Leveraging Duality: Using Humor with Borderline Clients
See Dr. Shapiro's professional biography .
91精品 faculty member Dr. Lauren Shapiro is conducting research on the use of humor as an intervention with clients diagnosed with Borderline Personality Disorder (BPD).
鈥淔rom what I鈥檝e learned about borderline clients, something they struggle with is integrating multiple seemingly contradictory thoughts or feelings,鈥� Shapiro explained. 鈥淔or example, they often engage in splitting鈥攖hey鈥檒l undervalue someone, and then switch to overvaluing them.鈥�
Since the essence of humor is the presence of two contradictory meanings simultaneously, Shapiro wondered if humor could be an effective tool with borderline clients. Anecdotally, she had heard from therapists about using humor in sessions, but she couldn鈥檛 find very much if anything written about it in the literature.
Inspired by this gap, Shapiro has embarked on a project interviewing 30 therapists who have worked with borderline clients for five years or more. In her interviews, she asks whether they use humor with borderline clients, and if so, when. She inquires about the nature of the humor and how patients have responded to it. She asks for anecdotes about times when humor has not landed well with patients and why鈥攁s well as advice for other clinicians about how to use humor effectively with borderline clients.
While the project is still underway, Shapiro presented her preliminary findings at the 91精品 in October to share her results thus far and get feedback from the community.
鈥淚 went in with some hypotheses about the clinical purpose鈥攕uch as humor as a way to foster cognitive appraisal, or help patients shift perspectives,鈥� she said. 鈥淚 also thought humor might be used as a way to strengthen the therapeutic relationship and that it might be a way to help clients tolerate distress.鈥�
Shapiro said all of these hypotheses have been confirmed, but that additional themes have emerged as well.
鈥淢any mentioned using humor as a diagnostic tool, for example assessing for symptoms of depression or for signs of Autism Spectrum Disorders,鈥� Shapiro said. 鈥淪ome said that they assign patients homework of finding jokes as a way to help build social awareness and understanding.鈥�
When deciding whether a particular patient is a good candidate for humor in session, Shapiro鈥檚 participants often said they use trial and error to gauge a patient鈥檚 openness to it.
鈥淥ne therapist used the great metaphor of administering humor like droplets of hot sauce鈥攇radually ramping it up to see how much they can take,鈥� Shapiro noted. 鈥淢any mentioned taking the client鈥檚 lead鈥攕aying that borderline clients are often very funny.鈥�
When using humor in sessions, Shapiro鈥檚 participating therapists emphasized that clinicians must be self-aware about their intentions.
鈥淭hey cautioned against using humor as a form of avoidance鈥攐n the part of either the client or clinician鈥攁s a way to escape and refrain from processing painful emotions,鈥� she said. 鈥淲hen using humor, they all said that it must come from a place of compassion rather from your own sense of frustration or as a means to collude with a client鈥檚 desire to avoid affect.鈥�
When in doubt, though, Shapiro鈥檚 participants stressed using humor only when it鈥檚 genuine.
鈥淚f you don鈥檛 feel like you鈥檙e a very funny person and you don鈥檛 feel comfortable using humor outside of sessions maybe it鈥檚 not the best idea with clients,鈥� she said. 鈥淚f it comes across as forced, clients are going to see through that.鈥�
Going forward, Shapiro intends to finish conducting and analyzing her interviews for this project and then move on to a second stage in the research in which she interviews clients about their experience with therapists using humor in sessions.
While the research is not yet complete, Shapiro believes the preliminary results are promising. Many therapists encouraged rising clinicians to take more risks using humor, because we are often afraid to be funny and genuine with borderline clients.
鈥淥ne of my favorite quotes was to use humor with an apology in your back pocket鈥攖hat making a mistake can set an example of how to repair a therapeutic breach in the moment,鈥� Shapiro said. 鈥淢any said this process can be profoundly healing.鈥�
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