by Jad Tompkins, LCSW

Jad Tompkins, LCSW is a Licensed Clinical Social Worker with over 10 years experience in clinical practice. He has been involved in researching humor and its uses in psychotherapy for much of the last decade. He currently provides both psychotherapy and training services at Emory University, and maintains a private practice.

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The objective of this course is to provide the mental health clinician with a comprehensive introductory overview of the appropriate and inappropriate uses of humor in psychotherapy. When the trainee completes this course, he/she will:

- Understand the nature of humor and the history of the use of humor in psychotherapy
- Know the benefits and risks of using humor in psychotherapy
- Grasp the contraindications and misuses of humor in psychotherapy
- Comprehend the complications of using humor with different patient populations: adult, child, adolescent, groups, couples
- Learn skills in applying humor successfully in psychotherapy

This course is primarily designed for clinicians in the earlier stages of their career, or for more advanced clinicians reviewing basic concepts in this area.

Course length:
7 contact hours: Core clinical


Section I: Introduction
Section II: Case Scenarios
Section III: Defining Humor
Section IV: Historical Support for the Use of Humor in Therapy
Section V: Introducing Uses and Misuses of Humor in General Psychotherapy Practice
Section VI: The Application of Humor in Psychotherapy with Adults in the Individual and Diverse Diagnostic Populations
Section VII: The Application of Humor in Psychotherapy with Children and Adolescents in Individual, Family, and Group Settings
Section VIII: Humor as a Short-Term, Managed-Care Friendly Strategy with Groups, Couples, and Families
Section IX: Laughing and Finality: The Application of Humor in Psychotherapy with Older and Terminally Ill Adults
Section X: Use of Humor within Models of Therapy

Section XI: Special Considerations: After the Laughter
Section XII: Analysis of Case Scenarios
References and Test




Section I: Introduction

“One extremely potent, yet apparently little recognized tool in psychotherapy is humor.”

- Harry Olson

Why discuss the importance of integrating humor into the practice of psychotherapy? As clinicians, part of our clinical obligation is to help our clients embrace and balance life’s competing demands. To simultaneously accept powerlessness - while becoming empowered - and to be flexible in responding to change - while also keeping firm commitments – these are just a few of the many paradoxes that therapists come across in the course of their clinical interventions.

For our own development and role modeling, we must constantly strive for balance in our therapeutic identity. If we can grasp the appropriate use of humor, in tandem with other approaches, we can illustrate a diversified blend of professionalism and humanity; seriousness and lightness.

This is the domain in which humor can work best: blending mutually contradictory aspects of life, and doing so in a manner that creates both a human connection and a shared experience of overcoming hardship and turning it into something less painful - or even pleasurable.

More specifically, here are a couple of the benefits of using humor in clinical practice that will be examined in this course. Sultanoff, a widely known modern pioneer and practitioner in the field of humor therapy, describes several of these points that are highlighted below.

- Humor can help people relate to others more easily and quickly.

- Humor can change the way people think and view the world.

- Humor partially transforms difficult emotions into more acceptable ones.

- Humor can communicate a desire to be emotionally engaged.

- Humor can more quickly help people take responsibility for difficult situations, decisions, or patterns they have been dodging.

- Humor can utilize the “mind-body connection” to improve overall health. The physical laughter changes the stressful perception that exists cognitively.

- Humor provides some immediate emotional and physiological gratification in a situation where it might otherwise be non-existent - or exist only in destructive ways.

Sensing and expressing humor appears to be a therapeutic, necessary and inseparable part of our existence. When performed with skill and knowledge, humor can be a uniquely powerful therapeutic tool to further the goal of helping patients adapt to difficult or overwhelming experiences.

All clinicians should consider humor as one of the many tools in the repertoire of skills that can be utilized in the therapeutic process. At the meta-level, a willingness to utilize humor establishes a more positive and more human context in which the connection between the patient and the clinician will take place. There is both warmth and understanding in humor, and humor can convey these two elements of the therapeutic relationship in a very powerful, rapid and compact form.

Conversely, an absence of humorous expression may communicate other messages at the meta-level. The client may perceive a lack of humor as a sense of disinterest or aloofness. This may result in the patient seeing his/her clinician as stoic - and unable to appreciate their idiosyncrasies or humanness.

By approaching clients without any humor or playfulness we may also run the risk of appearing too clinical – connecting with our patients as if they were merely a conglomeration of symptoms and diagnoses. An absence of humor may also be seen as a signal that our client's problems are so grim and serious that they can't be handled successfully, and there is no room for lightness and optimism.

This is to say that the choice to withhold or not use humor within the therapeutic encounter creates certain kinds of risks, just as a decision not to use cognitive restructuring, or any other fundamental therapeutic skill, creates certain kinds of risks. However, these must be balanced with other kinds of risks in the therapeutic interaction.

To be used successfully, humor must be used with understanding, skill and knowledge. Otherwise the interventions can have a variety of detrimental effects. In some instances, attempts at humor can leave the client confused, wondering what was meant. In other instances, humor can leave the client wondering whether something hurtful was intended.

At its worst, if we approach our clients without skill in the uses of humor - with either an excessive or an inappropriate use of humor – we run the risk of giving messages that signify disrespect to the client and/or trivialization of their core beliefs or issues. In this way, poor uses of humor can create emotional wounds or sources of conflict.

The essence of this course will not be exploring whether to use humor in our work with clients, but how it can best compliment and heighten our ethical, responsible, and sound clinical practice. There is a core belief in this approach: humor can help us connect with our clients, and help them connect with themselves and their relationships on a deeper cognitive, emotional, and spiritual plane.

In addition to examining appropriate and successful uses of humor, we will also attempt to provide some direction in how to avoid the inherent risks of using humor. Pursuant to this, we will also study how consistent self-awareness and self-evaluation will greatly minimize those dangers. We will highlight a series of criteria and methods to use humor in relationship-building, assessment, diagnosis, and treatment of individuals, groups, and families with various challenges.

In order to outline the potential uses of humor, let us first look at this concept from a more inclusive perspective. What are the commonalities that exist with humor, therapy, and life? Sultanoff (2002) identifies what he has observed to be “universal traits of humor.” These appear congruous with the natural occurrences and experiences of life, and therefore therapy.

These include a sense of incongruity, absurdity, the unexpected, pleasant surprise, being startled, cognitive appreciation, and emotional chaos remembered in tranquility. We will illuminate these in detail later.

Also, conscientious assessment of when to use humor, based on the variables encompassing the clinical context, is paramount. Included in this procedure is identifying the target of humor, the specific environmental conditions, and the individual’s receptivity. (Sultanoff, 1994) When, how, and with whom we choose to use humor is essential to its appropriate application.

In order to practice what this course is teaching, we will include various quotes, one-liners, and humorous activities that may be used by therapist and patient alike. Feel free to use them in your practice as homework assignments, in your personal life as ways to decompress, or just to provide a break from your relentless pursuit of CEUs!

We will also present some case scenarios to show the uses – and misuses – of humor in therapeutic work. Following each scenario, we will ask a series of questions about the uses of humor that has been shown. This will help to create a bridge between the theoretical and the practical, hopefully making the use of humor more real for the trainee.

After reading Section I, participants will be able to answer the following questions:

What are 5 purposes of utilizing humor in psychotherapy?

What can the therapist’s use of humor communicate to clients?

Therapeutic Riddle:

Q: How many therapists does it take to change a light bulb?
A: I’m sorry, time is up. You’ll have to wait until the next session to read the answer.