Psychiatric Care

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HUMOR need not be taken lightly. Humor is a form of communication - a method of self-expression. As such, it can be just as revealing as other forms of communication, such as eye contact, silence, touch, and verbaliza- tion. But the role of humor in the therapeutic rela- tionship has not been studied in depth, as have other forms of communication.

Even so, a review of the literature reveals some authors have recognized the importance of humor in group therapy. Mendel (1971), for example, observes, “A good way to understand people is to know what makes them laugh.” Through humor, he adds, “We get important clues about their anx- ieties and concerns, systems of self-esteem and feelings of inferiority.” Zuk (1966) maintains it is

by Lulu Hankins-McNary

important for a therapist to know what clients laugh at, because the information will provide in- sight into what the group stands for, and what it is attempting to do.

According to recent studies (Lefcourt et al., 1974), the use of humor is directly related to an in- dividual’s locus of control.* Certain people are better able to assimilate negative feedback than are others without becoming defensive or depressed. Lefcourt’s research indicates that those who ex- hibit an internal locus of control are more likely to respond humorously than those with an external *Locus of control is defined as the degree to which one perceives events as being largely the consequences of one’s own actions, and thus under one’s own control (internal con- trol), or as being largely unrelated to behavior, and thus beyond personal control (external control).

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locus of control. 1,efcourt observes that in- dividuals with an internal locus of control tend to smile and laugh more than those who usually deny personal responsibility. Moreover, those with in- ternal locus of control generally express amusc- ment upon realizing that they have been mani- pulated, or have been the object of a joke, unlike those with external locus of control, who are not likely to be amused in such circumstances.

In therapy, the use of humor establishes a non- serious condition upon which conflicts can be pro- jected. In a sense, humor lubricates the interac- tional process between members, and may serve to introduce and nurse conflicts in the group.

What kind of jokes do group members tell? What amuses or fails to amuse them? Through hislher understanding of group humor, the therapist can recognize sensitive areas of clients, and can assess their ability to face reality. In Cassell’s opinion (1974), a client’s response to humor can be a diagnostic device when the therapist uses it to identify conflict areas and general coping style.

The group therapist who is observant can deter- mine hidher clients’ level of anxiety on a specific topic by noting which metaphors are selected to express humor. The level of anxiety is directly proportionate to the degree the joke is disguised. Grotjahn (1970: 161) contends, “Jokes grow best on the graves of old anxieties.” Through humor, the story teller is allowed to receive vicarious pleasure by assuming a role of superiority. In a sense, laughing at others is a way of saving, “I am not like they are,” while at the same time denying that one is anxious about perceived inadequacies. Through a similar process, humor helps members of national and cultural subgroups dilute painful anxiety about perceived differences between themselves and the majority.

Laughter is based on the release of repressed

hostility, Grotjahn (1971) asserts. Like anxiety, hostility must be disguised, but Grotjahn (1971:237) points out that “the symbolic disguise of the aggression in the joke must remain understandable, or it would lose its liberating release in laughter.” Zuk (1966) concurs, observ- ing that jokes and humor are generally either an at- tempt to disguise other emotions, or a sign of recognition of the attempt to do so. Zuk (1964:89) maintains that humor, regardless of how bizarre, “is always a sign of some degree of readiness to reveal the thoughts which it seeks to disguise. It is a communication to the listener, be he family member, stranger, or therapist, that the thoughts are under some degree of pressure for expres- sion.” Cassell (1974) and Mendel (1971) further suggest that because humor is a disguised mes- sage, it may prove to be a useful tool for assess- ment and diagnosis in therapy.

In some instances, the use of humor in group therapy allows members to express thoughts that would be difficult to be transmitted in any other manner. Mendel (1971) notes that humor permits individuals to say things that they otherwise would not say, admit to themselves, or even as- sume the responsibility for thinking about. In other words, humor lets people express emotions which could not be verbalized directly because of the risk of facing the consequences of their direct expression.

More often than not, a person’s expression of humor and response to the humor of others can provide significant information about the in- dividual. The therapist who understands that humor offers a key to the client’s emotions, thoughts, anxieties, wishes, and fears, can “assess motivational systems, tensions and capacities of his clients.” (Mendel, 1971 5 4 )

On another level, in addition to basing client assessments on humor, the therapist also can use

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humor himlherself to facilitate the process of therapy. While the therapist’s use of humor is undertaken at the risk. of making him/her appear “imperfect, fallible, and human” (Roncoli, 1974: 179, it also gives the patient license to behave imperfectly, fallibly, and humanly. Grot- jahn (1971) contends the therapist’s own humor arises as a spontaneous reaction to the group, and should be expressed, because humor signifies emotional freedom and maturity. In addition, the therapist’s humor is a concrete demonstration that slhe does have emotions, and is not afraid of losing control.

What is more, Grotjahn (1971:234) asserts a therapist should display a sense of humor because, ‘.‘This is the most important safeguard against in- fantilization of the group.” If humor is present, then the relationship between group members, and between the group and the therapist, becomes more human. A human relationship and tolerant understanding of significant others in the group is important if the members are to achieve full maturational benefits from group process.

Jokes can be an excellent medium to use in mak- ing interpretations, Grotjahn (1971) notes, obser- ving that a “wisecrack,” when used as an inter- pretation by the therapist, can break through resistances and become acceptable much faster than conventional forms of communication. From clinical observations, Poland (197 1) corroborates that the use of humor with clients leads to further opening of associations rather than to closure. Poland (1 97 1 :637) asserts, “Wit can provide a very useful mode for the therapist’s intervention, and can be indicative ofthe state ofthe therapeutic alliance and of the patient’s observing ego.”

On the other hand, humor can be potentially destructive to the psychotherapeutic relationship. Kubie (1971961) warns that “humor has a high potential destructiveness, that it is a dangerous

weapon, and that the mere fact that it amuses and entertains the therapist and gives him a pleasant feeling is not evidence that it is a valuable ex- perience for the patient or that it exerts on the pa- tient an influence toward healing changes.”

The same source cautions that novice clini- cians, who use humor in an attempt to imitate ex- perienced therapists, “May do irremedial damage. Too often the patient’s stream of thought is diverted from spontaneous channels by the therapist’s humor; it may be even arrested or blocked.” (Kubie, 197 1236 1) Although he con- cedes that humor has its place in everyday life, Kubie cautions that humor should only play a limited role in psychotherapy.

Nursing Implications

The nurse-therapist’s decision as to whether or not to use humor, either as a tool of assessment or a method of intervention, should be based on a sound judgment about what humor may ac- complish, and what dangers are inherent in employing it. If the nurse-therapist does dare to show emotion, to self-reveal, to be human, then the decision to use humor has several important implications.

According to Poland (1971), the most crucial criterion to use in evaluating the therapist’s use of humor is the status of the therapeutic alliance. Moreover, the therapist needs to assess his/ her own motivations before using humor as a tool of intervention. It goes without saying that humor should never be motivated by aggressiveness, hostility, or annoyance toward the client.

Because persons who have an internal locus of control are more likely to accept, understand, and derive amusement from a joke of which they are the object, the nurse-therapist should make a com- plete evaluation of each group member before

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humor is used. In the event that such an evalua- tion does not take place, humor may uninten- tionally be used on a person who is unable to in- tegrate i t . In this instance, humor may serve to in- crease, rather than decrease, the patient’s ,:?’ 1 1 [y andlor depression.

In addition, through individual interviw\ , with each group member, the nurse-group therapist should determine how humor was used in the client’s family. In this manner, the therapist can learn to what extent clients were exposed to teas- ing and mockery in childhood. The knowledge may help determine whether humor would be constructive or destructive for the adult in therapy.

Finally, the nurse-therapist should understand the content of patients’ jokes as they relate to ef- forts at self-disclosure. Some clients may initially self-disclose in the disguised form of a joke, sent out like a trial balloon. If the painful (but dis- guised) act of self-disclosure is laughed at by the whole group, including the therapist, the patient would feel the “sting of the ridicule of the ther- apist.” (Mendel, 197 154) Naturally, such an ac- tion would not be therapeutic, but instead would delay the process of further self-disclosure for the particular person.

Humor in group therapy is different than in in- dividual therapy. In group therapy, the therapist may remain a witness, whereas in individual therapy, the joke is only between the therapist and the client, Grotjahn (1971) observes. Since the group therapist may not be one of the persons responding to humor, s/he is able to interpret the message transmitted in the content of a joke. Ac- cordingly, the therapist may be able to clarify issues that would otherwise have remained unar- ticulated.

In sum, humor is a significant form of com- munication whose self-expressive value has not

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been emphasized in therapy as much as other forms of commurlication. If the therapist can be objective, both in assessing the use of humor by group members and in using it himlherself,

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humor can be an effective tool in group therapy. 7 lo

References

Cassell, Jack I.., “The Function of Humor in the Counseling Process,” Rch~bil i tat i iv i Cororscliug Rirllerirr, Vol. 17, No. 4 (June) 1974.

Grotjahn, Martin, “Laughter in Group Psychotherapv,” The Itrrcriruriivtal Joirntul i f Group Ps~vchorhcrap~v, Vol. 2 1, No. 2 (April) 1971, pp. 234-238.

Grotjahn, Martin, “1.aughter and Sex,” in A Celebrario,i of Lurr,qltrer, Werner M. Mendel (ed.), 1.0s Angeles: Mara Rooks, 1970.

Kubie, 1.awrence S., “The Destructive Potential of Humor in Psychotherapy,” The American Jorrrnal of Ps~vchiarry, Vol. 127, No. 7 (January) 1971, pp. 861-866.

Lefcourt, Herbert M., Carl Sordoni, and Carol Sordoni, “Locus of Control and the Expression of Humor,”Jortriial of Persotrality, Vol. 42, No. 1 (March) 1974, pp. 130-143.

Mendel, Werner M., “Humor as an Index of Emotional Means,” Jottrital of Biological Psy l io lo~yv , Vol . 13, No. 2 (December) 1971, pp. 53-61.

Poland, Warren S., “The Place of Humor in Psycho- therapy,” The Americair Jortrtral of Psyhiarty , Vol. 128, No. 5 (November) 1971, pp. 635-637.

Roncoli, Marianne, “Bantering: A Therapeutic Strategy with Obsessional Patients,” Perspecrives in Psyclriarric C a r e , V o l . 12, N o . 4 ( O c t o b e r - D e c e m b e r ) 1974,

Zuk, Gerald H., “A Further Study of Laughter in Family Therapy,” Fa)iri!v Process, Vol. 3, No. 1 (March) 1964,

Zuk, Gerald H., “On the Theory and Pathology of Laughter in Psychotherapy,” Psyl torhcr~p.~: Theory, Research a d Pracrice, Vol. 3 , No. 3 (August) 1966,

pp. 171-175.

pp. 77-89.

pp. 97-101.

Bibliography

Coleman, Jules V., “Ranter as Psychotherapeutic Interven- tion,” The Aiiiericatr .Toirnrul of Ps-vchoana!vsis, Vol. 22,

Kempler, Walter, Priirsiplcs of Gesta!t Fuuri!v Therapy, Salt I.ake City, Utah: Deseret Press, 1974.

Millon, Theodore and Renee Millon, Abttoriital Behavior atid Pcr.wra/ir-v, Philadelphia: W.R. Saunders, 1974.

Robinson, Vera M., “Humor in NursinS,”A))rcri~.a)r .your- ml~!fNtrr.~ru,y, Vol. 127,No. 5 (May) 1970, pp. 1065-1069.

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NO. I , 1962, pp. 69-74.