Laughing with and at Patients: The Roles of Laughter in Confrontations in Addiction Group Therapy

By Arminen, Ilkka; Halonen, Mia | The Qualitative Report, September 2007 | Go to article overview

Laughing with and at Patients: The Roles of Laughter in Confrontations in Addiction Group Therapy


Arminen, Ilkka, Halonen, Mia, The Qualitative Report


In Minnesota treatment, the therapists aim at breaking clients' denial to encourage them to accept their addiction. However, the confrontation is risky since, instead of making the patient ready for a change, it may strengthen resistance against the diagnosis of addiction and the treatment recommendations. We will explore the role of laughter in confrontational practices. The study is based on conversation analysis of group therapy sessions in an inpatient addiction treatment clinic in Finland (7.5 hours of data altogether). The laughter prevails in three different kinds of practice: laughing off the troubles, strengthening the confrontation by laughing at the patient, and ameliorating the confrontation. Laughter is a flexible device for preventing or resolving the possible risks of confrontation. Key Words: Addiction Treatment, Confrontation, Conversation Analysis, Group Therapy, and Laughter

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Laughter appears in several roles in therapeutic interaction. In our data on addiction therapy, it tends to occur in connection with confrontational practices. In the kind of addiction therapy considered here (the Minnesota treatment, also known as the Hazelden treatment, see Anderson 1981), the therapist is suppose to confront patients. If the therapist chooses to do so strongly and overtly, this may provoke resistance and endanger the whole therapeutic process. On the other hand, if the therapist does not confront patients at all, or if the confrontations are very mild, the therapy may lose its edge and the patient's addictions remain unchallenged, which is as problematic from the point-of-view of addiction therapy. The addiction therapists following the Minnesota treatment paradigm thus face the dilemma of having to confront the patients, which poses a threat to the whole process (Arminen & Leppo, 2001). In this article, we study laughter and invitations to laugh as a strategic solution to this dilemma in addiction therapy. We will also discuss the limits of laughter, and show that some troubles are resistant to being laughed off.

The study has its roots in a large international research project on Alcoholics Anonymous (Makela et al., 1996). Part of the project concerned sharing of experiences in AA (i.e., how mutual help was achieved in interaction at meetings, Arminen, 1998). At time of the project Halonen assisted Arminen by transcribing his data from audiotapes. In addition to transcribing, Halonen also discussed with Arminen different kinds of methodological issues raised by the data. During that time of co-operation, an idea of another study was born and we established a project to investigate the ways in which the AA set of beliefs was transferred into professional practice, in the Minnesota Model of addiction treatment, which had converted the idea of mutual help through the support of other addicts into a strict program led by the professional therapists and other staff in the clinics. The Minnesota Model is based on the view that patients have to be convinced to see themselves as addicts needing help. Thus, it differs critically from AA in that the treatment is usually not voluntarily attended (e.g., Arminen, 2004; Arminen & Leppo, 2001; Arminen & Perala, 2002; Halonen, 2002, 2006). The strategies and dynamics of confrontation have been central to our studies, including this study on the role of laughter in confrontations.

In the 1960's, Harvey Sacks (1992a) noted the potential people have to act in covert ways in interaction (i.e., doing actions as if they had not been done). In calls to a suicide helpline, the caller sometimes reported not hearing the answerer's name, thereby avoiding giving a name without refusing to do so. Sacks also pointed out that laughter can act as a ceremonial form for ending the current phase of action, giving it tremendous potential in interaction. Through treating the request for help as a joke, the recipient of the request can respond to the joke instead of the request, and refuse help without overtly doing so. …

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