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Humor in Therapy: The Case

for Training Therapists in its
Uses and Risks
a
Louis R. Franzini
a
Department of Psychology , San Diego State
University
Published online: 30 Mar 2010.

To cite this article: Louis R. Franzini (2001) Humor in Therapy: The Case for Training
Therapists in its Uses and Risks, The Journal of General Psychology, 128:2, 170-193,
DOI: 10.1080/00221300109598906

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 The Journal of Generul Psychology, 2001, 128(2), 170-193
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Humor in Therapy: The Case for Training

Therapists in Its Uses and Risks
LOUIS R. FRANZINI
Department of Psychology
San Diego State University

ABSTRACT. Formal humor training for therapists is proposed as an elective part of their
academic curriculum. The paucity of rigorous empirical research on the effectiveness of
this historically controversial form of clinical intervention is exceeded only by the absence
of any training for those practitioners interested in applying humor techniques. A repre-
sentative sample of its many advocates’ recommendations to incorporate humor in the
practice of psychological therapies is reviewed. Therapeutic humor is defined, the role of
therapists’ personal qualities is discussed, and possible reasons for the profession’s past
resistance to promoting humor in therapy are described. Research perspectives for the eval-
uation of humor training are presented with illustrative examples of important empirical
questions. In addition to its potential salubrious effects on clients, therapeutic humor might
have the positive side effect of preventing or minimizing professional burnout in thera-
pists. This potentially major psychotherapeutic resource, highly praised by some, remains
insufficiently evaluated and essentially untapped.
Key words: clinical supervision, humor training, psychotherapy curriculum, therapy skills

WE ARE SEEING increasing interest in interdisciplinary humor research:

newsletters, web sites, humor and play conferences, an international society for
humor studies, psychology journal articles, and an entire journal, Humor: Within
the field of psychotherapy, texts and even four handbooks of “humor and psy-
chotherapy” (Buckman, 1994a; Fry & Salameh, 1987, 1993; Salameh & Fry, in
press) have appeared, all advocating the application of humor. The latest incar-
nation is a popular online chat hosted by a self-proclaimed “psychohumorist”
who offers advice heavily laced with humor on how to deal with life and work-
induced stress (Poe, 2000). Finally, the interdisciplinary American Association

An earlier version of this article was presented at the annual meeting of the Internation-
al Society for Humor Studies, Oakland, CA, in July 1999.
Address correspondence to Louis R. Franzini, Doctoral Training Center; San Diego
State University, 6363 Alvarado Court, Suite 103, San Diego, CA 92120-4913; send e-mail
to franzini@sunstroke.edu.

170
 Franzini 171

for Therapeutic Humor (AATH) promotes the healing power of laughter and
humor. There even are guidelines on how to form your own local laughter clubs,
which purportedly can help you achieve such idealistic goals as personal health
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and happiness and even world peace (Kataria, 1999)!

Most advocates of using humor in therapy have written from a variety of tra-
ditional psychodynamic (e.g., Mosak, 1987; Strean, 1994) or rational-emotive
perspectives (Ellis, 1977). Their essays and clinical anecdotes indicate many
potential therapeutic benefits from applications of humor. Appendix A is provid-
ed to summarize the numerous specific advantages described by those theorists.
Because duplicate mentions of benefits by multiple writers have been omitted,
this table provides only a sample of the hundreds of articles, chapters, and full
professional volumes advocating the use of humor in therapy.
The call for the use of humor in therapy has been longstanding and is grow-
ing stronger, even though most of those salubrious claims remain essentially
untested empirically. Little has changed since Saper’s (1987) review of humor in
psychotherapy in which he called for more controlled empirical proof of the effec-
tiveness and value of humor, while acknowledging that such research would be
“formidable, if not impossible” (p. 366). Other reviewers examining the literature
in the subsequent decade and beyond, such as Salameh and Fry (in press), are
decidedly more sanguine about the supportive empirical work affirming the value
of humor in therapy to both the client and the process itself.

Definition of Therapeutic Humor

Therapeutic humor includes both the intentional and spontaneous use of

humor techniques by therapists and other health care professionals, which can
lead to improvements in the self-understanding and behavior of clients’ or
patients. To be most helpful, the humorous point should have a detectable rele-
vance to the client’s own conflict situation or personal characteristics. The form
of the humor could include a formal structured joke or riddle (although that would
be relatively rare), a pointing out of absurdities, an unintended pun or spooner-
ism, behavioral or verbal parapraxes, examples of illogical reasoning, exaggera-
tions to the extreme, statements of therapist self-deprecation, repeating an amus-
ing punchline, illustrations of universal human frailties, or comical observations
of current social and environmental events. Qpically, the result is a positive emo-
tional experience shared by the therapist and the client, which could range any-
where from quiet empathic amusement to overt loud laughter.
The AATH’s official definition of therapeutic humor is “any intervention that
promotes health and wellness by stimulating a playful discovery, expression or
appreciation of the absurdity or incongruity of life’s situation. This intervention
may enhance health or be used as a complementary treatment of illness to

‘The terms client and patient are used interchangeably throughout this article.
 112 The Journal of Generul Psychology

facilitate healing or coping, whether physical, emotional, cognitive, social or spir-

itual” (Sultanoff, 2000, p. 1).
Salameh’s ( 1987) statement could be added, “Therapeutic humor is well-
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timed, taking into account the patient’s sensitivities and specific needs at the
moment when a humorous intervention is considered. The judicious therapist is
also aware of when not to use humor, depending upon the therapeutic material
under discussion and the patient’s level of absorption” (p. 224, [italics in origi-
nal]). He stressed that humor is the best gift we can offer our patients because it
demonstrates constructively that with a newly acquired positive view, their prob-
lems become solvable.
Mindess’s (1971) definition of therapeutic humor is comprehensive and per-
suasive. “Deep, genuine humor-the humor that deserves to be called therapeu-
tic, that can be instrumental in our lives-extends beyond jokes, beyond wit,
beyond laughter itself to a peculiar frame of mind. It is an inner condition, a
stance, a point of view, or in the largest sense an attitude to life” (p. 214). The
distinction between humor as a construct versus laughter as a behavioral event is
important and has research implications. The terms are not interchangeable, and
each may well have different consequences which, in turn, can be investigated.
Ventis (1987) noted that “the disputed cathartic effects of laughter are not criti-
cal for possible therapeutic effects of humor” (p. 155).
In his review of humor in psychotherapy, Saper (1987) defined humor “as an
affective, cognitive, or aesthetic aspect of a person, stimulus, or event that evokes
such indications of amusement, joy, or mirth as the laughing, smiling, or giggling
response. The personality trait sense of humor embraces at least two human
capacities: appreciation, or the set to perceive things as being funny, and cre-
ativity, or the ability to say and do funny things, to be witty. It implies a readi-
ness to find something to laugh about even in one’s own adversity” (p. 364, [ital-
ics in original]).
The reputed personal benefits of humor appear across multiple domains:
medical (e.g., the alleviation of pain and increased quality of life in terminally ill
patients [cf. Kisner, 1994]), physiological (e.g., an increase in released endor-
phins [Levinthal, 19881and improvements in natural killer cell activity [Bennett,
1998]), social (e.g., becoming a more pleasing social stimulus and expanding
one’s network of friends [Ruch, 1998; Salameh & Fry, in press]), and psycho-
logical (e.g., providing an effective coping device to modulate stress and enhanc-
ing an appealing personality trait [cf. Buckman, 1994a; Fry & Salameh, 1987;
Kuiper & Martin, 19981).

Therapeutic Benefits

Freud (1938) himself reportedly told jokes to his patients upon occasion and
wrote of the psychological usefulness of humor in gratifying sexual and aggres-
sive drives, which otherwise would be censored or frustrated. However, it is the
 Franzini 173

psychoanalyst Grotjahn who is credited with first publicly espousing the use of
humor in psychotherapy in 1949 in Samiska, an obscurejournal of the Indian Psy-
cho-Analytic Society.
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Since then, there have been increasingly frequent calls for the use of humor
in psychotherapy. For example, Kuhlman (1984), speaking for its many advo-
cates, pointed out, “Humor can serve as a potent force in change processes and
has a place within the psychotherapeutic relationship as it does in all other forms
of human relationships” (p. 2). Interestingly, in his review, Kuhlman found no
allusion to humor in the behavior therapy literature prior to the early 1970s and
he quoted Carl Rogers, founder of relationship-based,client-centered therapy, as
similarly eschewing humor because “therapy is hard work.”
In a survey of published research on the use of humor in behavior therapy,
Franzini (2000) found no explicit mention of humor other than two case reports
that were published in 1973. Nevertheless, 98% of practicing behavior therapists
in Franzini’s sample endorsed the intentional use of humor in therapy, especial-
ly for these purposes: to help establish rapport, to illustrate the client’s illogical
or irrational thinking, and to share a positive emotional experience with the client.
Ventis (1987), one of the two case study authors cited in Franzini’s article,
also reviewed the purposeful use of humor in behavior therapy and found only
the same two contributions plus an unpublished 1985 doctoral dissertation on the
topic. Ventis elaborated that humor in behavior therapy can serve several specif-
ic functions. It can be used to compensate for inadequate levels of relaxation with-
in systematic desensitization, it can promote self-efficacy in aiding the client in
coping with previously difficult situations, and it can facilitate assertion training
by reducing clients’ fears while also teaching appropriate expressions of feelings
in angry individuals.
The American Psychological Association’s Monitor recently featured the
“new” notion of therapeutic humor “to promote healing” (McGuire, 1999). In the
Letters to the Editor in subsequent issues, the article received praise from a clin-
ical psychology doctoral student, who wondered why psychologists needed
reminding of their humanity (Passarelli, 1999) and also a caveat from Kazdin
(1999), who warned, “It will be a very sad day if humor is promoted as treatment
without evidence in its behalf’ (p. 3).

Caveats
The strongest advocates of using humor in therapy also remind us that cer-
tain cautions in its use are appropriate. For example, Salameh, who has been one
of the most prolific writers promoting humor therapy, reprinted in his 1987 hand-
book his excellent chart contrasting the characteristics of helpful and harmful
therapeutic humor. Fry (in press) was equally enthusiastic about the beneficial
roles that humor can play in clinical interventions but also acknowledged that
there are circumstances in which it can be detrimental. Saper (1987) suggested
 174 The Journal of General Psychology

that improper humor is any humor that “humiliates, deprecates, or undermines

the self-esteem, intelligence, or well-being of a client” (p. 366). Surely no one
would disagree.
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Reynes and Allen (1987) urged “a balanced awareness of its risks and bene-
fits” (p. 261). Thomson (1990) noted that humor in therapy can have a powerful
impact, positive and negative, and so should be attempted only after establishing
a strong therapeutic relationship. Ventis (1987) cautioned, “therapists at any level
of experience . . . to remember that the use of humor and laughter in therapy is
not a goal in itself but one option for facilitating therapy” (p. 162). Saper (1987)
explicitly predicted a disaster if the adoption of humor in psychotherapy was
“premature.” Appendix B presents clinicians’ specific cautions.
Rarely does anyone come out 100% opposed to the use of humor in thera-
py. The closest to that position is probably Kubie’s (1971) classic paper aptly
titled “The Destructive Potential of Humor in Psychotherapy.” Even Kubie was
careful to point out that he was not intending “to persuade anyone never to use
humor or that humor is always destructive” (p. 37, [italics in original]). Although
he acknowledged that “sometimes humor expresses true warmth and affection”
(p. 37), he remained adamant that its role in psychotherapy, if any, is “very lim-
ited” (p. 42).

Patients’ Humor

In its simplest paradigm, psychotherapy is a dyad. The focus of the present

discussion primarily concerns the use of humor by the therapist, although the
patient, too, may use humor or attempt to do so. It is very important how the ther-
apist reacts to the patient’s humor. The therapist could laugh genuinely with the
patient, laugh falsely out of pity or sympathy, laugh disparagingly, attempt to top
the patient with a better story or remark, or instantly attempt to “use” this humor
data to interpret cracks or quirks in the patient’s personality structure or to diag-
nose hidden psychopathological tendencies. All of these reactions, except the
first, would probably be therapeutically counterproductive.
Salameh (1987) provided specific guidelines on how to introduce humor with
different patients who may reveal their negative past experiences with harmful
humor. Some patients may exhibit symptoms such as depression or paranoia,
which are likely to be associated with misinterpretations of a therapist’s well-
intentioned humor interventions. Saper (1987) confirmed the importance of
establishing a strong relationship with the client and gauging whether the client
can accept the therapist in a humorous role and even whether humor has a legit-
imate place in the therapy. These assertions should be regarded as empirical ques-
tions to be researched in controlled studies.
Relatively little has been written about the use of humor in couples’ treatment
(cf. Buckman, 1994b; Schnarch, 1990) or group therapy (cf. Bloch, 1987; Bloch,
Browning, & McGrath, 1983; Grotjahn, 1971; Hankins-McNary, 1979; Vargas,
 Franzini 175

I96 1), although the group setting would seem to be a natural opportunity
for the use of humor by both patients and therapists because of its built-in audi-
ence. Salameh ( 1983) summarized the findings from three unpublished doctoral
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dissertations on the use of humor in group therapy: that humor could facilitate or
disrupt the group process (Childs, 1975), that matching child-care workers with
young male delinquents on the basis of levels of successful humor was associat-
ed with fewer instances of delinquency (Taubman, 1980). and that laughter
episodes indicated an ongoing or imminent shift in the direction or level of group
interactions (Peterson, 1980).
In a special category of its own is Marcus’s (1990) incredible recommenda-
tion to treat the patient’s humor itself! He noted that other therapists have failed
to focus on the pathological aspects of their patients’ characteristic of “being
amused.” He argued that when such patients present with “smiling, laughter, and
a humorous attitude,” they are failing to take themselves seriously. He maintained
that such clinically relevant behaviors need to be understood as inappropriate
defenses against emotion that should be eliminated by the application of his struc-
tured approach to cognitive therapy.

Resistance to Therapeutic Humor

Psychotherapy has a very long tradition of being a grim and sober profes-
sional enterprise designed to treat psychopathology and to eradicate the perva-
sive symptoms of mental illness in our society. Saper (1987) used such language
and tone when he pointed out that the context of psychotherapy sessions defines
“a major problem of attempting to inject levity into a grave and solemn enterprise
such as therapy” (p. 365). Therapists’traditional goals have been to treat, to cure,
to teach, and to eliminate disabling and debilitating symptoms and interpersonal
conflicts. Surely these are serious and important objectives for our individual
patients and for the social benefits to society at large.
Why have therapists and their educators been slow or even actively resis-
tant to incorporating humor into their armamentarium? Several likely reasons
emerge: Consistent with the notion of the gravity of mental disorders, psy-
chotherapists have been formally charged with taking themselves too serious-
ly (Ellis, 1977; Kaneko, 1971; Mindess, 1971). Not only do they see their pro-
fessional work as very important and serious, they see themselves as very
important and serious.
Mindess (I97 1, in press) has long been an outspoken advocate of thera-
peutic humor. Yet even he claims that as long as therapists are committed to the
belief that their theories and techniques of therapy are “cogent, valid, and ben-
eficial, . . . a deep and genuine sense of humor cannot be achieved and there-
fore promoted” (1971, p. 220). Thus, if therapists strongly believe that their
techniques are already sufficiently powerful to help their patients, they may feel
 116 The Journnl of Geneml Psychology

it is unnecessary to add any new procedure to the process. Ventis (1987) made
a similar point with regard to behavior therapists who, thus far, have felt no par-
ticular pressure to add humor techniques to their repertoires because their stan-
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dard clinical procedures have been shown empirically to be so successful. Nev-

ertheless, he suggested that adding humor and laughter would facilitate the
practice of behavior therapy.
Jolley (1982) conjectured that “those therapists who are resistant to humor
have difficulty with the issues of closeness and power, and that is a major reason
why humor is not considered a ‘legitimate’ tool in some therapeutic societies” (p.
iii). She also highlighted the relevance of the therapist’s standard stance of
omnipotence and the usual accompanying professional role expectations. “The
real fear stems from how a therapist who uses humor will be seen through the
eyes of his colleagues. A person who laughs with someone is sharing, and a ther-
apist who does this is giving away some of his power, putting him more or less
on an equal level” (pp. 21-22).
Another contributing factor is that many psychotherapists simply may not
have the humor skills to implement humor techniques in therapy. Most people,
including therapists, can tolerate nearly any epithet about themselves except that
they are humorless. Humor theorists have identified two major components to a
person’s sense of humor: being a humor initiator and a humor appreciator (cf.
Lefcourt & Martin, 1986).Although many psychotherapists may be humor appre-
ciators, it could be that relatively few are themselves effective humor initiators in
any context. Thus, therapists, while possibly self-reporting excellent senses of
humor, may still not perceive themselves as active humorists or deem its use to
be appropriate in psychotherapy. A small percentage of therapists may even agree
with Kubie (1971), Kazdin (1999), and Saper (1987) that humor in therapy could
at times be “dangerous.”
A further complication is that the classroom instructors and senior clinical
supervisors of novice therapists historically have discouraged the use of humor
as part of the psychotherapeutic process. Despite any personal preferences to the
contrary, it seems highly probable that therapists in training would pragmatical-
ly adopt this no-humor-in-therapy value. Modeling processes and the reward
power of supervisors are very effective in producing similar values and, as is like-
ly in this case, non-humor behavior in their students (cf. Egan, 1998).
A notable recent exception is found in a chapter by Dunkelblau and two of
his supervisees in which they described the effective use of humor in therapy
supervision and noted the many striking parallels between the processes of psy-
chotherapy and stages of clinical supervision (Dunkelblau, McRay, & McFadden,
in press). Although they appropriately acknowledged potential risks of humorous
interventions in supervision, such as using humor to avoid serious topics or to
deny angry feelings, they strongly recommended using humor for its valuable
gratifying, nurturing, and educational qualities. They suggested that humor
enhances the supervisory relationship and fosters both competencies in clinical
skills and a clear professional identity.
 Franzini 177

A Modest Proposal

Given humor’s potential therapeutic benefit for clients, it seems prudent to

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recommend that the use of humor in therapy be conducted by qualified practi-

tioners and its effectivenessevaluated empirically.A compellingprocedural dilem-
ma emerges: Should this “new” clinical technique, or any innovative treatment
procedure, first be demonstrated to be effective in controlled research, or should
clinicians first be trained in the technique and the evaluation done subsequently?
The current controversial popularity of eye movement desensitization thera-
py (EMDT) perhaps is a relevant parallel. Practitioners are being urged by the
founder of the technique and her disciples to obtain certification in the use of
EMDT by attending expensive workshops, but many clinical supervisors and
researchers question the ethical and scientific basis of the procedure and the valid-
ity of the effectiveness claims (e.g.. Fish, 1992). Beere (1992) argued that clini-
cians should be trained in the EMDT technique first and then conduct the evalu-
ation research on it. With humor skills the cost of training would be far less-at
least until the invention of a certification program.
In view of the apparently increasing interest in using humor in therapy, I am
proposing that efforts be directed to developing a formal course in humor training
to be offered to all psychological therapists, regardless of their specific theoretical
orientation: psychodynamic,behavioral, cognitive, or the most frequently endorsed
orientation, eclectic therapy. This humor training can be accomplished through
classroom seminars, workshops, lectures, assigned readings, demonstrations, exer-
cises in humor writing and performance, and, most important, as a part of the clin-
ical supervision process. The opportunity for formal humor training would repre-
sent a revolutionary curricular development in the education of therapists.
The success of therapeutic humor relies heavily on spontaneity. Familiarity
with humor methods from such formal training opportunities would make their
spontaneous use more likely (Banmen, 1982).You cannot command spontaneity.
Similarly, you cannot simply order a therapist, novice or experienced, to be funny.
In fact, to force humor in a therapy session by a therapist uncomfortable or inex-
perienced in humor techniques would be unwise and counterproductive. For
example, the inappropriate use of satire could lead to a patient feeling humiliat-
ed or ridiculed; or the inappropriate use of exaggeration or the telling of a formal
joke might create the impression that the therapist is insensitive or uncaring or
excessively self-absorbed.
Some debate remains about whether the application of humor by therapists
can even be taught. Olson (1994) claimed that, like responsibility, “humor can-
not be taught didactically, but must be observed and personally experienced to be
mastered” (p. 197). Bloomfield (1980) cited the importance of “intuitively”
knowing when to make a humorous remark in therapy. In contrast, Tallmer and
Richman (1994) declared that humor as a “therapeutic tool can be learned, but its
effectiveness also depends on the artistic and stylistic talents” of the therapist
 178 The Journal of General Psychology

(p. 180). MacHovec (1991), Killinger (1987), and Salameh (1983) all argued that
applying humor effectively in therapy is a learnable skill.
Should such a course in humor skills be required for all therapists in train-
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ing? Probably not, especially when the trend in graduate clinical psychology edu-
cation seems to be to reduce the number of required courses of all kinds.

The Role of Therapists’ Personal Qualities

Greenson (1967) has suggested that the best therapists possess a good sense
of humor. Good rational emotive behavior therapists reputedly also actively use
humor in therapy to help their clients identify their silly and irrational beliefs
(Yankura & Dryden, 1994). Of course, the founder of rational emotive behavior
therapy (REBT), Albert Ellis (1977, 1984), has been outspoken in his advocacy
of using humor in therapy. Consequently his REBT therapy sessions become
vivid and memorable, especially when he leads his clients in group singing of
familiar tunes whose silly lyrics have been modified to conform to the principles
of REBT (Ellis, 1987). Strean (1994) added that success in using humor also
depends on personal qualities of the therapist such as maturity and flexibility.
Killinger (1987) also found that a therapist’s level of maturity was the key vari-
able in using humor effectively, not the length of his or her professional experi-
ence. Nagaraja (1985) noted that the therapist must be “genuine and capable of
savoring the comical” (p. 34) while remaining alert to the clinical opportunities
humor offers. Salameh (1987) pointed out that humor represents constructive
self-disclosure by the therapist who then reveals his or her own human side to the
patients: “We cannot prescribe humor for our patients unless we can accept it in
our own lives” (p. 223). Greenwald (1977), a psychoanalytically trained psy-
chotherapist and former stand-up comedian, wrote that if more psychiatrists had
a sense of humor, they would not have to prescribe so many pills to relieve ten-
sion in their patients.
To encourage a humorous outlook in our patients, therapists must keep that
dimension alive in themselves. Therapists must continually engage in self-mon-
itoring regarding why they are employing a particular intervention-humorous
or otherwise-to ensure that it indeed is enacted for the patient’s benefit and not
for self-gratification. Humor appreciation and initiation may be easier to facili-
tate via formal training than the other personal qualities that are universally
desired and recommended for therapists such as empathy, genuine concern, emo-
tional warmth, and a sense of moral and ethical responsibility (cf. Egan, 1998).

Humor Training Curriculum

As Appendix A shows, many theorists and therapists have written about the
value of humor in psychotherapy. The evidence for their recommendation, if any,
has been in the form of clinical case reports. Anecdotes of success, although
 Franzini 179

intriguing, cannot be scientifically persuasive. Nearly all of these authors make a

case for applying humor and perhaps issue a few words of caution about its inap-
propriate usage, but they hardly ever become specific about just how therapists
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might learn to use humor in their practices. Despite the extent of the literature
advocating the use of humor in therapy, it is remarkably rare for anyone to rec-
ommend specific humor training for practitioners. The few exceptions include
Prerost (1985), Salameh (1993,1994), Sultanoff (1994), and Thomson (1990).
Supervisors and trainees must first accept the value of incorporating humor
into the practice of therapy and commit to acquiring those skills. The formal humor
training should include these components: (a) the modeling and reinforcement of
therapist humor behaviors by clinical supervisors, (b) specific training in the vari-
ety of humor techniques, and (c) sensitivity to any humor attempts by their clients,
which can become critical transition points in the therapeutic process.
Therapists must first openly accept the value and desirability of adding
humor to their therapy. Obviously, to force such training on uninterested students
would be counterproductive. There is evidence that some therapists in training
desire their supervisors to demonstrate humor as a major feature of the supervi-
sors’ relationship skills. In an interview study of 85 family therapy trainees’ per-
ceptions of supervisor competence, the most frequently cited criterion was the
use of humor (Liddle, Davidson, & Barrett, 1988).According to Liddle et al., the
best clinical supervisor “helps trainees use their natural sense of humor in thera-
py and also uses own sense of humor in the supervisory relationship” (p. 392).
The educators and trainers of therapists must themselves appreciate and
model the appropriate use of humor in therapy. As noted previously, this appre-
ciation represents a major change from the historical tradition of discouraging
humor use. For example, Strean (1993) commented, “It may not always be a sign
of unprofessionalism to laugh with the patient when he or she is experiencing true
joy and thereby demonstrate that a serious, disciplined relationship has room for
laughs, too. . . . In teaching and supervising, I have often found that when stu-
dents and supervisees are laughing, they can listen with less resistance” (p. 212).
Clearly, mentors can shape the professional use of humor by their trainees
and interns through their explicit contingent approval of any efforts toward the
appropriate use of therapeutic humor. In their discussion of functional family
therapy training, Haas, Alexander, and Mas (1988) noted the reward potency of
trainers within the supervision process, “The supervisor may provide the trainee
with feedback in order to reinforce the trainee’s use of that particular tactic. . . .
Trainee change will be affected by observational learning, cognitive restructur-
ing, and evaluative feedback” (p. 135). Similarly, supervisors should be alert to
potential misuses of humor by their trainees and be ready to offer constructive
alternative verbal behaviors. Close supervision of novice therapists’ clinical work
is always essential, and that attention certainly should not be relaxed when using
humor techniques (cf. Dunkelblau et al., in press).
Finally, future and current therapists who express interest in applying humor
 180 The Journul of General Psychology

in their therapy can be offered didactic humor training seminars featuring dis-
cussions, readings, and practice role-plays. Relevant curricular topics in these
seminars might include the major psychological theories of humor, the available
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research findings on the advantages of the proper implementation of therapeutic

humor with illustrative examples, the risks from misuses of humor in therapy,
practice in sense-of-humor-building exercises, learning to heighten sensitivity to
humor stimuli in the everyday environment, the role of timing, and other spe-
cialized humor development and performance techniques.
McGhee ( 1994a) has presented a systematic eight-step humor development
training program along with an exercise workbook (1994b) intended for anyone
interested in improving his or her sense of humor. Although he specifically sug-
gested that the program was applicable to lay individuals, businesspeople, and
self-help groups, it would also seem to be a most appropriate basis for establish-
ing a humor training curriculum for therapists.
Prerost (1985, 1994) is one of the few humor-use advocates to describe a spe-
cific humor training technique for teaching therapists humor skills-the humor-
ous imagery situation technique (HIST). The HIST is a form of therapist-direct-
ed imagery primarily designed to reduce anxiety and to reinstate a sense of humor
in mildly depressed patients. The technique is quite similar to systematic desen-
sitization in behavior therapy.
Prerost (1985) indicated that the therapist first induces the patient to relax by
quasi-hypnotic mental and breathing exercises. Typical nonpersonalized images
are introduced to aid achievement of a state of relaxation, followed by images
which have specific personal meanings to the patient. At this point in the HIST,
the therapist draws the patient’s attention to humor in the fantasy scenes and then
provides comments that are intended to introduce incongruity and laughter into
the scenes. Observing humor in the fantasized scenes and the resolution of the
incongruities presumably helps the patient reflect on personal concerns and cope
with them more effectively. If the HIST were more widely adopted by practi-
tioners, systematic evaluations of its effectiveness could be conducted.
Sultanoff (1994) also has provided detailed descriptions about how to train
professionals in delivering therapeutic humor and how to distinguish helpful from
harmful humor. He pointed out that therapists must first examine the target of the
humor and the setting conditions for its delivery; then they must assess that spe-
cific patient’s receptivity to humor.
Targets of humor can be oneself, the situation, or other people. Healthy
humor, according to Sultanoff (1994), is “that which brings people together,
reduces stress, provides perspective, and feels good,” whereas harmful humor is
“that which alienates others, increases hostility, and ultimately feels bad” (p. 34).
If the humor is aimed at oneself, it is likely to be healthy; if aimed at others, it is
likely to be harmful; if aimed at situations, it likely falls in between. Environ-
mental conditions, such as the nature and bond of the relationship, the timing and
circumstances of the humor, and the delivery setting are all important factors in
 Franzini 181

successful therapeutic humor. Finally, Sultanoff suggested assessing the patients’

“humor quotient” by careful observation of their use and appreciation of humor
to determine the probable degree of receptivity to therapeutic humor. For exam-
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ple, if the patients use humor in healthful ways rather than in distancing ways,
such as sarcasm or put-downs, they will likely be receptive. In addition, the ther-
apist can question patients directly about the role that humor plays in their daily
lives. Finally, the assessment can include observing the patients’ ability to laugh
at themselves and noting their responses to the humor presented by the therapist.
Laughter or smiling, demonstratingan increase in energy, and sharing some form
of their own humor indicate a positive receptivity to therapeutic humor.
Salameh (1987, 1994) has created a formal humor training program to train
mental health therapists and others in humor creation and development. His
Humor Immersion Training teaches humor-making techniques such as overstate-
ment or exaggeration, understatement or simplification, incongruity by synthe-
sizing two nonsequiturs, reversals that create new meaning, and wordplay such
as puns and layered meanings. Trainees are taught the psychological and physi-
ological benefits of humor, the 11 major attitudes that can block uses of humor,
the 1 1 key distinctions between therapeutic versus harmful humor, and they learn
numerous exercises and role-plays through the 12 major facets of the program.
Salameh (1994) also urged therapists to use their personal history and their
own physical characteristics to identify funniness in their lives that would facili-
tate their humor-making. He also drew upon such diverse sources as the Zen tra-
dition by recommending metaphorical storytelling by the therapist to communi-
cate humor and behavioral environmental management theory by recommending
creation of an explicitly humor-oriented consulting room with funny posters,
quotes, or cartoons.

Research Perspectives for Humor Training and Humor in Therapy

Saper (1987), Kazdin (1999), and others have called for empirical studies on
the effectiveness of humor in therapy. As with the evaluation of any clinical pro-
cedure, new or old, such studies should be ongoing and continual. Salameh (1983)
has presented a 5-point Humor Rating Scale, ranging from destructive humor to
outstandingly helpful humor, which can assess therapists’ use of humor with
clients. Each of the five levels of humor is defined in detail and is illustrated by
a clinical vignette. This scale could be used to assess changes in therapist humor
prior to and following formal training in humor skills. The scale could also be
used to measure changes in humor use by the client as therapy progresses and as
correlates of symptoms increase or decrease.
Salameh (1983) has previously raised a number of critical empirical ques-
tions that can be addressed by clinical researchers immediately. For example, is
it important for therapeutic effectiveness to match therapists and clients accord-
ing to their levels of humor use? Does the role of ethnic humor by the client
facilitate the therapy process when the ethnicity, age, sex, or religion of the clients
 182 The Journal of Geneml Psychology

and the therapist differ or are the same? Are humor techniques more or less effec-
tive with clients of certain personality constellations or with certain symptoms or
diagnoses? Which forms of humor stimuli are most effective in therapy? Many
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important clinical research questions emerge concerning humor as a therapy

technique. It would be valuable to know whether a therapist can be equally effec-
tive without using humor.
Meanwhile, therapists are being encouraged to apply humor in their prac-
tices by popular and professional sources. It is being conducted in offices and
even on the internet. Humor as a technique to facilitate clients’ new learning and
the rethinking of their own problematic situations is now appearing in the latest
texts for students who are learning to be professional helpers (i.e., counselors and
therapists; cf. Young, 2001). Fry and Salameh (1987) have also identified two
likely beneficial side effects of the use of therapeutic humor for the therapists
themselves-as a coping device for stress reduction and as a preventive tool for
professional burnout.
Brooks (1994) has cautioned that therapists should never use humor with a
client they do not like. This point represents just another plausible assertion that
deserves empirical investigation. One could easily argue the opposite position-
that humor could help dissolve rapport difficulties and facilitate the liking of a
client. Data are needed on whether humor in therapy can be effective when the
therapist does not like the client.
Therapists must be especially sensitive to how clients are likely to react to any
humor efforts (Brooks, 1994). To be humorous, therapists must possess certain
humor skills, be verbally facile, and display a sense of comic timing. For those ther-
apists who have been drawn to use humor in their practices, it seems vital to train
them properly in humor techniques. Since it seems indisputable that such tech-
niques are already being applied, sometimes inappropriately and perhaps harmful-
ly, it is crucial to seek data on their effectiveness.Training formats such as formal
courses, seminars, or workshops must be evaluated for their effectiveness.
One indirectly related evaluation study has recently been reported. Some
of Salameh’s (1983, 1987) earlier humor training suggestions were incorporat-
ed in a 13-session training program for improving sense of humor conducted
by Nevo, Aharonson, and Klingman (1998). The participants were 101 female
high school teachers in Israel who frequently encountered frustration and pro-
fessional burnout. Although the participants in this study were not therapists or
counselors, this report illustrated that humor training can be conducted and
evaluated empirically. The components in this program included modeling,
reinforcement, specific teaching of humor techniques, joke telling practice,
lessons on the benefits and forms of humor, cognitive restructuring, countering
resistance, promoting acceptance through nonjudgmental attitudes, encourage-
ment to regress, and direct suggestions on how to apply humor in the classroom.
Nevo et al. (1998) reported mixed results indicating small and positive improve-
ment in some elements of the sense of humor, but no effects on participants’
humor production.
 Franzini 183

The Future of Humor in Therapy

Any proposed new therapeutic procedure must be empirically verifiable, and
its efficacy must be tested by controlled research. Humor is no exception (Kazdin,
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1999; Saper, 1987). Given the many potential positive uses of humor in therapy
(cf. Appendix A), innumerable empirical questions are available for controlled
research to investigate. The interdisciplinaryjournal Humol; now in its 14th year
of publication, attests that research in humor studies is increasing. However,
because of its broad scope of interests in humor studies, very little of the research
in that journal has addressed explicitly the questions of humor in therapy, such
as those posed by Salameh (1983) or Saper (1987).
In a recent therapy-related empirical study of conjugally bereaved volunteer
participants, laughter displayed in a structured grief-symptom interview con-
ducted about 6 months post-loss was associated with adaptive responses to stress.
Those adjustments were indicated by increased psychological distance from the
distress; reduced negative emotions such as anger; increased experiences of pos-
itive emotions; and enhanced bonds in social relations with friends, relatives, and
affiliated organizations (Keltner & Bonanno, 1997). This study featured direct
measures of smiling and laughter behaviors in the interviews, rather than self-
reports, along with a well-validated behavioral measure of distress.
Any clinical technique or medication that is powerful enough to be helpful
is powerful enough to do harm. Humor again is no exception. Its administration
should be governed by “dosage” guidelines for certain client problems and deliv-
ered by qualified practitioners. Salameh (in press) actually referred to the emer-
gence of humor in psychotherapy and toward human wellness as a “tectonic
force.” Why not systematically train those practitioners first and then empirical-
ly evaluate both the training programs and the effectiveness of those humor tech-
niques with actual clients?
The use of humor may turn out to be one of the more powerful specific ther-
apy techniques available. At this point we do not know that for certain. Humor
appears to be applicable within nearly all therapeutic schools ranging from the
analytically oriented to the humanistic and the behaviorally based. Once we know
what works and with whom and under what conditions and styles, then only prop-
erly trained practitioners who possess honed humor skills, the usual standard clin-
ical techniques, plus all the other requisite positive personal qualities of “good”
caring therapists should use humor in therapy.
The training in humor techniques will necessarily be mediated by clinical
educators and supervisors.As Liddle ( 1988)suggested, “Like therapy itself, train-
ing therapists is a serious business, but when we unwittingly check our perspec-
tive and sense of humor at the entrance to the observation room, we are sudden-
ly in jeopardy of losing our humanness and, indeed, compassion itself-a pair of
any supervisor’s most powerful allies” (p. 168).
 184 The Journal of General Psychology

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APPENDIX A
Positive Uses of Humor in Psychotherapy as Suggested by RepresentativeTheorists
Barry, 1994 To signify an “encouraged person” with positive mental
health.
Bloomfield, 1980 To scale the idealized therapist down to size (i.e., to human-
ize the therapist). To challenge preconceived and sacred
 Franzini 189

notions. To pinpoint resistances. To recognize absurdities and

contradictions between feelings and their expression. To
express affection and to provide intimacy.
Cassell, 1974 To resolve intractable resistances. To highlight the fatuous
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nature of patient’s irrational beliefs.

Corey, 1986 To learn that one is not unique or alone in pain or tragic situ-
ations.
Dewane, 1978 To measure level of patient’s ego strength. To serve as cathar-
tic release. To broach sensitive or potentially embarrassing
material. To serve as a test of assertiveness. To understand
how culture influences patients’ behavior. To promote a
“god’s-eye view” (an objective, indifferent, semi-detached
perspective on one’s situation).
Dreikurs, 1967 To encourage easy acceptance of therapist’s interpretations of
patients’ self-worth. To allow the therapists to demonstrate
their humanness as “regular” folks.
Ellis, 1977 To make the therapy sessions more vivid and memorable. To
accept responsibility for one’s own disturbances. To teach
unconditional self-acceptance despite errors and other human
fallibilities. To cease demanding utter certainty from a world
of degrees of probabilities. To accept reality and its imperfec-
tions. To reduce role disparity between therapist and patient.
Ellis, 1996 To treat morbid jealousy in those patients who usually have
lost their humor.
Ellis, 1998 To display genuine emotion. To teach humorous coping strate-
gies. To puncture low frustration tolerance. To further the
development of insight.
Ellis & Dryden, 1987 To stop taking themselves and life itself overseriously.
Epstein, 1998 To reduce “discomfort anxiety” from being in therapy invol-
untarily. To broaden patients’ schemas (i.e., to shift their per-
spectives in a dramatic way). To identify biases in patients’
thinking processes. To reinforce the therapeutic alliance. To
show that life can be fun; to feed into the philosophy of hap-
piness and joy. To get unstuck from relationship deadlocks.
Erickson, 1984 To choose fun in “serious” life areas, after breaking taboo of
having fun in therapy.
Farrelly & Mathews, 1981 To move toward positive self-concept and other self-affirming
behaviors.
Freud, 1938 To overcome “inhibitions of shame and decorum.” Regression
of id elevates the ego.
Friedman, 1994 To avoid replicating patient’s inability to tolerate ridicule.
Furman & Ahola, 1988 To serve as an antidote to “hypnotic” pull of patients’ efforts
to influence the therapist to see their problems in the same
way that they do.
Gelkopf & Kreitler, 1996 To create an immediate emotional gratification and a later new
cognitive perspective (insight). Humor is a neutral but broad
tool useful in a variety of therapy systems.
 190 The Journul qf General Psychology

Greenwald, 1977 To address the inevitable by reflecting on death and dying. To

learn that laughter is incompatible with depression.
Grossman, 1977 To alert the therapist to specific problems and probable prog-
nosis.
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Kaneko, 1971 To coerce, control, seduce, or charm. To cover feelings of

inadequacy or sexual identification confusion. To obtain
restoration or respite from pain or shame and embarrassment.
To gain mastery and superiority via projection.
Klein, 1974 To enhance self-observation skills and improve interpreta-
tions.
Kuhlman, 1984 To achieve short-term tactical benefits in therapy process.
Levine, 1977 To provide a safety valve in controlling sexual and aggressive
urges.
Lusterman, 1992 To disarm and touch patients deeply, using the humorous
metaphor for therapeutic goals.
MacHovec, 1991 To lighten mood, to test insight and treatment progress, and to
assess mental status.
Mann, 1991 To develop capacities for richer experiences with self and oth-
ers and to play. To indicate stages in the evolution of the trans-
ference.
Mindess, 1971 To become more resilient to the stresses of living. To endure
reality.
Mindess, 1976 To encourage the ability to laugh through one’s tears by see-
ing the funny side of life.
Nagaraja, 1985 To identify patient’s veiled and yet revealed thoughts.
Napier & Whitaker, 1978 To keep the therapists sane!
O’Connell. 1975a To permit patients to see the useless things they are doing
without becoming offended. To indicate a therapeutic alliance
and the patient’s observing ego.
O’Connell, 1975b To allow the patient to see that that everything can also be
something else.
O’Connell, 1981 To travel the royal road toward self-actualization and a “nat-
ural high.”
Olson. 1994 To reduce patient’s anxiety about awesomeness of therapist
and process of therapy. To facilitate trust in the client and
respect for patient in building the therapeutic alliance. To
inform patient that therapist is hopeful and not overwhelmed
by patient’s problems. To grow in feelings of self-control over
problems, especially depression. To provide a model of sense
of humor.
Poland, 1971/1994 To demonstrate the therapist’s concordant identifications with
the patient. To teach emotional modulation. To release
repressed hostility via laughter.
Prerost. 1985 To revive a healthy sense of humor in the patients and increase
their positive social exchanges.
 Franzini 191

Ravella, 1988 To treat couple’s differing levels of sexual interests with

humorous homework tasks.
Rosenheim, 1974 To provide a corrective interpersonal and intrapsychic experi-
ence. To strengthen accurate perception of both internal and
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interpersonal realities. To create a closer therapeutic alliance

than would be possible by formal means. To make it possible
for patient to express ambivalent, contradictory feelings.
Roth, 1987 To make the unbearable bearable (the essence of psychother-
apy).
Rutherford. 1994 To have the courage to be imperfect. To enhance social inter-
est and move from feelings of inferiority to superiority. To
strive for a healthy attitude toward conforming and a healthy
perspective.
Salameh, 1983 To promote cognitive and emotional equilibrium. To attack
negative behaviors while affirming the essential worth of the
patient. To act as an “interpersonal lubricant.” To “help define
problems in a quick, flexible, economical, and easily retriev-
able format.”
Sands, 1984 To transcend emotional dilemmas. To refresh one’s self-esteem
and offer “peace for the superego.” To recognize double binds
and avoid getting caught in them. To regulate affect both
intrapsychically and socially. To rely less on unrealistic
defense mechanisms. To gain more self-control over behaviors.
Satow, 1994 To express spontaneity, mastery, and strength by the patient.
To permit expression of id impulses. To serve as an adaptive
mechanism (psychic economy). To integrate a different, more
intimate reality. To force the patient to confront the wider
world. To enhance group cohesion in group therapy.
Shaughnessy, 1984 To transcend one’s problems (i.e., so that logotherapy patients
can rise above themselves).
Shelly, 1994 To muffle anxiety in both patient and therapist. To instigate
affective responses.
Smith, 1973 To countercondition anger responses in behavior therapy.
Tallmer & Richman, 1994 To point out anxiety-provoking themes. To illuminate conflict
and aid ego in overcoming stress. To monitor effectiveness of
therapy programs.
Thomson, 1990 To develop alternatives for change and to reframe problems in
positive context.
Ventis, 1973 To replace anxiety responses in systematic desensitization
therapy.
Wolfe, 1998 To develop an attitude of playfulness in sex therapy. To pro-
mote anti-perfectionism and anti-grandiosity in cognitions.
Yankura & Dryden, 1994 To serve as a novel teaching device.
Young, 1988 To detect nonverbal collusive family alliances and to promote
positive reframing of problems.
 192 The Journal of Generul Psychology

APPENDIX B
Cautions Noted in Using Humor in Psychotherapy by Representative Theorists
Bloomfield, 1980 Risk that patient will accuse therapist of making fun of
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hider.
Cassell, 1974 Humor at times will be inadequate as a monitoring or change
tool. Humor does not give a complete picture of patient or
therapy needs.
Dewane. 1978 Can “exacerbate the complex entanglements of countertrans-
ference.” Can be threatening to paranoid or other psychotic
patients.
Ellis, 1977 Risk that patients feel attacked rather than an attack on their
irrational beliefs.
Ellis, 1998 Can put patients down or be inappropriate (e.g., racist humor).
Can make therapy appear too easy, when it requires work and
practice by the patient.
Epstein, 1998 Least appropriate uses: word play and impersonating patient’s
style. Specific contraindications: tragic situations, grief,
depression, when patient is concrete and wants only a serious
discussion, and there is a poor therapeutic relationship.
Grossman, 1977 Jokes can hide conflicts and prevent patient from facing prob-
lems.
Kaneko, 1971 Humor can help patient maintain a “neuroticism or charac-
terological rigidity.”
Kubie, 1971 Therapist may indulge a fantasy of having a license to attack.
Can blunt the sharpness of disagreement. Can mask hostility.
Can seduce therapist out of therapeutic role. Can divert
patient’s flow of feelings and thoughts. Usually perceived as
“heartless, cruel, and unfeeling.”
Kuhlman, 1984 In short-term, humor can increase psychological distancing,
and in the long-term it can “tyrannize” the patient under guise
of being helped. Therapist’s amusement at patient’s humor
could be seen as approval of the taboo being voiced. Nona-
musement in the therapist may be felt as disapproval of
patient.
Lusterman, 1992 If humorous metaphor turns to simile, it can engender resis-
tance.
MacHovec, 1991 Humor can be disparaging and a direct or indirect weapon.
Mann, 1991 Can disrupt chain of associations. Can be expression of con-
flict with therapist. Therapist can collude with patient’s defen-
sive use of humor.
Mindess, 1971 Can be “risky” and not well received.
Olson, 1994 Must exclude sarcasm and cynicism.
Parry, 1975 Jokes or responses to them are not appropriate in this serious
setting.
Poland, 1971 Dangers in use of humor: acting out some erotic interaction
 Franzini 193

on a symbolic level, to gratify sadistic aggressive impulses,

and to get narcissistic gratification. Humor cannot and should
not be a “major tool” of therapist.
Rosenheim, 1974 Possible countertransference problems (e.g., therapist’s
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inability to take a humorous attitude when called for or if the

therapist is “unduly humorous”).
Rosenheim & Golan. Humor is not likely to be appreciated by obsessive or depressed
1986 patients.
Salameh, 1983 Humor Rating Scale includes “destructive, harmful, and min-
imally helpful forms.”
Sands. 1984 Even if use of humor personally benefits the patient, social
usefulness may not follow. Effects of humor are not always
predictable.
Saper, 1987 Need to assess patients’ personality and specific humor pref-
erences first. Not advisable to add humor if the only purpose
is comic relief.
Satow, 1994 Must avoid scapegoating when using humor.
Schnarch, 1990 Avoid sarcasm, ridicule, and self-aggrandizing buffoonery.
Some patients feel misunderstood or disqualified by authori-
ty figures. Patients with hearing difficulties or cognitive
deficits may miss the point.
Sultanoff, 1994 When patient is in stressful situation, humor intended to attack
that situation may be confused with a personal attack leading
to alienation and hostility.
Thomson, 1990 Humor can imbalance the therapeutic relationship, block
effective communication, and produce negative feelings in
patients.
Vargas, 1961 Permits patients to conceal distressing or undesirable person-
ality features.
Wolfe. 1998 Could lead to possible misinterpretations by either patient or
therapist.

Manuscript received January 27, 2000

Revision accepted for publication October 9, 2000