Psychotherapy Doesn’t (Always) Have to be Pserious

photo by Samsung uk ON unsplash

After a recent Zoom workshop featuring several MAPPsters, that is, alumni of Penn’s Master of Applied Positive Psychology (MAPP) program, I was asked to write this piece due to my being an addiction counselor and my “strengths of humor and playfulness.” I quickly said yes, a habit I’m trying to break, because it felt good to be asked. I briefly regretted saying yes when the guidelines were sent because they stipulated APA citations and references, which made me wish I had a pricing structure that said I’ll write anything for free unless it requires APA—in which case I charge $250,000.

Quickly, however, my mind shifted to the task at hand. There are evidence-based play therapies (more on those later), but I have no expertise in their use. They’re mostly used with children, and (thankfully) substance use disorder (SUD) treatment for children is quite rare and isn’t something I’ve needed to do (yet). 

I am a playful person. If a situation calls for a level of formality between 7–9 on a 10-point scale, count on me to be as close to the 7 as possible without falling below it (often). Playfulness is integral to the counseling I provide. For example, yesterday I was reviewing a treatment plan and diagnoses with a patient, and after sharing with him that I was diagnosing him with severe anxiety and moderate depression, I told him I was also diagnosing him with being excessively handsome. Safe to assume you had to be there, but he laughed, and he was the relevant audience. I live in Denver and will wear Green Bay Packer gear to the group because many attendees then enjoy mocking the Packers, or Wisconsin, or bringing up the Broncos’ Super Bowl win over Green Bay in the late 1990s. The atmosphere that welcomes them teasing me creates trust for other sharing and camaraderie amongst them as they gang up on me.

If a therapist is to have success helping a patient, they must establish good rapport. University of Scranton professor John C. Norcross, PhD, ABPP, who chaired an American Psychological Association (APA) task force on patient-therapist relationship factors in therapy, stated that “anyone who dispassionately looks at effect sizes can now say that the therapeutic relationship is as powerful, if not more powerful, than the particular treatment method a therapist is using” (DeAngelis, 2019, para 3). Most importantly, this relationship, often also referred to as rapport or alliance, hinges on the establishment of trust via authenticity and attentiveness (Drevitch, 2025). This means patients may go through a process that’s somewhat like dating—one therapist’s style will generate rapport with one patient and destroy any chance of rapport with another. I interned at a facility that helped unhoused men with SUDs in Denver where other interns were in their 20s, nice, curriculum‐centric, and extremely politically correct. I, on the other hand, was in my 50s, with shared SUD experience, and spoke more like the men we were treating. Many of these patients had horrific life stories of abuse, incarceration, and homelessness. Both approaches worked; but some of the guys wanted the young interns as their counselor, and some of the guys wanted the guy with whom they had more in common. 

Now, a bit about risk and reward: The intern approach is much lower risk. I won’t compare the approaches on the reward front, except to say that if I’m not my authentic self, my chances of developing trust and rapport become much lower. In general, my style usually works very well, but when it doesn’t—it fails spectacularly. 

The upside of my approach is that when I’m my authentic self (less formal), it relaxes most of my patients. Knowing that they’ll laugh many times during our sessions reduces my clients’ anxiety. They look forward to and enjoy the sessions because when they aren’t digging deep to contemplate or express their innermost feelings, I’m providing psychoeducation with dumb movie references, silly examples, or self-deprecating stories from my experience. The more a patient enjoys (or the less a patient dislikes) therapy, the less likely they are to quit participating in it. This makes them less likely to return to problematic substance use. Krentzmann et al. (2024) found that happiness with recovery predicts treatment retention and abstinence, so having patients leave sessions happier than they were when they arrived is a good thing.

Now, a bit about the risk: Until 2020, I worked as a general manager in the elevator industry. One of the guys who worked for me oversaw a team of elevator mechanics, and he came to me for advice. He said that when he teases his mechanics, they get mad at him. I told him he can’t tease mechanics, certainly not in front of other mechanics. “But you do!” He said. And I replied, “Yes, I do. But I’m funnier than you.”

 So, there it is! Let’s see if Adam Grant decides to run with that leadership advice gem. 

I told him that if I tease an employee in front of other employees and the teased employee laughs, and they’re free to tease me back, it’s all good. If I tease them in front of other employees and they don’t laugh or can’t return fire, then I’m just a jerk. This is the authenticity piece. I told this employee that he needed to be himself, not to try to be me. In fact, every employee I had who got promoted into management in another branch got this lecture from me. I promised them that if they tried to manage like me, they’d be in trouble with human resources within a month. 

Okay, so I’ve established that playfulness can be useful in building rapport if it’s authentic and you’re good at it. I would also say that this applies to pretty much everything, not just developing psychotherapeutic rapport. But since this article is about play in addiction counseling, here’s some experience-free research: For adults, play therapy is likely to feature role play or creativity (Geoffrion, 2018). To use a metaphor that may be lost on those who haven’t driven a stick shift, I use play therapy to try to establish a breakthrough and a little momentum with patients who have difficulty getting into first or second gear of participation. I’m more likely to set up their role play scenarios in ways that are a bit ridiculous to get them to laugh than to set up a deep introspective scenario, but again, that’s a personal style/approach. Per Geoffrion (2018), this is consistent with the benefits of most research cited in various applications, whether it helps quiet people to verbalize feelings or less verbal people to express feelings via art or symbols.

It seems like an article about playfulness should be more playful, so I’ll end with one more personal example. Nicknames can be fun, except when people don’t like theirs. When I was a manager, and now as a group therapist, I give people veto power over nicknames they receive. Recent patients have been C-3PO, Choppy, and SMOD (Sweet Meteor of Death). Regrettably, one vetoed nickname was RBF, which stood for Resting (Female Dog) Face. It was so perfect, but he wasn’t feeling it. That said, he got to veto it and exercise some agency in a way that he appreciated.

Alcoholics Anonymous meetings often feature a lot of laughter, and AA is at least as effective in treating substance use disorders as psychotherapy (Kelly et al, 2020). AA Meetings often feature a fair amount of gallows humor, a common method of coping with the stress of difficulties like combat, being a first responder, or putting your life back together (Lancaster & Philips, 2021). 

A serious, formal therapist may lean on actual play therapy while a less formal, serious therapist such as myself may lean more towards just being generally playful when situations allow. Like all psychotherapeutic orientations and interventions, play will work for and with some therapists and patients and won’t work for or with some others. Laughter and play in therapy can make dealing with tough things less tough, which makes people more willing to confront tough topics. I once heard someone describe addiction counseling as convincing people to walk towards whatever they’ve been running from. Playfulness and play can make that a more pleasant and less intimidating walk for them. I know it makes it more pleasant for me.

References

DeAngelis, T. (2019, November 1). CE corner: Better relationships with patients lead to better outcomes. Monitor on Psychology, 50(10). https://www.apa.org/monitor/2019/11/ce-corner-relationships

Drevitch, G. (2025, November 10). Therapeutic alliance. Psychology Today. https://www.psychologytoday.com/us/basics/therapeutic-alliance

Geoffrion, C. (2018). Play therapy techniques with adults in an inpatient setting. Expressive Therapies Capstone Theses. 66. https://digitalcommons.lesley.edu/expressive_theses/66

Kelly, J. F., Humphreys, K., & Ferri, M. (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. The Cochrane database of systematic reviews, 3(3), CD012880. https://doi.org/10.1002/14651858.CD012880.pub2

Krentzman, A. R., Bowen, E. A., & Zemore, S. E. (2026). Happiness with recovery from alcohol and substance use disorders predicts abstinence and treatment retention. Journal of Positive Psychology, 21(1), 117–124. https://doi.org/10.1080/17439760.2024.2431686

Lancaster, C., & Phillips, P. (2021). How does the use of humour in the UK ambulance service affect a clinician's well-being? British Paramedic Journal, 6(2), 26–33. https://doi.org/10.29045/14784726.2021.9.6.2.26

About the author | Don Thiry, Licensed Addiction Counselor Candidate (C’25), retired from management in the elevator industry in 2020 to focus on helping people struggling with substance use disorders and the people who love them—a calling since he emerged from the grip of alcohol and cocaine in 2004. Don jokes that he’s the only person he knows of with a 3:3 ratio of graduate degrees to stints in rehab (if you know anyone with a 4:4 ratio, please let him know).

 In the 1990s, Alcoholics Anonymous taught Don to live better. In the 2010s, he added stoicism and Buddhism. And in the 2020s, positive psychology and other philosophers joined the chorus. As a result, he’s become a bit of a goofy well-being caveman guru wannabe for subsets of friends and family.

Currently, Don is working towards licensure as an addiction counselor in Denver, CO, where he lives with his wife Rochelle, 3 dogs (Gorman, Emerson, and Captain Chaos), 1 cat (BB King), and a coral reef aquarium (too many names to list). He volunteers for Hazelden Betty Ford, serving as Chair-Elect of their National Alumni Committee and a guest lecturer in their graduate school. Don enjoys hiking and golfing (poorly).