alternate world. We may suggest a funny metaphor to a client at a frightening developmental transition: “Is it like when an egg breaks, you can’t tell if it’s hatching or getting smashed like Humpty Dumpty?” We can also be alert to hearing the creative, colorful, and incisive metaphors our clients provide to help us understand their lives more deeply and immediately.

One day, a client of mine (Kevin’s) with social anxiety introduced the metaphor of having two characters sit on either shoulder, “constantly bickering, like an old married couple.” One was the worrywart with the what-ifs; the other wanted to get out and live a little. We laughed together as my client played out the escalating bickering in different tones of voice.

“You never want to do anything fun!” one said. “That’s not true: sitting at home is fun!” the other argued. The metaphor, the imagery, and the exaggeration—all generated by the client—gave us more space to play within the intensity of treatment, building our engagement and moving the treatment forward.

Wordplay with malapropisms and slips of the tongue also offers opportunities for new insights through the humor that sometimes attends misspeaking. Again, of course, pointing out an error is only therapeutic or funny if both of us can see the humor in it—so tread lightly. For instance, I (Marti) did not laugh when a client told me I was “opening up Panorama’s Box” with a particular question I’d asked, but it was still funny to me. I similarly didn’t display a trace of amusement when, in a custody battle, one parent accused the other of making their child a “spawn in their game.” Highlighting mistakes in these contexts would be both untherapeutic and unkind.

But here’s an example of a wordplay discussion that helped a therapy move forward. George was having marital problems and came to therapy (with Marti) at his wife’s urging. He reported that she wanted him to pay more attention to her and give her what she needed without having to ask or fight him for it. One day, a few weeks into treatment (and, not incidentally, around the time of March Madness), he began the session by reporting on another evening of bickering. Exasperated, he exclaimed, “She wants me to have ESPN!”

I noticed the slip and knew he’d see the reveal in it, so I asked curiously, “Wait, she wants you to have ESPN?” Together, we cracked up. After a moment, he shook his head and said, “Well, there’s one problem I don’t have!” From this lighter place, we were able to dive more deeply into ways he might find out what was on his wife’s mind without needing to resort to supernatural powers he didn’t have.

With a deadpan expression, a twinkle in my eye, and a slight inflection of sarcasm, I replied, “Yeah, that makes sense.”

Well?

We readily imagine that, in reading our vignettes, you found a few of them, or maybe even all of them, decidedly . . . unfunny. Some of these stories may have even made you recoil: “You said what?!” But that’s really the point. Humor lives in an intersubjective space co-created within the therapeutic relationship. It’s both in the moment and momentary.

Though it gets lost in translation, therapeutic humor can be both welcome and useful. It fosters connection and develops attachment. It supports diagnosis and intervention. It helps us be us and helps our clients be them. You don’t have to be a comedian to find humor in therapy, but you do need to show up with your open heart and a willingness to go off-script and improvise. The best therapy invites the full range of affective engagement; indeed, our clients won’t get better simply by understanding that they need more joy and communion in their lives. They do well to experience these in real time with us. And in these hard and isolating days, that’s no joke.

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Martha B. Straus, PhD, a professor in the Department of Clinical Psychology at Antioch University New England, is the author of Treating Traumatized Adolescents: Development, Attachment, and the Therapeutic Relationship and, most recently, coauthor of the third edition of The Lost Art of Listening: How Learning to Listen Can Improve Relationships.

Kevin McKenzie, MS, is a doctoral candidate in the Department of Clinical Psychology at Antioch University New England. His work and training have focused on integrating developmental and interpersonal perspectives in therapy with adults and emerging adults.

PHOTO © ISTOCK / SDI PRODUCTIONS

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In On the Joke

Teaching clients to find play and humor in their lives should be an unofficial treatment goal. It builds rapport, helps clients reframe what’s going on in their lives, and 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 most of us have some fantastic material in mind, we don’t want to transform into a one-person standup comedy act overnight. And we 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 relay something funny that happened to you—and invite your clients to do the same!

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’d 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.

Kate Sample, MA, LPC
Eau Claire, WI




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