Leveraging Duality: Using Humor with Borderline Clients

See Dr. Shapiro's professional biography here.


Wright Institute Clinical Psychology faculty member Dr. Lauren Shapiro is conducting research on the use of humor as an intervention with clients diagnosed with Borderline Personality Disorder (BPD).

“From what I’ve learned about borderline clients, something they struggle with is integrating multiple seemingly contradictory thoughts or feelings,” Shapiro explained. “For example, they often engage in splitting—they’ll undervalue someone, and then switch to overvaluing them.”

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’t 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—as 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 Wright Institute in October to share her results thus far and get feedback from the community.

“I went in with some hypotheses about the clinical purpose—such as humor as a way to foster cognitive appraisal, or help patients shift perspectives,” she said. “I 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.”

Shapiro said all of these hypotheses have been confirmed, but that additional themes have emerged as well.

“Many mentioned using humor as a diagnostic tool, for example assessing for symptoms of depression or for signs of Autism Spectrum Disorders,” Shapiro said. “Some said that they assign patients homework of finding jokes as a way to help build social awareness and understanding.”

When deciding whether a particular patient is a good candidate for humor in session, Shapiro’s participants often said they use trial and error to gauge a patient’s openness to it.

“One therapist used the great metaphor of administering humor like droplets of hot sauce—gradually ramping it up to see how much they can take,” Shapiro noted. “Many mentioned taking the client’s lead—saying that borderline clients are often very funny.”

When using humor in sessions, Shapiro’s participating therapists emphasized that clinicians must be self-aware about their intentions.

“They cautioned against using humor as a form of avoidance—on the part of either the client or clinician—as a way to escape and refrain from processing painful emotions,” she said. “When 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’s desire to avoid affect.”

When in doubt, though, Shapiro’s participants stressed using humor only when it’s genuine.

“If you don’t feel like you’re a very funny person and you don’t feel comfortable using humor outside of sessions maybe it’s not the best idea with clients,” she said. “If it comes across as forced, clients are going to see through that.”

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.

“One of my favorite quotes was to use humor with an apology in your back pocket—that making a mistake can set an example of how to repair a therapeutic breach in the moment,” Shapiro said. “Many said this process can be profoundly healing.”


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