PsychologicalReporrs, 1990, 66, 795-801.

O Psychological Reports 1990

USES O F HUMOR I N PSYCHOTHERAPY

SHARON A. DIMMER
Michigan State Uniuersiiy

JAMES L. CARROLL GWEN K. WYATT

Central Michigan Uniuersify Michigan State University

Summary,-Given demonstrated usefulness in facilitating learning, aiding healing,

and reducing stress, humor has gained recognition as a clinical tool. This article re-
views some uses and potential misuses of humor in psychotherapy and suggests
directions for practice and research.

Recently there has been growing interest in the clinical uses of humor.
Research suggests that humor may be important in facilitating learning (Ziv,
1988), helping to reduce pain (Adams & McGuire, 1986), enhancing immune
system functioning (Dillon, Minchoff, & Baker, 1986), lowering stress (Trice
& Price, 1986), and promoting general health (Carroll, 1990). Within the
last 40 years many therapists representing a variety of schools have recom-
mended the use of humor in both diagnosis and treatment (Goldstein,
1987). In their Handbook of Humor and Psychotherapy, Fry and Salameh
(1987) presented a 306-item bibliography of books, articles, and presenta-
tions relating to the utility of using humor in psychotherapy. One hundred
sixty-four references from 1970 onward attest to interest in the subject; an
extensive earlier bibliography was presented by Treadwell (1967).
According to Greenwald (1976), laughter is incompatible with depres-
sion. Rosenheim and Golan (1986) have stated that a humorous approach to
life is characterized by flexibility, potential for broadening one's perspective,
and discovering new options. Harder (1976) believes that humor is both the
producer and the product of good mental health, while Greenwald (1987)
believes humor, usually followed by laughter, is a useful treatment for various
types of psychiatric clients. The purpose of this article is to review the
recent literature and research on the use of humor in psychotherapy, address-
ing some of its uses and potential misuses, and suggesting directions for
research.
Humor as a Method of Intervention
Humor in psychotherapy can be used to deviate anxiety and tension,
encourage insight, increase motivation, create an atmosphere of closeness and

'The authos thank the Faculty Committee for Research and Creative Endeavors at Central
P h i g a n University for their support.
Reprint requests should be sent to Sharon A. Dimmer, A-230 Life Sciences Building, Michigan
State University, College of Nursing, East Lansing, MI 48824-1317.
796 S. A. DIMMER, ETAL.

equality between therapist and client, expose absurd beliefs, develop a sense
of proportion to one's importance in life situations, and facilitate emotional
catharsis (Rosenheim, 1974; Mindess, 1976; Haig, 1986; Rosenheim &
Golan, 1986; Reynes & M e n , 1987).
Freud (1960) placed emphasis on the content of the humor stimulus and
its relation to the individual's current conflicts. Freud thought that humor
helped people cope with anxiety by permitting a release of hostile or sexual
feelings and allowing a person to say something he could not say openly.
Later, Grossman (1976) suggested that it was not as threatening to tell a joke
as to describe a dream.
Humor is often an ingredient in paradoxical approaches to therapy.
Paradox is a technique for mobilizing psychological resistance to eliminate
destructive behavior patterns, specifically for people who take life too seri-
ously. Olson (1976) and Ellis (1977) thought that disturbed people tend to
take themselves and their problems too seriously. Fay (1978) recommended
paradoxical therapy because he found that humorous comments facilitate the
disruption of damaging values and enable the person to gain a different per-
spective. He stated that, even if the patient does not change, paradoxical
methods may prevent the patient's support people from becoming frustrated
and destructively angry. Erickson and Rossi (1979) also advocated the use of
paradox, which they believe helps people break through their too-limited
mental sets and initiate unconscious searches for new levels of meaning.
Some clinicians (Farrelly & Lynch, 1987; Roller & Lankester, 1987) advocate
provocative therapy, a paradoxical approach. They suggest that both clients
and therapists overrate the clients' fragility, which can cause the therapist to
avoid helpful interventions. If humorously provoked, the client will tend to
move toward more effective behavior.
Goodman (1983) thought that it was possible for people to invite
humor intentionally without overdoing it. Goodman, h e c t o r of the Humor
Project (a nonprofit foundation based in Saratoga Springs, NY, dedicated to
the therapeutic use of humor), has suggested a variety of experiential tech-
niques including educating people about their "comic vision" so that they
can see humor that is around them. He cited an example from a church bul-
letin announcing a baptismal service: "This afternoon there will be meetings
in the north and south ends of the church. Children will be baptized on
both ends" (Goodman, 1983, p. 8). O'Connell (1976) thought that humor
techniques should occur in an accepting, playful atmosphere where the
patient is treated with kindness and respect. Greenwald (1976) took this idea
further, positing that therapy should be fun for the therapist to set an exam-
ple for the patient.
Research and Clinical Studies
Scogin and Merbaum (1983) tested the assumption that an inverse rela-
 USES OF HUMOR I N PSYCHOTHERAPY 797

tionship exists between humor and depression. They presented cartoons to

clinical psychology students and used the Beck Depression Inventory as the
criterion for depression. They found no significant differences between
mildly depressed and nondepressed college students on self-reported humor
appreciation. They did find, however, that students with higher anxiety,
depression, and hostility found cartoons with "other" as the target or focus
of the humor significantly more humorous than those with ''self'' as the
object of the humor. This suggests a person who is feeling depressed, anx-
ious, or angry may be threatened by humor that comes too close to personal
feelings of vulnerability.
Rosenheim and Golan (1986) investigated preferences of hysterical,
obsessive, and depressive patients for humorous or nonhumorous therapeutic
interventions. Their results supported the notion that there is a significant
interaction between the type of humor preferred and personality. Depressed
patients rejected humor aimed at development of perspective but not humor
aimed at emotional confrontation and anxiety reduction. Hysterical patients
preferred the opposite kind of humor preferred by depressed patients.
Obsessive patients strongly rejected all three types of humor. The results sug-
gest that both depressed and obsessive patients may have difficulty accepting
humorous invitations to change their bleak view of life; however, the authors
concluded that, even though these patients preferred nonhumorous ap-
proaches, they still may benefit from other humorous therapeutic approaches.
I n a more recent study, Rosenheim, Tecucianu, and Dimitrovsky (1989)
investigated the humor appreciation of 25 nonchronic schzophrenic patients
in an Israeli mental hospital. The patients were told that the researchers
wanted to determine the therapeutic appropriateness of various interven-
tions, presented in either a humorous or nonhumorous style. The results
were similar to the earlier Rosenheim and Golan (1986) study-the patients
did not appreciate the humorous intervention strategies. However, the
authors cautioned that this might be from patients' lack of experience with
humorous interventions. Another finding suggested that there was a relation-
ship between personality deterioration and the ability to appreciate the
therapeutic apsects of humor. Paranoid patients who had a better organized,
though emotionally vulnerable personality structure, were less rejecting of
humor than were nonparanoid patients.
Humor has been used to reduce the anxiety that clients often exper-
ience early in therapy. I t has been speculated (Reynes, 1987) that its use may
demonstrate to the client that the therapist will accept and treat him as a
person rather than as a problem. Rosenheim (1974) reported his experience
with a young man who had been raised with emphasis on obedience, serious-
ness, and respect for authority. H e took therapy seriously and never allowed
himself any small talk, let alone a smile. The therapist asked him if he ever
798 S. A. DIMMER, ETAL.

wondered how therapists managed their own lives. The patient responded in
such a way to indicate that such "heretical" thoughts never entered his
mind. The therapist responded, "You really think I was ordained for 'angel-
hood'?" After this, the patient was apparently freer with the therapist and
had more relaxed body posture.
Levine (1976) illustrated how humor can facilitate a new perspective
and help the client to move from a narrow, over-emphasized view of his
problem to considering alternative ways of viewing problems and solutions.
H e reported that a female client frequently complained about her unfaithful
and inconsiderate husband. When asked why she still chose to stay with
him, the patient responded that as bad as he was, she was afraid that she
could not find anyone better and she was afraid of being alone. The thera-
pist acknowledged her loneliness but pointed out another aspect of her
choice to remain married by relating a story. The story was of the man who
worked in the circus cleaning up after the animals and giving enemas to con-
stipated elephants. An old friend of his, observing the menial type of work
that he was doing, offered to help him get another job. To which he replied,
"What,'and give up show biz?" The patient was angry at first and then
amused. She was able to recognize some of her covert motives for her com-
plaints about her husband. This laughter and her willingness to share it was
the first sign of a positive change in the severity of the woman's depression
and marked the beginning of significant therapeutic progress.
Savell (1983) studied the effects of humor on depression in adult psy-
chatric patients attending a day-treatment program. H e used the Beck
Depression Inventory to rate the patient's level of depression. A treatment
group listened to tapes of jokes and anecdotes recorded by six nationally rec-
ognized comedians once a day for eight days. The types of humor used were:
self-degrading humor in which the comedian is self-debasing, hostile humor
in which the comedian attacks his audience or directs his jokes toward belit-
tling others, and situational humor in which the humor of the joke is based
upon the absurdity of the situation in a nonhostile way. Savell found that
self-debasing, hostile humor and situational humor stimuli used in the study
were not effective in reducing depression but they did not inhibit the effec-
tiveness of other treatment approaches. H e found that the enjoyment of
situational humor increased as the patient's depression decreased. Another
finding pointed out that hostile humor was less associated with the depres-
sion than with other types of humor (i.e., even when the patients became
less depressed they still disliked hostile or mistreatment humor). This sug-
gests that it is the least desirable type of humor to use with depressed
patients.
While humor has been described as a positive therapeutic tool, Haig
(1986) points out the double-edged aspect of humor in psychotherapy by
 USES OF HUMOR I N PSYCHOTHERAPY 799

reporting examples of both constructive and destructive humor in a clinical

case. Kubie (1971) expressed the strongest concern about using humor as a
therapeutic tool. Both authors listed some of the following concerns:
(1) Humor might be used to avoid uncomfortable feelings by the
patient or therapist;
(2) Humor could be used by patients to defend against accepting the
importance of their illness;
(3) Sarcastic humor could be used to mask the therapist's hosthties
toward the patient;
(4) The therapist could use humor to show off how amusing and clever
he can be; and
(5) Were humor excessive, the patient might doubt that h e is being
taken seriously.
Both Kubie (1971) and Haig (1986) were concerned that the therapist
would use humor to serve their own interests to the disadvantage of the cli-
ent, a concern that must be respected as valid. However, if therapists keep in
mind the possible pitfalls of humor in treatment, they can apply humorous
interventions constructively (Mindess, 1976; Ruvelson, 1988).
Problems and Directions
While some data (anecdotal and otherwise) exists, more and better
research on the use of humor in psychotherapy is needed (Saper, 1987). In
an effort to objectify the use of humor, many researchers have used canned
or prepared jokes which cannot be generalized to spontaneous therapeutic
humor. Practitioners engaged in the clinical aspect of their work may use cre-
ative approaches, such as "tell your favorite joke"; however, their findings
are mostly anecdotal and their approaches have not been systematized (Kil-
linger, 1976). The study of therapeutic humor needs a common ground
which takes into account the complexity of psychotherapy as an art, the
diversity of humor stimuli, and the need for standardzed research.
Salameh (1983) devised a five-point Humor Rating Scale to rate thera-
pists' use of humor in psychotherapy. Level 1 refers to destructive humor,
level 2 to harmful humor, level 3 to minimally helpful humor, level 4 to very
helpful humor response, and level 5 to outstanlngly helpful humor
responses. The author gives an illustrative clinical example for each level.
This tool may be useful for both clinical and research classification of humor
used in therapeutic interactions, and a taxonomy by Berger (1976) could
assist therapists in classifying themes of humorous material.
Clearly it is important to consider the client's needs as well as h s per-
sonality structure if appropriate humor is to be effective in the therapeutic
process. Currently there have been few studies that assess the long-term
effects of humorous interventions in a controlled manner; such research is
needed before use of humor can be validated. Research is also needed in the
800 S. A. DIMMER, ETAL.

following areas: humor as a coping mechanism, the role of humor in increas-

ing client's inner confidence, and the use of humor to increase personal
humility (in both client and therapist).
Therapists probably need specific training either during formal psycho-
therapy courses or through continuing education in the "art" of humor
intervention. Other therapists come by their skills "naturally," and only need
permission to use their skills therapeutically. A recent book by Mosak (1987)
provides approaches to the incorporation of humor to establish rapport, offer
interpretations, implement changes, and determine readiness for termination.
And finally, another important consideration must be the understanding
of cross-cultural issues in humor. Currently many psychologists are struggling
with trying to understand the multicultural issues clients bring to the thera-
py. Few articles have been written that address cross-cultural aspects of
humor; Fry and Salameh (1987) listed only two items of a cross-cultural
nature while Mosak (1987) listed seven. Further research into cross-cultural
aspects of humor in therapy is clearly needed.
In conclusion, the authors advocate humor as one useful tool for anxiety
reduction and facilitation of insight. Others have taken even a stronger
stand. Mindess wrote, "The best way I can envisage for us as therapists to
encourage a humorous outlook in patients is to maintain such an outlook in
ourselves (1976, p. 338). Narboe (1981) points to the need for risk-taking
interventions in his quote, "Our usefulness as therapists lies in the range
between what is expected and what is intolerable. Too safe and there's no
reason to move; too risky and there's no support for movement."

REFERENCES
ADAMS,
E. R., & MCGUIRE,F. A. (1986) Is laughter the best medicine? A study of the effects
of humor on perceived pain and affect. Adaptation and Aging, 8(3-4), 157-175.
BERGER,A. A. (1976) Anatomy of a joke. lotirnal of Communications, 26, 113-115.
CARROLL,J. L. (1990) The relationship between humor appreciation and perceived physical
health. Psychology-a Journal of Behavior (in press)
DILLON,K. N., M~NCHOFF,
B., & BAKER,K. H. (1986) Positive emotional states and enhance-
ment of the immune system. International Journal of Psychiatry in Medicine, 15, 13-18.
ELUS, A. (1977) Fun as psychotherapy. Rational Living, 12(1), 1-6.
ERICKSON, M. H., & ROSSI, E. L. (1979) Hypnotherapy: an exploratory casebook. New York:
Irvington.
FARRELLY, F., & LYNCH,M. (1987) Humor in provocative t h e y y . In W. F. Fry & W.A.
Salameh (Eds.), Handbook of humor and psychotherapy: a vances zn the clinical use of
humor. Sarasota, FL: Professional Resource Exchange. Pp. 81-106.
FAY,A. (1978) Making things better by making them worse. New York: Hawthorn.
FEUD, S. (1960) Joker and their relation to the unconscious. London: Routledge & Kegan.
FRY,W. F., & SWH, W. A. (Eds.) (1987) Handbook of humor and psychotherapy: advances
in the clinical use of humor. Sarasota, FL: Professional Resource Exchange.
GOLDSTEIN, J. H. (1987) Thera eutic effects of laughter. In W. F. Fry 8: W.A. Salameh (Eds.),
Handbook of humor anfpsychotherapy: advances in the clinical use of humor. Sarasota,
FL: Professional Resource Exchange. Pp. 1-20.
GOODMAN, J. (1983) HOWto get more smileage out of your life: making sense of humor, then
serving it. In P. E. McGhee & J. H. Goldstein (Eds.), Handbook of humor research:
Vol. 11. Applied studies. New York: Springer-Verlag. Pp. 1-21.
 USES O F HUMOR IN PSYCHOTHERAPY 80 1

GREENWALD, H. (1976) Humor in psychotherapy. In A. J. Chapman & H. C. Foot (Eds.), It's

a f u n y thing, humour. New York: Pergamon. Pp. 161-164.
GREENWALD, H . (1987) The humor decision. In W. F, Fry & W. A. Salameh (Eds.), Handbook
of humor and psychotherapy: advances in the clinical use of humor. Sarasota, FL:
Professional Resource Exchange. Pp. 41-54.
GROSSMAN, S. A. (1976) The use of jokes in psychotherapy. In A. J. Chapman & H.C. Foot
(Eds.), It's a funny thing, humour. New York: Pergamon. Pp. 149-151.
HAIG,R. A. (1986) Therapeutic uses of humor. American Journal of Psychotherapy, 40, 543-
553.
HARDER,J. (1976) Mental health and a sense of humor: the imperative connection. Marriage
and Family Counselors Quarterly, 10, 45-46.
KILLINGER, B. (1976) The place of humour in adult psychotherapy. In A. J. Chapman & H.C.
Foot (Eds.), It's a h n n y thing, humour. New York: Pergamon. Pp. 153-156.
KUBIE, L. (1971) The destructive potential of humor in psychotherapy. American Journal of
Psychiatry, 127, 861-866.
LEVINE,J. (1976) Humor as a form of therapy: introduction to symposium. In A. J. Chapman
& H. C. Foot (Eds.), It's afunny thing, humour. New York: Pergamon. Pp. 127-137.
MINDESS,H. (1976) The use and abuse of humour in psychotherapy. In A . J. Chapman & H.
C. Foot (Eds.), Humor and laughter: theory, research and application. New York: Wiley.
Pp. 331-341.
MOSAIC, H . H. (1987) HaHa and aha: the role of humor in psychotherapy. Muncie, I N : Accele-
rated Development.
NARBOE,N. (1981) Why did the therapist cross the road? Voices, 16(4), 55-58.
O'CONNELL,W. E. (1976) Freudian humour: the eupsychia of everyday life. In A. J. Chapman
& H . C. Foot (Eds.), Humor and laughter: theory, research and application. New York:
Wiey. Pp. 313-329.
OLSON,H. A. (1976) The use of humor in psychotherapy. Individual Psychologist, 13, 34-37.
REYNES,R. L., & ALLEN,A. (1987) Humor in psychotherapy: a view. American Journal of
Psychotherapy, 41, 260-270.
ROLLER,B., & LANKESTER, D. (1987) Characteristic processes and therapeutic strategies in a
homogeneous group for depressed outpatients. Small Group Behavior, 18, 565-576.
ROSENHEIM, E. (1974) Humor in psychotherapy: an interactive experience. American Journal of
Psychotherapy, 28, 584-591.
ROSENHEIM, E., & GOLAN,G . (1986) Patients' reactions to humorous interventions in psycho-
therapy. American Journal of Psychotherapy, 40, 110-124.
ROSENHEIM, E., TECUCLANU, F.,& D ~ R O V S KL.Y ,(1989) Schizophrenics appreciation of hu-
morous therapeutic interventions. International Journal of Humor Research, 2, 141-152.
RWELSON,L. (1988) The empathic use of sarcasm: humor in psychotherapy from a self psy-
chological perspective. Clinical Social Work Journal, 16, 297-305.
SALAMEH, W. A. (1983) Humor in psychotherapy. In P E . McGhee & J. H . Goldstein (Eds.),
Handbook of humor research: Vol. 11. Applied studies. New York: Springer-Verlag. Pp.
109-134.
SAPER,B. (1987) Humor in sychotherapy: is it good or bad for the client? Professional
Psychology: Rest-arch a n l ~ r a c t i c e ,18, 360-367.
SAVEU,H . (1983) The effects of humor on depression in chronic emotiondy disturbed adult..
Unpublished doctoral dissertation, Univer. of Mississippi,
SCOG~N, F. R., & MERBAUM,M. (1983) Humorous stimuli and depression: an examination of
Beck's premise. lournal of Clinical Psvcholonv, 38, 165-169.
TREADWELL, ? (1967)- ~ i b l i o g r a ~of h ~ekpiricz studies of wit and humor. Psychological
Reports, 20, 1079-1083.
TRICE, A. D., & PRICE, G. J. (1986) Joking under the drill: a validity smdy of the Coping
Humor Scale. Journal of Social Behavior and PersonaliQ, 1, 265-266.
Zrv, A. (1988) Teaching and learning with humor: experiment and replication. The Journal of
Experimental Education, 57, 5-15.
Accepted March 23, 1990.