The therapist who laughs in the session: observations and reflections on the role of rice in psychotherapy

The therapist who laughs in the session: observations and reflections on the role of rice in psychotherapy

Can a therapist feel empowered in a sincere and transparent way to indulge in a joke or laugh?


My colleague (and namesake) Virginia Failoni long ago gave us a beautiful article on the role that crying can take on within the therapeutic setting, an event that has earned the construct of ‘Therapists’ Crying In Therapy’. In fact, we are not talking about any cry but that of the therapist. Yes, yes, you got it right: even the psychotherapist can indulge in emotion and crying. Her colleague reports, to her surprise, the few scientific references and literature data in this regard but the conclusions have normalized the tears that we sometimes share with our patients. In the wake of his contribution, I thought about a moment in my last year of specialization. I asked my supervisor if laughing was allowed during the session. What did I expect? Did he tell me I was mad or laugh in turn to my question? Instead his reaction was: ‘Let me understand … what are you thinking about?’

And there they are, the frames on duty. During the week I had welcomed a patient and a few seconds earlier I had listened to the audio of a friend. I opened the door for him while I was still laughing. When he entered the room he looked at me with a visibly sad face and made an expression of contempt. Conversely, with another patient who had told me a really funny story, I barely laughed. Not that I didn’t find it funny. Indeed it was but immediately I wondered if it was right-possible-correct-adequate-etc. etc. laugh during the session. However, the following month, a patient with very intense blue eyes had just finished crying telling me about her father’s death. To wipe away her tears, she took a tissue from the box which turned into a million bits that remained glued to her eyelids. As if it were a comic sketch, I started laughing without being able to stop anymore. As soon as she understood the reason, she laughed heartily with me. The whole thing lasted for a few minutes.

Returning to my supervisor, I remember that he told me that if I had spent two hours in the corridor of his study I would have heard a lot of laughter and tears from both the patients and the therapists. He was right: there are no prescriptions. If not the ones we built in our mind, during our development history or during the years of professional training.

Life events in fact consolidate interpersonal maladaptive patterns within us (Dimaggio et al. 2013; 2019) with which we give meaning to events. If, in fact, chases us and dominates the idea of ​​having to always show us serious, composed and adhere to the collective imagination that sees the therapist imperturbable to everything, then it will be more difficult to let go. We may be ashamed of the idea of ​​transmitting cheeky laughter in the same way that sharing a few tears can be difficult. Maybe we return scenes in which we were told ‘Loafer … be concentrated at work, there is no room for anything else’. We could feel fear at the idea of ​​not knowing how to manage the consequences and consequences in the relational space of therapy. On the other hand, we may notice consequences in the relationship even when,

Just like Virginia, I also tried to take a ride on Pubmed, and I discovered that the likes of Ellis, Perls, Erickson, Satir, Rogers are considered to be ‘super-therapists’ capable of using humor and laughter in therapies with severe patients, within both individual and group therapies, both in private settings and in institutionalized contexts (Adams, 2008). They are, however, very precise techniques, aimed at the active induction of a positive mental state through the vision of films, images or stories, for example (Martin, 2007). Linge-Dahl et al. (2018) showed the importance of the use of laughter in palliative care and, scrolling through research, there are other results regarding the application of laughter and irony in cases of insomnia, addiction, panic attacks and much more.

Instead, what I want to focus on is another aspect of laughter and refers to the completely natural and sincere, casual component, not far from what happens during a dinner with friends. At this point the question should be asked differently: can a therapist feel empowered in a sincere and transparent way to let go of a joke or a laugh? But on this, no research data. However, I found an interesting study in which the subjects interpreted the laughter of the other (therefore also that of their therapist) as mockery or mockery. Obviously these are patients with paranoid ideas or with social anxiety who struggle to decentralize and not to interpret the reactions of others except in a self-reported and negative way.

Here the mystery is solved. There is probably no standard or universal idea about rice in the therapy room but it is necessary for the therapist to ask himself what he can represent and, above all, to explore together with the patient what goes on in his mind while he sees his therapist letting go to laughter, from the one reserved to the loudest one. We have a question that, in its simplicity and sincerity, allows us to really investigate everything. Sounds like ‘But how are you perceiving me right now?’ not much differently than when we ask ourselves how what the patient is saying or doing at a given moment. And there you have to arm yourself with openness to be able to collect any type of response from the other. Safran and Muran (2019) clearly explain the importance of this internal disposition, in some ways difficult to cultivate, but important for probing what happens in relational dance in front of physiological and automatic emotional reactions such as tears and laugh, or even the blush, the raised eyebrow of contempt, the eyes wide with fear. Thanks to this type of comparison, I discovered that the patient I mentioned earlier, felt underestimated in his need for attachment when he saw me smile at the door. Conversely, the patient with the tissues on her eyes told me that it had been important to note that even intense pain can be temporary and modifiable. Finally, the theme of caring for me also emerged: he feared he had weighed me down with his father’s story. And so it was that we discovered a further element of its functioning.