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Laughter Breaks Ice During Psychotherapy

By Steven Reinberg
HealthDay Reporter

THURSDAY, Oct. 14 (HealthDayNews) -- Therapists and their patients can develop a stronger relationship by sharing a laugh, a new study suggests.

Many therapists try not to show emotion, since it could influence patients and may be seen as judgmental, but this study found that showing emotion may have a positive effect, especially if it's done mutually.

In their study, the researchers found that laughter is used to communicate an emotion, "much like an exclamation point at the end of a sentence," said lead researcher Dr. Carl Marci, the director of social neuroscience at Massachusetts General Hospital.

Moreover, patients and therapists laughing together increases the intensity of the emotion and may help build feelings of rapport between them, Marci said.

"Contrary to the historic record, laughter in psychotherapy is not about ridicule or humor, but really about communication," Marci said. "Specifically, it's about emphasis over and above the content."

Marci's team has been studying many aspects of psychophysiology and empathy. In the current study, the group videotaped therapy sessions and took physiologic measurements of both therapists and patients, according to their report in the October issue of the Journal of Nervous and Mental Diseases.

The patients were being treated for common mood and anxiety disorders. The therapists used what is called psychodynamic therapy, which uses the relationship between patient and therapist to help patients develop insight into their emotions.

The physiologic responses of patients and therapists were measured using skin conductance recordings. This method is commonly used to measure the activity of the sympathetic nervous system, which controls physiologic arousal and rates of blood pressure and the heart.

In 10 recorded sessions, the research team identified 145 episodes of laughter. They found that patients laughed more than twice as often as therapists. And patients were more likely to laugh at their own comments. In addition, therapists were more likely to laugh in response to what patients said.

Skin conductance measurements found that laughter caused a physiologic arousal in both patients and therapists. The arousal was most pronounced when both laughed together. "This is physiological evidence for a shared experience that the patient and therapist are having," said study co-author Scott Orr, of Massachusetts General Hospital and the Veteran's Affairs Medical Center in Manchester, N.H.

The actual meaning of laughter needs to be placed in the context of what was being said before and after it occurred, Marci explained. "It could be anything from happiness to anxiety and nervousness," he said.

When patients and therapists laughed together, the response was greatly magnified, Marci said. "But even when the therapist didn't laugh with patients, they also had a physiologic reaction, suggesting a type of connection between the patient and therapist."

According to Marci, "This combination of psychology and biology can help us understand how we interrelate."

Jacques P. Barber, a professor at the Center for Psychotherapy Research at the University of Pennsylvania School of Medicine, said he wasn't sure whether the study has a practical application. It "does not provide us much news, and certainly not many clinical implications," he said.

Barber added that one expects therapists to use humor rarely. "Patients, however, laugh more often. The question is why they laugh during a specific event. Is it nervous, out of embarrassment, or is it a genuine laugh? It's hard to distinguish sometimes."

Barber said he wanted to know something about the relation between the different kinds of laughs studied and the quality of the patient-therapist relationships, or the relation between the laughs and therapy outcome. "We know that the quality of the patient-therapist relationship is one of the best predictors of outcome in psychotherapy," he said.

More information

The National Mental Health Information Center can tell you more about psychotherapy.

(SOURCES: Carl Marci, M.D., director, social neuroscience, Massachusetts General Hospital, Boston; Scott Orr, Ph.D., Massachusetts General Hospital and the Veteran's Affairs Medical Center, Manchester, N.H; Jacques P. Barber, Ph.D., professor, Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia; October 2004 Journal of Nervous and Mental Diseases)

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