Thinking Outside the Box

Giving Stuck Clients a Therapy Experience Like They've Never Had Before

Cloe Madanes

We’re now so firmly in the era of standardized, manualized, empirically validated, insurance-friendly, client-soothing psychotherapy that it’s easy to forget the radical origins of our field. In late 19th-century Vienna, Freud shocked conservative, straight-laced, bourgeois society with his radical ideas (i.e., the psychic challenges adults face mostly stems from childhood sexual traumas) and treatments (i.e., all talk, all the time). Similarly, even if all the creative, new movements in the field—behaviorism, gestalt therapy, humanist psychology, cognitive-behavioral therapy, family therapy—weren’t equally revolutionary, in their day they all had at least a certain out-of-the-box quality. Today, however, it often seems that the only unbreakable rule for doing therapy is never to surprise, never to be anything other than soothing, neutral, nonconfrontational, usually nondirective, and pleasant, and never to shock anyone—not clients and certainly not the insurance companies that reimburse their treatment.

But there are times when clients are so deeply stuck, not just in the unhappy circumstances of their pain—the failing marriage, the unrelenting depression, the crippling anxiety—but in the unshakable sense that nothing they do will make any difference, that they need a little benign shaking up. Having tried and tried and tried to make things better—usually, of course, by engaging in the same, ineffective behavior, over and over again—they give therapy a go. Often, they’ve seen several therapists; perhaps they’ve been in therapy of one sort or another, talking about their “insoluble” problem for years.

In fact, most of the clients I now see are consultations referred by desperate therapists. If I’m not going to give them a version of the same old thing that hasn’t worked before, I have to do a kind of therapy that some would consider provocative, even outlandish. I must come up with a new perspective, a new kind of strategy, one that the clients don’t expect, something unlike all the therapy they’ve had before.

Most of the clients I see—even though they may be successful in certain areas of their lives—are stuck feeling that their negative emotions are uncontrollable, their relationships unchangeable, their circumstances unalterable. They’ve come to believe in the ineradicable unchangeability of their unhappiness: thus it has always been; thus it will always be. It follows that they’ve lost all sense of perspective, all capacity to see any possible humor or lightness in their problem or in their lives, emotionally and cognitively trapped in their own sad story.

The approach that I’ve found most useful is a kind of soft shock therapy in the form of a humorous paradoxical directive. By consciously and knowingly directing clients to do something preposterous and absurd, but uniquely suited to them and their dilemma, I aim to upend their expectations of therapy and life. Before you recoil in horror, know that I never ask them to do anything immoral, illegal, dangerous, or humiliating. But I do ask them to do things that’ll help them find the humor in their tragedy, and I always explain the rationale behind my directive.

Tragedy and humor are closely interconnected. Freud is noted to have said there’s no such thing as a joke, meaning that humor is the way humans deal with the saddest, most tragic circumstances of life. By using humor to help clients reconstruct their problems—almost make parodies of their own dilemmas—I help them acquire a healing distance from their woes, learn to take themselves less seriously, and gain more perspective about themselves, even more wisdom.

Playful, humorous strategies can be like therapeutic life preservers, which keep both therapist and client afloat until both can get back to shore. Often humor can help clients gain different, more useful perspectives, helping them regard their stories less as melodrama than as comedies of errors; less tragic romance, more epic adventure. People frequently become helpless when things don’t go a certain way or meet certain expectations. But humor is a natural way to accept that surprising things happen, readying people to adapt to new life conditions and learn to tolerate or even enjoy them. In this sense, humor is a trigger for change because it reboots the emotions and enables us to look at our situation with fresh eyes.

Following a technique used by stand-up comedians, therapists can set up a serious, even solemn atmosphere and then give an unexpected, humorous directive. One of the ways I use this technique in therapy is with a typical problem presented by husbands: they complain that their wives want to talk constantly about unpleasant matters, be it money, in-laws, the children, or their lack of intimacy. At dinner together, on a walk, during a visit with friends, even on vacation, the wives bring up the same issues. Of course, they want to be heard; being heard makes them feel understood and loved. But the husbands become overwhelmed by the negativity that seems to permeate every interaction and end up incapable of hearing their wives at all. The tenor of these “conversations” is all too familiar: the wife nags endlessly while the husband repeatedly tries to change the subject or sinks into sullen unresponsiveness, which just makes matters worse.

In these situations, I’ll typically explain how important it is to contain these unpleasant conversations to a specific time and place, instead of letting them invade the couple’s entire life. I ask the couple to decide on a day and time, once a week, when they’ll meet for lunch. I tell them to bring notebooks in which they’ll have listed their issues and to take turns discussing them, knowing that the issues may not be solved and that this might be one of many conversations that they’ll have in the future. It’s important that these meetings always be on the same day at the same time, and that they happen in a public place, like a restaurant, so the couple doesn’t start screaming at each other. I tell them that these issues won’t be discussed at any other time, unless it’s a dire emergency. When they’re both nodding solemnly in unison, agreeing to the weekly meeting, it’s time for the comic punch line.
tell the husband that if the wife forgets the agreement and begins to discuss one of these matters outside of the special meeting, he should begin to take off his clothes. He might first remove his tie, his watch, his shoes, his socks, and continue undressing, no matter where they are, for as long as the wife continues to talk about the issues. He should continue to undress, even if it means that he’ll end up naked in public.

Typically, the husbands laugh and say something like “I can do that.” The wives usually laugh too, and the atmosphere of the session lightens. This is an outrageous strategy, but it works to break the pattern of negative interactions and turns them into playful exchanges. Humor involves outrageous behavior, and so can therapy. Plus, I don’t think I’ve ever had a husband who had to remove more than three or four items of clothing.

A Risqué Intervention

The element of the unexpected and incongruous is important to both humor and therapy. But to make a good joke or a good paradoxical intervention, something about the payoff has to be appropriate and jarring at the same time. Take this joke, for example: a man is sitting at a drive-in movie theater and notices in the truck in front of him a dog that’s crying. The man thinks this is amazing because the dog is crying at an extremely sad movie. After the movie is over, the man goes to the owner of the dog and says, “I can’t believe how intelligent your dog is. It’s amazing that he’s crying at this really sad movie.” The owner of the dog says, “I know, I don’t understand it because he hated the book.”

The good directive, like an effective punch line, is perfectly fitted to the circumstances: it’s not just illogical nonsense, but invites a perspective on what’s happening that’s subtly, yet clearly, a bit skewed. It’s like placing clients in front of funhouse mirrors: they see themselves and their behavior in both familiar and strange and distorted ways. The experience gives them an instructive perspective on themselves and what they’re doing.

The Therapist as Miss Marple

As I see it, a good therapist is primarily a kind of detective, a Miss Marple (Agatha Christie’s elderly lady sleuth) with a degree in social work or psychology. Our mission is to burrow in and find out who our clients really are and the sources of their problems—even when they themselves aren’t entirely sure or aware of what drives them (which is often the case). This kind of work requires, more than many forms of therapy, an ability to pick up on the sometimes hidden-in-plain-sight idiosyncratically funny details of their situation.

There’s no way to do this ethically and effectively without first forging a strong therapeutic relationship built on mutual respect, trust, and appreciation—a relationship in which clients feel deeply seen, heard, and understood. None of my clients would even consider my “silly” directives, much less try to follow them to the letter, if they didn’t feel I cared about them and had some insight into what troubled them. Without that level of mutual regard, this kind of work would be a travesty, and I’d have no clients. They do what I ask on trust—trust that I know and care about them enough not to harm them, even inadvertently.

Built on thoughtfulness, deep attention, and obvious regard for the clients, these kinds of directives work because they wake people up from their misery-trance. You can see the new spark in their eyes, almost hear their brains start to buzz with more liveliness. Garrison Keillor, host of A Prairie Home Companion, once said that “God writes a lot of comedy. The trouble is, he’s stuck with so many bad actors who don’t know how to play funny.” In a sense, these paradoxical directives are a bit like acting class: the clients may start out as melodramatic tragedians, but during this process they learn how to do pretty good stand-up comedy!

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This blog is excerpted from "Soft Shock Therapy" by Cloe Madanes. The full version is available in the March/April 2014 issue, Playing the DSM Game: Do We Have a Choice?

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Photo © Caspar Benson/Getty

Topic: Professional Development

Tags: behavioral therapy | Cloe Mandanes | depression | humor in therapy | soft shock therapy

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4 Comments

Tuesday, May 6, 2014 12:44:53 PM | posted by courtneya
Nice article by Cloe. I wholeheartedly agree with her and find integrating humor and the unexpected decreases anxiety, lifts the client's mood, and often triggers creative solutions to problems. Having expertise in treating trauma, I find people who've been through trauma often have a wonderful sense of humor. It's a way they learned to cope and they seem to really enjoy my inviting humor into therapy. Thanks, Rich for stimulating discussion on how we can free ourselves up to be more engaging and create experiences in sessions that cause emotional shifts!

Friday, May 9, 2014 4:48:04 PM | posted by Barbara Rosenkrantz
Thirty years ago (it seems like yesterday), a terrible tragedy befell my family and myself, when my son was involved as a teenager in a fight with a bully, and finally killed him. The repercussions were overwhelming and difficult for us all. When I received phone calls from my friends, we would often end up laughing until we cried. You must be able to see the irony and absurdity of life as a whole, with a large dollop of humor, to live through hard times. Plenty of therapy and a strong sense of knowing that "This too will pass", pulled me through by the seat of my pants. Wish I could have done stand up comedy to share my crazy life. Humor works, but you must be careful not to use it as a weapon for humiliation and shame.

Thursday, May 26, 2016 2:48:53 AM | posted by Karen J
As client, I'm delighted when M says something like this. Humor, even grave-yard humor, makes me smile when I'm in the midst of a depressive episode, and gives me a fighting chance of looking at the situation from a different angle. Thanks for bringing this idea out closer to the mainstream.

Sunday, May 20, 2018 8:01:49 AM | posted by M Farrell
I think therapist need to be very very cautious about trying to introduce humor. There are studies that show therapists think they are funnier than clients do and the clients often find therapist's humor inappropriate and damaging.