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The Therapeutic Use of Humor 95 assertion of its own vulnerability” (Freud [1905] 1926). But he also spoke to the possibility that humor was a reflection of underlying anxiety, bitterness, or unspoken hostility (Freud [1905] 1960). Many other authors have questioned the use of humor in therapy. Greenson (1977) pointed out that patients can cover hostility and anger with humor and sarcasm. Paul (1978) agrees that a patient’s humor or teasing is often disguised hostility, and Kubie (1971) is adamant in stating that a therapist’s use of humor might stem from aggressive, hostile feelings toward the patient. He adds that, for a beginning therapist, using humor could divert the patient’s stream of feeling and thought from spontaneous channels, act as a defense against the therapist’s anxieties, lead to doubt about the therapist’s seriousness, and distort transference phenomena. If humor or jokes are excessively or inappropriately used, the patient may begin to doubt if he or she is being taken seriously. Both patient and therapist may, if not watched carefully, resort to the use of humor to avoid dealing with difficult, conflicted, or painful areas and thereby inhibit the therapeutic process (Haig 1986). However, when the therapist is comfortable with his or her ability to use humor appropriately, when the same sensitivity that we expect a therapist to exhibit in other areas of the treatment process is applied to the use of humor, it can indeed be an invaluable tool, especially when working with an adolescent population. My adolescent/young adult group has been meeting regularly and faithfully for about nine months. With the exception of one person who left because she had to be hospitalized, the membership has been steady. The girls seem to like one another; some have developed a support network outside the group; and most of them are able to relate to one another in the here and now. The group was cohesive and functioning well—but it was much too serious! My occasional attempts at puns and humor (i.e., “I guess you can’t have your cake and eat it, too”; “That statement really gives us food for thought”; “Tell us again about swallowing your anger or being starved for attention”) were met with smiles or a polite chuckle at best—until the time Karen, an outgoing, verbal sixteen year old who had been flirting with several forms of bulimia, told the group about the previous night’s experience. She related that her mother, on the pretext of “helping her straighten out her closet,” had found several
96 The Therapeutic Use of Humor of the empty or near-empty boxes of laxatives Karen had been using on and off for several weeks. “Wow! You should have seen her!” she said. “If you guys thought she used to get angry at me before, that was nothing! This time the shit really hit the fan!” The laughter that ensued, spontaneous and honest, was a catalyst for the group and the group process. Karen’s unplanned joke/pun helped her understand, probably better than a “formal/serious” interpretation, the tremendously hostile components of her bulimic behavior. In conclusion, humor can be a powerful and important tool in psychotherapy if used appropriately and with sensitivity. Adolescents especially have trouble participating in the therapeutic process if they perceive the therapist as patronizing and “fake.” Humorous interventions and banter are a way of lessening their discomfort and making them feel they are being treated as equals. Humor is, of course, inexorably linked to the therapist’s personality and to his or her degree of comfort with its usage; but when used by a skilled practitioner, it can help patients gain an objective view of their behavior, point out the self-damaging effects of blackand-white thinking, debunk some of their myths and distortions, and, most of all, cement the therapeutic alliance. References Driscoll, Richard. 1978. “Humor in Pragmatic Psychotherapy.” Handbook of Humor and Psychotherapy. Professional Resource Exchange, 133. Freud, S. [1905] 1926. “Humor.” International Journal of Psychoanalysis 9:16. ———. [1905] 1960. Jokes and Their Relation to the Unconscious. Translated by J. Strachey. New York: Norton. Greenson, R. 1977. Technique and Practice of Psychoanalysis. New York: International University Press. Haig, Robin A. 1986. “Therapeutic Uses of Humor.” American Journal of Psychotherapy 40, no. 4 (October): 549. Kubie, L. 1971. “The Destructive Potential of Humor in Psychotherapy.” American Journal of Psychiatry 128:861–66. Paul, I. 1978. The Form and Technique of Psychotherapy. Chicago: University of Chicago Press.
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editor BARBARA P. KINOY EATING DISO
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Eating Disorders New Directions in
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To our patients’ children and gra
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viii Contents 3. Psychiatric Consul
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x Foreword Although serious deficie
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preface In 1994, in the first editi
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Preface xv psychological hazards to
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Preface xvii partial, complete, or
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acknowledgments We wish to acknowle
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contributors Debra Bader, CSW, BCD:
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Eating Disorders
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Introduction diane w. mickley I am
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Introduction 3 needs of patients wh
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Introduction 5 therapy or on medica
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1 Medical Aspects of Anorexia and B
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Medical Aspects of Anorexia and Bul
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2 Recovery Through Nutritional Coun
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Recovery Through Nutritional Counse
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Lesson 1: Daily Caloric Need and Me
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ical activity to a normal level. If
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patient who binges, it may be helpf
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and allowing herself to consume a l
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Figure 2.3 Typical Hunger and Food
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herself. She frequently feels hopel
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Page 70 and 71: Recovery Through Nutritional Counse
Page 72 and 73: Recovery Through Nutritional Counse
Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
Page 78 and 79: Psychiatric Consultation 53 difficu
Page 80 and 81: Psychiatric Consultation 55 Obsessi
Page 82 and 83: 4 A Family Systems Perspective on R
Page 84 and 85: A Family Systems Perspective on Rec
Page 90 and 91: she calls her mother and tells her
Page 102 and 103: 5 Relationship to Food as to the Wo
Page 104 and 105: iors—somehow to integrate the fra
Page 106 and 107: treatment, Theresa wanted to see an
Page 108 and 109: Relationship to Food as to the Worl
Page 114 and 115: 6 The Therapeutic Use of Humor in t
Page 116 and 117: The Therapeutic Use of Humor 91 Amy
Page 118 and 119: The Therapeutic Use of Humor 93 was
Page 122 and 123: The Therapeutic Use of Humor 97 Ron
Page 124 and 125: Jodie’s Story 99 capacity to make
Page 126 and 127: Jodie’s Story 101 house and a ter
Page 128 and 129: Jodie’s Story 103 She did not do
Page 130 and 131: adness. The dream also revealed tha
Page 132 and 133: 8 Eating Disorders and Managed Care
Page 134 and 135: Eating Disorders and Managed Care 1
Page 136 and 137: Eating Disorders and Managed Care 1
Page 138 and 139: Cognitive-Behavioral Therapy and Ot
Page 152 and 153: 10 The Nurse’s Role in a Pilot Pr
Page 154 and 155: The Nurse’s Role in a Pilot Progr
Page 156 and 157: The Nurse’s Role in a Pilot Progr
Page 158 and 159: 11 Individual Psychotherapy: A Long
Page 160 and 161: Individual Psychotherapy 135 Such p
Page 162 and 163: Individual Psychotherapy 137 empath
Page 164 and 165: weight and shape, as well as change
Page 166 and 167: Individual Psychotherapy 141 vomiti
Page 168 and 169: Individual Psychotherapy 143 During
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Individual Psychotherapy 145 and re
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Individual Psychotherapy 147 Mitche
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Young Adult Women 149 to surface an
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Young Adult Women 151 with their at
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Young Adult Women 153 ing; in fact,
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Young Adult Women 155 doomed, and a
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part of a treatment team where the
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13 Recovery margaret goldkopf-woodt
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Recovery 161 I can appreciate both
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Recovery 163 meant. I certainly cou
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Recovery 165 ate other uncomfortabl
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Recovery 167 connection between my
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Recovery 169 safe place, and our ow
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Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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