Category: Humor

A client once burst into my office for his first session and collapsed onto the couch. A little startled, I began with my usual protocol, asking what he had come for help with. “I’m a teepee,” he said. I stared at him, unfazed. “I’m a wigwam,” he continued. I nodded. “I’m a teepee,” he repeated. “I’m a wigwam!” I took a deep breath. “Obviously,” I explained, “you’re two tents.” This story didn’t happen, but it’s my favorite therapist joke. (If you haven’t gotten it yet, read it again aloud). People who know me outside the therapy room tend to think of me as a comedic fellow. The reason being, I surmise, is that I am in fact a comedic fellow — if I must say so myself. Some of them wonder how I could possibly be a therapist as well. Often, they do this aloud and in my presence. People generally regard therapists as serious professionals helping people with their serious problems in a calm, soft-spoken, (non-comedic) manner. It’s a fair question, and one answer is that I actually do have a serious side. It comes out mostly when I’m asleep, but it also makes appearances in the therapy room. If you wanted to psychoanalyze me, you might discover that my powers of humor derive from a sincere desire to spread joy, happiness, and empathy — which I maintain is foundational to all therapy — and is consistent with that desire. The other answer is that humor can be a powerful tool in the therapy room. Many people come for their clinical visit feeling terribly nervous and uncomfortable. This is especially true in my area of expertise, couples counseling, in which two people come to meet with a complete stranger to share their most personal moments (especially the most personal failures). Can they be blamed? Who’s excited about discussing their sexual dysfunction with anyone, let alone someone they just met? In this particular venue of counseling, I have found humor helps loosen us all up. It helps chip away at some of the discomfort and the shame and the resistance that clients bring with them. Donna and Dwayne As an example, consider Donna and Dwayne, an African American couple from Baltimore City who came in for help with their relationship. She walked in looking timid but hopeful. He followed behind looking P.O.’d from the get-go. He literally sat back on the couch, crossed his very muscular, tattooed arms, and glared at me. I started off with the usual pleasantries and asked them what brought them to therapy today. Donna looked at Dwayne, who didn’t move his gaze from me. She began to explain that they were having problems in their relationship. I listened for a few moments, nodding. When Donna finished the broad overview, I looked at her, then at him, and replied (mostly to him), “Uh-huh. So let me see if I get what happened: she’s unhappy with you, so she said, ‘hey, let’s go talk to a scrawny white Jewish guy about our problems and that’ll make everything better,’ and you were like, ‘that sounds GREAT!’” He did a very subtle double-take when I tagged myself as a scrawny white Jewish guy, then cracked a smile. That loosened things up enough for me to get a foot in the door with a client who was clearly not excited to be there to begin with. Humor has been a great connector for me, inside and outside of the therapy room. Someone somewhere said, “Everybody laughs in the same language.” (I just Googled it — turns out it was Yaakov Smirnoff, another comedic scrawny white Jewish guy. Go figure). Research tells us that the single most important factor in the outcome of therapy is the relationship between the client and the therapist. Nothing helps build relationships like a good shared laugh. Clients know when they come see me that it’s not going to be an interrogation or a kumbaya circle. It’s going to be a real conversation between real people. It’s going to be deep, but it’s going to be fun. It’s going to be us connecting to help them manifest change in their lives. I don’t think that can be accomplished by the clinician being a detached professional. At least not this clinician. But you can’t do that as a friend either. The sweet spot shares some features of both extremes. Pete Pete was a young man who I was seeing for depression. He started off one of his sessions with a new concern: “I think I may have some short-term memory loss,” he suggested. “I know,” I replied. “You told me that five minutes ago.” He looked concerned for a moment, then he broke out in a grin. Pete “got better” in due time. Not from that joke, you understand. But the camaraderie that undergirded our intense conversations, and the jokes that peppered them, certainly helped. Poking a bit of fun at the problems can also make them less menacing. “I need help with my procrastination,” said Avi, the husband of a couple I was working with. “We can talk about that later,” I replied. Of course, you have to know your audience. You don’t make a joke about memory loss with a senior. You don’t make off-color jokes or (do I need to say this?) racist jokes. Self-deprecating jokes are usually a safe bet. Puns likewise are not terribly risky, but let’s be honest, also not terribly funny. Sure, some of my jokes fall flat. But that happens in real life too. I’d say that just makes the therapeutic relationship all the more genuine. You know what I think? Laughter is love. And love is the most buoyant of human experiences. If you’re coming to me for help, I’ll use whatever tools I’ve got to lift you up. Comedy is just one of them. But yeah, it’s my favorite. Questions for Thought and Discussion How does the author’s premise about humor in therapy sit with you? How do you use humor in your own clinical practice? Have there been instances when humor facilitated therapy? Hindered it? If you appreciate humor in your life, do you bring it into therapy? If not, why?

Let me tell you the relief I felt when it clicked for me that acting like a therapist with patients was not the way to go — that actually being a real person would be far more therapeutic. The idea of needing to look, sound, and even dress a particular way was the perfect storm for imposter syndrome. And I was constantly fearful that I would be found out in the act. It was clearly unsustainable. I watched my peers gain confidence in their own therapeutic work and realized that it was not just increasingly necessary, but quite possible to find my own style, and have it be unique.

But being freed of that anxiety naturally brought with it a whole new feeling of uncertainty. While helping my patients find their own sense of self, I had to find my own. And quickly! Coming from an immigrant South Asian background, I grew up with the message that praise follows being able to figure out unsaid expectations and meeting them, prioritizing the collective rather than myself. I became far too skilled at fitting into a mold. I hadn’t stopped to think about who I was or how I wanted to relate to others and myself. I really didn’t have to until I was sitting across from my patients, one on one, and they looked to me to discover their own sense of self. Working with my patients and being more mindful in my personal relationships has been so instrumental in figuring out the parts of me that could also exist. A big part of this is my playfulness.

Ask anyone who knew me before my 20s, and they wouldn’t exactly describe me as funny or playful. I had been highly judgmental of these parts of myself in efforts to tone them down. But in challenging these judgments, I finally found an affinity for sarcasm, cleverness, and wit. I enjoyed gently teasing others in a way that helped them to feel seen as well as better about themselves, not worse. This side of me has been tremendously helpful in my work to the point of becoming a crucial clinical intervention and the hallmark of what it means to work with me. For starters, playfulness as an approach to hot topics has been a way for me to move past sticky spots with the intention of revisiting them with more seriousness at a later juncture. It has also allowed me to foster a sense of trust so that my patients have been willing to take on deeper and more painful topics. Doing so has also allowed them to prepare for addressing difficult emotions and pacing those experiences. Playfulness through metaphor, chuckling, and coyness have opened doors to more, rather than less therapeutic progress. And this has been especially so when patients have been resistant or apprehensive, opening them to the guidance I have been able to provide.

Playfulness and humor are parts of real and healthy relationships, especially those I form with people naturally. Relating to my patients as authentically and therapeutically possible means having to let this come through in some way. I’m very aware that I have an affinity for puns and cheesy humor. I get excited by thought exercises and how metaphors can be extended to perfectly capture added experiences. I don’t shy away from these parts of me; I own them. I want my patients to experience me as comfortable in my own skin so they can laugh at me and with me at first, and then at and with themselves. This is especially helpful with patients on my caseload who are struggling with depression. These patients usually harbor intense judgment and criticism toward themselves. Demonstrating an alternative way to approach the self can be reparative.

Authentic relationships also have a playfulness to them that can function as a reprieve. People generally present to treatment to feel better, to be able to experience feelings opposing chronic distress. Relationships, much like individual people, have range, with seriousness on one end and humor on the other. A therapeutic space must have range, too. The therapeutic space is not simply a reflection of what a patient’s inner experience currently is, but what it could be and hopes to become as well.

In deciding between a tone of playfulness rather than seriousness as an intervention, I often take the lead from my patient. Some patients bring entirely new material altogether, seemingly unrelated to what we’ve been working on, signaling some heightened discomfort and a need for a break. Others directly ask for a lighter session, subtly warning me that they can’t handle more that day. Some patients may need to be pushed, but some simply need to be held. My instinct is to highlight the growth in expressing their needs and implementing boundaries, especially with me. I joke that we could talk about shoes if it would be more therapeutic. I’ve had a few patients actually take me up on it.

I have found that this range in the therapeutic space may even help with patients’ attendance to session and that the playfulness I encourage contributes to a relatively low attrition rate. While at the start, I’m the one to introduce levity into the session, as patients tend to increasingly benefit and join in the playfulness, they begin to initiate this on their own, and the space already begins to feel lighter. That lightness can then be internalized over time when patients are ready.

The intervention is successful when we start playing together. The goal of any treatment includes using the therapeutic work between sessions, a result of being able to internalize the therapeutic relationship. When patients begin to refer to earlier sessions, observations I’ve made with them, or metaphors we’ve developed together, I know something is working. They may pay more attention to my reactions or anticipate what I might ask and answer the question before I pose it. Patients may even introduce their own language or metaphor, presenting with excitement to share with me, knowing I will very obviously appreciate it.

My work with Vaani is a nice example of how effective playfulness can be in breaking through self-imposed barriers to progress. Vaani presented to treatment feeling completely defeated and at odds with herself. She struggled to make sense of her opposing emotions, citing mood swings and difficulty showing her needs and, thus, feeling unsupported by others. Vaani tried to distance herself from her thoughts and feelings by criticizing herself, leading instead to an extremely negative self-view.

At the start of treatment, Vaani looked to me for direction and approval, some sign that she was doing therapy right. I sensed her discomfort with focusing inward and could feel her need to have the spotlight on me. In addition to my usual emphasis on affect, language, and thought patterns, I started to respond with inquisitive and teasing facial expressions when Vaani escaped into not knowing. I would lightheartedly suggest, “That’s such a Vaani thing to say,” and she would laugh along and try again. She started to anticipate moments I would challenge her further, eventually anticipating these stuck points and refusing to take any more comfort in her resistance. She seemed to find some relief in finding metaphors and analogies; in fact, she typically lit up when she could express herself more effectively than ever. Through our work together, Vaani has come to express a feeling of wholeness, a result of being able to approach the judged parts of herself with curiosity, compassion, and humor, rather than shame. Our relationship remains playful as she continues to reflect inward from a place of safety and security.

***

We all want to play. I did for so long but didn’t know I did or didn’t know how, in part due to my cultural upbringing. In realizing this, and the powerful reflection that came with it, I was able to find an authenticity that felt right. I wouldn’t be the same without it, and neither would my work. I thoroughly enjoy working with people who might benefit from this or a similar discovery to feel better, gain perspective, and move toward healing.  

As I tap away on the first installment of a my little blog about mental health in music, I sit only a hundred yards or so from a Chinese restaurant in my little East Texas town where, legend has it, Mick Jagger was at one time known to dine on occasion with his former paramour, model Jerri Hall. Hall is or was the owner of a ranch in the general vicinity, according to local lore. In any case, while wondering if Mick and I may possibly have in common a love of the establishment’s sumptuous Pu Pu Platter, I find myself also musing upon the 1966 Rolling Stones classic, “Mother’s Little Helper.”

This twangy two minute and 40 second tune is a scary short story of ennui and substance abuse set to music; complete with the trendy-at-the-time spooky sitar riff (which according to some experts may instead be a rather less-exotic electric 12 string guitar.) It tells the tale of the growing disenchantment of a mid-century suburban housewife and her descent into a rather tenuous pharmacologic subsistence. The mother sung of, it seems, has a doctor who writes her prescriptions for a “little yellow pill” even “though she’s not really ill. ” The listener meets the doleful protagonist at the point she has begun to rely more and more on this ostensible remedy for her world-weariness and to make it through her “busy dying day.”

The medication Jagger and the song’s co-author Keith Richards mention by size and color but not by name can be pinpointed by those details, the song’s context and a little knowledge of cultural and pharmaceutical history as Valium in 5mg dosage. A blockbuster product launched in 1963, the same year Betty Freidan published her best seller The Feminine Mystique, Valium promised prompt relief from what Friedan’s book called “the problem that has no name.” The pharmaceutical industry and advertising wizards of the era took a shot at naming it anyway and came up with “psychic tension.”

As the song progresses, Jagger disdainfully warbles on about the mother of the title exceeding her dosage (“Outside the door, she took four more”) after pleading for what probably was an early refill (“Doctor please, some more of these”) and alludes to dark consequences if things keep on this way. And in point of fact, Andrea Tone, in her 2008 examination of America’s troubled love affair with tranquilizers post WW II, The Age of Anxiety, seems to feel that the lady in the song is a goner. The “busy dying day,” Tone suggests, is actually a day in which mother’s busy dying. However, absent co-ingestion of potentiating substances, medical literature finds benzodiazepine overdose to generally be associated with low levels of mortality. (Not that it is a “safe” drug to consume counter to a prescriber’s instruction by any means–no drug is.)

But nevertheless, the wife and mother (the primary social constructs that much of society at the time, and probably she herself would employ in her cultural categorization) sounds as though she is falling victim to the all too common misconception that prescription drugs are harmless. Since her trusted doctor blithely prescribes her little yellow pills, and he in fact keeps giving her more, they must by definition be safe. If a little is good a lot is better.

While the song is a fictional vignette, it is perhaps rather representative of the negative potential of the power differential between physician and those in the patient role (particularly suburban homemakers) in the period before such considerations were even a matter of concern in care delivery. In a 1979 qualitative study seeking to determine social meanings of tranquilizer use, researchers Ruth Cooperstock and Henry Lennard identified “the culturally accepted view that is the role of the wife to control the tensions created by a difficult marriage” and an accompanying “implicit” acceptance “that drug use is justified in order to accomplish this.” All gender politics aside, mother’s negative feelings do abate for a time after the pills are taken. It’s just that she’s swallowing more and more pills, more and more often.

Yet sooner or later the haze lifts, albeit briefly, and there remains, as there always remains, that same unappreciative spouse, those same unyielding children and that more recently arrived acrid stench of burnt steak and cake resulting from stuporous attempts at cookery. All of which drive her to the distraction of her little yellow pills and further along the road to overdose and subsequent rest cure in a nearby sanitarium (this song is perhaps backstory for The Stones’ earlier hit, “19th Nervous Breakdown”). After all that there may indeed be “no more running for the shelter of a mother’s little helper,” at least not in the form of diazepam. The song’s good doctor would probably just scribble for something newer and “safer” when mother’s discharged with a clean bill of health. After all, she “isn’t really ill.” She’s just suffering from an unwanted buildup of psychic tension that can be washed away with the right chemical, as is the waxy yellow buildup on her lime-green kitchen floor.

The underlying human desire to avoid or extinguish psychic distress is of course much older than even The Rolling Stones (formed circa 1962). From the beginning of time, people in pain have sought what frequently turn out to be illusory or half-measure methods (e.g. a bottle of little yellow pills) to escape it. Often doing so to their greater disadvantage. Another Pop (psychology) Icon R.D. Laing, who somewhat coincidentally gave refuge to a confused gentleman who believed himself to be Mick Jagger at one of his “therapeutic communities” in the 70s, had this to say about such evasion, “There is a great deal of pain in life and perhaps the only pain that can be avoided is the pain that comes from trying to avoid pain.”