The present report discusses the usage of humor in the therapeutic practice. Various risks and benefits are given and further dissected to determine if humor in therapy is a viable technique that requires additional empirical research. In addition, the characteristics of both the client and the therapist are presented to determine what traits are necessary in each party for humor to be successful in the therapeutic setting. A brief discussion of neural processing regarding humor is presented to facilitate in understanding how using humor may affect a client’s brain. Furthermore, detailed studies are given in order to focus on using humor in therapy with diverse groups, specifically those in a cultural standpoint and families with disabled children. Lastly, implications and future research are presented to highlight the major gaps in the humor in therapy literature.
An Overview of Humor Usage in Therapy
Using humor in a therapeutic setting is a generally new technique that has increased in recent years. Because of this, literature on the topic is scarce in providing empirical evidence, with majority of published articles focusing on the advocacy of utilizing humor in therapy rather than quantitatively measuring its effectiveness through researchers’ conducting tests (Sultanoff, 2013). Therapeutic humor involves both the intentional and spontaneous humor usage by utilizing a wide array of tactics, such as “structured jokes or riddles, pointing out absurdities, unintended puns, examples of illogical reasoning, extreme exaggerations or comical observations of [one’s] surroundings” (p. 171) in the therapeutic setting that leads to the clients improved understanding of their self and their behaviors (Franzini, 2001). The popular opinion of humor usage in therapy is a positive one in which the client is given the opportunity to view their problems as approachable and solvable (Francine, 2001). On the other hand, many potential risks are present due to humor as being a subjective topic. Because the client-therapist relationship is a highly delicate one, the inappropriate usage of humor can destroy rapport between the parties and further cause destruction for the client (Sultanoff, 2013).
According to Vrticka, Black and Reiss (2013), humor appreciation is linked to stimulating a sense of reward on our “neural dopaminergic signals” (p.863) in our amygdala where intrinsic social significance is activated. In essence, we feel a sense of belonging and positive internal arousal when we find an event or statement humorous. Incongruity detection and resolution theory suggests that the brain processes humor as two incompatible elements that create an unexpected violation of moments, facts, or intentions that then lead to arousal in one’s cognition, which is associated with feelings of amusement (Vritcka et al., 2013). So, when two events do not make sense or fit into what we believe is the norm, we will then feel a sense of positive sensation in our cognition that we outwardly label as humor. In addition, when one finds something humorous, catecholamine and adrenaline are produced in the brain which increases both alertness and memory, that, in turn, extends to heightening an individual’s learning process (Chiarello, 2010).
In a study conducted by Chiarello (2010), students felt “a greater sense of accomplishment, sense of self, as well as an overall positive clinical experience when humor was used as a teaching-learning strategy” (p.40). Although this study was conducted between professors and student nurses, it can be established that this connection is similar to a nurse and patient relationship, and therefore, a therapist and client relationship because all are vital in learning, essential in maintaining one’s health and welfare, and presumably delicate in connection since the relations can be damaged easily. Because the client acts as the main party learning from the therapist-client relationship, the therapist must have an already existing knowledge of when humor is appropriate for usage (Chiarello, 2010). If the therapist uses humor at the wrong time, the client may learn inappropriate tactics from the therapist, such as using humor to avoid difficult feelings that may develop overtime and become a defense mechanism. In this instance, the therapist must know when to embrace the client’s overruling emotions such as fear or overt crying rather than dismissing these actualities (Chiarello, 2010).
In a study by Kelly (2002), the significance between worry and sense of humor were measured and results showed that worry was negatively correlated with sense of humor. Researchers in the present study defined sense of humor as “the cognitive ability to manipulate and reframe events as funny instead of frightening, annoying, or stressful” (Kelly, 2002, p. 659). Findings also showed that worriers were less susceptible to taking risks, and that initiating humor was considered a risky situation, which therefore meant worriers were less likely to make such jokes (Kelly, 2002). So, we can infer that clients who show high levels of worry, similar to anxiety, may not initiate humor, but they may still be receptive to a therapists use of humor intervention, that will further result in lessening the client’s worry and increase their humorous state.
Humor has the potential to bring additional benefits to clients in psychotherapy, but it is up to the therapist to already have previous knowledge on how to successfully utilize humor and to contain certain personal characteristics for the technique to be at its most beneficial for the client. Building rapport is among the primary factors in knowing whether a therapist should use humor with a client. Chiarello (2010) claimed that therapists may be able to use humor with low risk clients during instances that are not stressful, in order to simultaneously humanize the therapist and teach the client a lesson. As previously stated, humor usage increased the alertness and memory of the client, so, utilizing humor with low risk clients may allow them to easily recall the humorous moment and lesson taught at a later time outside of the therapeutic session (Chiarello, 2010). In addition to building rapport, it is essential that the therapist already holds knowledge of their client, which refers to knowing the client’s boundaries of what they are willing and unwilling to discuss at that moment, their culture, their personality, their sexuality, and overall the general knowledge of what the client finds funny (Sultanoff, 2013). By assessing what is usual or normal for a client varies across each individual, therefore therapists must remain self-aware in following their gut and instincts when using humor in the therapeutic setting.
Carl Rogers’ proposed the necessary conditions that must be present for successful psychotherapeutic processes— empathy, genuineness, and positive regard (as cited in Sultanoff, 2013). In the present study, Sultanoff (2013) further related these three conditions to the use of humor in therapy and their presence as necessary characteristics of the therapist. Therapist empathy for the client should come naturally, but in regards to humor, true empathic feelings for the client show through the content of the humor used, in which it must come off only as showing care for the client. Genuineness is showing the therapists true self to the client by revealing what they truly find funny and not “laugh falsely out of pity or sympathy” (Franzini, 2001, p. 174). Lastly, positive regard must be present in the therapist where they use humor solely for the benefit of the client and hold no other intentions besides this (Sultanoff, 2013).
On the other hand, clients must also hold certain perspectives and be receptive in situations where humor is being presented from one’s therapist. Vrticka, Black and Reiss (2013) discuss the two components in one’s brain that influence humor appreciation, that is, properly considering what is humorous to the individual— an emotional component and cognitive component. The cognitive component regards the individual’s ability to comprehend the humor being presented, while the emotional component depends on what makes the individual “feel good” and what activates signals for reward and arousal in their brains (Vrticka et al., 2013). Examples where humor may not be receptive from the clients could vary from individuals with deficits in cognitive functioning, such as autism spectrum disorder and schizophrenia who may have difficulties regarding their cognitive component, whereas, individuals suffering from cataplexy may experience an overdrive in positive emotions which affects their emotional component (Vrticka et al., 2013). However, any individual can face difficulties with humor in therapy. The client must be in a humorous state to successfully receive the intended humorous intervention (Sultanoff, 2013). An extreme instance would be if a therapist were to crack a joke in attempts to break the silence with a rape victim or murder witness. This would put the clinical relationship at risk and can further damage the client’s state of mind. In addition, the client must perceive the therapist as an individual who has the client’s best interest at heart (Sultanoff, 2013). Overall, for the humorous intervention to be successful, the client must be well aware of the humor, find it funny, and perceive that the therapist presented the intervention from a compassionate and genuine self.
When both parties, the client and the therapist, are in sync with utilizing humor in a therapeutically successful context, numerous benefits arise. As we have already stated, utilizing humor can assist in building rapport with a client and improve their memory and comprehension. The use of humor in therapy can also facilitate relaxation, promote flexible thinking, increase insight and understanding between both parties, and decrease the resistance within the client (Consoli, Mandil, Bunge, & Whaling, 2018). When the client begins to feel relaxed with their therapist, a sense of calmness, comfort, and security is formed between the client and therapist which allows the therapeutic setting to become a safe space for the client. When a client is in distress, humor can make overwhelming tasks seem both accomplishable and may even create a satisfying experience when diffusing anxiety or stressful situations (Consoli et al., 2018). Overall, humor utilization in therapy can help the client enjoy the self improvement process in addition to creating a lighthearted atmosphere where the client can take constructive criticism lightly rather than beating themselves up for a trait or mistake (Sultanoff, 2013).
Like all techniques, similar to confrontational and interpretational techniques, humor comes with both advantages and multiple risks since its success relies heavily on the therapists’ opinions and assumptions (Sultanoff, 2013). The major risk of using humor in therapy is that it can completely destroy the therapeutic alliance for various reasons. Just like confrontation, if humor is presented at the wrong time or interpreted inappropriately — such as if the client is unprepared to accept the given information in a lighthearted tone and takes it as an insult— it can make matters worse for the client, which can result in the client feeling offended or thinking that the therapist is uncaring, hostile, insensitive, or even lead to termination (Sultanoff, 2013). Additionally, if the therapist utilizes humor that veers away from the sole benefit of the client, then it can further disrupt their safe space. For instance, if a therapist presents an experience in attempts to “better” the client’s experience or instantly uses the clients humor to diagnose any hidden tendencies, the therapeutic intervention would be counterproductive (Franzini, 2001). In this instance, genuine laughter with the client would be the most acceptable when they present an experience that is both parties find humorous and relevant and beneficial to the client’s case. From the clientele standpoint, risks of using humor can act as a defense mechanism where the client is deliberately using sarcastic remarks and jokes to avoid difficult and vulnerable topics when it is necessary to discuss them head on (Chiarello, 2010). When a client is using humor as a defense mechanism, it may be ideal that the therapist should avoid using humor simultaneously because it may falsely validate the client’s technique when avoiding the discussion of specific topics. When the therapist embraces the emotion at hand, it will validate the client’s feelings and allow them to feel safe in embracing that emotion themselves (Franzini, 2001). So, the therapist must constantly be aware of the client’s present emotion so that it can be properly validated, and at times, humor may not be the proper technique to use.
Therapists’ knowledge of their clients and how to utilize humor are vital in making this type of intervention a success. However, because humor in therapy is a relatively new therapeutic technique, therapists who find their already existing practices effective may deem it unnecessary in adding this new tactic to their practice (Franzini, 2001). And, due to its subjective nature, it is not surprising when therapists report that they have excellent senses of humor, but may not perceive themselves as active humorists or advocate its use in psychotherapy (Franzini, 2001). Similar to the worriers in Kelly’s (2002) study discussed previously, one can report having a great sense of humor, but initiating humor with strangers can be considered a risky situation, and so, the therapeutic setting may not be an ideal place for therapists take absurd risks regarding humor that could harm the client.
Because of the lack of empirical research on humor techniques, it is vital for practitioners to develop formal humor training in forms of seminars, workshops, and especially role plays so that the basis of humor techniques can be learned (Franzini, 2001). Role plays would specifically be beneficial for therapists because they will have opportunities to experience various instances where humor can be used with a client, or learn alternative responses if humor is used inappropriately from either the client or the therapist. Franzini (2001) claimed that novice therapists are historically discouraged in using humor by their class instructors and clinical supervisors. But, one must consider once these trainees become licensed, the use of humor in their practice becomes an opportunity that, like any other technique, requires some guidelines and additional training outside of licensing procedures. In addition to formal humor training, researchers must conduct more quantitative studies to measure specific aspects of humor in therapy since majority of the literature is to advocate for the use of humor, rather than presenting clinical evidence (Franzini, 2001). Implications such as focuses on how to use humor in therapy, learning techniques for novices, when it may be most appropriate to use humor, and who it would be most effective with, are some more specific questions that existing literature fails to answer (Franzini, 2001).