Sunday, August 8, 2010

Humor in Therapy

Humor is considered a high level of defense or coping strategy. Since Norman Cousins demonstrated the healing capacity of humor, it's been a standard part of therapy. Psychiatrists asked about their use of humor in therapy validated this. It was said however that one had to be cautious with it's use.

A young psychiatrist admitted that he was new in his latest position only a few years with a department where there was really little humor and much more 'seriousness' than where he'd trained.

"Seriousness" is a common defense or coping strategy used by those who lack confidence and lack leadership skills. "Seriousness' can be equally inappropriate if not more so than humor and often indicates 'toxicity' in the work place.

Both humor and 'seriousness' are appropriate in context. Yet the person who doesn't smile commonly is not called on their 'lack of humor' in the same way as the 'serious' feel free in not only calling but not uncommonly attacking those who use humor appropriately. Those who are uncomfortable with humor commonly aren't aware of it and more commonly take offense if their lack in this regard is brought to their attention. Seriously, they must be taken seriously.

Part of the problem in this regard was Freud who probably due to his addictions had difficulty with humor and felt that it represented veiled aggression. Certainly it can but more often it cements relationships and relieves suffering.

Today humor has been studied in much greater depth showing that laughter contributes to healing. Indeed there are groups that 'laugh' together as a form of spiritual awareness. Laughter relieves stress and can unite people.

Humor moves however from lowest forms such as sarcasm to higher forms of humor such as plays on words. Where humor is veiled aggression is where it scapegoats an individual or separates people rather than bringing them together.

In the trenches of war, 'black humor' at it's lowest form has been a basic coping mechanism.

In studies of military leaders who lacked humor it was shown that many suffered from post traumatic stress disorder, and their 'seriousness' was indeed affected their ability to make the best decision. "Seriousness" too narrowly focusses a person's attention and while it serves a task for a time, without release, it becomes counterproductive.

All work and no play make Bill a dull boy.

As cognitive behavioral therapy I've assigned the task to patents of learning a joke and bringing it to therapy to tell me. This weekly task which was applied for chronic dysthymic patients who saw negative everywhere caused them to actually have to redirect their attention from catastrophizing and awfullizing to looking for something they found funny and learning this to bring to sessions. Ironically they would go on not only to tell me the jokes but would tell others who not surprisingly began to treat these previously 'cold' fish more warming.

Using journalling as a task I've asked patients to record positive anecdotes of daily events that made them smile. This has been even more enlightening as the patients who had previously focussed on reasons to kill themselves returned with stories of being amused by something as simple as a child's laugh. Indeed I've even asked the most recalcitrant patients with chronic dysthymia to ask children to tell them what they find funny.

Watching children the early therapist saw that play and humor were essential parts of positive development. Further they're associated with good health and healthy communities.

Naturally one doesn't do slapstick stand up routines with the patient who comes in the door whose baby has been eaten by a coyote but it would be equally wrong not to laugh when a patient shared a particularly funny episode from their day.

Timing is important. As a family physician humor was what helped in the practice for patients and staff alike. Good natured joie de vivre ruled. In psychoanalytic therapy there was much more limitation on humor but in the psychopharmacological psychiatric practice the model is much closer to a good general practice model than it is to psychoanalysis. Certainly humor plays a major part in the therapy of addiction.

A drug addict tried to con me into refilling their narcotic prescription we both laughed when I responded to their lame excuse of losing the prescription by saying "I'd have been more willing to consider it if you'd said the dog ate your homework."

Paranoids will consider everyone as laughing at them and borderlines might well use any excuse to claim they have been victimized. As anyone who has tried to retell a funny story has found so much of humor is highly contextual. It has an effervescent quality that gives some of it's capacity for lightening the heart.

Some might say it's not safe for a therapist to use humor despite the overwhelming evidence of it's potential benefit for the patient but the same people would prefer not to be doctors treating patients one to one hands on and up close. "Seriousness" is akin to 'pretentiousness' when it's inappropriate and out of context. Such 'serious' people prefer to be 'critics' than actually participating in the healing process.

Recently I've been bringing my puppy to the office and his greetings and antics have been a source of much laughter. It reminded me of the study of improved wellness in a geriatric setting with the introduction of a caged 'budgie' in the lounge. The withdrawn came out of themselves and laughed at the antics of the little bird. There have been many other benefits attributed to pet therapy and many different explanations for those benefits. Admittedly my Gilbert, the cockapoo, is a particularly funny little guy even more so when he appears to be trying to be 'serious'. Likely an older pit bull wouldn't cause as much laughter.

Laughter is good in therapy and can be a clear sign of healing but like all of medicine consideration must be made for dose and specificity with overall concern for what is best for the patient.

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