Taylor Larsen, PsyD, LPC, CCTP-II
Believe it or not, therapists have lives outside of the therapy room. After graduating with my doctorate, I quickly became bored with being a psychology expert. I needed more spark and creativity in my life, so I undertook stand-up and comedy writing. Upon the first day of comedy school, my entire perception of the world, others, and life changed. I was introduced to a new way of thinking. Comedy makes me want to pick up rocks and turn them over. It makes me want to play devil’s advocate. It makes me want to look at the consensus and search for holes. It makes me want to find the parts of life that people aren’t talking about. It makes me obsessed with finding things that are truthful and yet surprising. That’s where the juice is. It’s given me a different way of seeing the world. I love that and wouldn’t trade it for anything. Comedy and my job as a therapist are a huge part of what makes me me. I have learned to allow myself to collide the world of comedy and therapy together, and it has been life-changing not only for my clients but for myself too.
What’s So Funny?
It’s sometimes difficult to picture humor itself as an intervention, but I believe it can be a powerful way to connect with our clients. I openly invite humor into the therapy room because it often feels like our expected seriousness as therapists paradoxically pushes away our client’s chance for deeper reparative emotional experiences. I chuckle when I think about the archetypal, uber-serious psychiatrist, Dr. Leo Marven, from the 1991 comedy film “What About Bob?” I wonder how safe his clients felt in sessions with him. He sets up a clear power differential with his cold, lawyer-esque office to convey he’s there to “fix” clients. Of course, this hilarious movie purposefully conveys the ridiculousness of Richard Dreyfuss as a self-important psychiatrist, but it also shines a light on the near impossibility of deep therapeutic work when clients fear our clinical stature.
I am not suggesting we respond to all client tragedies with our best one-liner; humor must be sensitive and thought through.[1] As with any other intervention, I rely on clinical judgment when assessing a client’s openness to humor. One day, a long-time client of mine, Brittany (whose name is obviously not ACTUALLY Brittany), sat across from me in session teary-eyed. She had just spent a solid five minutes weeping over a recent break-up, and I could see that both her body and mind were exhausted. Instead of reaching for my Kleenex box to wipe her face, Brittany pulled a half-used roll of toilet paper from her purse. I watched as she unrolled a solid foot of it. She looked up at me, my head tilted as I watched her with a slight smile on my face. At that, Brittany burst into laughter. I then remarked, “I’d like to thank you for your Kleenex Conservation efforts, Brittany. I was running low.” In that exchange, my smile and humor reflected both an acknowledgment of Brittany’s exhaustion and prompted her much-needed emotional shift.
Uniform humor is not appropriate across the board, however. I would not have used this same intervention with a new client. What if she didn’t have the ego strength for this sort of acknowledgment? What if her parent had just passed away, or she feared being put on the spot? This joke deepened an already-established therapeutic relationship that took time to build. I always monitor for intentionality and appropriateness when integrating humor into sessions. Properly executed, I’ve witnessed humor reduce high levels of depression and anxiety in the room.
Regarding anxiety, I’ve used humor to address some very large elephants in the room. For example, working with traumatized, marginalized, and underprivileged clients, you bet some of these clients size me up at the first meeting. Many of them have been deeply wounded by negative experiences with “The System,” be it the justice, political, social, healthcare, economic, or systemic systems. And, to some of them, I am seen as a socioeconomically privileged extension of this oppressive system. I quickly learned authenticity and transparency are the best ways to gain trust and connect with these clients. I give them both. For instance, 18-year-old Jason came into my office for an initial session. He sat down, guardedly looked at the ground, and muttered, “Hey,” pulling his black Slipknot hoodie covered in graphic blood over his head. His hypervigilance was palpable despite stating that “nothing” was wrong in his life. As a matter of fact, he mentioned he wasn’t sure why he was even attending therapy outside of his girlfriend, making him go for “anger issues.” He reported feeling that discussing his concerns is pointless, as people do not change and will always be “rude, evil, selfish, and greedy.” After a few shrugs for answers, I stopped asking questions and sat back in my chair.
“Jason,” I said quietly, “Can I tell you a secret?”
His eyes peered from behind his bloody hoodie with reserved interest.
“Jason. I get it, sometimes ‘people equal shit’…” – A phrase from Slipknot’s song, “People = Shit.”
He looked at me incredulous. A moment passed. He then put his hand in front of his mouth, dropped his head, and started laughing uncontrollably.
“No, she didn’t”, he said.
“Oh, I totally just did.”
He made eye contact with me for the first time in the session and stated, “We're cool now.”
That joke expressed my respect for Jason by acknowledging and validating his feelings around the fact that sometimes people hurt us, and at times, it can make us feel helpless. I modeled authenticity and owning who I am (which is a metalhead) for Jason while establishing my humble intent to understand and hear his story.
How Does Laughter Work in the Therapy Room?
Laughter enhances attachment between therapist and client explicitly (consciously) and implicitly (unconsciously). Explicitly, when we laugh in the room, we convey our humanity and humility to clients. We express that we are not “thera-bots” merely seeking to “fix” them, but instead, like our clients, complex beings with many sides, one of them being silly. I’ve been stunned by how expressing my humanity through a quick quip reduces a client’s need for defense.
Implicitly, synching up with a client’s nervous system through humor works to reduce anxiety and depression, increasing one’s capacity to feel the pleasure needed for developing healthier self-regulation. I base this neuro-psycho-biological power of laughter on, among other sources, Dr. Allan Schore's Modern Attachment Theory teachings. Dr. Schore consistently provides breaking research on the effects of early attachment trauma on the brain. In his publication, “Attachment and the Regulation of the Right Brain” (2000), he explains that because a baby’s central nervous system continues to develop postnatally, one key early task for a primary caregiver is to co-regulate the child’s nervous system through right-brain-to-right-brain attachment behaviors. This right brain implicit attachment (differing from left brain explicit attachment) must include a capacity to both upregulate the child (create pleasure) and downregulate the child (soothe distress). Ideally, the child internalizes this modeling over time, learning how to self-regulate. If these attachment tasks are not met, that child may be thrown into emotional dysregulation, which, compounded over time, leads to many of the mental health issues presented in our rooms. Based on this concept of neurobiological primary attachment trauma[2], one of my goals in therapy is to help repair emotional dysregulation beneath presenting issues. Over time, I work with my clients to help repair attachment trauma through conscious and unconscious empathetic connection via syncing up the right-brain-to-right brain, helping them hone tools for self-regulation.
Clinicians often focus on downregulating clients when presented with heightened anxiety. Indeed, quick breathing and bouncing knees call for some grounding exercises. However, a clinician’s ability to upregulate their client’s nervous system is equally important in co-regulation. This is where humor comes into play. It works as a chain reaction, enhancing attachment between therapist and client and then reducing anxiety and depression, which then increases a client’s capacity to experience authentic praise. This praise then works to elevate self-worth, which ultimately reduces presenting issues. In addition to co-regulation, Judith Nelson (2008) explains that humor in the room may provide “clues about attachment style, patterns of affect relation, (and) attachment history (p. 47)”.
That’s Not Funny. Avoiding Humor in Therapy.
Can humor in the therapy room hurt clients? Any intervention can do this, especially if overused, careless, or inappropriate. One popular opponent to humor in therapy was the late psychoanalyst Lawrence Kubie. Kubie (1971) expressed his concern, claiming humor may heighten a client’s resistance, muddle the therapist-client relationship, and/or encourage a client to mask feelings. I half agree with this idea. I do think inappropriate, thoughtless jokes have the potential to injure clients, and I strongly advise against them. However, with or without jokes, therapists make mistakes in the room all the time. Additionally, a client’s negatively distorted perception may twist around anything a therapist says or does (humorous or not), resulting in damaged rapport.
Most arguments against using humor in the therapy room are not against using humor overall but rather against using specific forms of humor, such as sarcasm or self-deprecating humor. Though Albert Ellis was known to promote the use of sarcasm as reality testing in his Rational Emotive Behavior Therapy (REBT). I find that sarcasm is humor laced with a bit of crude honesty that most people use to deride or disrespect others. Even in everyday life, that style of funny tends to go over poorly. No one is a fan of being mocked.
That’s Only Sort of Funny. When Clients Make Jokes.
I keep my eyes open to all variations of defense, laughter included when sitting with some of the darkest trauma out there. Most of us have seen and heard this darkness, horror stories our clients have told us with blank or incongruent affect. A client laughs, and we wonder what she could possibly be finding funny. My 26-year-old client, Lacey, once sat across from me, describing how she would systematically cut five vertical lines into her leg. She then giggled, adding: “I’ve been thinking of switching it up to four vertical lines with a diagonal slash to indicate five.” After that, I sat in silence with her for a while, allowing her space to access the probable despair beneath her masked smile. This would not be a time that I joined in with her humor, but instead a reminder of one of humor’s important functions: Survival.
Viktor Frankl, in his book “Man’s Search for Meaning” (1963), describes in dreadful detail his daily life as a prisoner in the Auschwitz Concentration Camp. He poignantly observes the use of humor to survive, explaining that it helped prisoners find a sense of meaning and purpose in their lives even with death and disaster all around them. When faced with trauma and grief, we humans try to make sense of the senseless. And when we can’t, we sometimes cope by making fun of it. One of my favorite quotes from Frankl’s book remains: “Humor, more than anything else in the human makeup, affords an aloofness and an ability to rise above any situation, even if only for a few seconds (p.54).” A client’s ridiculous exaggeration and mocking of trauma for the purpose of comic relief may be exactly that: a moment of relief as they process deep pain.
Final Thoughts.
Psychologist Rod Martin (2006) surmises that research on the effects of humor in therapy is limited, running the gamut of negative, neutral, and positive results. I’ll add that each clinician’s unique mixture of educational background and clinical style colors any intervention implemented, including humor. As clinicians, we get to choose what style of humor to use and when to use it. We must be thoughtful and appropriate with its use and prepared for our clients’ reactions, as well as their dishing it out. If you’ve never thought of using humor in therapy and the opportunity presents itself, consider trying it. It may create a new pathway of both conscious and unconscious empathetic connection. If a joke does go south, as with any therapist-client conflict, your bomb may provide the opportunity for a reparative emotional experience through processing that disconnect.
A good starting position on your clinical humor journey is a solid idea of therapeutic humor. The Association for Applied and Therapeutic Humor created a great definition: “…any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life’s situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, or spiritual (2014)”. Essentially, don’t be a stick in the mud. Life can be funny, and it’s okay to laugh when it is. Using this base, connect with your authentic self as a clinician, have fun, and laugh.
Comedy will always be a part of me. I cannot deny the feelings of intoxication brought on by audience laughter. In my experience, Stand Up can feel like empty validation and hinder human connection. Only a caricature of myself connects with an audience that is hardly visible through stage lights. When I laugh with my clients now, I’m not pulling laughs; I’m sharing them. Which feels more satisfying, authentic, and fulfilling. [3]
References:
Association for Applied and Therapeutic Humor [Website]. (2000). Retrieved (2014) from http://www.aath.org/general-information
Frankl, V. E. (1963). Man’s search for meaning: an introduction to logotherapy, pp. 54. New York: Washington Square Press.
Kubie, L. S. (1971). The destructive potential of humor in psychotherapy. American Journal of Psychiatry, 127(7), pp. 861–866.
Martin, R. (2006) The psychology of humor: An integrative approach, pp. 346- 349. Burlington, MA: Academic Press.
Nelson, J. (2008). Laugh and the world laughs with you: An attachment perspective on the meaning of laughter in psychotherapy. Clinical Social Work Journal, 36, pp. 41-49. doi: 10.1007/s10615-007-0133-1
Schore, A. N. (2000). Attachment and the regulation of the right brain. Attachment & Human Development, 2, pp. 23–47.
** Taylor Larsen, PsyD, LPC, CCTP-II, is a psychotherapist currently running a private practice in Phoenix, Arizona. She is also a Certified Humor Professional and Laughter Leader who completed her Humor Project focusing on Exploring Comedy as an Intervention for Trauma and Eating Disorders in 2023. Dr. Larsen is a Humor Researcher through the International Society of Humor Studies and continues to practice humor daily in the therapeutic setting.