Laughter in therapy: seriously important!

As my previous blog dealt with tears and crying in therapy, I thought writing about laughter might be a good natural balancing act. I can certainly say that in my years of training to be a psychologist, I have never thought that I would laugh as much as I do while doing therapy. I was probably mentally more prepared for heaviness, sadness, tears and serious struggles than I was for all the laughing that happens on a daily basis in my office.  The laughter might take the form of a smile, a chuckle, a mutual appreciation of irony, or sometimes even a good old belly laugh together with the client. (On a few occasions I have even had to wipe the tears of laughter from my face after some serious hilarity!)

Why would a therapist choose to laugh a lot? For me the answer is quite instinctive and devoid of anything academic. I laugh simply because I cannot imagine NOT laughing when there is a humorous, ironic or downright funny moment in therapy. It comes naturally, and to stifle it would be to let go of something organic and intrinsic in the connection there is between people – even in a formal relationship like the therapist-client one.  

Research backs up my intuition – laughter in therapy is truly a good thing:

Biologically speaking, laughter is a fabulous stress reliever. Endorphins aplenty rush through the body, and the oxygen-rich air that you breathe in deeply when laughing enhances heart, lung and muscle function. It can even boost your immunity and relieve pain!

On a psychological level, it is highly beneficial for the therapeutic relationship to laugh together. When I laugh at something funny the client has said, I am hoping he or she hears: “I am really enjoying working with you, this is not just a chore or a boring slog, I am truly interested in what you are saying, and – most importantly – I like you”. So many clients with long-term psychological struggles come to therapy with deep-seated beliefs about their own unlikeability and unwantedness. They might see themselves as anxious or depressed, or socially awkward, or as prone to “make mistakes” in interpersonal relationships, as if they were pushing people away. Often these clients battle with self-acceptance.  This impacts the way their emotional “radar” picks up signals from the external world: allowing those signals that confirm the belief of unacceptability in, and deflecting the signals that actually indicate the opposite (i.e. being acceptable, wanted and appreciated). This would constantly reinforce their perception of themselves as being in some way dysfunctional, unaccepted and excluded by others. Laughing together spontaneously in therapy is such a strong way to combat this unhelpful belief. 

Another benefit for the therapist-client relationship is that laughing together underlines our shared humanity. It shows that the process of therapy is indeed not that the “faulty one” (the client) that has to be “fixed” by the diametrically opposite “healthy one” (the therapist). The therapist acts as a guide, as a fellow-explorer of the client’s thoughts, feelings and experiences, but is never the all-knowing white-coated expert that will provide smart answers. In the moment of laughter, we are just two human beings who happen to find the same thing funny at the same moment. Laughing together closes the gap. Laughing together builds the relationship, and as I have mentioned in a previous blog, it is always the relationship that heals, and not necessarily the specific interventions that are utilised.

One last psychological benefit of laughter in therapy is that it often helps the client to disempower the problem to some extent. Especially in the modalities of narrative therapy and ACT (Acceptance and Commitment Therapy) the focus is not so much on getting rid of a problem, but rather to re-negotiate the relationship to it. Initially in therapy it might feel as if the problem is ever so much bigger than the person. The client might feel completely overwhelmed by anxiety, depression, grief, relationship issues or worry. Getting the client to “unhook” or step aside from this sense of overwhelm, and re-calibrate to find a sense of personal resilience or strength or courage is a significant part of the therapeutic process. In order to do this it is often helpful to disempower strong dysfunctional beliefs (e.g. “I am a terrible person”, “I know something bad is going to happen when I go out”, “I will feel like this forever”, “No-one likes me”, “The world is an awful place”). In traditional CBT (cognitive behavioural therapy) the beliefs would be refuted by logic and testing their truthfulness. This is a great strategy (especially for quite serious clients!), but I do find that adding a bit of humour can be highly beneficial. By having a chuckle at how smart our minds are at making us believe that our thoughts (including the highly unhelpful ones) are all true, or by picturing our inner critic as a funny little general marching up and down in our minds, or by using the ACT unhooking technique of facetiously saying “Thank you, Mind, for reminding me constantly that I am going to fail in everything I try”, we reach the same goal as when we very seriously refute negative thoughts.  Humour empowers the client, and disempowers the problem (to some degree at least).

As usual, there is a caveat to the broad brush stroke statement that laughing in therapy is always a great thing. Firstly, laughing should not function as a distraction from the real issues that should be tackled, untangled and worked through. If I find myself feeling that the laughter brings a sense of superficiality to the session, repeatedly, session after session, or that the client becomes more prone to cracking jokes around certain topics, it might be therapeutic gold to reflect on it gently and respectfully. Usually I will not phrase it as an interpretation or statement, but rather as a curious question along these lines: “I notice that we have been laughing a lot lately, and I love it! It is so important that we feel we are on the same team, and laughing together often helps us to get that sense of camaraderie. I just want to check in on your experience: do you feel that our laughing together is a positive thing, or do you feel that we both sometimes use humour to shy away from some thorny issues that are tricky to discuss, or is it a bit of both?”

(A little side note: Never forget to put in the option of “a bit of both” in any either/or type of questions we as therapists put to a client! I haven’t done a formal tally, but my gut feeling says that by far the majority of my clients have always gone for the “a bit of both” option. This of course opens the road for fruitful discussion of both parts of the equation, with the additional benefit of modelling to our clients that they can indeed have the mental flexibility to hold two different thoughts or feelings in the head and heart at the same time.)

The second reason that we cannot simply say that laughing in therapy is always a good thing, is that the therapist’s laughter should never be experienced by the client as something disrespectful or hurtful. I should never joke around – especially with sarcasm – at my client’s expense. To me, the idea of laughing together with the client is the key concept here. Never is the laughing at a client (this would be belittling and dismissive) but always with the client over something that we both find amusing.

How wonderful it is that we who work as psychologists today can easily move beyond the stark, strict, identity-less, serious image of the traditional psychoanalyst! Having said that, this very formal image still manages to find its way into memes and jokes nowadays. Take a look at these two jokes a friend sent me the other day:

Both make me chuckle, I love the play on words and the humour. I have mixed feelings about the portrayal of therapists though! But, rather than being caught up in annoyance, or even anger or sadness, I have a whole-hearted smile – I am so happy that the image of the therapist I can be can include so much more than a notebook, an aloof stance, certificates on the wall and an aura of all-knowingness. It can even include a mighty belly laugh!  

Lindie Oppermann
Psychologist
Felix & Sage Psychology

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