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Clinical Meeting: On laughing with the client

The title of our meeting this month was “Provocative Therapy: the use of humour and reverse psychology in medicine and psychotherapy”. Led by Brian Kaplan, a medical doctor and provocative therapist, and his wife Hephzibah Kaplan – art therapist and the London Art Therapy Centre’s director – the presentation considered the different ways in which humour in the therapeutic encounter can be used to bring about therapeutic change. The theme for the art-making part of the session was the word “Abracadabra”. This choice, Brian later explained, was related to the “eureka” moment of insight in psychotherapy, causing a shift in the client’s understanding of him/herself. Nearly all of the images featured circles, and several magic wands were made; there was a sense of child-like excitement and the expectation of a magic show. In group discussion we talked about the way our clients do, at times, expect us to perform “magic” and make their difficulties disappear; at the same time, we have all experienced moments in therapy that truly can be described as inspiring, even magical. Yet in reality, this is only possible if the change originates from the client. All we can do, as therapists, is to facilitate a space that allows for such occurrences to happen.

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Image by Amanda Lebus
Image by Amanda Lebus

Brian then talked about the various uses of humour. On a societal level, it can be found in the earliest known comedies as well as contemporary political satire; its role is to put a mirror to society in order to make it see itself. As such it can often be subversive – South Park in the US and The Thick of it in the UK are recent examples, and it is not surprising that oppressive regimes, such as Burma, have banned several comedians from performing. Additionally, laughter is known to have numerous physiological health benefits which are well-documented by Dr. William Fry from Stanford University.

Creating a light-hearted, relaxed setting where insight is delivered through the use of humour can make difficult issues easier to address. So, the logic goes, if humour can hold a mirror to, and challenge, society, can it also work on an individual level? Can a client be encouraged to laugh at their “inner joke”, the absurdity of their own self-defeating behaviours and attitudes and – like the needle on a broken record – be “jolted” away from a familiar yet unhelpful path? The historical example of this is the court jester, who had the permission to joke at the monarch’s expense with the view of showing the king or queen the folly of their actions. As with the court jester, the key in Provocative Therapy is permission. The therapist must have the client’s permission to use humour; to provoke; to say outrageous things.

Provocative Therapy emerged when Frank Farrelly, who had trained with Carl Rogers, began to use his own method of applying reverse psychology and contrarianism in his work. As his clients – especially those who have not been making progress for a long time – began to improve, it became clear that this approach was highly effective in helping clients find new solutions within themselves. Hephzibah explained that when using a provocative approach as part of an art therapy intervention, she presents the idea to clients and asks if this would be something they are interested in exploring. The idea is never to laugh at the client’s expense; rather, it is always about working collaboratively and laughing at the client’s inner joke together. The work must always take place with “with a twinkle in the eye and affection in the heart”. This, together with the client’s clear understanding of the nature of the intervention, are crucial to avoid misunderstandings or distress. Additionally, the therapist must watch the client’s body language for any signs of discomfort and maintain a relaxed environment.

A few examples of Provocative Therapy…

  • Advising clients to do “more of the same”: for instance, suggesting to clients who say they haven’t been able to give up smoking to smoke more. Further, challenging the client by asking why they would even want to give up smoking in the first place and questioning whether this is a good time to try; “you’ve clearly got too much on right now. Perhaps it is best to try quitting in a few years?” This often has the effect of making the client reject the therapist’s reasoning (which is an exaggeration of the client’s internal reasoning) and finding the willpower within themselves to move forward.
  • Telling clients they are not engaging “enough” with the self-sabotaging behaviour: advising a chronic worrier that they are not worrying enough about all the different eventualities that could go wrong in a certain scenario and conjuring absurd, exaggerated versions of the scenarios clients tends to worry about. This can help the client start to get a sense of perspective about their anxieties.
  • Providing absurd solutions: for example, telling an art therapy client who says he cannot make a picture because he “comes across a wall” every time he look at a blank page to “draw a ladder” in order to climb the wall. While not diminishing the client’s “block”, this adds a sense of playfulness and lessens resistance

Brian and Hephzibah discussed several case studies from their clinical work and Brian gave us a brief demonstration. They finished the talk with contra-indications: Provocative Therapy is not appropriate for some psychotic clients and and the therapist needs to know the client and their limitations well. Precautions should also be taken with people who have extreme mood swings. Clients with BPD are not usually suitable for this intervention and other contra-indicated conditions include mood-altering physiological conditions, such as diabetes and brain tumours. As with all therapy, appropriate training and supervision is required.

Further reading: | Frank Farrelly & Jeffrey Brandsma: Provocative Therapy (Meta Publications 1973)  

Posted by Nili Sigal, art therapist &
clinical meetings coordinator

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