Psychiatric playfulness

Humor as a strategy in dealing with stressful situations.

Humor as a strategy in dealing with stressful situations (photo credit: TNS)
Humor as a strategy in dealing with stressful situations
(photo credit: TNS)
Therapeutic humor, as defined by the Association for Applied and 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 situations.”
Killinger points out that humor appears to release patients from a narrow, ego-centered focus while loosening rigid, circular thinking. Thought processes that had become ruminatively stale and closed are interrupted through humor and a new fresh perspective emerges. “The shift in focus facilitated by humor may then serve to unlock or loosen the rigid repetitive view that individuals often hold regarding their particular situations.” 
Below are described several personal examples of the use of humor as an adjunctive strategy in decreasing stress and anxiety of psychotherapy patients (and people in general). 
1. In my first year as an intern in clinical psychology, my distraught patient announced that after the session she was going to commit suicide because of her unbearable situation. After several futile attempts at dissuading her regarding her plans, I excused myself for several minutes and ran to my supervisor in a heightened state of panic and informed him regarding my patient’s intentions. Noticing my heightened state of anxiety, my supervisor told me not to worry and calmly reassured me that if my patient should carry out her threat, he will provide me with another patient. His thoroughly “inappropriate” response stunned me at first and then I started laughing. After my anxiety level dropped considerably, we were able to discuss appropriate therapeutic interventions.
2. Years later, I was able to utilize this intervention with a very dependent patient who suddenly had to terminate therapy because she was forced to relocate to another city because of a job transfer. In the last session, she was in a heightened state of anxiety and began ruminating about what she was going to do as this was her last meeting and that next week she was moving to another city. The question, “Doctor, what should I do, I am moving next week?” was repeated over and over again. The therapist calmly suggested to the patient to immediately make arrangements with a moving company. This unexpected response had the effect of short-circuiting the patient’s anxiety and enabled her to discuss her separation anxieties in a more controlled and effective manner.
3. An obsessive-compulsive (OCD) patient of mine with a severe hand-washing compulsion, upon returning from the bathroom, began washing her hands for several minutes. This behavior prompted me to remark, “Now I understand why the water level of the Kinneret (Sea of Galilee – the largest reservoir in Israel) is at its lowest level in many years.” This humorous comment evoked unrestrained laughter in the patient and immediate cessation of her activity.
NOW for two humorous but highly embarrassing goofs in my professional career. 
As a result of a heavy snowstorm, I arrived late at the psychiatric clinic in Brooklyn and much to my surprise, my first appointment was anxiously waiting for me. Upon seeing her, I impulsively blurted out, “You have to be crazy to come out of the house on a day like today.”
It was my first year in Israel and at the last meeting of the adolescent therapy group that I was conducting with a co-therapist, I wanted to ask one of the participants if she felt that she changed. Instead of saying in Hebrew, “Ha’im at hishtanet?” (“Did you change?”), I said, “Ha’im at hishtant?” (“Did you urinate?”) The patients and my co-therapist began to hysterically laugh at my blooper.
Tennis Anyone?
Though tennis is a “gentleman’s game” with a tradition of fairness and etiquette, it is still a competitive sport. Therefore, it seems reasonable that all means are acceptable, including the use of psychological principles and interventions (“psyching out” one’s opponent) to triumph. (Foreman, 1990).
In regard to the above, a recent match in which I participated comes to mind. Because of my greater experience and in spite of my greater age and slower speed and reaction time, I generally best my regular tennis partner, the scores ranging from 6-0 to 12-10, depending on what kind of day each of us is having. At one match, I found myself behind 4-0 and was looking desperately for a strategy to turn around the situation. At the start of the fifth game, I mentioned to my opponent that he only had to win the next two games in order to achieve a shutout, a feat that he had never accomplished in the three years we have been playing together. From that moment on, my partner proceeded to lose the next five games and the final score at the end of game time was 6-5, in my favor.
All’s fair in love and tennis.
Spurious rejoinder by Charles S. Hoaxter, PhD
The use of psychological principles and interventions in psychotherapy requires careful vigilance in drawing conclusions from patient responses. A basic challenge all psychotherapists face is the potential for patient manipulation.
As a long-time observer of the practice of psychotherapy, I have become impressed by the ease with which even the veteran practitioner falls prey to his own expectations. The use of psychological interventions may often lead to desired results, but cautious interpretation is a sine qua non for assuring that it is the patient whose behavior is being altered and not the psychotherapist.
I report here on the successful intervention with a veteran psychotherapist who, while believing that he was resourcefully winning the battle, was actually losing the war.
The psychotherapist tennis player engrossed in the challenges, opportunities and strategies of playing the game often exhibits dangerous signs of depression and frustration. A recent match that I participated in comes to mind.
My regular tennis partner is a veteran but sensitive strategic psychotherapist. So as not to induce a severe depressive reaction, I generally permit him to triumph in our matches. My relative youth, greater speed, and faster reaction time would allow for my winning consistently, but his psychological well-being requires my bowing to his greater experience. In one match I accidentally found myself ahead 4-0 and my opponent was beginning to show worrisome signs of depression. I began searching desperately for a strategy that would allow his regaining self-respect. At the start of the fifth game, he gave me the opening. He mentioned that I needed to win two more games in order to achieve a shutout (6-0). I immediately seized the opportunity. Knowing that he would be blinded by his “intervention,” I had no difficulty realistically losing the next five games. The final score was 6-5 in his favor.
My psychotherapist tennis partner left that day smugly noting the success of his psychological intervention, while I departed knowing that I had rescued a friend’s mental health.
The writer, a PhD, is a supervising psychologist at the Marbeh Daat Mental Health Center, Mayenei Hayeshua Medical Center in Bnei Brak. He recently published Interface Between Psychotherapy and Judaism (2017) and The Interface Between the Ultra-Orthodox Community and Mental Health (Hebrew, 2018). Golden Sky Books.