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How do therapists understand and use humour in their work with obsessive-compulsive clients? A grounded theory study

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Densham, Rachel (2021) How do therapists understand and use humour in their work with obsessive-compulsive clients? A grounded theory study. Doctoral thesis, London Metropolitan University.

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Abstract

This qualitative research study seeks to explore how experienced therapists - the majority of whom are Cognitive Behavioural Therapists - understand humour; and how they use it in the treatment of Obsessive-Compulsive Disorder (OCD). Between two and three per cent of the population have OCD and the World Health Organization ranks it in the top ten most disabling illnesses. However, forty per cent of obsessive-compulsive clients who engage in Cognitive Behavioural Therapy (CBT) for OCD either refuse, do not finish or fail to benefit from treatment. At the same time, research indicates that the therapeutic alliance is the primary driver for client change in therapy; and that humorous interventions help to strengthen this alliance. Data from semi-structured interviews with eight participants were analysed using Willig’s abbreviated grounded theory method (2013) and a tentative model was constructed. Humour is presented as an expression of paradox in OCD (it being at once illogical, distressing and dangerous; as well as creative, informative and absurd). Participants continuously assess the type and function of humour used in session. ‘Light’ and soothing humour promotes constructive outcomes (distancing while closely bonded, playfulness, normalising, reframing); while ‘dark’ and provocative humour risks negative results (defending, offending, rupturing). When making decisions about humour use, participants have regard to both in-the-moment, and longer term, feedback on the strength of the therapeutic relationship; as well as certain individual differences (religion, class, gender, age, etc. of the client) and intrapsychic variables (the participant’s own experience, training and professional reputation). The implications for theory and practice are discussed, with an emphasis on enhancing knowledge in the field of counselling psychology. Recommendations for future research are also made.

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