The Healing Power of Humor and Laughter in Therapy

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Counseling, as a process, can be difficult and uncomfortable. At times, humor and laughter can create a lightness or ease the tension in a session.

Humor, when used successfully, can enhance the effectiveness of therapy by increasing trust and rapport. When a client and a counselor connect with humor or laughter, this can help the client relax, let go, decrease symptoms and engage in creative problem-solving.

Humor and laughter are powerful tools, which should be used with awareness and sensitivity. This needs to be utilized case-by-case because not every client appreciates humor. As a counselor, you can watch for various cues from the client. Notice when and how your client uses humor during therapeutic sessions. Also, gauge how your client responds to your humor.

Empathy, Genuineness & Positive Regard

As a counselor, it is important to embody three characteristics regarding humor: empathy, genuineness, and positive regard for your client.

From Sultanoff 2011, In addition to being skilled in the use of humor, the sender of the humor must have conscious intent and embody three central core conditions or “ways of being.” These ways of being are empathy/compassion, genuineness/congruence, and positive regard/acceptance.

Empathy

The sender of the humor must experience compassion and caring for the receiver. Empathy embodies a “feeling” of understanding and compassionate sensitivity to the other person and of their situation in life.

Genuineness

The sender of humor must experience genuineness or congruence within themself. Genuineness/congruence is the sense of internal consistency that naturally results in presenting oneself as “real.” There is no façade or phoniness in one’s being, and therefore, no phoniness in one’s presence.

The sender of the humor is “real” and uses humor that is congruent with their way of being in the world. If the humor being used is incongruent, it will be experienced by the client/receiver as fake, insincere, clumsy, and out of context.

Positive Regard (Acceptance)

The sender of the humor must embrace acceptance (positive regard) for the receiver.

The humor is offered out of respect for the receiver and specifically for the receiver’s benefit. The sender does not “judge” the receiver. The humor is not for the gratification of the sender by, for example, “teaching the receiver a lesson,” correcting the receiver (hostile/judgmental), or sending a “corrective” message as in a hostile tease, but is for the purpose of (without bias or with minimal bias) activating the therapeutic process within the receiver. The humor is intended to benefit the receiver.

The Benefits of Humor in Counseling

Moments of joy and shared laughter in session create a special bond therapeutically. Counselors can build trust and rapport by demonstrating their desire to connect with the client’s experience through humor’s effective and responsible use.

In “The Counseling Relationship,” the American Counseling Association (2014) defines the counselor’s role:

Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote [the] formation of healthy relationships. Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the client’s right to privacy and confidentiality.

Therapeutic humor has many benefits, in addition to increasing trust, it also has been found to reduce tension, break through resistance and find a healthy release from emotional states. From the International Journal of Mental Health, Dziegielewski et al.:

Within therapy, humor can be utilized to break a client’s resistance, reduce tension, generate catharsis, and increase trust in the client/therapist relationship. Within groups and/or teams, the effects of humor can assist in increasing cohesion and goal attainment. Furthermore, humor can be beneficial in the form of laughter when aimed at the goal or task.

The Association for Applied and Therapeutic Humor is a non-profit organization dedicated to studying and applying humor to effect positive change. Their research has demonstrated:

The strategic use of humor sparks connection, increases influence, improves communication and can be used as a competitive advantage in any industry. What’s more, humor provides innumerable benefits to our overall health and well-being, including reduced stress, greater resilience, decreased depressive symptoms, and even increased pain tolerance.

Humor acts as a distraction from distressing mental health symptoms and chronic pain. The act of laughing relaxes the body, mind, and spirit. In a research study published in the Journal of Aging Research,

Older persons in a nursing home were invited to join an eight-week humor therapy program (experimental group), while those in another nursing home were treated as a control group and were not offered the program. There were 36 older people in the experimental group and 34 in the control group.

Upon completion of the humor therapy program, there were significant decreases in pain and perception of loneliness, and significant increases in happiness and life satisfaction for the experimental group. The use of humor therapy appears to be an effective non-pharmacological intervention.

How Do You Incorporate Laughter or Humor Therapy into a Counseling Session?

If you find it difficult to connect to your natural sense of humor, remember humor can become a habit. Various materials can be used to remind you how to cognitively associate humor with experiences or events. This can be done by placing humor items around the office, in the waiting room or restroom area. Many counselors post humorous pictures, sayings, or leave out humor books where clients can read them.

Laughter or humor therapy can be used in individual, couples, family therapy, and group counseling sessions. Humor can be relayed through various mediums. For example, a counselor can tell a humorous story to the client. You can also elicit humor through reading materials, such as cartoons or memes. Games can be used with children or therapy groups to bring about laughter.

Also, laughter and humor could be elicited for group counseling sessions by watching a comedy show or movie. Laughter yoga is another humor technique that often involves breathing, stretching, and mindfulness in conjunction with simulated laughter.

Simulated Laughter & Laughter Therapy

Simulated laughter is self-induced laughter. When you pretend to laugh, a genuine laughter response can be initiated. A 2019 study conducted by van der Wal & Kok suggests “‘simulated’ (non-humorous) laughter is more effective than ‘spontaneous’ (humorous) laughter, and laughter-inducing therapies can improve depression.”

Whether laughter is simulated or genuine, it has healing properties. In a 2021 study from Current Research in Physiology:

Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention that can be used during this pandemic as a useful supplementary therapy to reduce the mental health burden. Laughter therapy can physiologically lessen the pro-stress factors and increase the mood-elevating anti-stress factors to reduce anxiety and depression.

In this ongoing stressful period of the Covid-19 pandemic, keeping necessary social distance, it is important to create a cheerful environment that will facilitate laughter among the family, neighbors, and community to cope with the stresses…

Humor Considerations

Counselors may be concerned with using humor that they may appear less competent or lack boundaries. Effective humor can benefit the client relationship with proper boundaries and guidelines. Humor is a powerful therapeutic technique that does not need to be feared but is used with reverence.

Before utilizing humor in a client session, assessing your client’s personality and openness to connecting with humor is important. Humor is best used when pointing out the humanness of the counselor, rather than directing it at the client. This type of humor can model self- forgiveness and kindness about being an imperfect being.

Self-effacing humor is best as it demonstrates our ability to be lighthearted about being human and can serve as a teaching moment for clients. Ensure you are not belittling your skills or professional abilities, as that can create a lack of trust in the relationship.

Louie et al., 2016 found:

…laughter shared between the provider and patient conveys a measure of trust and light-heartedness. Furthermore, humor can improve communication, as a joke can signal a transition in the conversation from the serious to more benign topics.

In general, medical providers do best when acting cautiously and following the patient’s lead. Knowing a patient well and acknowledging any humor expressed by him or her is recommended.

Humor used therapeutically must be timed correctly. Dean & Gregory, cited in “Using Humor in Palliative Care,” discuss the importance of timed humor:

Receptivity to humor was influenced not only by individual preferences and circumstances but also by timing. Participants talked about being observant for particular moods or times of day when receptivity may vary. In hospice/palliative care, patients vary in levels of comfort, cognition, and relaxation. Skill in observing variations related to time meant that staff came to know when humor was welcome and when it was superseded by the need for comfort and reassurance. Recognition of cues indicating receptivity to humor is a skill that calls for astute observation and sensitivity.

As a counselor, it is important to understand cultural differences in regard to humor. According to Jiang, Li and Hou 2019,

Humor is a pan-cultural phenomenon but is also interculturally different. Previous literature provides substantial evidence suggesting that perceptions of humor, humor usage, and the relationship between humor and psychological well-being differ across cultures. Specifically, Easterners do not hold a positive attitude toward humor as their Western counterparts do. Among Easterners, Chinese have ambivalent attitudes toward humor. This perception makes Easterners less likely to use humor as a coping strategy in comparison with their Western counterparts.

When clients use dark humor to describe a sad situation, it is important for counselors to address this incongruity. Dark humor can cover up feelings of depression, sadness, or anger. Counselors can gently address how the client seems uncomfortable in these moments and probe for deeper meanings. Counselors also need to set boundaries with any instances of inappropriate humor.

When to Avoid Humor

Counselors want to avoid harming the client, including with humor.

The American Counseling Association (2014) “Code of Ethics” in section A.4.A. (“Avoiding Harm and Imposing Values”) states: “Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.”

There are times in which humor should be avoided. Humor is not to be used for the deflection of emotions. The counselor wants to ensure the client is able to sit with uncomfortable emotions and process them. Denying emotions or suppressing them is counter to the therapeutic process. That said, it can be healthy at times to detach from pain, whether it is emotional, spiritual, or physical to view it from another perspective.

A few closing thoughts on therapeutic humor and laughter to keep in mind:

Use humor sparingly, like self-disclosures. Allow it naturally to come forth. Humor does not need to be a part of every session, but it can add authenticity when used at the right time.
Keep in mind cultural differences. What some cultures find funny, others may not.
Stay away from sarcasm. When dealing with clients, certain people may not have the cognitive awareness to pick up on sarcasm and may take what you say literally.

Lisa Hutchison, LMHC

Writer & Contributing Expert

Lisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.

Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.