The Use of Humor in Therapy : Research-Based Training Recommendations

Despite its essential and universal nature, humor has historically received limited attention from the behavioral sciences, particularly as compared to other affective experiences like anger and sadness. Some authors (e.g., Bell & Malhi, 2009; Provine, 2000a; Roeckelein, 2002) suggest that this is because researchers have traditionally failed to "take humor seriously" and, according to O'Connell (cited in Roeckelein, 2002), have too often pursued its study in a piecemeal manner lacking scientific rigor, resulting in "no comprehensive network of facts about the development and purposes of humor in human existence" (p. 1). Roeckelein (2002) found not a single mention of humor, laughter, wit, comedy, or theories relating to these topics in introductory psychology textbooks published between 1930 and 1996.While research interest in the area has grown, especially over the last decade, it remains an elusive and nebulous topic, more likely to be examined in specialty psychology texts (e.g., social psychology and child development) than general ones (Martin, 2007; Roeckelein, 2002). Organizations (e.g., The International Society for Humor Studies; The Association for the Advancement of Therapeutic Humor), journals (e.g., Humor: International Journal of Humor Research) and internet phenomena such as "The Humor Project" (www.humorproiect.com) have made great strides in integrating information about humor from discreet fields such as the arts and humanities, biological and social sciences, education, and business management. Still, the therapeutic potential of humor remains a relatively young subject of serious scientific inquiry (Marci, Moran, & Orr, 2004; Sala, Krupat, & Roter, 2002). While humor does make appearances in self-help books and publications addressing clinical applications, these sources are much ...

The Dilemma of Obesity Stigma in Psychotherapy

This paper explores the ways in which the growth of obesity in the United States is likely to impact psychotherapy, particularly in its implications for the management and awareness of obesity stigma in therapists' work with obese clients. Obesity poses a dilemma because no element of an individual's identity should be stigmatized in psychotherapy, and yet obesity impacts the individual's physical health and psychological well-being (Ogden & Clementi, 2010). As stigma specific to obesity is only beginning to be understood, the purpose of this paper is to examine obesity stigma through the lens of Erving Goffman's (1963) theories put forth in his book Stigma: Notes on the Management of Spoiled Identity. A case example is offered as a means of understanding the therapeutic issue of weight loss and psychotherapy with an obese client, particularly from the standpoint of Acceptance and Commitment Therapy.

The Lighter Side of Anorexia.

Anorexia nervosa is a disorder characterized by ego-syntonic self-starvation and is associated with impairment in functioning, emotional distress, psychiatric comorbidity, and an elevated mortality risk. Evidence-based data on treatment interventions for anorexia nervosa are scarce despite the need for more targeted and effective treatments. This paper offers an integrative model using humor as a therapeutic intervention for the treatment of anorexia nervosa. It proposes that the integration and application of humor in psychotherapy can be a powerful adjunct in treatment because it has the potential to activate change in the physiological, cognitive, emotional, and interpersonal realms negatively affected by this disorder.

The Utility of Therapeutic Assessment Style Fables During the Termination Stage of Psychotherapy

Stories, fables, and myths have been used for a long time in human history. They serve as a way for cultures and people to communicate, preserve important cultural values, and create meaning. The use of narratives has been recognized as a helpful technique in the field of psychology and can be found in many orientations and intervention techniques (Dwivedi, 2006; Roberts, 2000). Narrative therapy, bibliotherapy, trauma narratives, and Therapeutic Assessment (TA) are some of the areas in which the benefits of using written stories are incorporated into work with clients. In this paper, the clinical utility of using Therapeutic Assessment style fables in the termination phase of psychotherapy is explored. The termination phase is a challenging time for both therapists and clients. The use of rituals in the process of termination has been found to have a positive impact on the experience (Gutheil, 1993). This paper presents several case studies and examines the subsequent impact and clinical benefits of using termination fables in psychotherapy.

Do Things Change in Therapy That Are Not Measured By Self-report Instruments?

This study investigates a new way of assessing change in psychotherapy, with the goal of decreasing the schism in the field of psychology between research and clinical practice. Change in psychotherapy was assessed in clients presenting with depressive symptoms who were seeking therapy at the Professional Psychology Center (PPC) at the University of Denver. Prior to beginning treatment, the subjects completed the Beck Depression Inventory- II (BDI-II) and the Symptom Checklist-90-R (SCL-90), and were also assessed by independent clinicians using the Shedler-Westen Assessment Procedure II (SWAP-II). Six to nine months later, after completing at least 12 psychotherapy sessions (range 12-21 sessions), the assessment procedure was repeated.There were no significant differences pre- to post-treatment on any measure. However, two subjects in the sample appeared to benefit from treatment, as assessed by both the self-report measures and the SWAP-II. The findings for these two subjects suggest that the SWAP-II can provide a greater depth of understanding about what can change in therapy than self-report measures alone. Possible reasons for the lack of treatment effects in the larger sample are discussed.

Translating and Subtitling Humor Through Theory and Practice

This project assesses translating and subtitling humor in Italian and Spanish language films subtitled into English. Humor in film is problematic to translate when subtitling: visual humor may need no assistance to be delivered to a target audience, but verbal humor requires thorough analysis to be constructed effectively in the target language. To keep humor alive in target language translations, translators must understand the structure and function of humor. This project researches humor theory, translation and subtitling. It analyzes humor function through humor theory and applies this knowledge to translating audiovisual mediums. An understanding of joke structure and humor function can serve as a guide for translators to recognize, devise and evaluate equivalent translations of humor in film.

Examining the Alliance-Outcome Relationship: Reverse Causation, Third Variables, and Treatment Phase Artifacts

Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth and adult literatures. Despite these consistent findings, prospective associations are not sufficient to support the claim that the alliance is a change mechanism in psychotherapy. The current study examined the direction of effect of the alliance- outcome relationship, the contribution of early symptom change in treatment to the development of therapeutic alliance, and the potential for pretreatment interpersonal functioning characteristics to be third variables that account for the association between alliance and outcome. Participants were adolescents with depression and a history of interpersonal trauma that presented to a community mental health center for treatment. Findings demonstrated that a more positive therapeutic alliance predicted greater subsequent symptom improvement, even after removing symptom change occurring before the measurement of alliance. Results also suggested that early change only slightly contributed to alliance development. Finally, though pretreatment interpersonal functioning was related to the first session alliance, these pretreatment client characteristics were not related to later alliance or symptom change. Overall, results provided some support for therapeutic alliance as a mechanism of change in psychotherapy. Methodological and clinical issues are discussed.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

The Importance of the First Psychotherapy Case in the Development of the Therapist's Professional Self as Viewed Through the Lens of Self Psychology

This paper explores the gap in the literature between what is herein referred to as the "first psychotherapy case" and its impact on the development of the trainee psychotherapist's professional self. The self psychology concepts of identity development, selfobject needs and fulfillment, narcissism, shame, countertransference, and structuralization are incorporated into the theoretical framework from which this developmental milestone is viewed. The theory's emphasis on early experiences and the development of self highlight the distinctiveness of the first case for the therapist. The beginning psychotherapy case poses a unique context for selfobject experiences and the developing self, involving both the therapist's presumably mature needs (assuming an existing cohesive nuclear self) and more infantile needs as the professional, peripheral self develops. As a result, the potential and important implications for the psychotherapist, the patient, training implications for the supervisor, and the ensuing treatment through termination are identified. The intent is to shed light on an area that is understudied thus far, and to begin a conversation as to why and how the impact of the first case on the psychotherapist should be examined. Implications, limitations, and ideas for future exploratory and qualitative research are also discussed.

Personal Reflections on Providing Psychotherapy in a Third Language

This paper reflects upon the increasing diversity of the United States and the subsequent necessity for mental health providers who can provide psychotherapy services in more than one language. Review of the current literature of clinicians who provide bilingual services highlight the challenges and rewards of working in a second language. The literature focuses on the experiences of those bilingual clinicians who are bilingual in English and Spanish. However, there is little to no research concerning clinicians who can provide psychotherapy in three languages. This writer speaks of her experience growing up in a bilingual Vietnamese-English household in Southern California and her journey of becoming fluent in Spanish. Lastly, she provides recommendations to training programs on how to support trainees who aim to provide psychotherapy services in multiple languages.

Development of a psychological assessment battery to measure client beliefs about the effectiveness of psychotherapy

The author attempted to develop a brief scale to measure clients' beliefs about the effectiveness of psychotherapy. The study is an early pilot study to determine if the scale can predict therapy outcomes. While the scale did differ significantly between clients who were active in therapy and those who were not, higher scores on the instrument were not indicative of greater involvement. Possibilities for future research to refine the instrument are discussed.

Once Upon a Time in Therapy: Crafting Therapeutic Narratives to Help Familiarize Children with the Therapeutic Process.

Young children often harbor misconceptions about psychotherapy and the role of psychologists. These misconceptions are ignited by rumors and misinformation that are provided to the child by a variety of sources and can compromise both the effectiveness of therapy and the therapeutic dyad. In this paper we explore how recent trends in patient engagement in child psychotherapy, cultural dynamics between patients and practitioners, and children's lack of knowledge surrounding mental health services can negatively impact therapy. Wednesday Afternoons with Dr. J. (WADJ) is a whimsical fictional therapeutic narrative created to inform children about aspects of the therapeutic process while providing adults with tangible structure surrounding how to talk to children about mental healthcare. The advantages of utilizing this narrative to prime children for therapy are discussed, as are methods for promoting the narrative to the greater community.

Phototherapy as an Intervention in Identity Development with Adolescents.

Identity development in adolescence is a period of exploration and experimentation. During this stage of development, adolescents are defining their identity in terms of ethnicity, sexual orientation, and gender. It can be a confusing time and the lack of resources and support influence the ability of the adolescent to form a cohesive identity. This struggle to define an identity may lead to symptoms of depression and difficulties with interpersonal relationships. Identity interventions are limited and primarily involve the adolescent talking to a therapist and attempting to verbalize and define subjective distress. The use of a phototherapy intervention focuses on using an adolescent's subjective experiences. Phototherapy provides a way for the therapist and client to explore the photographs the client takes and opens different avenues in the areas of non-verbal and visual communication. Photographs can also promote increased communication about an adolescent's ethnic, sexual or gender identity. Interpretations made by the adolescent about images in the photographs will get in touch with emotional experiences that may be missed in traditional "talk therapy." This paper reviews literature on identity development, specifically in the areas of ethnicity, sexual orientation, and gender identity. Phototherapy, the use of photography to enhance traditional psychotherapy, is described and a rationale is provided for the utilization of phototherapy in adolescent identity development. Vignettes are provided illustrating how phototherapy can be used when working with adolescents who are questioning and exploring ethnic identity, sexual orientation, and gender identity.

The Impact of Sexual Boundary Violations in Supervision and Therapy: A Qualitative Study of a Trainee's First-Hand Account

This study involves a qualitative analysis of a doctoral-level psychology trainee's first-hand account of sexual attraction and boundary violations that occurred in her clinical supervision and psychotherapy. Concepts of power, gender, social performance theory, and relational framing are applied to two case examples, illustrating the differing demands on a trainee when her relationships were sexualized in two distinct professional contexts. Ramifications of supervisory exploitation and the impact of such an experience on a trainee's professional development are discussed. Recommendations are provided for improving psychology training programs' prevention and response efforts.