Humour therapy

1. Introduction

Version followed: the structured humour-skills group training based on Paul McGhee's 7 Humor Habits Program (7HHP), in the German clinical adaptation by Falkenberg, McGhee and Wild (Humorfähigkeiten trainieren, Schattauer), as delivered and published by Tagalidou et al. (2018: seven 90-minute group sessions); plus the self-administered humour-based positive psychology exercises tested by Proyer, Ruch and Wellenzohn; plus published guidance on therapist-initiated humour within ordinary psychotherapy. The manual's own exercise texts are not publicly available; session contents come from the published pilot and randomised trial [source: Tagalidou et al. 2018; Tagalidou et al. 2019] and the publisher's extract [uncertain on manual-level detail].

"Humour therapy" is not a single school. It is an umbrella for (a) structured training of humour as a skill and resource, delivered as a group programme or self-help exercises, and (b) the deliberate, attuned use of humour by a therapist inside any psychotherapy. The core idea of change: sense of humour is trainable; practice redirects attention towards humour opportunities in everyday life, builds a playful, less over-serious stance, and lets people take distance from aversive states and use humour to cope with stress [source: Wild 2016 extract; Ruch et al. 2018; Broda 2022]. Falkenberg, McGhee and Wild present it as a transdiagnostic, salutogenic element that can be added to different treatments, not tied to one therapy school [source: Broda 2022].

Evidence status, briefly and as reported: a randomised trial (N=110) found sense of humour can be trained with the 8-week 7HHP, with peer-noticed change and higher life satisfaction [source: Ruch et al. 2018]; the Salzburg clinical pilot was uncontrolled and its authors call results promising but not conclusive [source: Tagalidou et al. 2018]; a small randomised trial of the manualised training in people with depression, anxiety or adjustment disorder found humour gains that did not differ significantly from wait-list [source: Tagalidou et al. 2019]; three of five online humour exercises outperformed placebo on happiness or depressive symptoms up to six months, with mixed replication for depression [source: Wellenzohn et al. 2018]. Humour work is an adjunct to wellbeing and coping; it is not a treatment for physical or mental disease, and claims about brain or immune effects should be presented to clients only as researchers' hypotheses [synthesis].

Related entries: for unconditional, exercise-based laughter (breathing, simulated laughter) see 184 Laughter yoga; for clown work in hospitals and care settings see 124 Medical clowning. This guide does not repeat them.

Professional frame. There is no regulated profession of "humour therapist" in the UK, US or German-speaking countries [synthesis; no registration body found]. The Association for Applied and Therapeutic Humor (AATH) runs a Humor Academy and a Certified Humor Professional programme (founded 2009) [source: Morrison et al. 2024]; this is a voluntary credential, not a licence to practise psychotherapy. Use these methods within your existing licence (psychologist, psychotherapist, counsellor, arts therapist under HCPC or equivalent) and your usual supervision. In the Salzburg pilot, groups were co-led by two clinical psychologists in training or near-graduate master's students with clinical experience, introduced to the programme [source: Tagalidou et al. 2018]. Clinicians who want the full session materials should obtain the Falkenberg, McGhee and Wild manual, which includes slides, materials and exercise descriptions [source: Broda 2022].

2. Framework

Phase 0: Screening and orientation (1 individual contact) [source for criteria: Tagalidou et al. 2018; rest synthesis]

Goals: decide suitability; screen for fear of being laughed at (gelotophobia); set expectations that this is practice, not performance.
The Salzburg pilot excluded current mental disorders (except recurrent depression in remission), poor language skills and cognitive deficits such as dementia, assessed by structured diagnostic interview [source: Tagalidou et al. 2018]. The follow-up clinical trial, which used the Falkenberg, McGhee and Wild manual, included adults with mild or moderate (recurrent) depressive, anxiety or adjustment disorder, good language skills and no cognitive deficits; it excluded severe recurrent depression, PTSD, personality disorders, bipolar disorder, schizophrenia, current substance misuse and any past delusional, manic or psychotic episode [source: Tagalidou et al. 2019]. Falkenberg, McGhee and Wild's manual is written mainly for inpatient psychiatric groups, with outpatient use also suitable [source: Broda 2022]; the manual's own inclusion and exclusion criteria are [uncertain].
Move on when: the client understands the format, consents, has no acute crisis, and either is not gelotophobic or has a plan agreed for gentler participation [synthesis].

Phase 1: Skills-building programme (7–8 weekly group sessions)

Format followed: 7 sessions of 90 minutes over 7 weeks, two co-leaders, mixing psychoeducation, role play, games and discussion, plus homework applying content in daily life [source: Tagalidou et al. 2018]. In the clinical trial, groups had eight to ten members and two trainers, and the manual was used with minor changes such as more up-to-date media [source: Tagalidou et al. 2019]. Ruch et al. ran an 8-week group version, with and without "Home Play" exercises [source: Ruch et al. 2018].
Order of sessions (each builds on the last): introduction and own sense of humour; seriousness versus playfulness; laughter; verbal humour; everyday humour; laughing at oneself; humour under stress [source: Tagalidou et al. 2018]. This progression runs from low-exposure, playful material to the harder skills (self-directed humour, humour under stress).
Move between sessions on schedule; inside the group, move a member to the next level of exposure only once they participate voluntarily in the current one [synthesis].

Phase 2: Consolidation and maintenance (follow-up at 1–2 months)

Published trials followed up at one month [source: Tagalidou et al. 2018] and two months [source: Ruch et al. 2018]; Ruch et al. note that strategies for consolidating gains need more work.
Goals: keep a daily humour habit (for example a funny-things diary), identify which habit helps most under stress, and fold the skill into ongoing therapy goals [synthesis].

Alternative format: individual self-administered exercises (1 week each)

Each humour-based positive psychology exercise was run as a one-week, self-administered, online programme [source: Wellenzohn et al. 2018]. In therapy, set one as between-session homework and review it next session [synthesis].

Alternative format: humour within ongoing psychotherapy

No phases; humour is used when attunement allows, monitored for the client's response [source: Humor in professional coaching review 2024, summarising Valentine and Gabbard 2014; Brooks et al. 2023].

3. Guiding principles

Humour cannot be forced or imposed. Offer, never require; interactions must fit the situation [source: Wild 2016 extract].
Give permission to play. The training explicitly allows participants to be playful, witty and partly childlike; model it first yourself [source: Wild 2016 extract].
Humour is learnable and needs practice. Frame homework as practice with no talent required [source: Wild 2016 extract; Ruch et al. 2018].
Train attention, not jokes. The main lever is noticing humour opportunities in everyday life; homework targets noticing [source: Wild 2016 extract].
Laugh with, never at. "Belittling, laughing at, or mimicking the client" erodes trust [source: Sultanoff 2013, quoted in the 2024 coaching review]. The client, their body, identity, culture, illness or loss are never the target.
Use safe targets. Safe: shared situations, absurdity in circumstances, the therapist's own harmless foibles; unsafe: the client, third parties' identities, trauma content. The distinction between safe and unsafe targets is taught by Sultanoff; the example lists are the writer's [source: Sultanoff course description; synthesis].
Warmth and compassion in style. Prefer affiliative and self-enhancing humour; avoid aggressive and self-defeating styles in your own humour and do not reinforce them in the client's [source: 2024 coaching review citing Franzini 2001, Ortiz 2000, Valentine and Gabbard 2014, Schneider et al. 2018].
Watch the response, every time. Pay attention to how the client takes each humorous moment and adjust at once [source: 2024 coaching review citing Brooks et al. 2023].
Humour can signal avoidance. A client's joking can deflect from painful material; note it rather than join it automatically [source: 2024 coaching review citing Panichelli et al. 2018].
Spontaneous beats scripted in therapy. In-session humour should arise from empathic attunement, as distinct from planned interventions [source: 2024 coaching review citing Valentine and Gabbard 2014].
Culture and gender shape humour. Initiation and acceptability of humour, including aggressive and self-deprecating forms, differ across cultures and genders; ask, do not assume [source: 2024 coaching review citing Kneisel et al. 2022, Schneider et al. 2018].
Timing with grief, trauma and crisis. Do not introduce humour in acute crisis, fresh bereavement or trauma disclosure; follow the client's own humour later, if it appears [synthesis].
Screen for fear of being laughed at. Laughter-heavy formats can stress gelotophobic people, who may read others' laughter as hostile [source: Tagalidou et al. 2018; Wellenzohn et al. 2018].
Adjunct, not cure. Present humour as a coping and wellbeing resource alongside indicated treatment, never as treating disease [synthesis].
Work on your own humour. Developing the therapist's own sense of humour is part of training [source: Sultanoff course description].

4. Intervention inventory

Part A covers the seven-session group programme. The session topics (introduction; playfulness versus seriousness; laughter; verbal humour; humour in everyday life; personal weaknesses; humour and stress) and the session-3 activities are from the published deliveries [source: Tagalidou et al. 2018; Tagalidou et al. 2019]. The step-by-step running of the other sessions is the writer's reconstruction around those topics; the manual's session scripts are not publicly available [synthesis]. Use the manual's own exercises where you have it.

Physical and materials safety for all group sessions [synthesis]: clear floor space for games; seated alternatives for every movement game; no food-based games without allergy checks; no shared props that touch the face (masks, noses) without cleaning; for vigorous laughter exercises, apply the screening in 184 Laughter yoga.

A1. Session structure (every session)

Purpose: a predictable frame that makes play safe; mood check before and after shows the group is shifting.
Steps: (1) opening game; (2) brief review of homework; (3) short psychoeducation on the session theme; (4) experiential exercises, role plays or partner tasks; (5) discussion of what was noticed; (6) homework set; (7) closing game. Ruch et al. measured cheerfulness, seriousness and bad mood before and after each session [source: Tagalidou et al. 2018 for the components; Ruch et al. 2018 for mood measurement; ordering is synthesis].
Example language (illustrative): "Nobody has to be funny here. The task is to notice, try, and see what happens."
Watch for: members who never join games (see section 5); mood ratings that drop after a session. Working: cheerfulness rises and seriousness falls across sessions, as Ruch et al. reported [source: Ruch et al. 2018].

A2. Session 1: Introduction and one's own sense of humour

Purpose: build safety; define humour broadly; let each member locate their own humour.
Steps: (1) meet and greet with a low-stakes name game [synthesis]; (2) collect the group's definitions of humour [source: Tagalidou et al. 2018]; (3) each member describes what makes them laugh, who in their life is funny, and when their humour went missing (a humour biography) [synthesis]; (4) agree group rules: laugh with, not at; anyone may pass; confidentiality [synthesis]; (5) homework: notice one moment a day when you smiled.
Example language (illustrative): "Think of the last time you laughed until it hurt. Who were you with?"
Watch for: shame when someone says "I have no sense of humour"; normalise that it can be dormant. Working: members tell humour stories voluntarily.

A3. Session 2: Seriousness versus playfulness

Purpose: show how chronic seriousness affects daily life, and restore play as a legitimate adult activity.
Steps: (1) discussion of the effects of seriousness on everyday life [source: Tagalidou et al. 2018]; (2) brief psychoeducation on the function of play and playful behaviour [source: Tagalidou et al. 2018]; (3) a structured, rule-based group game that requires no wit [synthesis]; (4) members name one area where they are over-serious and one small playful act to try [synthesis]; (5) homework: one deliberate playful act daily.
Example language (illustrative): "Being playful is not the same as not taking your problems seriously."
Watch for: members who feel play is childish or disrespectful of their suffering; validate and make it optional. Working: members report trying small playful acts.

A4. Session 3: Laughter

Purpose: psychoeducation on laughter and practice of laughing more readily.
Steps (activities as published) [source: Tagalidou et al. 2018]: (1) opening game; (2) psychoeducation on physical and mental effects of laughter, presented as researchers' findings, and the difference between genuine (Duchenne) and posed (non-Duchenne) smiles and laughter; (3) quiz: tell real from posed smiles in pictures; (4) imagination exercise (for example, recalling or picturing a funny scene); (5) partner task: try to make your partner laugh, using faces or jokes; (6) closing game. Homework: laugh more often and more heartily in daily life [synthesis].
Example language (illustrative): "In pairs, one of you tries to get a laugh using only faces. Swap after a minute. Stop whenever you like."
Watch for: gelotophobic members, who may experience partner laughter as ridicule; offer the observer role. For prolonged or forced laughter exercises and their physical cautions, see 184 Laughter yoga. Working: genuine laughter in pairs; members describe the difference between posed and real laughter.

A5. Session 4: Verbal humour

Purpose: build the cognitive skills behind verbal humour: noticing ambiguity, exaggeration, wordplay.
Steps: (1) members tell a joke if they wish [source: Tagalidou et al. 2018 for joke-telling]; (2) psychoeducation on ambiguity and exaggeration as humour mechanisms [source: Tagalidou et al. 2018]; (3) practice: find double meanings in everyday phrases or headlines; exaggerate a small annoyance to absurd size [synthesis]; (4) homework: collect one joke or pun a day, and create one.
Example language (illustrative): "Take something small that annoyed you this week and blow it up to ridiculous size."
Watch for: jokes that target groups, sex, disability or members; stop them kindly by restating the group rule. Working: members create, not only repeat, verbal humour.

A6. Session 5: Everyday humour

Purpose: change perspective and look deliberately for humour in daily situations.
Steps: (1) psychoeducation on perspective change [source: Tagalidou et al. 2018]; (2) each member brings a mildly frustrating everyday situation; (3) the group views it from other angles: an outside observer, a cartoonist, a child [synthesis]; (4) the owner of the situation picks which reframe, if any, feels true [synthesis]; (5) homework: three funny things diary (see B1).
Example language (illustrative): "If this happened in a sitcom, what would the audience find funny?"
Watch for: the group making fun of the person rather than the situation; the owner always has the last word. Working: members spontaneously report humour found in daily life.

A7. Session 6: Laughing at oneself

Purpose: take a lighter, accepting view of one's own weaknesses, and know when self-directed humour helps or harms.
Steps: (1) discuss pros and cons of self-directed humour [source: Tagalidou et al. 2018]; (2) distinguish gentle self-acceptance from self-put-downs (self-defeating humour) [source: 2024 coaching review citing Schneider et al. 2018; framing synthesis]; (3) members choose a minor, non-core foible and describe it with affectionate exaggeration [synthesis]; (4) homework: notice one small mistake a day and respond to it with mild amusement, not criticism.
Example language (illustrative): "Pick something small, like your sense of direction, not something that hurts."
Watch for: members with low self-esteem or depression who turn this into self-attack; redirect to kind exaggeration. Never invite humour about trauma, body, identity or illness here. Working: members can name a flaw with a smile and without shame.

A8. Session 7: Humour under stress

Purpose: use the skills built so far to cope with stress; close the group.
Steps: (1) psychoeducation: what stress is and how humour can affect it [source: Tagalidou et al. 2018]; (2) members choose a current moderate stressor (not trauma) and try the earlier skills on it: perspective change, exaggeration, a playful act [synthesis]; (3) each writes a personal plan for which habit to use under stress [synthesis]; (4) feedback on the programme [source: Tagalidou et al. 2018]; (5) closing ritual.
Example language (illustrative): "Which of the habits could you reach for when the day goes wrong?"
Watch for: pressure to find humour in serious, ongoing adversity; humour under stress is an option, not a duty. Working: members name concrete strategies; follow-up shows humour used on hard days, which McGhee stresses as the point of practice [source: McGhee 2001 column].

A9. Home Play (between-session practice)

Purpose: transfer skills into daily life. Ruch et al. tested the programme with and without "Home Play" exercises; McGhee links each step to Homeplay activities [source: Ruch et al. 2018; McGhee 2001 column].
Steps: set one small, specific task at the end of each session tied to its theme; review at the next session's start; praise attempts, not wit [synthesis for the procedure].
Example language (illustrative): "This week, just count how often you smile. Nothing else."
Watch for: low adherence due to lack of time, which participants reported [source: Tagalidou et al. 2018]; shrink tasks. Working: tasks are done and members report noticing more humour.

Part B covers the self-administered humour exercises. Each was a one-week, self-administered programme; the procedures below are from Wellenzohn et al. (2018) and, for B1, the Greater Good in Action page. The in-therapy setting and review steps are [synthesis].

B1. Three funny things

Purpose: increase happiness and noticing of humour; useful as homework from mid-therapy, or as maintenance after the group [source: Wellenzohn et al. 2018; GGIA].
Steps: (1) each evening for a week, write down the three funniest things of the day: heard, seen, done or experienced; (2) note how each felt; (3) write why it happened; (4) keep a written or typed record, because remembering is not enough; give each a short title, include small moments, add detail on who, where and what was said [source: GGIA; Wellenzohn et al. 2018]. About 10 minutes daily [source: GGIA]. (5) Review the diary in session [synthesis].
Example language (illustrative): "Before bed, jot down three things that made you smile today, even tiny ones, and why they happened."
Watch for: finding three things can be hard in a low week [source: GGIA user report]; in depression, allow "one funny thing" and reduce shame about empty days [synthesis]. More extraverted people benefited more in one study [source: Wellenzohn et al. 2018]. Working: entries come more easily over the week.

B2. Collecting funny things

Purpose: re-experience amusement by recalling the funniest things ever experienced; adapted from the gratitude visit [source: Wellenzohn et al. 2018].
Steps: (1) recall the funniest experiences of your life; (2) write each in as much detail as possible; (3) continue over one week [source: Wellenzohn et al. 2018]; (4) bring one to session to retell [synthesis].
Example language (illustrative): "Write down the funniest thing that ever happened to you, in as much detail as you can."
Watch for: memories that lead into grief (for example, funny moments with someone who has died); allow sadness and do not push for laughter [synthesis]. This exercise did not show placebo-superior effects in that trial [source: Wellenzohn et al. 2018]. Working: vivid, enjoyable retelling.

B3. Counting funny things

Purpose: build attention to humour with minimal effort; adapted from counting kindnesses [source: Wellenzohn et al. 2018].
Steps: (1) through each day, count every funny thing that happens; (2) note the daily total; (3) one week [source: Wellenzohn et al. 2018].
Example language (illustrative): "No writing, just keep a tally of every funny moment, and note the number at night."
Watch for: low counts read as failure; treat the number as data, not a grade [synthesis]. Reported to enhance happiness against placebo [source: Wellenzohn et al. 2018]. Working: counts rise across days.

B4. Applying humour in a new way

Purpose: actively bring humour into the day; adapted from using signature strengths in new ways [source: Wellenzohn et al. 2018].
Steps: (1) notice humorous experiences during the day; (2) add humorous activities to the day; (3) one week [source: Wellenzohn et al. 2018]; (4) plan the activities in session in advance (for example, watching a favourite comedy with a friend, telling a joke at dinner) [synthesis].
Example language (illustrative): "Pick one new way each day to bring something funny into your routine."
Watch for: activities that rely on mocking others; steer to affiliative humour [synthesis]. Reported to enhance happiness and reduce depressive symptoms against placebo [source: Wellenzohn et al. 2018]. Working: client names new humorous activities done.

B5. Solving a stressful situation in a humorous way

Purpose: practise humour as coping by revisiting a stressor; adapted from "one door closes, another door opens" [source: Wellenzohn et al. 2018].
Steps: (1) think of a stressful experience; (2) consider how it could have been solved in a humorous way; (3) one week [source: Wellenzohn et al. 2018]; (4) in therapy, choose a moderate everyday stressor, not trauma, loss or abuse [synthesis].
Example language (illustrative): "Take a recent hassle, like the late train. How might a lighter response have changed it?"
Watch for: the client feeling their distress is being minimised; validate the stress first [synthesis]. Reported to reduce depressive symptoms against placebo [source: Wellenzohn et al. 2018]. Working: new humorous options generated without self-blame.

Part C covers humour inside ordinary psychotherapy, drawn from the literature summarised in a 2024 review; the original papers are cited at second hand [uncertain on detail]. Steps are [synthesis] unless tagged.

C1. Screening and assessment before humour work

Purpose: identify people for whom humour may harm (gelotophobia, paranoid ideation, acute crisis) and learn the client's humour style.
Steps: (1) ask what makes the client laugh, and how humour was used at home and school (mocking, teasing, bonding) [synthesis]; (2) ask directly about fear of being laughed at; if you want a standard measure, Ruch and Proyer's GELOPH<15> is a 15-statement self-report questionnaire with cut-offs for slight, pronounced and extreme gelotophobia [source: Ruch & Proyer 2008]; its items and cut-off values are not reproduced here; (3) consider humour-style measures (affiliative, self-enhancing, aggressive, self-defeating) and cheerfulness measures if you use outcome measures; the instruments' items are not reproduced [uncertain]; (4) note cultural and religious norms about joking in therapy [source: 2024 review citing Kneisel et al. 2022; procedure synthesis].
Example language (illustrative): "Some people find laughter in a group uncomfortable, even threatening. Is that true for you?"
Watch for: a history of bullying or ridicule; proceed slowly or not at all. A client's own jokes can also inform assessment [source: 2024 review citing Gelkopf 2011]; never treat humour style as diagnostic on its own [synthesis].

C2. Spontaneous, attuned therapist humour

Purpose: deepen the working alliance and convey warmth [source: 2024 review citing Vendl et al. 2024; Gelkopf 2011].
Steps: (1) use humour only once rapport exists [synthesis]; (2) let it arise from what is happening between you, not from prepared jokes [source: 2024 review citing Valentine and Gabbard 2014]; (3) keep it warm and compassionate [source: 2024 review citing Franzini 2001]; (4) check the response straight away [source: 2024 review citing Brooks et al. 2023].
Example language (illustrative): after a client lists twelve tasks for one morning, "And before lunch, presumably, world peace?" delivered warmly, then back to seriousness.
Watch for: a flat or hurt response means repair (C6). Working: shared laughter followed by easier disclosure.

C3. Humorous reframing and perspective change

Purpose: shift towards a less heavy view of a problem, a "cognitive re-shift" [source: 2024 review citing Goldin et al. 2006; Scott et al. 2015].
Steps: (1) validate the problem fully first; (2) offer a lighter angle tentatively, as a question; (3) let the client accept, change or reject it; (4) return to the serious work [synthesis].
Example language (illustrative): "I wonder what your inner critic would look like if it had to wear a silly hat?"
Watch for: the client hearing "you're overreacting". Working: the client builds on the reframe in their own words.

C4. Exaggeration, metaphor and jokes (including provocative techniques)

Purpose: loosen rigid beliefs by exaggerating them to absurdity, or by using metaphors and jokes [source: 2024 review citing Panichelli et al. 2018]. Provocative therapy (Farrelly and Brandsma 1981) combines humour with paradoxical intention and exaggeration [source: 2024 review].
Steps: (1) use only with a strong alliance and a client who enjoys humour; (2) exaggerate the belief, never the person; (3) signal warmth throughout; (4) drop it at the first sign of hurt [synthesis]. Provocative styles and "provocative nicknames" carry high ridicule risk: do not use them without specific training and supervision in that method [synthesis].
Example language (illustrative): "So if you make one mistake at work, the whole company collapses, the stock market crashes, and they name a recession after you?"
Watch for: shame, compliance without laughter, withdrawal. Not for clients with paranoia, gelotophobia, severe depression, recent trauma or a history of being mocked [synthesis]. Working: the client laughs and spontaneously qualifies the belief.

C5. Working with the client's own humour

Purpose: use client-initiated humour as a sign of change, and spot humour used to avoid feelings [source: 2024 review citing Gelkopf 2011; Panichelli et al. 2018].
Steps: (1) notice when and about what the client jokes; (2) if it brings connection or new distance from a problem, enjoy it and reflect it; (3) if it deflects from pain, name it gently and invite the feeling underneath; (4) track change in humour use over therapy; Panichelli et al. reported that humour was less frequent in patients with more severe problems [synthesis for steps; source: 2024 review].
Example language (illustrative): "That was funny, and I noticed we laughed just as we got near something painful. Can we stay there a moment?"
Watch for: self-defeating jokes as a habitual style [source: 2024 review citing Schneider et al. 2018]. Working: the client can both joke and stay with feeling.

C6. Repair when humour misfires

Purpose: responding when a humour intervention does not work as intended is a taught competence [source: Sultanoff course description].
Steps: (1) notice the signs: silence, a forced smile, a change of subject; (2) name it and take responsibility; (3) invite the client's experience; (4) do not explain or defend the joke; (5) return to the client's agenda and note the boundary for the future [synthesis].
Example language (illustrative): "I think my joke landed badly. I'm sorry. What was that like for you?"
Watch for: a client who says "it's fine" but disengages; revisit next session. Working: the client says how they felt, and the alliance holds.

C7. Developing the therapist's own sense of humour

Purpose: building your own humour is part of training for this work [source: Sultanoff course description]; the programme's exercises can be done by the therapist [synthesis].
Steps: do B1 for a week yourself; review recordings of sessions for humour targets and styles in supervision [synthesis].
Example language (illustrative) [synthesis]: "In supervision I'd like to look at a moment where my joke landed badly, and what it was doing for me."
Watch for: humour that serves the therapist's need to be liked, or relieves the therapist's discomfort with the client's pain [synthesis].

C8. Children and young people

Purpose: age-appropriate humour work [synthesis; no published child protocol cited].
Steps: get parental consent and the child's assent; use developmentally suited humour (slapstick and silliness for young children, wordplay for older ones); never tease about appearance, family or abilities; watch for peer ridicule in groups and stop it at once; follow local safeguarding and mandatory-reporting duties if a child's jokes or play hint at harm, without treating play as evidence [synthesis].
Example language (illustrative) [synthesis]: "In this group we laugh together, not at anyone. If something someone says hurts, you can tell me, and we stop."
Watch for: teasing turning into bullying; children who laugh along to fit in.

5. Handling problems

The sources cited report few problems. Items tagged [source] come from them; everything else is the writer's synthesis.

Gelotophobia: fear of being laughed at [source: Tagalidou et al. 2018; Wellenzohn et al. 2018]. Laughter-heavy group formats can stress these clients, and they may read others' laughter as hostile. Response [synthesis]: screen beforehand (C1); offer individual exercises (B1–B5) instead of the group; in a group, give an observer role, pair them with a trusted partner, avoid laughter-at-a-person exercises, and check in after sessions.
Shame and ridicule. Self-directed humour can become self-attack, and group humour can single someone out [synthesis]. Response: restate the "with, not at" rule; stop jokes that target a member, identity, body or illness; repair privately with anyone hurt (C6); in session 6 keep to minor, chosen foibles.
Humour as avoidance. Clients may joke to deflect [source: 2024 review citing Panichelli et al. 2018]. Response: name it gently (C5), and do not let a humour programme replace the trauma or grief work that is needed [synthesis].
"This trivialises my suffering" (resistance). Response [synthesis]: agree that the problem is serious; explain that humour is an extra coping resource, not a claim that things are fine; make every exercise optional; begin with noticing exercises (B3) rather than performing.
Stuck: "I can't find anything funny", common in depression [synthesis; GGIA user report notes difficulty in low weeks]. Response: shrink the task to one small moment; widen to "anything that made you smile, even slightly"; use recalled humour (B2) or a favourite comedy; treat empty days as information; reassess mood and refer for indicated treatment if anhedonia is marked.
Overwhelm and grief triggers. Funny memories can bring up loss; laughter can trigger memories of being mocked [synthesis]. Response: pause, allow tears, ground, and make humour optional for that person; no humour about trauma content; after bereavement, follow the client's own humour rather than introducing it.
Non-adherence to Home Play. Participants cited lack of time and wanted more practical games [source: Tagalidou et al. 2018]. Response [synthesis]: shrink tasks to two minutes; tie them to existing routines (bedtime for B1); review every week; spend more session time on games.
Low motivation or dropout of other members was a reported negative [source: Tagalidou et al. 2018]: 6 of 35 dropped out or missed three or more sessions. Response [synthesis]: confirm attendance commitment at screening; contact absent members; keep the group cohesive with a predictable structure.
Ruptures from therapist humour. Misread clients or humour "as a weapon" damage trust [source: 2024 review citing Franzini 2001; Sultanoff 2013]. Response: repair at once (C6); review in supervision; return to a more serious style with this client.
The class clown dominates the group [synthesis]. Response: appreciate the contribution, then structure turn-taking; give the person a role (time-keeper of a game); talk privately if their humour is aggressive or crowds others out.
Aggressive or sexual humour in the group [synthesis]. Response: stop it at once, restate the rule without shaming, and refocus on affiliative humour.
Cultural, religious and gender mismatch. Humour norms differ [source: 2024 review citing Kneisel et al. 2022; Schneider et al. 2018]. Response [synthesis]: ask about norms; avoid language-dependent puns with non-native speakers (poor language skills were an exclusion criterion in the pilot [source: Tagalidou et al. 2018]); check that exercises do not breach religious or cultural norms; let the client set what is acceptable.
Elevated mood, mania or disinhibition [synthesis]. Response: defer group participation until stable; humour work can increase arousal; liaise with the treating psychiatrist. The clinical trial of the manualised training excluded bipolar disorder and any past manic episode [source: Tagalidou et al. 2019].
Psychosis and paranoid ideation. Falkenberg, McGhee and Wild report studies including people with psychotic illness [source: Broda 2022]; their selection criteria are [uncertain]. The Salzburg clinical trial, by contrast, excluded schizophrenia and any past delusional or psychotic episode [source: Tagalidou et al. 2019]. Response [synthesis]: only within a supervised clinical programme; avoid ambiguity and irony that can feed misinterpretation; prefer concrete, warm, shared humour.
Suicidal jokes or gallows humour about self-harm [synthesis]. Response: do not laugh along; ask directly about suicidal thoughts and carry out a standard risk assessment; humour work pauses while risk is addressed.
Claims of disease benefit. Clients may hope humour will cure illness [synthesis]. Response: say plainly that it is a wellbeing and coping adjunct, and that it does not replace medical or psychiatric treatment.
Children: teasing turns into bullying [synthesis]. Response: stop it, speak with both children separately, inform carers as agreed, and follow safeguarding procedures if needed.

Sources

Pages consulted:

Books cited:

Falkenberg, I., McGhee, P., & Wild, B. (2013; later edition 2021 per Broda 2022). Humorfähigkeiten trainieren: Manual für die psychiatrisch-psychotherapeutische Praxis. Schattauer.
Wild, B. (Ed.) (2016). Humor in Psychiatrie und Psychotherapie: Neurobiologie – Methoden – Praxis (2nd ed.). Schattauer.
McGhee, P. E. (1999). Health, Healing and the Amuse System: Humor as Survival Training. Kendall-Hunt.
Farrelly, F., & Brandsma, J. M. (1974). Provocative Therapy. Fort Collins, CO: Shields Publishing [source: Texas A&M University Libraries catalogue]; the 2024 coaching review cites a 1981 date [uncertain: possibly a later printing].

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