HUM9997 - SECTION 7: THE APPLICATION OF HUMOR IN PSYCHOTHERAPY WITH CHILDREN AND ADOLESCENTS IN INDIVIDUAL, FAMILY, AND GROUP SETTINGS
We have all experienced and referenced how we notice the giddiness children display when learning about their environment. Since humor is such an integral part of a child’s yearning to discover, language expansion, and relationship development, it is more than apparent why we are devoting an entire section of this course to how to utilize humor with children and adolescents.
Humor in Child Therapy: Is it only Childs Play?
Most children inherently bring to therapy “the willingness to play, fantasize, and be silly.” Thus, the notion of “meeting the client where they are” requires that we consider the many opportunities to apply humor in our work with them. Though few scholarly sources illuminate the use of humor with this exciting population, even critics such as Buckman (1980) point to the near necessity of using this with children, adolescents and families. (Zall, 1994, 25)
One of the most common examples that one might conger about humor with toddlers may include the “peek-a-boo” interchange between an adult and child. This clearly demonstrates how a child finding that funny would likely help the clinician assess that they have not mastered Piaget’s construct of object permanence.
Most likely, when discussing infants and toddlers, jokes about all aspects of flatulence and a morbid curiosity about things some adults would consider less than appealing. In the case of a child who has recently been “potty-trained,” laughing about another child who had an “accident” may indicate mastery over controlling their bowel movements.
As work with children less than six years-old will often be treated more-or-less with their parents in family, play, or art therapy, the majority of this section will focus on how humor can be used in assessment and treatment of latency aged children (6-11). From a developmental viewpoint, a child’s adaptation of humor may represent competence in accepting and managing aggressive impulses and sexual awareness. (Freud, 1960) Also, children will often derive pleasure from ongoing cognitive discoveries. (Levine, 1969)
Wolfenstein (1954) points out the observation that children will often not express issues related to sexuality or aggression because they will get “in trouble” or fear because it might seem “babyish.” Humor provides an opportunity to express these loaded issues with a diminished sense of shame and increased sense of efficacy.
Client: (Angry) I don't know why I hit my sister.
Therapist: (Gently) Is your sister a big poo-poo head sometimes?
Client: (Smiling) My sister is the biggest poo-poo head in the world.
Therapist: And we always get angry at big poo-poo heads.
Client: (Smiling) We always get angry at poo-poo heads.
Therapist: Being angry is normal, but I wonder if we can't find a different way to show that we are angry at poo-poo heads.
While verbal jokes and riddles may be used to express humor, so might play and performing for others. According to many authors (Grotjahn, 1957; Apte, 1985; Gardner, 1986, 1988, 1989; Lawler, 1989), humor can also be used in relaying a grasp of language or physical coordination. Physical activity may be a healthy outlet for a child to deal with anxiety by giving them an outlet or sense of control or euphoria.
There is a deeper purpose in using humor with children that has developmental implications. As we have noted, children use their imagination to help manage the pace of facing challenges - and to contain their own emotional and psychological reactions to challenges - by sliding back and forth between reality and fantasy.
The comfort accorded by the retreat to fantasy allows children to gradually approach and take on the reality in small, manageable pieces. Humor exists in that space between reality and fantasy and gives children a tool to make important bridges as they change and grow. The use of humor with children can help with the pace with which new or challenging ideas are assimilated, allowing a child to hold the new idea separate from their emotional selves until they can integrate it successfully.
Additionally, because children do not always understand reality with great precision, they can sometimes view the world – and their actions in the world - through distorted perspectives. If there is a great deal of emotion tied to these distorted perspectives, the perspectives can get very stuck – causing problematic reactions.
As we have already noted, humor is an excellent tool for deconstructing rigid cognitive/emotional constructs so that an opening exists to examine that idea or construct from a different (and hopefully healthier) perspective. Frequently, children have not yet deeply internalized their more rigid and unhealthy ideas, since those ideas have not had time to solidify with repetition over time. There is more plasticity, since the ideas and perspective are still in the formative process.
Likewise, children are not as likely to have solidified an overly serious and rigid approach to life; they are still too close to their naturally exuberant sources of imagination and play. When the adult clinician gives permission to access that imagination and play through the use of humor, restructuring of the rigid ideas can proceed much more easily than it may with adults.
Client: (Sad) I'm no good at school. I don't know anything.
Therapist: (Gently bantering) So you don't know your colors?
Client: (Squinting) I know my colors.
Therapist: (Still bantering) So you don't know your numbers?
Client: (Smiling) I know my numbers.
Therapist: (Gently bantering) So you don't know your letters?
Client: (Starting to smile) I know my letters.
Therapist: (Still bantering) So you don't know what the animals are and what the animals say?
Client: (Smiling) I know all that stuff. That's baby stuff.
Therapist: Oh, I thought you couldn't learn anything, I thought you had a brain that was frozen or something. But you already know a lot of stuff. Maybe we can figure out how to use that to help you figure out the other stuff at school.
Often children who have rigid ideas about themselves have learned those ideas from their families. The use of humor in family therapy can model other and better approaches to handling problem behaviors and feelings in young children.
Humor and the Adolescent
Anyone who has ever interacted with, much less engaged in therapy with adolescents can expect humor to lace their interpersonal repertoire. The antiauthority and sexuality themes are, of course, most popular. Even authors such as Kubie (1971) who almost always contraindicate the use of humor with other populations, admit that the role of humor with adolescents cannot be neglected. (Brooks, 1994, 56)
Before undertaking the interpretation or implementation of humor with the adolescent, the clinician must grasp the developmental challenges faced with this population. Brooks (1994) outlines these nicely as independence (i.e., needing guidance and support from adults but needing to view themselves as self-reliant), intimacy (i.e., considering own needs and feelings while including the needs and feelings of others), and identity (i.e., a sense of direction and uniqueness in their self-image, values, and goals).
Regardless of the specific diagnostic presentation of the adolescent, the use of humor may be helpful in addressing factors such as readiness to build alliances, degree of willingness to acknowledge their own problems, comfort level in accepting help, self-perception as alienated by their issues, and motivation to find ways to deal more effectively with their problems. (Brooks, 1994, 60)
Adults may be more comfortable in direct expressions of their problems than the typical adolescent. Adolescents, who spend time and energy in trying to maintain a cohesive sense of self may lack the capacity to approach problems and shortcomings that directly. The adolescent’s use of humor can sometimes provide a less threatening avenue to view and enter their internal world.
Early in the therapeutic process, failure to respond to adolescent’s initial angry presentation in a useful way may result in early dropout or power struggles. Brooks (1994) provides an example of building with the hostility by responding to an adolescent’s proclamation of his ugliness by offering to carry on the session from the closet! (54)
While the aforementioned example is extreme and should be used in rare occasions with caution, using humor early on may prove to be diagnostic and therapeutic. Not responding to humor could be indicative of concrete thinking, altered or psychotic thought process, or the degree of symptom impairment or focus.
Remember, the clinician cannot overlook gauging his/her own comfort level with humor. The timing and tone could easily communicate their discomfort or frustration and sabotage the interaction.
For example, many teenage clients are likely to insult an adult’s appearance, demeanor, age, and intelligence (just for starters). A therapist needs to be constantly aware of their own issues in these areas as well as the purpose of such statements – to avoid, displace, project, or otherwise act out their own issues.
Once the therapist has participated in their own internal dialogue that normalizes the adolescent response and detaches from any counter-transference, they may begin to respond to the adolescent.
The following is an example of using humor with a 14-year-old who has struggled with worsening school performance, shoplifting, and increasing verbal hostility with other family members while his parents were divorcing.
Client: (angrily) No way, I am not talking to another old fart shrink like you. You look like a complete moron. Who created that artificial diploma on your wall, anyway?
Therapist: (subdued understatement) Wow, you’re even more excited to be here than I would have guessed. Can you imagine anything that sucks worse than coming here?
Client: (less angry) Not really, can you blame me?
Therapist: I guess not…What should we do?
Client: Let me go early. Tell my parents I don’t need to be here, it’s their mistake.
Therapist: Well, I could do that…but they might take you to see someone older and lamer than me instead. Client: Yeah, you’re probably right. I’m just soooo tired of talking about my problems.
Therapist: Understood…How can we make this session more bearable?
Sometimes, humor with the adolescent may be more subtle and sarcastic rather than overtly hostile. The next example involves a 15-year-old, girl with increasing depression and isolation at school, as well as irritability at home.
Client: (arms folded, sighing, staring to the side to avoid eye contact) Alright, let’s get this session over with. How long is this thing supposed to be anyway?
Therapist: As long as we decide together.
Client: (sarcastically and chuckling) Great.
Therapist: (interested and mildly playfully) Even though you not saying much with your words, your enthusiasm speaks volumes!
Client: (beginning to laugh): You know it. I have been told I have a knack for sarcasm, and I’m not sure that’s a complement.
Another instance where humor may be applicable is with “treatment-wise” adolescents who are looking for a power struggle. Often times, these clients tend to be challenging because they can easily pinpoint “hot buttons.” It is important to reinforce the appropriateness of communicating a message while challenging the adolescent to deliver it in a constructive, socially acceptable way.
Client: Your program really sucks! What a bunch of $#%*)%()_@! (Laughing in a condescending way)
Therapist: You’ve got strong feelings about that!
Client: Come on, do you really expect people to learn something here?
Therapist: I’d be interested in hearing how we could be helpful to you…
Client: (unconvinced) Yeah, right…Like you want to hear what I have to say!
Therapist: Having valuable ideas is one thing…cursing about what you don’t like is another…Are you suggesting we use more profanity in our program?
Another use of humor may be geared towards helping the adolescent manage their fears of being humiliated or different (Brooks, 1994, 65). Also, the following excerpt how one might also confront a teenager’s manipulation and provide necessarily elements of surprise that will be memorable. Moreover, psycho-educational material can be conveyed in a way that is engaging rather than one-sided lecturing.
Client: I know I can never use marijuana again. I want to have a future in college and stay out of jail.
Therapist: Is this the first time you have ever felt that way or said that?
Client: Well, kind of. This time is clearly different. I turn 18 soon – and any possession charges will be permanent on my record.
Therapist: What else keeps you clean right now?
Client: What other reason do I need?
Therapist: Well, the whole sexual thing…
Therapist: Well, marijuana causes impotence and breast development in men.
Client: (startled but amused) Are you serious, no way! No man boobs for me! When the guys give me crap for seeing a shrink, wait until they get wind of that…Who will be laughing at whom then!?
Using humor can be a method for helping a withdrawn, ashamed teenager“ break their silence.” Brooks (1994) refers to this as the “Monologue as Dialogue Technique.” The next example demonstrates how a therapist showing their quirks may provide a venue for the adolescent to self-disclose after seeing a role model.
Client: (Sitting quietly, looking down)
Therapist: Talking to himself) I know, I don’t know what to do.
Client: What are you talking about?
Therapist: Actually, sometimes I talk out loud to myself. Silence on the outside doesn’t necessarily mean quiet on the inside. I often have mixed feelings that I am afraid to share with others.
Client: Whatever…I thought I was crazy!
Therapist: Well, even if I might be crazy, many people tend to have those same experiences, but are ashamed to talk about…
Client: I know what you mean…
Sometimes, using humor can help interrupt other excessive or disruptive behaviors in a sensitive way. Examples of this may be obsessing, preoccupation, crying, or avoidance. The next interchange involves an adolescent who complained of uncontrollable crying spells whether she was anxious or angry.
Client: (Crying) I just can’t help it. No matter what medication I’m on or what I do, all that I do is cry!
Therapist: I know it’s got to be frustrating considering the time and energy we have put in.
Client: Crying more) Well, this is something else I failed at!
Therapist: Well, I guess that depends on how you define failure.
Client: (Sniffling but curious) What do you mean?
Therapist: Well, maybe you’re subconsciously trying to break a world record for consecutive crying spells. It does release endorphins and provide natural cleansing. Many people complain of not being able to access their tears. In fact, maybe there is something in your tears that we could use to study…it could be a contribution to medical science!
Humor in Child and Adolescent Groups
As we have stated in other contexts, the use of humor is helpful provided there is a purpose and an understanding of the client. Therapist and client initiated humor in groups, especially with children and adolescents, can be extremely beneficial under to right conditions. Another “rule of thumb” when initiating humor might be safer includes when it is directed at a situation, idea, or the therapist rather than a client. This factor becomes even more salient when in a peer setting, as this only magnifies a child’s or teenager’s self-consciousness.
Especially with this population, observing the use of humor during childhood may provide valuable clues to a child’s bio-psycho-social development. Role playing and imaginary friends are can be viewed early on. Also, teasing and play with other children may provide an opportunity to identify developmental stages; concrete and abstract thinking, double meanings, giftedness and delays. (Dana, 1994, 41)
Adults can be supportive of children during this time by validating the appropriate activity or risk – by smiling and recognizing the attempt that resulted in a minor “boo-boo”. This can help children began to develop an observing ego by allowing them use humor to provide comfort – and continue to be engaged in the process of interacting with the world.
When the child is a little older, the therapist taking on the role of “banterer” can be very useful. Several clinicians identify different rationales for this – including “information-conveying (Zhao, 1988)” and objectifying the client’s behavior by replacing the negative affect surrounding it and replacing it with light-heartedness. (Roncoli, 1974; Coleman, 1962) An example of this may include imitating an adolescent’s non-verbal responses (e.g., rolling eyes, loud sighing) or giving a paradoxical intervention (e.g., You might think this idea sucks!).
Sperling (1953) notes that bantering with a group can help them develop a sense of competence in dealing with conflicting but omnipresent experiences. These include pleasure / pain, hostility / friendliness, and seriousness / playfulness. As encountering these is inevitable, safely exposing this population in a controlled setting may prove beneficial to coping with the external world.
Interventions that help the child or adolescent understand “balance” in their coping styles are vital, given the characteristic of polarized thinking. Humorous interventions can help them become assertive without being aggressive, playful without being hostile, focused without being closed-minded. Given the risk of denial or embarrassment in these situations, sometimes using a “Mystery Client” to illuminate these issues is helpful in allowing the groups to more objectively evaluate their own struggles. (Dana, 1994)
Since the adult is usually the target of a child or adolescent’s ridicule, it is vital for the clinician to capitalize on this tendency (provided it is not overly aggressive or obscene). Also, the counselor can role model acceptance of one’s shortcomings in realistic proportions – which translates in the child being able to do so. This equates to greater self-esteem through a process Selman (1980) coins “social perspective taking.”
If the group begins to use more aggressive humor with the leader, this may provide an opportunity for the group to learn to empathize with the victim of the aggressive humor, realize the impact they are having, and learn what purpose that served. Sometimes an honest response of how something comes across can humanize the therapist, and therefore each other. “I didn’t know you would feel that way too!” or “I never thought about it that way” are common responses.
Roncoli (1974) states that in a group setting, this grants permission for members to “take risks and reveal their imperfections”. Due to the quality of egocentric thinking, this can be an opportunity to help this population combat over-seriousness. An example of this may involve the therapist laughing at a mistake they make (either initiating this or laughing with the group).
The adolescent’s use of humor in the group may identify the stage of group development, resistance, avoidance, or scapegoat patterns (Grotjahn, 1971). This can help the therapist connect with the group, though they may often use this opportunity to identify serious themes by directly addressing the issue the therapist suspects is being avoided. (Dana, 1994, 41-51)
After completing Section VII, participants will be able to answer the following questions:
What factors would help you decide what types of interventions to utilize with children and adolescents?
Could you elaborate on 3 examples of humor interventions with children and adolescents?
What unique challenges might be posed with this population?
Laughing lowers levels of stress hormones and strengthens the immune system. Six-year-olds laugh an average of 300 times a day. Adults only laugh 15 to 100 times a day.