Humor in Evaluating and Treating Children and Adolescents - NCBI

Humor

in Evaluating

Children

and

WILLIAM

can provide

ing the psychiatric and

adolescents

demonstrate nostic

Clinical

how humor

help

the child

with

resistance.

humor

itself

Humor

examples

is useful

as a diag-

conduct

and adolescent

and

patient

help the therapist

may

In some can

become

aggression, problems.

of using

humor

the

and the role of technique. Humor

circumstances, an agent

social Both

the

ineptitude,

the benefits

exdeal

and

T

hat

statement

The

author,

was

published

Charles

in

R. Shaw,’

1961.

described

several ways in which he used humor ing with children and adolescents.

in workThis arti-

of de-

cle

and

and

material has been

of change.

has been used in the treatment

pression, risks

of children

tool; how it can be used to shape

plore feelings

For the child psychiatrist, humor is an indispensable diagnostic and therapeutic tool. Some of us use it often, others seldom; some employ it deliberately and with a careful awareness of its meanings, others more spontaneously and intuitively. It has a major function in both the outpatient office and the inpatient treatment center.

dur-

information

can also faci litate the

therapeutic relationship; hunwr as a therapeutic may

M.D

evaluation and

process.

therapeutic

useful

Treating

Adolescents

BERNET,

Humor

and

the

builds

ence

are discussed.

on

Shaw’s

observations

from the intervening derived from both

and

research

Humor eral reasons.

adds

30 years that clinical experi-

in humor.

is important As children

for children for sevgrow cognitively and

socially, they become aware of humor, and their awareness grows through developmental stages. Humor is a component of peer relationships.

part cents humor that

The

of what

ability

it takes

to feel a sense of can be important adults

have

with

cents in parenting, ical care. Because

Vanderbilt Adolescent

1992;

From

University, Psychiatric

a joke and

is

adoles-

competency. Also, in the exchanges and

children

education, humor

many ways for young people, that it should be important ReceivedJanuary8, June 22, 1993.

to enjoy

for children

adoles-

and even is important it seems in the

medin

natural psycho-

revisedJune 21, 1993; accepted the Department of Psychiatry, and the Vanderbilt Child and Hospital, Nashville, Tennessee.

Address reprint requests to Dr. Bernet, 1601 TwentyThird Avenue South, Nashville, TN 37212-8645.

Copyright

JOURNAL

OF PSWiIOTHERAPY

PRACTICE

© 1993 American

AND RESEARCH

Psychiatric

Press,

Inc.

308

WrrH

HUMOR

therapy

of children

and

adolescents.

of affects;

The use of humor in psychoanalysis in the treatment of adults, adolescents, children

has

been

discussed

Golan,7

and

Saper8

humor

in group

au-

casm

in confronting

discussed

the

involving

these tages

tween

chiatric

patients.

theoretical psychoanalysis,

and

development

Poland9

discussed

clinical aspects of humor in saying, ‘The facilitating of the

of the patient’s

capacity

ture

humor

is one of the happiest

est

effects

of

Shaughnessy

clinical and

the research

analysis”

Levine,’2

and

and

proud-

(p.

224).

Ventis,’4

from

1970

and

Shaw,’

Yorukoglu’5

Schimel’9

discussed

the use of humor

chiland in treat-

ing adolescents. Most of these authors suggested one or two ways in which humor might be used in evaluating and treating children

agent

resistant

or modifying

adoles-

of

the therapeutic

as promoting rapport beand client; humor as a diag.

of change. In addition,

advantages humor

I describe

the potential

and complications into

Although

in the clinical

humor examples

in this article, in some instances there risk that the patient would misinterpret said.

At all times

the

dis-

of introducing

psychotherapy.

successfully

therapist

was a what

must

be

sensitive to how her statements will be understood. Humor can be a powerful tool in psychotherapy, [Note:

but it can also be dangerous. General references below to ther-

apists and patients use feminine and masculine pronouns, respectively, for readability.]

and adolescents. The purpose of this article is to review and organize the material that has

HuMoR

AND

THE

THERAPEUTIC

been published previously and to describe several new ideas about how humor might be with these patients. Among the techniques and material described in this article, some are well known to therapists who work with young people, such

highly

nostic too4 and the use of humor as a therapeutic technique; which includes using it to explore feelings, to deal with resistance, and as an

was

described the use of humor in treating dren, and Bernet,’6 Prerost,’7 Saper,’8

such

therapist

was used

to 1990.

Orfanidis,’3

therapy,

in shaping

relationship,

for ma-

Wadsworth’#{176} summarized

on this topic

Gardner,” Ventis

both

assign-

and employing especially using sar-

This article considers psychotherapeutic humor from three perspectives: the use humor

both the advanhumor with psy-

homework

humor;

cents.

use of humor in the treatment of adult patients, giving many clinical examples. Most of authors considered and the risks of using

AND ADOLESCENTS

patients

ments

by various

have

giving

and and

thors. Coleman,2 Fry and Salameh,3 Haig,4 Kuhhnan,5 Reynes and Allen,6 Rosenheim and

CHILDREN

RELATIONSHIP

used

as

using

sense

therapist

ing-, using humor to explore feelings; and using humor to deal with resistance. Some of the concepts discussed here are relatively

interrupt

new, in that they have been described rarely or not at all in the literature. Such techniques include using humor to communicate mutu-

peutic

tions

using that

treatment;

the diagnostic

rapport; process

using

in several

cognitive development, social development, and some aspects of psychological function-

ality;

create

be used

therapist a sense

during

to

may

to assess

humor

in the inventory

VOLUME

2

#{149} NUMBER

that

the

something

in common; the

cent patient the ultimate

to influ-

and

brings purpose

the patient

and to challenge

assumptions

Humor

Nonpsychiatric mental

likely than

4.

and the patient; to of mutuality, i.e., a

that

the

have and adoles-

to the relationship, with of improving the thera-

alliance. Using

humor to interrupt the assumpthe adolescent patient brings to including

ways

ence and shape the therapeutic relationship. It can be used to promote a positive rapport between the communicate

humor

humor

Humor

FALL 1993

to Create

Rapport

physicians are health professionals

more to use

309

BERNET

humor for the purpose of building For instance, a gastroenterologist

rapport. told his

young patients a funny joke having with dirty underwear, and orthopedic geons

this remark

may overuse

who

have broken their arms:

your

humerus.

to do sur-

funny,

times said something ridiculous to the youngster, such as, “Good morning, doctor, did you wish to consult with me about a patient?” and

thoughtthat conveyed

inely

observe

reassured

his company. the child’s

Others

might

He

would

it awkward

trived to try to be funny at the psychiatric evaluation. However, make sense to insert ajoke the evaluation process.

care-

and

con-

onset of a it might

at a later

point

in

up his own joke

his fear of injury body part.

some

Although

the therapist

joke,

another

a different have

from

Charlie’s

righttime

asked

and

the

therapist place might

approach.

The

the patient

it is useful of mutuality,

Mutuality

in therapy to prowhich is the sense

and the therapist

are

in the

both

struggling

may

be imposing

have some-

same

with

boat,

issues

and

that they

and forces

are that

powerfuL

During the height of the Cold War there were fears that a nuclear conflict might occur. A psychiatric resident was treating an older adolescent, and he knew that they both were anxious about the international tension. At the end of the hour he said, “I’ll see you next week, if there is a next

OF

mutuality, about

that the patient

were sharing the same In addition to communithe resident’s

the next

ing the tension another

humorous

appointment

re-

seemed

to

they both were experiencillustrates the fine line the

therapist must recognize that is helpful and hurtful.

little

preferred

therapist

communicated

defuse the anxiety ing. The example

it

that

have

week.”

remark

mark

to

thought

he learned

JOURNAL

for

between humor Instead of reduc-

in the air, the same remark

patient

might

increase

to

anxiety.

was

genitals

to make

clinician

Charlie where

that

cating

other

was the

Sometimes a feeling

and the therapist human experience.

doing several things at once: building rapport by responding in kind to the patient’s joke; communicating that the therapist respected Charlie’s sense of humor, and presenting a kind of test, to see if the patient was willing to displace

the material

to Communicate

mote

That

Charlie, a 9-year-old boy who had been admitted to an inpatient program because of habitual firesetting, spontaneously related ajoke. He asked the therapist if he had heard about a particular man who was shot in the war. “Do you know where was he shot? He was shot in the Philippenis” The therapist responded by asking Charlie if he had heard about another man who was shot in the war. “Do you know where he was shot? He was shot in the German-knee.”

By making

Humor

filed

to his initial

him diagnostic inforas to how to proceed

find

Using

therapist

was genu-

response

gambit because it gave mation as well as clues with the interview.

simply

reference.

thing in common. The therapist may want to get the point across that the patient and the

the child

that the interviewer

enjoymg

fully

humor

have

future

is it?”

Shaw began his initial interviews with children with humor. For instance, he some-

Shaw

or could

to children

“Well, you broke

But it isn’t very

about the man who was shot in the war; could have asked Charlie if he knewanyotherjokes;

could thejoke

PS’StHOTHERAPY

Using

Humor

Interrupt

the

to

Assumptions in this

Humor

used

surface,

but its purpose

way seems is quite

funny

on

serious.

In reviewing the literature, I did not find a previous description of this technique, which is intended to challenge and modify the assumptions that the adolescent patient brings to treatment. Some adolescents exert control over adults by engineering power struggles,

PRACTICE

AND

RESEARCH

310

HUMOR

marked

by dramatic

parents.

Such

therapist

and expects

he will misbehave will disapprove and

arguments

an adolescent

then

they

the same

will argue

out

that

their

of his

relationships

previous

therapist.

AND

ADOLESCENTS

his father

with

and

HUMOR

AS

A

DIAGNOSTIC

TOOL

his behavior.

for the therapist transference, that patient

is assuming

Humor can be used in several ways in the diagnostic process. Considered together with other information, humor can indicate the

that the therapist is going to be the same his parents. In that scenario, the adolescent

as

level of cognitive and social development children and adolescents. The child’s

seems

of

structive of mental

to sit back

and

the interview. An innovative disrupt

control

the

therapeutic

the scenario

with

course

approach

is to

That

is, the

humor.

works, both therapist and patient laughing together. More important, tient

has been that

thrown

therapy

off balance

is not

end the because

as predictable

than the patient. the power struggle

he as he

thought it would be. Most important, ever, is that the therapist controls the view rather undermines

up pa-

howinter-

The therapist that the ado-

lescent usually developed as his primary fense against acting responsibly. Finally, therapist’s

active

unexpected

use

situation,

of

humor

which

creates

gives

feelings and new defenses. One risk of using humor that both patient and parents fended.

The

patient

for the therapist

might

feel

an

rise to new

in this might

to be teasing

dethe

way is be of-

it is strange him.

The

par-

ents might miss the point and feel that the therapist is not taking their child’s case seriously. In

an

eloquent

article,

Schimel’9

de-

scribed a gentler version of this use of humor to interrupt the assumptions that the patient brings to the meeting. Schimel explained how he had introduced

“a note

of mental

Cognitive McGhee20’2’

illness.

Development has described

the

develop-

ment of a child’s understanding of incongruous humor through several stages: the use of an object in an incongruous action (a girl pretending to comb her hair with a pencil); the

incongruous

events

(a child

labeling playfully

of

objects

referring

and

to a boy

as

a girl); conceptual incongruity (laughing at a cat that is saying “moo”); and the awareness of multiple meanings (the use of puns in riddles). McGhee thought that the appreciation of riddles requires concrete operational thinking. A higher level of humor, the appreciation of irony, cence

does

and

tional

not

the

occur

until

beginning

thought.

McGhee

early

adoles-

of formal

opera-

explained

difference (concrete

between the incongruity operational thinking)

congruity ing). In

of irony a pun,

through more pened

fantasy.

the

of a pun and the in-

(formal operational thinkincongruity is resolved The

realistic, in that that is unexpected

incongruity

in irony

something but not

is

has haptotally im-

possible.

of playfulness

and humor” male, which

in therapy of a late adolescent resulted in the patient feeling

amused

puzzled.

and

of con-

use of humor can be an indication health; a child’s humorless outlook

may be an indicator

therapist teases the patient about his behavior, makes fun of it, and parodies the behavior to the point of its being ridiculous. When this

finds

his

that

the therapist the patient;

about

the

CHILDREN

to the

scenario:

in some way; and admonish

The traditional intervention would be to interpret the is, to point

with

is brought

WnH

In the end,

the patient

was able to develop a healthy alliance with Schimel that was not simply a recapitulation

VOLUME

2

#{149} NUMBER

Social

Development

Humor is important in the gradual formation of the child’s social awareness. When the child

learns

4. FALL 1993

that incongruity

can be funny

311

BERNET

as well as puzzling, he is in part modeling response on the reactions he has observed others.

Most

humor

has a significant

sonal

aspect to it: ajoke it is shared with someone

is more else.

his in when

ite jokes

favorite joke of a 9-year-old would propriate if it involved ariddlebased favoritejoke

likely

of a 13-year-old

be based

on irony. the maturation

ceptualized several

developmental

ating

a child

Mental The therapist’s ing device

evalu-

but their

child may half-hearted quickly

and

seldom

ways

to looking

social

and sense help

are

competency

Being

the humorous

a youngster “Tell

get Your

A therapist

found

whether

through

hard

Favorite

Joke”

useful

share some little with the evaluator. Many

therapists

the piece

patient

he

had

to say. The

child

child’s

joke

in family

use

permission,

the

and

the meaning

explain

the parents. Sometimes effective, because the

therapist

that parents

of the

therapy.

With would of it to

was extremely realized that

the humor tapped into feelings that the child had not been able to express effectively.

One

Inventory

of Affects

way to organize

view of a new various feelings

the diagnostic

inter-

patient is to go down a list of and ask the child to tell about

a time that he felt that way-, for instance, “Fell me about a time that you felt very sad,” and ‘Tell me about a time that you felt discouraged.” The therapist can also inventory hu-

information To has She

is willing

independently

JOURNAL

favorite

The

times.

of his personal have

a

may

a patient to tell his favoritejoke. start with, she learns whether the child the social awareness to remember ajoke. learns

what

had a very strict father. Yorukoglu went on to make

When

by asking

also

the

two patients who related the same joke, one lived in the household of a and tyrannical grandfather and the

tell the joke

can be an importable to lighten up side of adversity

may learn

the

the production and academic

in children. humor

other

child’s

and make a only to revert

Masten

between of humor

Of the favorite dogmatic

to

of not responding

somber.

used appropriately, ant coping device.

patients to have

replied: “I was only going to say that there was a bug on your plate.”

respond

realize the humor attempt to smile,

positive relationship and appreciation

adolescent happened

joke:

his child

A schizophrenic child is apt to look or become confused. A depressed

different. puzzled

favorite

and

patients

adults. favor-

Illness

youngsters

humor,

line

youngster’s response to the humor has been used as a screenfor mental illness. Depressed or

psychotic

Two

the

the de-

was a father who forbade everyto talk at the dinner table. One day one of the children wanted to say something. No sooner had he opened his mouth than the father stopped him, saying: “Whatever you want to say, say it when the dinner is over.” After they were through with the meal, the father asked

to knowwhere

the youngster is along the developmental for the appreciation of humor.

about Allen6

body

more

Adinician

it helpful

of inquiring Reynes and

There

Anna Freud22 conof children along

lines.

may find

same

be age-apon a pun. would

of his child

in Turkey.

A psychiatrist conducting an evaluation could use this information to size up the cognitive and social development of a child. The

The

the usefulness favorite joke.

scribed their use of this techniquewith Yorukogl&5 related and explained

interperfunny

covered patient’s

to

world dis-

OF PSHOTHERAFY

morous feelings something funny child

by asking happened

did something

about a time that or a time that the

silly or a time

that he felt

embarrassed. During the course of the inventory of affects is a good time to ask, as an aside, whether the patient happens to have a favorite

PRACI1CE

joke.

It seems

AND RESEARCH

to fit naturally

into

that

312

HUMOR

part of the interview, and at some the inquiry about a favorite joke

other might

point seem

HUMOR

jokes

AS

to be funny

A

Humor

to Explore

a patient

spontaneously

the content,

affect

of the joke

in work with might express

pose

Feelings

brings intent,

of mastering

one’s

(p.

died!

Paddy

died!”

When

she said, “Daddy

commented Kenny’s

that

it involved

non

that

occurred

good

that

toward mishearing,

hostility

also

When

died.”

a child

in Kenny’s

funny.

Freud

purpose

are either of aggressive-

of aggressive that

Humor

With

re-

jokes

feelings

Using

Gardner” humor in the He recognized

and sexual are

usually

re-

to Deal

Resistance

gave examples of the use of mutual storytelling technique. that there are many aspects of

therapy that are such as discussing

unpleasant for fears or traumas

knowledging

child’s

the

own

children, and ac-

defidencies.

Gardner said that humor helps to keep up the child’s interest in the treatment process and intensifies sages.

the In one

impact

of the

therapist’s

mes-

case,

his

Gardner was treating a passive boy namedJoey who had a very low sense of self-esteem. The boy had made up a story about a garbage can that suffered many indignities but simply walked away when somebody hurt it. Gardner thought thatJoey needed to learn how to stand up for himself, so he responded with a very funny story about how the garbage can found a way to throw garbage right in the face of its tormentor.

joke

mani-

and

a phenomefamily.

patient

it is usually in some

a way.

If you skip that step and immediately launch into an analysis of the joke, you will distance yourself from your patient and he probably won’t tell you any morejokes. a clinical judgment whether

expression

and critical pressed.

154).

his father

or adolescent

up a joke in therapy, idea to smile or respond

being

(attacking moral institutions and religion). Freud thought that jokes allowed for the in-

direct

(p. 152)

the

simply

as-

mother ran in, he explained that he had not been upset earlier because he had thought

beyond

the

in

study,

no particular

(“serving

a patient unaccept-

in her

serves

are “tendentious,”bywhich the joke does have some pur-

ness, satire, or defence”) or obscene (“serving the purpose of exposure”) or cynical

and

anxieties”

the joke

hostile

[There wasl a little boy with a pet frog named Paddywhodied one daywhile the boy was in schooL When his mother told him, the boygave no response, but in the middle of the night he began to scream, “Paddy

and

up

comment or is well known

adults. For instance, hostile or otherwise

Kenny, one of the patients lated the following joke:

brings

to

tendentious

treatment of 10 children. She thought that “humor is a way of sharing feelings of fear and aggression, of breaking down social barriers,

fested

or simply

that

able feelings through ajoke. Orfanidis’3 systematically described the humor that came up spontaneously in the

Orfanidis

humor

thought

can be studied

the same way that any other fantasy or dream might be. This

and

patient’s

aim. Otherjokes he meant that

TECHNIQUE

in therapy,

sociated

the

AND ADOLESCENTS

Sometimes ajoke is only ajoke. Sigmund Freud24 said that somejokes are simplymeant

THERAPEUTIC

When

CHILDREN

question enjoy it.

out of place.

Using

WrrH

Of course, to analyze

VOLUME

it is and

2

#{149} NUMBER

Some olescents, insulted

young

patients,

tend to become when asked direct

especially

early adembarrassed or questions regard-

ing sexuality. comfortable

Humor can be used as a more way to slide into a discussion of

this

subject.

A youngster

some

of

4” FALL

the

1993

details

must

of sexuality

be aware of to get the

313

BERNET

point

of many

jokes

that

are popular

among

early adolescent boys. For instance, suppose a patient told the following joke: A boy was in a drug store and, for some reason, was totally naked.

Suddenly

two

elderly

women

and

pretended

to be a statue.

first woman touched the boy and “Oh dear, I set off the lemonade The

second

‘That’s lotion.” ing

woman

not The

for lemonade. therapist could

dumb,

to some

The

It’s for Jergen’s respond by play-

extent,

and

getting

the

patient to explain the point of thejoke, which could lead to a discussion of the youngster’s knowledge and attitudes about sexuality. Aside

from

which humor sexuality. An

jokes,

there

are

other

can be a bridge example was Big,

ways in

to discussing a movie that

was a parable about puberty. In this movie the character played by Tom Hanks was on a date with

a very

self back could

attractive

to his apartment

sleep

meaning

over the

in the

theater.

If Big

the

therapist

bers

that

can part.

whether to discuss

arouse

ask

patient be

many

that she to be on top,

gets

happens

Then

the can

That

with

used

the

a big

to be

early

an

explain

discussed

can the

see joke.

as a nonthreatening

subjects

that

might

way otherwise

defensiveness.

Another

way of using

humor

to deal

with

resistance is “banter therapy,” a style of therapy described by Coleman.2 As the name sug-

cepted,

cared

for, and

loved.

bantering

was

short-term tient is not

psychotherapy insight oriented

alytic

particularly

effect on the would feel

paac-

He thought

that

appropriate

in

in which the pain the psychoan-

sense.

with

a teasing,

a 16-year-old boy, had recently gotten his driver’s license and had already crashed the family car on two occasions. He was an irrespon-

rebellious

youngster

who

wore

counter-

culture outfits and a haircut that could be described as a modified Mohawk. Stan was explaining his plan to persuade his parents to let him drive again. He asked if the therapist thought he should be allowed to drive. The therapist pronounced that he should not be allowed to drive because he did not look and act preppie enough. Stan seemed to understand that the therapist was teasing him about his appearance but that the therapist was also very concerned about

his irresponsible

driving.

Therapeutic

bantering

mishandled,

and

by some Kubie.Th found

the

of Coleman’s Although a

can

technique

obviously was

colleagues, Coleman

to banter

way

structive,

with

therapeutic

bantering approach have a fragile sense or who

do not

therapist. sters who not

be

criticized

especially apparently

patients

manner,

in a con-

some

thera-

OF PS’xHOTHERAPY

with adolescents of trust in other

yet have

who people

an alliance

with

the

Itmightbe appropriate with younghave a therapeutic alliance but are

making

progress

narcissistic

in treatment

because

or passive-aggressive

of

personality

traits.

as an Agent

Humor

seen

of Change

In the examples given thus far, humor as a catalyst that facilitates the therapeu-

tic process. For instance, judicious use humor can lower the patient’s defensiveness so that

examples, treatment. of change,

JOURNAL

to a patient

comment.

Stan,

gests, the therapist creates a dialogue with the patient that has a somewhat teasing and flippant quality. Coleman intended that the teasing would be done with a friendly tone, that it would have a comforting tient, and that the patient

across

bantering

work with adolescan sometimes get

pists who tried to imitate his approach may have been less sensitive. As a general rule, a therapist would not want to use a teasing,

adolescent,

therapist

can

laugh

if he remem-

patient the

her-

he said

and

bunk.

session

She invited

if he got

only

top

in a therapy

Humor

woman.

a point

sible,

exclaimed,

dispenser.” the boy and said,

touched

Some therapists who have found that they

came

into the store. They were both very nearsighted. In order to hide, the boy jumped on a counter

cents

PRACTICE

therapy

can

begin.

humor is closer By considering I do not

AND RESEARCH

mean

In

the

following

to being humor that

the actual as an agent

the

therapist

is

of

314

employs

humor

thereby referring

cheer to

bodied

laughter

Redi and

cancer

and

explosive

at

a program

promote the

developed

They the

control

situations,

decontamination.”

of anger.

the

found

staff

to halt situation technique He

intervention

the child

many

expression

in the

first

worked

whatever

that

had

been

invulto the

upsetting

that the child needs ble of feeling good needs to think of

it helpful to a homework

to realize that he is capaand feeling happy. He himself as a potentially

rather

than

destined to be morose. Another rationale patient ment

early

of latency

adolescents.

Children with their

wits

as a way

of showing

age-appropriate jokes

which

peers

are

since

one

would

attitudes get

is

a child

the

use riddles as a peers. They tell Among

adoles-

be

part

have

a common

point

and

used to help define of a particular in group,

might

and

children

off in a healthy,

manner.

cents,

to

who

for instructing

relationships

to match

jokes

as a child

to learn ajoke as a homework assignis based on the importance of humor in

the peer

jokes

of some

to

share

fund

jokes.

common

of information

A child

VOLUME

reason coaching

may by

The therapist is something

of simplejokes.

The

home-

is for the child to learn some children at school or in the

taneously, whether group

2 #{149} NUMBER

tell

it occurs

spon-

needs to determine is defending the

dealing

with be

“Jokes and riddles” in group therapy with When

sometimes

When

the therapist the joke-telling

against

Therapy

adolescents

therapy.

or if the jokes can work of the group.

an important

used

issue

to facilitate

the

may be a useful topic children and early ad-

the group

agrees

thatjokes

are going to be the topic for the meeting, the therapist should set up some basic guidelines. That is, everybody in the group needs to take a turn before Every patient

anybody gets a second should get some feedback

garding

the

joke

what and

his delivery.

group The

to explain that the patients of joke they want in the

turn. re-

thought

about

therapist

may want

his

can tell any kind meeting, but that

does not necessarily mean that they are allowed to tell the very same joke on the inpatient unit or at school or even at home. The reason for that admonition is that somejokes that come up in therapy might or offensive to other people. does not want to communicate

be provocative The therapist that her toler-

ance of thejokes in the group meeting that a teacher will allow the same joke

means in the

classroom. Telling jokes in group therapy with children relates to several therapeutic goals. Almost any child is willing to participate in a group

who

in Group and

in group

olescents.’6 have found child patient

assignment: learn a joke and bring it in for the next therapy appointment. The purpose of this technique is not simply to cheer the patient up. What the therapist has in mind is

person

a couple

Children

the

by a combithe

relationships

other and

enjoy doing together. The the ball rolling by telling

Humor

place.

Some therapists give the depressed

happy

peer

neighborhood.

child that nothing hurtful or destructive had taken place; helping the child give up the tantrum in a face-saving way and creating a from

satisfying

work assignment new jokes from

the progby using “humor-

thought

nation of factors: demonstrating nerability of the adult, communicating

diversion

formed

that many children therapist can start

of excessive

however,

it was more therapeutic of an angry, explosive humor. Redl called this humorous

treated

adolescents to

not

both parents and the therapist. can point out that telling jokes

a physiological

that ress ous

has

ADOLESCENTS

triggers

WinemanV

also

In some

and

AND

because of shyness or some need a good deal of support

House.

techniques and

witty

diseases.

and

Pioneer

anger

be

counteracts

aggressive

called

to

CHILDREN

patient up. Also, I am not idea that frequent, full-

that

deadly

other

simply the the

mechanism

way

WrrH

HUMOR

story.

meeting The

4. FALL

meeting

1993

by telling

a joke

is structured

or

a funny

in such

a way

315

BERNET

that

the child

feedback

is going

to get

some

after his presentation.

positive

The

make

children

are more spontaneous realize that their jokes

because they do not may reveal informa-

tion about themselves. child understand that

Finally, it helps the there is a difference

between

what is acceptable

therapy

and

what

one

to bring

talks

about

up

in

at other

some

or ridiculing

or

might

apeutic name-calling.” tion, of course, for to not

take

mocking

him

engage

in “ther-

in

It is the ultimate rejecthe therapist and the

a member

seriously.

teasing

by the

group

makes

tient feel weak and rejected The therapists do not spend

The

ing picking

on the

new

the

but

pa-

and other

intense

strong bond among the members. The therapists

feelings group have

instead

a and that

their strong emotional bond with the patients makes their confrontations even more powerful. This use of humor in group therapy seems effective because the patient is deflated and finds it hard to defend and excuse previous misconduct. Finally, patients undergo

this painful

initiation

or hazing

on to form a strong attachment therapy values of the group. When dramatic; quite

it works, however,

damaging.

to the

this form of a wrong move

Some

cinidans

JOURNAL

humor could

The

think

that these

therapists

who

cannot

be reached

with more

COMPLICATIONS

potential

pitfalls

in using

humor

in psy-

chotherapy and Haig.4

have been described Instead of creating

by Kubie” rapport,

humor

alienate

may

helping

a child

appoint

the

the

patient

the

learn patient

Instead

of

social

patient. skills,

it may

dis-

who

learns

how

es-

or the

therapist

might

use humor

his who go pro-

A patient

who

does

not want

to take

himself seriously may use humor defensively. Humor works best when the issues that are

the

subject

of the joke

are understood

by

both the patient and the therapist. For example, a white therapistwould need to be careful bantering

with

an African

Amencan

adoles-

cent. A Jewish psychiatrist might know the perfect way to frame a clinical issue in a funny way, but the humor might confuse and offend her Southern Baptist patient. Because all of us ha’e

sensitive

areas

ous

another

person,

to

contemplates cautious and Although clinician finds ful,

to

thoughtful,

OF PS’KtHOTHERAPY

PRACTICE

able

therapist

methods.

AND

is be

are

emotional

seethe

CONTRAINDICATIONS

therapy.

creates leaders found

intensely

as a means of ingratiation, which would keep the two of them away from painful issues in

create other opportunities for sharing intense emotions. This form of treatment seems to be effective for several reasons. First, the sharing of laughter

patients

tranged he is from other youngsters. Instead of reducing the patient’s resistance, an inappropriate attempt at humor may fortify his resistance and denial and repression. Either

and immature. the entire meet-

patients,

this

patients

orthodox

purpose of this use of humor is to reframe the youngster’s behavior, which in the past made him feel powerful and accepted and grown

up. The

their

is an unusual and intherapy, which is in-

way. The group

group

bers:

youngsters

tended for highly defended youngsters with severe conduct disorders who are treated in a residential program. What happens is that the therapist initiates a new group member by teasing

of the

are mean. In any case, this powerful use of humor should only be considered for defiant

Some group therapists find humor and sarcasm to be effective tools in confronting patients. This form of group

use

of therapy:

as truly concerned about theirwelfare. Other clinicians use the same words and the same sarcasm, but they do not communicate that fundamentally they respect the group mem-

times.

resistant novative

good

form

ously

in a way

in most

that

may not be obviany

using humor considerate.

therapist

needs

who

to be both

there may be instances when herself using humor spontanethat

cases

is therapeutically successthe therapist should give

conscious

AND RESEARCH

consideration

to the

a

316

strategic

use of humor.

be aware and other use

WFFH

HUMOR

of her factors

of humor

The

with

a particular

particular time. Humorous

approaches

some

and

issues her

patient come

trainees

at a

in the hands is probably

naturally

but seem

that

therapists

of humor and them at all. The most humor

of others. This gentrue of other treat-

serious

sistic

therapist

therapist

may

a captive

work

tries may

for

unwittingly

manipulate

narcis-

patients for

into

misguided

humor.

of

and

risks

in psycho-

recommendations

should

be

that

they

aware

are of the

hu-

experience

in the same way that they other feelings. If the

with should be therapist

should

learn

pros

and

using humor in therapy. Although may want to use humor cautiously priate situations, they should be against simply copying experienced therapists.

the

cons

of

trainees in approcautioned

humor

of more

It would be useful to study systematically the effect of humor in clinical settings. Of the examples

DIScUSSIoN

Humor

is a multifaceted,

It can

be used

between

the

multipurpose

to influence patient

as improving the mutuality between

the

and

the

rapport them.

In

tool.

relationship

therapist, or

or defensive,

apeutic

humor

process

aware

being patients

can

more

the sense the diagnostic

of what

reveal

make

the

acceptable.

they

important

are

particularly

presented

important

in this article, to research tiveness of humorously confronting adolescents in group therapy.

itwould be the effecresistant

Kip

Ph.D.,

of the tech-

such of

evaluation, the patient’s use of humor provides information about his cognitive development, social skills, sense of competency and coping style. With patients who are resistant

of humor

feelings

Trainees

use

The

benefits

the use

the following

morous

to be funny of patients.

of hostility.

audience

therapy,

offered: Therapists patients, aware

potential

with

chooses to use humor in therapy, she should do it deliberately and for a specific purpose.

of using

advantage

as the victims

being

the use

not

complication

taking

sadistic

patients

it does

a therapistwho

is chronically The

that

ADOLESCENTS

has been used to treat depressocial ineptitude, and con-

disorders. Given the

associated

clumsy

may try to mimic

find

is that

Finally, humor sion, aggression,

to

ment modalities, such as hypnosis and psychoanalysis. In any case, there is the possibility

AND

themselves in jokes that are spontaneously offered and that are elicited by the therapist.

should

duct

therapists

or awkward eralization

therapist

countertransference that may be influencing

CHILDREN

A version

of this paper

young

meeting and Adolescent

about

24-28,1990.

information

suggested

some

M.D., Williamj Houghton, L Licamel#{231},M.D.

ther-

annual

Without

saying,

Parrish,

niques described in this article. The author aLso achnowledges the suggestions of Barrj Nurcombe, M.D.,

and

uw.zs presented

William

at the 37th

can Academy of Child Chicago, 14 October

of theAmeri Psychiatiy,

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AND RESEARCH

as Perceived

Within.

NewYork,

by