nostic tool; how it can be used to shape the therapeutic ..... the hour he said, âI'll see you next week, if there is a next week.â That remark ... to sit back and control ... (a girl pretending to comb her hair with a pencil); the incongruous labeling.
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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PRACTICE
D: Controlsfrom
AND RESEARCH
as Perceived
Within.
NewYork,
by