By Sylvia Mauger
There is no doubt that any form of counselling, be it psychotherapy, stress management or anything else, is a very serious business. We read so many serious texts and go to so many serious meetings and classes that it is easy to get into a mode of solemn gravity. And, of course, this is largely because we are committed to treating our clients with respect. But in this paper I would like to suggest that respect can include humour and that laughter during a counselling session can be very therapeutic.
Humour: what is it and what place does it have in stress management counselling?
The Oxford Concise Dictionary defines humour as ‘the quality of being amusing or comic; the ability to perceive or express humour or take a joke’, but this is not particularly helpful in therapeutic terms. What is amusing or comic to one person may not be to another and, of course, we are not in the business of entertaining our clients as comics. So if humour is not necessarily about telling a joke, then what is it and how can it have beneficial effects in stress management counselling?
Windy Dryden, writing in Brief Rational Emotive Therapy, quotes Albert Ellis saying ‘that one way of conceptualising psychological disturbance is that it is the tendency of humans to take themselves, other people and life conditions TOO seriously.’ He goes on to describe how, in order to change, negative events need to be taken seriously, but that if they are taken too seriously, emotional disturbance may follow and action for change can be impaired. Indeed, as the whole model of stress management as conceived in Rational Emotive Behaviour Therapy and Cognitive Behavioural Therapy is based on the idea that people suffer emotional dysfunction when their thinking is irrational, humour can be seen as one of the many ways of ‘untwisting’ a client’s cognitive distortions.
Of course, this does not imply that every stress management counsellor can laugh and joke their way through every session with every client, but it does mean that if a counsellor is sensitive to the mood of the client, a little humour can go a long way. If the therapeutic bond is comfortable, it will be clear to the client that the therapist is not laughing at the client but at the irrationality of her/his ideas. Laughing with people is compassionate, laughing at them is immoral and unethical. Indeed, it can often be the case that laughing together can act, not only as a tool of communication, but can strengthen the bond between the two people concerned. As Victor Borge, the American entertainer, once wrote, ‘Laughter is the shortest distance between two people’. (quoted by Robert Holden, ISMA)
The physiology of humour
It is well known that stress causes physiological changes that are dangerous when prolonged Cortisol levels and blood pressure are elevated and the heart rate is increased amongst a host of other stress triggered responses. There is now considerable research that suggests that laughter lowers cortisol levels and stimulates the immune system, off-setting the immunosuppresive effects of stress. (Patty Wooton, Humour: An Antidote for Stress).
This research was preceded in 1979 by Norman Cousins who had, through his personal experience, attracted the attention of the medical profession to the possible therapeutic effects of humour. He contracted ankylosing spondylitis in 1964 and decided that the hospital regime of strong medication, dull food and the institutional regime was so depressing that any benefits he was gaining could be maximised outside the conventional regime. So, based on his own research, he developed a programme of therapy consisting of megadoses of a mix of vitamin C combined with regular doses of laughter stimulated by re-runs of the Marx Brothers films and Candid Camera. These treatments of belly laughs appeared to relieve his pain considerably and, indeed, when his levels of inflammation were tested, they were found to have decreased. Cousins also asserted that the increased release of endorphins caused by laughter eased the pain.
The beneficial effects of humour
A patient of mine suffering from a combination of physical and psychological stresses, not the least of which was a severely deteriorating irreversible eye condition, stated emphatically at one point that she would like a magic wand to cure all her ills. As it happened I had been given a gift of a joke wand and I promised her we would try out its properties at the next session. I duly brought it in and waved a shower of tinkling sparkles at her. She laughed delightedly although she could not have seen much apart from the basic shape and the sparkling effect. When I added my regrets that although I had a wand, I did not know the spells to go with it, she laughed even more and agreed that CBT would have to do instead. As I joined in her laughter, I felt that this shared experience had brought us closer, and indeed, she referred to it on several occasions afterwards. In her case it seemed that the laughter – particularly at something so absurd – had mitigated her stress by providing a coping mechanism. And when we had finished laughing, we seemed able to return to the serious matters at hand with renewed application. This is supported by Robert Holden, Stress Consultant, in his description of an
‘after-glow period in which we relax muscle tension, reduce stress in the nerves, massage the lungs, restore a full and flowing breathing pattern and gently expand our circulation once more’.
This sort of experience supports the concept of the counsellor as ‘authentic chameleon’ (Lazarus 1993). The key to this theory is that, in order for the client to achieve maximum benefit, the counsellor needs to be as flexible as possible to meet the client’s needs. Some clients will prefer a formal mode of interaction and the counsellor may choose to match this with more formal clothes and body language than are used with other clients and to use an empathic but business like dialogue. This sort of client may well be bewildered by the use of laughter. At the other end of the scale, there are clients who are most comfortable with a very casual style of communication. Clearly the therapist is unlikely to change clothes for every client but, provided they are sensitive to their clients’ individual backgrounds and personalities, they will try to adapt their body language and style of address. This adaptability also includes making a judgement as to the appropriateness of the use of humour.
When I used my magic wand, I sensed that my client felt supported by the counsellor joining her at The same level. Assuming that the humour is appropriate and genuine, not merely a gesture to please the other person, then the ideal of unconditional positive regard can be reinforced. To some extent it can be assumed that many clients feel they are talking to ‘an expert’ implying that they themselves are ‘lesser beings’. The employment of humour can be useful in reducing this distance and bringing about parity between client and therapist. And it does not always have to be the case that it is the counsellor who introduces the element of humour. In a recent session with a client who was experiencing difficulties in his relationship and who confessed to being a poor listener, I was discussing ways in which people show they are listening. The two-way discussion soon turned into my monologue as he stopped talking and just sat looking at me thoughtfully with the odd ‘hmm’ thrown in. There followed a pause and I asked him what was going through his mind. He beamed at me silently, then explained that he was listening in an appropriate manner, and we both roared with laughter. I was delighted that he was comfortable enough to be able to laugh at our situation.
My magic wand was used in a fairly light situation, but humour seems to have beneficial effects on a pretty extensive continuum of situations. Charles Rubin, in his book for parents of drug addicts, says:
‘Having a sense of humour in a situation that isn’t necessarily funny can lighten the tension of what’s going on. By trying not to take every little thing seriously, you will greatly reduce stress. There is a lot of drama associated with drug and alcohol addiction. If you can begin to see how ridiculous most of it is, you can start to put things into perspective. If you can just laugh and hang up when the addict calls … you’ve graduated to a new level.’
Humour can often be used to reinterpret or re-frame distressing events. As laughter distances the individual from the stressor, a feeling of perspective and safety is created. This certainly appeared to be the case for an elderly agoraphobic client whose homework had progressed to travelling two floors in a lift. In the event, being a person of extremes, she decided to visit a friend who lived on the twelfth floor. She went up in the lift for four floors – a triumph in itself – but when she left her friend, was too embarrassed to let him see her walk down the stairs, so took the lift all the way down the twelve floors. This client smiled broadly as she walked into the session, told me I’d never believe what she had to tell me, then laughed uproariously as she described the situation, realising that embarrassment was more important to her than her fear of lifts. The laughter encompassed relief that she had survived such a feat and also understanding of the absurdity of the incongruity of the situation. I felt it helped her to see her fears in a slightly different light and provided some reinforcement in her belief that she had some control over the situation.
Appropriate humour never belittles or criticises. It is based on caring and empathy. An invitation to laugh is an invitation to share and, as such, it is supportive and so builds confidence between two people. This can be as true in a group situation as that of one-to-one counselling. A group of part- time women trainees, for example, who had known each other for only two weeks, began a very brief course of stress management with me. They were a little reticent to begin with as can be expected in a situation where trust has not yet been established. Within the first 20 minutes it emerged that one of them felt she had a problem with her adult daughter who still lived with her and for whom she did all the washing, cleaning, cooking and ironing. She laughed in an embarrassed fashion as she told us about this, but soon the entire group was laughing uproariously with her as they predicted what she would be doing for her daughter before and after she was married. The raucous details can be imagined. The laughter proved to be a bonding experience as it showed her that everyone there identified with and shared her feelings. Thus a basis of trust was established within which it became possible for the group to take seriously the issues of why she behaved in this way and what she could do to change.
Laughter with a client about himself or herself can serve to reinforce their understanding of globalising and perfectionism. If, for example, a client has appreciated the irrationality of dismissing anything positive about themselves or the world but has not yet developed a firm counteracting belief, a little mockery of this negative perspective can help them to accept the irrationality of the core belief. The feeling that ‘things can’t be that bad if I can still laugh’ can be a considerable relief as well as having a distancing effect on the problem.
As stated at the beginning of this paper, there is no suggestion here that a counsellor can laugh all the way to a successful therapeutic conclusion for every client. And, indeed, it would be extremely foolish to laugh at all unless the client has indicated that they feel safe, supported and able to see a funny side to the issues that they bring to the sessions. Counsellors must however always be alert to the dangers of using humour for drawing attention to their own cleverness. There must also be a constant sensitivity to the client’s cultural background: an inappropriate laugh can do untold damage to the therapeutic relationship.
Nevertheless, the notion that humour can have beneficial effects is demonstrated by the current plethora of related web sites. In this country, one of the best known is Robert Holden’s Oxford- based Happiness Project. This was set up after he launched the UK’s first laughter clinics in 1991 with NHS funding. Holden runs workshops and also runs eight-week Happiness Programmes targeted, amongst others, at health professionals and also top level managers of some of the country’s largest companies.
Another ‘laughter practitioner’ is Dr. Brian Kaplan, a medically qualified doctor who claims that as soon as you start to laugh at a problem, ‘the problem is completely disempowered’. Further afield, the American, Cathy Ripplinger Fenwick, fronts an ‘Online Laughter Therapy Centre’ which advises on ways to ‘put more laughter into your life’. There are also panic/anxiety disorders web sites which advise readers to ‘laugh yourself calm, and papers on humour in emergency work (Moran and Massam).
Some of these web sites may be questionable in that they imply that self-help through humour is easy, but there is no doubt that the current trend is to take the funny side of things seriously and to appreciate the psychological benefits that humour can bring.
Summary
In this paper I have tried to cover the main benefits of the uses of humour in stress management counselling. There appears to be both anecdotal and scientific evidence that humour and laughter can act as antidotes to stress. Humour can:
• act as a communication tool as well as provide an emotional bonding and a demonstration of supportiveness and acceptance
• enhance the therapeutic alliance by confirming parity between client and counsellor
• help to reinterpret a distressing event and to distance the individual from the stressor thus providing a more realistic perspective on the problem
• serve to reinforce belief in new adaptive ways of thinking
• improve the physiological state
There remains one more area to be addressed and that is the use of humour to the counsellor. If we take ourselves too seriously we may become too concerned with our own thought processes and so risk losing sight of the clients’ issues. To be able to laugh at ourselves, acknowledging that we are fallible human beings, is an effective tool that enables us to see things in perspective. It is quite often the case that a good laugh in the middle of a serious discussion can provide the relief from tension that is needed to carry on with the seriousness of the deliberations.
‘Life does not cease to be funny when something bad happens any more that it ceases to be serious when we are laughing.’ Cathy Fenwick. Online Laughter Therapy Centre
Bibliography
Adams, M. Humour in the Psychotherapeutic Relationship, Counselling, Volume 11 No. 3
Dryden, W. Brief Rational Emotional Behaviour Therapy. Wiley, 1995 3
Ellis, A. A New Guide to Rational Living Robert Harper 1975
Fenwick, C. An Online Laughter Therapy Centre, (undated)
Lazarus, A. The Practice of Multimodal Therapy: John Hopkins 1989
Massam, Margaret & Moran, Carmen: An Evaluation of Humour in Emergency Work. The Australasian Journal of Disaster and Trauma Studies: volume 1997-3
Rubin, C. Don’t Let Your Kids Kill You. Element Books 1996
Trower, Casey and Dryden. Cognitive-Behavioural Counselling in Action. Sage Publications, 1988
Wooton, P. Humour: an Antidote for Stress. Anti-stress.htm undated
Sylvia Mauger works as a Stress Management Counsellor in the NHS and in private practice in South London. She also delivers Personal Effectiveness training in a Further Education setting. Sylvia is a member of ISMA (International Stress Management Association).
Reproduced by kind permission of the author © Sylvia Mauger.
Humor And Healing
The following is an excerpt taken from Chapter 3: Humor and Healing, or Why We’re Building a Silly Hospital of Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy.
Thank you to Patch Adams for kindly giving me permission to reproduce the said excerpt.
The arrival of a good clown exercises more beneficial influence upon the health of a town than of twenty asses laden with drugs.Dr. Thomas Sydenham,
seventeenth-century physician
Humor is an antidote to all ills. I believe that fun is as important as love. The bottom line, when you ask people what they like about life, is the fun they have, whether it’s racing cars, dancing, gardening, golf, or writing books. Philosophically speaking, I’m surprised that anyone is ever serious. Life is such a miracle and it’s so good to be alive that I wonder why anybody ever wastes a minute!
Anyone who has picked up a copy of Reader’s Digest in the last forty years knows that laughter is the best medicine. In spite of the empirical nature of this truth, the mainstream medical literature hasn’t refuted it, as far as I know. The late Norman Cousins wrote eloquently about having laughed himself back to health after suffering from a serious chronic disease. The experience had such an impact that he changed careers late in life to help bring this information to the health care profession. Jokes seemed so important to Sigmund Freud that he wrote a book on the subject. But we don’t need professionals to tell us about the magnetism of laughter. With great insight, we call a funny person “the life of the party.”
Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. I am astounded that anybody feels the need to prove something so obvious. When individuals and groups are asked what is most important for good health, humor invariably heads the list even over love and faith, which many people feel have failed them. Few people deny that a good sense of humor is essential for a successful marriage. All public speakers recognize that humor is essential in drawing attention to what they are saying.
People crave laughter as if it were an essential amino acid. When the woes of existence beset us, we urgently seek comic relief. The more emotions we invest in a subject, the greater its potential for guffaws. Sex, marriage, prejudice, and politics provide a bottomless well of ideas; yet, humor is often denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated and even condemned, except in speeches and anecdotes. The stress is on seriousness, with the implication that humor is inappropriate. Health education does little to develop the skills of levity. On the contrary, hospitals are notorious for their somber atmosphere. Although hospital staff members may enjoy camaraderie among themselves, with patients their goal seems to be to fight suffering with suffering. What little humor there is occurs during visiting hours.
The focus on humor in medicine at Gesundheit Institute has often been declared a major deterrent to our getting funds. Still, I insist that humor and fun (which is humor in action) are equal partners with love as key ingredients for a healthy life.
Although humor itself is difficult to evaluate, the response to humor-laughter-can be studied quite readily. Research has shown that laughter increases the secretion of the natural chemicals, catecholamines and endorphins, that make people feel so peppy and good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. Thus, laughter appears to have a positive effect on many cardiovascular and respiratory problems. In addition, laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occur at the same time and that the relaxation response after a hearty laugh can last up to forty-five minutes.
Psychologically, humor forms the foundation of good mental health. Certainly the lack of a good sense of humor indicates underlying problems like depression or alienation. Humor is an excellent antidote to stress and an effective social lubricant. Since loving human relationships are so mentally healthy, it behooves one to develop a humorous side.
I have reached the conclusion that humor is vital in healing the problems of individuals, communities, and societies. I have been a street clown for thirty years and have tried to make my own life silly, not as that word is currently used, but in terms of its original meaning. “Silly” originally meant good, happy, blessed, fortunate, kind, and cheerful in many different languages. No other attribute has been more important. Wearing a rubber nose wherever I go has changed my life. Dullness and boredom melt away. Humor has made my life joyous and fun. It can do the same for you. Wearing underwear on the outside of your clothes can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp. People so unabashedly thank you for entertaining them.
Being funny is a powerful magnet for friendship, life’s most important treasure. Nothing attracts or maintains friendship like being a jolly soul. I know that humor has been at the core of preventing burnout in my life. Finally, as a nonviolent person, I feel that humor has often protected me by deflecting potentially violent situations.
In the twelve years we saw patients during the pilot phase of Gesundheit Institute, we had many opportunities to explore the relationship between humor and medicine. Although we greatly appreciated casual humor, it seemed imperative that we deliberately incorporate it into our day-to-day lives to prevent an atmosphere of agony and despair. Some of this humor came from a stream of jokes that patients and staff brought with them. However, jokes die quickly, and we found that for an atmosphere of humor to thrive, we had to live funny.
We learned to first develop an air of trust and love, because spontaneous humor can be offensive, and we wanted it to be taken in the spirit of trying. (Cautious people are rarely funny.) It soon became clear that silliness was a potent force in keeping the staff together as friends. And I, as a physician, began to see the potent medicinal effect of humor on diseases of all kinds.
Humor is important, too, for the health of a community, whether a neighborhood, church, club, or circle of friends. It has helped me live communally for more than twenty years. The first twelve years we used our home as a free hospital, surrounded by patients who had great mental and physical suffering. The staff stayed many years without pay or privacy because it was so much fun. As physicians, we also discovered that humor was a major medicine. Humor, maybe even more than love, made our pioneering project work; it would have been impossible without this great social glue.
We live in a troubled world. Many aspects of society are unhealthy or even deadly, and large segments of the population live on the edge. If we are to doctor society we must rely heavily on humor. Often in public a parent and child are at odds, and the frustrated parent is ready to strike out at the child. If I put on my rubber nose and act goofy, most of the time the situation is defused and neither parent nor child has a win/lose feeling.
How can one inject more humor into a medical setting? First, it must be a joint decision by administration and staff. The most important elements of bedside manner are not medical knowledge or skill but the qualities inherent in fun and love. Once the medical establishment has agreed to accept more humor, people at all levels of employment will be willing to take steps in this direction. It is easiest to be funny when people are familiar with one another. Spend time together learning your limits and practicing being funny. Invite patients and visitors to participate. Be open to experimentation and escalate slowly. Expect many experiments to fail and even to cause some pain. Avoid racist and sexist humor. Strive for goofiness and fun, not an infinite string of jokes.
Some hospitals have begun the process already. At Duke University Hospital, humor carts deliver videos, cartoon and humor books, juggling equipment, toys, and games. DeKalb Hospital, near Atlanta, has created a Lively Room for romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units, which visit children’s hospitals on a regular basis to bring joy and assist with patient care. The Association of Therapeutic Humor is creating a clearinghouse with information about humor and about people who practice it as therapy. Finally, we at Gesundheit Institute are building the first silly hospital, where the entire context will be geared to fun and play.
There are many avenues to explore. I think hospitals need to give patients a choice between a goofy ward or a “straight,” solemn ward. In lectures all over the United States, I ask medical groups which ward they would choose, and more than 90 percent always choose the goofy ward. In any hospital, “fun” rooms could be designated as playful environments for all to enjoy. This could attract many of the community’s creative people, forge closer bonds between hospital and community, and diminish the hierarchical nature of current medical practice.
For all levels of staff, I suggest classes, intimate gatherings, picnics, and even slumber parties to cultivate the closeness needed to ensure more humor and joy in the workplace. I suggest creating humor support groups and maybe a place where people come just to laugh. Many hospitals have realized the importance of faith and have included ministers and priests on the staff. The same could be done with humor: hire clowns and playful people. Many large communities have performers and artists who could be invited to bring their specialties to the hospital. Some hospitals might even consider creating space for them, including a well-stocked costume and prop room.
The practice of medicine is hurting at many levels. Patient discontent is so great that many are resorting to lawsuits. Many health care professionals are so dissatisfied that they are quitting or even killing themselves. Few if any happy hospitals exist. Most people hate going to a hospital and have traumatic experiences when they do. Yet, it doesn’t have to be this way if we make great efforts to change it. Service to people in times of pain and suffering should – and can – bring rich fulfillment. Let us call on humor to lend a hand and make medicine fun.
Adams P with Mylander M (1998) Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy Rochester: Healing Arts Press
There is no doubt that any form of counselling, be it psychotherapy, stress management or anything else, is a very serious business. We read so many serious texts and go to so many serious meetings and classes that it is easy to get into a mode of solemn gravity. And, of course, this is largely because we are committed to treating our clients with respect. But in this paper I would like to suggest that respect can include humour and that laughter during a counselling session can be very therapeutic.
Humour: what is it and what place does it have in stress management counselling?
The Oxford Concise Dictionary defines humour as ‘the quality of being amusing or comic; the ability to perceive or express humour or take a joke’, but this is not particularly helpful in therapeutic terms. What is amusing or comic to one person may not be to another and, of course, we are not in the business of entertaining our clients as comics. So if humour is not necessarily about telling a joke, then what is it and how can it have beneficial effects in stress management counselling?
Windy Dryden, writing in Brief Rational Emotive Therapy, quotes Albert Ellis saying ‘that one way of conceptualising psychological disturbance is that it is the tendency of humans to take themselves, other people and life conditions TOO seriously.’ He goes on to describe how, in order to change, negative events need to be taken seriously, but that if they are taken too seriously, emotional disturbance may follow and action for change can be impaired. Indeed, as the whole model of stress management as conceived in Rational Emotive Behaviour Therapy and Cognitive Behavioural Therapy is based on the idea that people suffer emotional dysfunction when their thinking is irrational, humour can be seen as one of the many ways of ‘untwisting’ a client’s cognitive distortions.
Of course, this does not imply that every stress management counsellor can laugh and joke their way through every session with every client, but it does mean that if a counsellor is sensitive to the mood of the client, a little humour can go a long way. If the therapeutic bond is comfortable, it will be clear to the client that the therapist is not laughing at the client but at the irrationality of her/his ideas. Laughing with people is compassionate, laughing at them is immoral and unethical. Indeed, it can often be the case that laughing together can act, not only as a tool of communication, but can strengthen the bond between the two people concerned. As Victor Borge, the American entertainer, once wrote, ‘Laughter is the shortest distance between two people’. (quoted by Robert Holden, ISMA)
The physiology of humour
It is well known that stress causes physiological changes that are dangerous when prolonged Cortisol levels and blood pressure are elevated and the heart rate is increased amongst a host of other stress triggered responses. There is now considerable research that suggests that laughter lowers cortisol levels and stimulates the immune system, off-setting the immunosuppresive effects of stress. (Patty Wooton, Humour: An Antidote for Stress).
This research was preceded in 1979 by Norman Cousins who had, through his personal experience, attracted the attention of the medical profession to the possible therapeutic effects of humour. He contracted ankylosing spondylitis in 1964 and decided that the hospital regime of strong medication, dull food and the institutional regime was so depressing that any benefits he was gaining could be maximised outside the conventional regime. So, based on his own research, he developed a programme of therapy consisting of megadoses of a mix of vitamin C combined with regular doses of laughter stimulated by re-runs of the Marx Brothers films and Candid Camera. These treatments of belly laughs appeared to relieve his pain considerably and, indeed, when his levels of inflammation were tested, they were found to have decreased. Cousins also asserted that the increased release of endorphins caused by laughter eased the pain.
The beneficial effects of humour
A patient of mine suffering from a combination of physical and psychological stresses, not the least of which was a severely deteriorating irreversible eye condition, stated emphatically at one point that she would like a magic wand to cure all her ills. As it happened I had been given a gift of a joke wand and I promised her we would try out its properties at the next session. I duly brought it in and waved a shower of tinkling sparkles at her. She laughed delightedly although she could not have seen much apart from the basic shape and the sparkling effect. When I added my regrets that although I had a wand, I did not know the spells to go with it, she laughed even more and agreed that CBT would have to do instead. As I joined in her laughter, I felt that this shared experience had brought us closer, and indeed, she referred to it on several occasions afterwards. In her case it seemed that the laughter – particularly at something so absurd – had mitigated her stress by providing a coping mechanism. And when we had finished laughing, we seemed able to return to the serious matters at hand with renewed application. This is supported by Robert Holden, Stress Consultant, in his description of an
‘after-glow period in which we relax muscle tension, reduce stress in the nerves, massage the lungs, restore a full and flowing breathing pattern and gently expand our circulation once more’.
This sort of experience supports the concept of the counsellor as ‘authentic chameleon’ (Lazarus 1993). The key to this theory is that, in order for the client to achieve maximum benefit, the counsellor needs to be as flexible as possible to meet the client’s needs. Some clients will prefer a formal mode of interaction and the counsellor may choose to match this with more formal clothes and body language than are used with other clients and to use an empathic but business like dialogue. This sort of client may well be bewildered by the use of laughter. At the other end of the scale, there are clients who are most comfortable with a very casual style of communication. Clearly the therapist is unlikely to change clothes for every client but, provided they are sensitive to their clients’ individual backgrounds and personalities, they will try to adapt their body language and style of address. This adaptability also includes making a judgement as to the appropriateness of the use of humour.
When I used my magic wand, I sensed that my client felt supported by the counsellor joining her at The same level. Assuming that the humour is appropriate and genuine, not merely a gesture to please the other person, then the ideal of unconditional positive regard can be reinforced. To some extent it can be assumed that many clients feel they are talking to ‘an expert’ implying that they themselves are ‘lesser beings’. The employment of humour can be useful in reducing this distance and bringing about parity between client and therapist. And it does not always have to be the case that it is the counsellor who introduces the element of humour. In a recent session with a client who was experiencing difficulties in his relationship and who confessed to being a poor listener, I was discussing ways in which people show they are listening. The two-way discussion soon turned into my monologue as he stopped talking and just sat looking at me thoughtfully with the odd ‘hmm’ thrown in. There followed a pause and I asked him what was going through his mind. He beamed at me silently, then explained that he was listening in an appropriate manner, and we both roared with laughter. I was delighted that he was comfortable enough to be able to laugh at our situation.
My magic wand was used in a fairly light situation, but humour seems to have beneficial effects on a pretty extensive continuum of situations. Charles Rubin, in his book for parents of drug addicts, says:
‘Having a sense of humour in a situation that isn’t necessarily funny can lighten the tension of what’s going on. By trying not to take every little thing seriously, you will greatly reduce stress. There is a lot of drama associated with drug and alcohol addiction. If you can begin to see how ridiculous most of it is, you can start to put things into perspective. If you can just laugh and hang up when the addict calls … you’ve graduated to a new level.’
Humour can often be used to reinterpret or re-frame distressing events. As laughter distances the individual from the stressor, a feeling of perspective and safety is created. This certainly appeared to be the case for an elderly agoraphobic client whose homework had progressed to travelling two floors in a lift. In the event, being a person of extremes, she decided to visit a friend who lived on the twelfth floor. She went up in the lift for four floors – a triumph in itself – but when she left her friend, was too embarrassed to let him see her walk down the stairs, so took the lift all the way down the twelve floors. This client smiled broadly as she walked into the session, told me I’d never believe what she had to tell me, then laughed uproariously as she described the situation, realising that embarrassment was more important to her than her fear of lifts. The laughter encompassed relief that she had survived such a feat and also understanding of the absurdity of the incongruity of the situation. I felt it helped her to see her fears in a slightly different light and provided some reinforcement in her belief that she had some control over the situation.
Appropriate humour never belittles or criticises. It is based on caring and empathy. An invitation to laugh is an invitation to share and, as such, it is supportive and so builds confidence between two people. This can be as true in a group situation as that of one-to-one counselling. A group of part- time women trainees, for example, who had known each other for only two weeks, began a very brief course of stress management with me. They were a little reticent to begin with as can be expected in a situation where trust has not yet been established. Within the first 20 minutes it emerged that one of them felt she had a problem with her adult daughter who still lived with her and for whom she did all the washing, cleaning, cooking and ironing. She laughed in an embarrassed fashion as she told us about this, but soon the entire group was laughing uproariously with her as they predicted what she would be doing for her daughter before and after she was married. The raucous details can be imagined. The laughter proved to be a bonding experience as it showed her that everyone there identified with and shared her feelings. Thus a basis of trust was established within which it became possible for the group to take seriously the issues of why she behaved in this way and what she could do to change.
Laughter with a client about himself or herself can serve to reinforce their understanding of globalising and perfectionism. If, for example, a client has appreciated the irrationality of dismissing anything positive about themselves or the world but has not yet developed a firm counteracting belief, a little mockery of this negative perspective can help them to accept the irrationality of the core belief. The feeling that ‘things can’t be that bad if I can still laugh’ can be a considerable relief as well as having a distancing effect on the problem.
As stated at the beginning of this paper, there is no suggestion here that a counsellor can laugh all the way to a successful therapeutic conclusion for every client. And, indeed, it would be extremely foolish to laugh at all unless the client has indicated that they feel safe, supported and able to see a funny side to the issues that they bring to the sessions. Counsellors must however always be alert to the dangers of using humour for drawing attention to their own cleverness. There must also be a constant sensitivity to the client’s cultural background: an inappropriate laugh can do untold damage to the therapeutic relationship.
Nevertheless, the notion that humour can have beneficial effects is demonstrated by the current plethora of related web sites. In this country, one of the best known is Robert Holden’s Oxford- based Happiness Project. This was set up after he launched the UK’s first laughter clinics in 1991 with NHS funding. Holden runs workshops and also runs eight-week Happiness Programmes targeted, amongst others, at health professionals and also top level managers of some of the country’s largest companies.
Another ‘laughter practitioner’ is Dr. Brian Kaplan, a medically qualified doctor who claims that as soon as you start to laugh at a problem, ‘the problem is completely disempowered’. Further afield, the American, Cathy Ripplinger Fenwick, fronts an ‘Online Laughter Therapy Centre’ which advises on ways to ‘put more laughter into your life’. There are also panic/anxiety disorders web sites which advise readers to ‘laugh yourself calm, and papers on humour in emergency work (Moran and Massam).
Some of these web sites may be questionable in that they imply that self-help through humour is easy, but there is no doubt that the current trend is to take the funny side of things seriously and to appreciate the psychological benefits that humour can bring.
Summary
In this paper I have tried to cover the main benefits of the uses of humour in stress management counselling. There appears to be both anecdotal and scientific evidence that humour and laughter can act as antidotes to stress. Humour can:
• act as a communication tool as well as provide an emotional bonding and a demonstration of supportiveness and acceptance
• enhance the therapeutic alliance by confirming parity between client and counsellor
• help to reinterpret a distressing event and to distance the individual from the stressor thus providing a more realistic perspective on the problem
• serve to reinforce belief in new adaptive ways of thinking
• improve the physiological state
There remains one more area to be addressed and that is the use of humour to the counsellor. If we take ourselves too seriously we may become too concerned with our own thought processes and so risk losing sight of the clients’ issues. To be able to laugh at ourselves, acknowledging that we are fallible human beings, is an effective tool that enables us to see things in perspective. It is quite often the case that a good laugh in the middle of a serious discussion can provide the relief from tension that is needed to carry on with the seriousness of the deliberations.
‘Life does not cease to be funny when something bad happens any more that it ceases to be serious when we are laughing.’ Cathy Fenwick. Online Laughter Therapy Centre
Bibliography
Adams, M. Humour in the Psychotherapeutic Relationship, Counselling, Volume 11 No. 3
Dryden, W. Brief Rational Emotional Behaviour Therapy. Wiley, 1995 3
Ellis, A. A New Guide to Rational Living Robert Harper 1975
Fenwick, C. An Online Laughter Therapy Centre, (undated)
Lazarus, A. The Practice of Multimodal Therapy: John Hopkins 1989
Massam, Margaret & Moran, Carmen: An Evaluation of Humour in Emergency Work. The Australasian Journal of Disaster and Trauma Studies: volume 1997-3
Rubin, C. Don’t Let Your Kids Kill You. Element Books 1996
Trower, Casey and Dryden. Cognitive-Behavioural Counselling in Action. Sage Publications, 1988
Wooton, P. Humour: an Antidote for Stress. Anti-stress.htm undated
Sylvia Mauger works as a Stress Management Counsellor in the NHS and in private practice in South London. She also delivers Personal Effectiveness training in a Further Education setting. Sylvia is a member of ISMA (International Stress Management Association).
Reproduced by kind permission of the author © Sylvia Mauger.
Humor And Healing
The following is an excerpt taken from Chapter 3: Humor and Healing, or Why We’re Building a Silly Hospital of Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy.
Thank you to Patch Adams for kindly giving me permission to reproduce the said excerpt.
The arrival of a good clown exercises more beneficial influence upon the health of a town than of twenty asses laden with drugs.Dr. Thomas Sydenham,
seventeenth-century physician
Humor is an antidote to all ills. I believe that fun is as important as love. The bottom line, when you ask people what they like about life, is the fun they have, whether it’s racing cars, dancing, gardening, golf, or writing books. Philosophically speaking, I’m surprised that anyone is ever serious. Life is such a miracle and it’s so good to be alive that I wonder why anybody ever wastes a minute!
Anyone who has picked up a copy of Reader’s Digest in the last forty years knows that laughter is the best medicine. In spite of the empirical nature of this truth, the mainstream medical literature hasn’t refuted it, as far as I know. The late Norman Cousins wrote eloquently about having laughed himself back to health after suffering from a serious chronic disease. The experience had such an impact that he changed careers late in life to help bring this information to the health care profession. Jokes seemed so important to Sigmund Freud that he wrote a book on the subject. But we don’t need professionals to tell us about the magnetism of laughter. With great insight, we call a funny person “the life of the party.”
Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. I am astounded that anybody feels the need to prove something so obvious. When individuals and groups are asked what is most important for good health, humor invariably heads the list even over love and faith, which many people feel have failed them. Few people deny that a good sense of humor is essential for a successful marriage. All public speakers recognize that humor is essential in drawing attention to what they are saying.
People crave laughter as if it were an essential amino acid. When the woes of existence beset us, we urgently seek comic relief. The more emotions we invest in a subject, the greater its potential for guffaws. Sex, marriage, prejudice, and politics provide a bottomless well of ideas; yet, humor is often denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated and even condemned, except in speeches and anecdotes. The stress is on seriousness, with the implication that humor is inappropriate. Health education does little to develop the skills of levity. On the contrary, hospitals are notorious for their somber atmosphere. Although hospital staff members may enjoy camaraderie among themselves, with patients their goal seems to be to fight suffering with suffering. What little humor there is occurs during visiting hours.
The focus on humor in medicine at Gesundheit Institute has often been declared a major deterrent to our getting funds. Still, I insist that humor and fun (which is humor in action) are equal partners with love as key ingredients for a healthy life.
Although humor itself is difficult to evaluate, the response to humor-laughter-can be studied quite readily. Research has shown that laughter increases the secretion of the natural chemicals, catecholamines and endorphins, that make people feel so peppy and good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. Thus, laughter appears to have a positive effect on many cardiovascular and respiratory problems. In addition, laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occur at the same time and that the relaxation response after a hearty laugh can last up to forty-five minutes.
Psychologically, humor forms the foundation of good mental health. Certainly the lack of a good sense of humor indicates underlying problems like depression or alienation. Humor is an excellent antidote to stress and an effective social lubricant. Since loving human relationships are so mentally healthy, it behooves one to develop a humorous side.
I have reached the conclusion that humor is vital in healing the problems of individuals, communities, and societies. I have been a street clown for thirty years and have tried to make my own life silly, not as that word is currently used, but in terms of its original meaning. “Silly” originally meant good, happy, blessed, fortunate, kind, and cheerful in many different languages. No other attribute has been more important. Wearing a rubber nose wherever I go has changed my life. Dullness and boredom melt away. Humor has made my life joyous and fun. It can do the same for you. Wearing underwear on the outside of your clothes can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp. People so unabashedly thank you for entertaining them.
Being funny is a powerful magnet for friendship, life’s most important treasure. Nothing attracts or maintains friendship like being a jolly soul. I know that humor has been at the core of preventing burnout in my life. Finally, as a nonviolent person, I feel that humor has often protected me by deflecting potentially violent situations.
In the twelve years we saw patients during the pilot phase of Gesundheit Institute, we had many opportunities to explore the relationship between humor and medicine. Although we greatly appreciated casual humor, it seemed imperative that we deliberately incorporate it into our day-to-day lives to prevent an atmosphere of agony and despair. Some of this humor came from a stream of jokes that patients and staff brought with them. However, jokes die quickly, and we found that for an atmosphere of humor to thrive, we had to live funny.
We learned to first develop an air of trust and love, because spontaneous humor can be offensive, and we wanted it to be taken in the spirit of trying. (Cautious people are rarely funny.) It soon became clear that silliness was a potent force in keeping the staff together as friends. And I, as a physician, began to see the potent medicinal effect of humor on diseases of all kinds.
Humor is important, too, for the health of a community, whether a neighborhood, church, club, or circle of friends. It has helped me live communally for more than twenty years. The first twelve years we used our home as a free hospital, surrounded by patients who had great mental and physical suffering. The staff stayed many years without pay or privacy because it was so much fun. As physicians, we also discovered that humor was a major medicine. Humor, maybe even more than love, made our pioneering project work; it would have been impossible without this great social glue.
We live in a troubled world. Many aspects of society are unhealthy or even deadly, and large segments of the population live on the edge. If we are to doctor society we must rely heavily on humor. Often in public a parent and child are at odds, and the frustrated parent is ready to strike out at the child. If I put on my rubber nose and act goofy, most of the time the situation is defused and neither parent nor child has a win/lose feeling.
How can one inject more humor into a medical setting? First, it must be a joint decision by administration and staff. The most important elements of bedside manner are not medical knowledge or skill but the qualities inherent in fun and love. Once the medical establishment has agreed to accept more humor, people at all levels of employment will be willing to take steps in this direction. It is easiest to be funny when people are familiar with one another. Spend time together learning your limits and practicing being funny. Invite patients and visitors to participate. Be open to experimentation and escalate slowly. Expect many experiments to fail and even to cause some pain. Avoid racist and sexist humor. Strive for goofiness and fun, not an infinite string of jokes.
Some hospitals have begun the process already. At Duke University Hospital, humor carts deliver videos, cartoon and humor books, juggling equipment, toys, and games. DeKalb Hospital, near Atlanta, has created a Lively Room for romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units, which visit children’s hospitals on a regular basis to bring joy and assist with patient care. The Association of Therapeutic Humor is creating a clearinghouse with information about humor and about people who practice it as therapy. Finally, we at Gesundheit Institute are building the first silly hospital, where the entire context will be geared to fun and play.
There are many avenues to explore. I think hospitals need to give patients a choice between a goofy ward or a “straight,” solemn ward. In lectures all over the United States, I ask medical groups which ward they would choose, and more than 90 percent always choose the goofy ward. In any hospital, “fun” rooms could be designated as playful environments for all to enjoy. This could attract many of the community’s creative people, forge closer bonds between hospital and community, and diminish the hierarchical nature of current medical practice.
For all levels of staff, I suggest classes, intimate gatherings, picnics, and even slumber parties to cultivate the closeness needed to ensure more humor and joy in the workplace. I suggest creating humor support groups and maybe a place where people come just to laugh. Many hospitals have realized the importance of faith and have included ministers and priests on the staff. The same could be done with humor: hire clowns and playful people. Many large communities have performers and artists who could be invited to bring their specialties to the hospital. Some hospitals might even consider creating space for them, including a well-stocked costume and prop room.
The practice of medicine is hurting at many levels. Patient discontent is so great that many are resorting to lawsuits. Many health care professionals are so dissatisfied that they are quitting or even killing themselves. Few if any happy hospitals exist. Most people hate going to a hospital and have traumatic experiences when they do. Yet, it doesn’t have to be this way if we make great efforts to change it. Service to people in times of pain and suffering should – and can – bring rich fulfillment. Let us call on humor to lend a hand and make medicine fun.
Adams P with Mylander M (1998) Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy Rochester: Healing Arts Press