Therapy

The Beneficial Use of Humor in Psychotherapy

A therapist's careful use of humorous interpretations can facilitate changes.

Posted Feb 19, 2020

In art and literature, irony and humor serve to exemplify, instruct, charm, provoke, enrage, and otherwise move both readers and viewers. More important for the therapeutic use, however, humor serves as a cue to the patient that something other than a literal faultfinding meaning is intended.

Nevertheless, the use of any type of humor in therapy has been a topic of some controversy. A therapist’s display of wit or humor is considered by some to be, at a minimum, either seductive or competitive or self-aggrandizing and, at a maximum, a way of shortcutting and suppressing the exploration of a patient’s psychodynamic concerns. All of these criticisms are potentially valid but they need not deter the proper use of humor in therapy. They serve both to emphasize the potentially useful functions of therapeutic humor and as cautions or limits regarding improper use.

First, although it can be used seductively by the therapist, humor does have the function of facilitating intimacy and warm relationships. It can be used to help the patient to feel intimate with the therapist without an accompanying feeling of guilt and fear. It can demonstrate a therapist’s genuine positive feelings toward the patient and his willingness to relax and be friendly, and it can allow the patient to experience similar feelings in return. With some patients, relaxed or positive feelings are far more risky and guilt-ridden than are negative hostile ones.

Second, although humor can be used to obscure and bury issues that are anxiety-provoking both to patients and therapists, it also serves as a valuable release of anxiety in circumstances where therapy has become bogged down or where anxiety has reached an insupportable level. Each and every conflict that a patient brings to therapy is not necessarily explorable.

Third, although humor can be used just to display the cleverness and wit of the therapist, it nevertheless does derive from positive skills. It requires a certain degree of flexibility and freedom on the therapist’s part and usually the same type of skill with words that is required in every psychotherapy. Also, it often requires a certain degree of perceptiveness and insight. Moreover, as some identification with the therapist always occurs, exposing these skills and attributes may serve as a positive model for patient development.

Finally, although humor often has an aggressive component, it is not therefore necessarily hostile to the patient. Aggressiveness in humor may not be at all greater than that in literal admonitions, confrontations, or even direct interpretations. When humor and humorously-stated irony become charged with hostility, there is a shift into sarcasm. Although technically sarcasm is considered to be a form of humor, it does not share any  of the positive characteristics I have just outlined.

Seldom, if ever, does sarcasm or a sarcastic intervention have a use or valuable function in therapy. Although sarcastic interchanges between two individuals may seem humorous to a third party, they are always hostile attacks at the expense of one or the other individual. The dividing line between friendly humor and sarcasm is sometimes rather thin and for this reason humor must be used with care in the therapeutic situation.

The simultaneously antithetical character of an ironic remark is critical both for its non-hostile effect and for its operation as a therapeutic intervention. When both the literal aspect and its implied opposite are conveyed and experienced as meaningful and applicable, the ironic remark then functions as an interpretation of conflict. Beyond a simply literal interpretation, moreover, the humorous ironic intervention provides an affective acceptance of the patient’s hostile wish.

Rather than literally telling the patient that he is all right and uninjured, he enacts and demonstrates his comfortable state of being with his good humor. if that were not the case, however, the ironic intervention can convey a greater degree of acceptance by the therapist than other types of interpretations.

A moderately depressed person, for example, may pour out a series of complaints about himself, such as: “I try to be nice to people but it never seems to work. Everybody acts as though I’m antagonistic, or lazy, or a bother. I used to be able to make friends; I used to have a lot of energy. I don’t know why I try; I feel like giving up.” To these, the therapist may ironically reply: “So, I guess you’re just a worthless, nasty bum.” Such a comment conveys the therapist’s implied formulation of the opposite, i.e., “you’re not worthless,” and it also conveys an understanding that the patient actually does feel worthless. Moreover, instead of simply reassuring the patient, it acknowledges both sides of the conflict. On the one side, there is the element of truth in the self-deprecatory content of the complaint that commonly appears in depressed states. The patient is, and wishes to be, passive and nasty. On the other side, there is the wish to be active, make friends, and feel a sense of self-esteem and worth. Both sides are interpreted and, because of the friendly, humorous tone, acceptance of both sides is conveyed. It is necessary that the patient both apprehend the irony and apply it in the ongoing therapeutic process.

Usually, this is manifested by a development of insight which may or may not be expressed by the patient as a prepositional or intellectual formulation. For example, a patient was considering terminating therapy but the therapist knew that he was deeply ambivalent about doing so. Beginning a therapy hour with the description of a highly problematic situation at his office, his rendition of the details made it clear that he had become entangled in, for him, a repeated constellation of difficulties. He was being downgraded by his co-workers and his boss, a circumstance in which he characteristically responded with passive withdrawal. As he recounted the story, he began to talk about his growing awareness of the constellation and of his own tendency to withdraw. Reporting that he had this awareness in mind while working in the office the previous day, he described himself taking an active stance. He told his coworkers how much he resented their scapegoating and, in addition, took on a job for the boss that he completed successfully.

Although he told all this to the therapist with some hesitation and discomfort, a distinct tone of pleasure also crept into his voice as he reported his effectiveness and success. The therapist at that moment became aware of the patient’s simultaneous wishes for both success and failure conveyed by the content of the tale and the manner of presentation.

Thus, in a friendly tone of voice, he said: “Well, now, we can’t have that kind of behaving! For all we know, you’re going to continue doing this kind of thing; you’re going to keep on understanding the source of your difficulties and correcting them. You’re going to begin to be able to handle yourself in all kinds of difficult situations. The next thing we know you’ll feel that you’re better and will want to terminate therapy. Then, you may even feel cured. We can’t have that! What are we going to do then?” The tone, as I said, was friendly. The patient, who had heard humorous comments from the therapist before, smiled and immediately replied, “Yes, we can’t have that. What am I going to say to my friends and my wife if I’m better?”

Following this, he started tentatively exploring some specific goals in that session that might lead to termination of therapy. He continued to work on these goals in subsequent weeks. In this ironic formulation, the therapist conveyed that he was aware of the patient’s conflict about success and failure and interpreted both sides at once. He spoke literally of the sequence of the desired events that might follow the therapeutic movement and also acknowledged the patient’s desired opposite in his negating and humorous phrasing. He indicated uncritically that the patient might wish to fail in order not to leave therapy and still be perceived as being ill —an aspect of the interpretation verified by the patient’s own ironically stated and insight-containing response. Also, he showed support and friendly pleasure for the patient’s genuine wishes to improve and be on his own.

It is necessary that a humorous ironic intervention be related to the patient’s specific conflicts and that the opposites involved develop from the particular context. Using humor for its own sake also will not necessarily touch on a patient’s concerns. Using humor in the form of jokes told to the patient, or in the form of witty aphorisms, is similar to other types of storytelling or to what Milton Erickson called “embedded metaphor” technique. It will be effective if it derives from careful observation and understanding of a patient’s specific concerns. To know that this is so requires a patient’s confirmatory responses.

It is important to emphasize, however, that all life experience is perfused with irony and paradox. Life ends in death, wars are raged for “moral” reasons, evil is banal. Many of the formulations I mention ultimately derive their validity from the intrinsically paradoxical and ironic nature of life itself.