In Therapy

A user's guide to psychotherapy

Laughter in Therapy

Something's funny in therapy

To get to the other side? How droll!
A client jokingly told me his cat was traumatized because “it heard profanity” in the house. I thought he said the cat was upset because of “turd profanity.” I asked “is there something about ‘turds’ that bother your cat?”

We laughed. We recognized the miscommunication and absurdity and laughed about it. A lot.

I recently had a termination session with a long-term client and we spent the time reminiscing about our work together. He recalled a session where he asked a question that seemed to perplex me. The way he pantomimed my puzzled response from a year ago was so exaggerated, so ridiculous, we spent five minutes laughing the kind of aching-face, sore-belly, eye-wiping guffaw typically reserved for old friends or a Flomax commercial. It was awesome. Was this laugh therapeutic? In the final session at that? I think so.

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A journalist recently asked me about the most surprising parts of being a therapist. Among many things, I can honestly say I never expected to laugh this much. It’s one of the secrets barely mentioned in graduate school. Along with the tears, the anguish, the confrontation, the insight, and the mirroring inherent to therapy, there is laughter. Not just the occasional chuckle or sardonic harrumph either, I’m talking about lose-your-breath belly laughs. I once thought therapy was cold and clinical, too serious and grave to allow for laughter. But no, I spend a fair amount of time laughing in therapy. Not laughing at, mind you, laughing with.

Freud said (I know, we always have to trot out Old Man Freud) jokes are the expression of deep impulses that society usually forbids or suppresses. They’re the shocking, unexpected, vaguely inappropriate words or gestures that convey a feeling that many have, but few act upon. “Turd profanity” was so absurd, so out of place in a therapy office, we snickered heartily. The mimicry of my discombobulation was so personally and professionally outlandish we laughed hysterically. They were two experiences of client and therapist sharing a fun moment together, adding a nice chapter to a relationship usually focused on serious issues.

Is laughter okay, or should psychotherapy stay dire and detached? I can think of three great reasons to yuk it up in therapy:

Bonding - Therapists and clients don't take road trips together or do happy hour, they have to find their positive bonding moments in the therapy office. Of course the meaningful moments of empathy and insight builds bonds, but sharing a good laugh does wonders to break down walls. If we laugh at the same stuff, we can't be all that different. 

Perspective - You know a shift has taken place when a client moves from "I do this thing and I'm horribly ashamed of it" to "I do this thing an I laugh about it." It's that head shaking, smiling, "there I go again" laughter that makes issues seem more manageable. It's possible to take our therapeutic work seriously without taking ourselves too seriously. 

Comic Relief - Don't get me wrong, I know we're here to roll up our sleeves and do the hard work of introspection, expression, connection and making life-changing decisions. But even the toughest therapy warrior needs a breather once in a while. An occasional wise crack, friendly ribbing, or non sequitur between deep moments is understandable and may provide a much needed temporary break.

To be fair, giggles aren't always an indicator of great therapeutic work. In the interest of equal time, here are three situations where laughter may not be the best medicine:

Avoidance - Like any deep conversation, there are times when talking about the important issues becomes difficult, and we resort to our trusted defense mechanisms. Some intellectualize, some try to change topics, and some turn it into a joke. When you go for the joke instead of confronting the difficult issue, you miss an opportunity to grow and learn.

Incongruence - There are times in therapy that call for deep, raw authenticity. When a client starts laughing at a situation from their life that is not objectively funny, like their own abuse or a significant loss, I’ll point out how incongruent this is. Many of us learn to cope with tragedy by laughing, but this can also be a distancing maneuver. I can’t face the pain right now, so I’ll laugh at it. This may be fine for a while, but in therapy this defense isn’t necessary. I’ll point out how laughter doesn’t match the data they’re presenting and invite them to feel the emotions beyond the laughter. Likewise, therapists may feel their own discomfort and collude with this defense, laughing along or cracking their own inappropriate jokes when deeper work is warranted. Of course, you're welcome to call this out because you can say anything to your therapist.

Inappropriate Therapist Laughter - Therapists are human. Sometimes they laugh when they feel anxious. Something from their own life may have triggered a giggle fit. Or they may have a sense of humor completely different from yours. Either way, it is possible to have the occasional humor mismatch or misunderstanding. If your therapist laughs and you don’t understand why, you can ask what’s so funny. It’s an awkward moment, but better than wondering if the joke was at your expense.

In summary, laugh in therapy because it feels good and builds the relationship, but ask yourself if you’re laughing to avoid your issues or working your way through them. Healthy laughter builds connection and makes the rest of the work more tolerable. Unhealthy laughter is avoidant and blocks lasting change.

I know I’m not the only person to chuckle in session. Please share your therapy chortle stories in the comments section.

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Come and laugh with, not at, my Facebook page and website.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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