LETTERS

Humor in therapy

THE ARTICLE ON THE USE OF humor in therapy (March Monitor) addressed the subject well. But the article failed to address the sociocultural nature of humor. While laughter is a universal behavior, underlying humor is not. The roots of humor are culturally based. Humor usually is better shared and enjoyed among members of the same group or a particular subculture.

What is humorous or funny in one culture may not be humorous in another.

In fact, inappropriate humor can be disrespectful, disruptive or even offensive. Differences in humor, both in their verbal and nonverbal forms, exist among all subcultures, age groups, communities, customs and even local families. A modern example would be the professional humor that is enjoyed among groups of certain specialties.

Professionals often use their own language and terminologies to laugh, joke and induce some amusement.

So, what is true to therapists is also true to other caregivers and helping professionals. They need to be very careful regarding the style, content and timing of the laughter or humor they introduce. Like in other styles of communication, employing humor in therapy requires cultural sensitivity and a high level of awareness, ingredients that are essential to any meaningful human encounter, whether inside the counseling room or outside the country's borders.

Naji Abi Hashem

Seattle

THE LEAD ARTICLE OF THE March Monitor raises the prospect of the utility of humor in psychotherapy. Humor might well play a role in therapy. The underlying issue of the article has little to do with humor and indeed, is actually lamentable. I refer to the absence of any expression of interest in the theoretical or empirical basis of the putative benefits of humor.

The last thing the field needs is another untested idea of what to do in psychotherapy. There are now more than 550 documentable psychotherapy techniques. The vast majority of these have never been studied empirically and have no evidence (controlled or otherwise) in their behalf. The APA Monitor must not only report what might be interesting but also retain the tenets for which we stand, namely, a scientific approach to the subject matter. In the case of therapy, scientific also means humane; namely, providing individuals in need of care with only those interventions that can be justified. The criteria for "interesting" are vast; the criteria for what can or ought to be promoted as therapy are constrained. Compelling case histories are a wonderful point of departure. We must move beyond the compelling case histories of yesteryear. Tenets of science are no more important in any area than those involving the care and welfare of life. It will be a very sad day if humor is promoted as treatment without evidence in its behalf.

Alan E. Kazdin

New Haven, Conn.

Thanks for the news

THANK YOU FOR THE ARTICLE about blind psychologists in the March Monitor. I am a blind psychology undergraduate student and I so appreciated the article. I would support an APA support page or mentoring system for blind psychologists 100 percent! I will graduate in May and face graduate school and/or the job market. Thanks again for the news.

Melissa Layne

Danville, Va.

Don't hold your breath for NASA

IN THE MARCH ARTICLE "NASA should boost behavioral research," the remark by Patricia Santy that "NASA remains somewhat cool toward psychological issues," is understatement at its best.

My interest dates back to 1963, when I carried out an extensive study of the 17 members of the 1963 American Mount Everest Expedition, which I had framed as a pilot study that could lead to more systematic studies with astronauts. That study was designed to explore personality data in relation to stress reactions. I had to abandon the stress aspect because neither I, nor a sociologist on the team, could deal with the concept of stress with any precision. Even then NASA was producing reports that highlighted the importance of studying psychological aspects of space flight such as compatibility, but nothing ever came of it. Since then it has seemed to me that every 10 years or so someone notices the opportunities being missed, holds a conference, writes a report. Then the matter dives into oblivion again.

If nothing else, NASA's skirting of an obvious and potentially interesting research topic is a fact that cries out for some explanation. At the time I was knocking on their door, I learned that the astronauts themselves had a powerful influence over what studies were permitted, and of course they were negative about any procedures that might result in dismissal from the program. I assume that today's astronauts have less of that kind of power. But NASA remains, appropriately, a community largely made up of engineers, and an environment in which psychological questions aren't cultivated.

Finally I have to wonder: Is there anything to motivate NASA to encourage psychological research? Have there been any problems with stress management during space missions, any serious issues of incompatibility?

If there have been would the research community--much less the public--have been allowed to hear about it?

I'm glad the issues have been raised once again. But I'm not holding my breath until a substantial psychological research program is supported at NASA.

James Lester, PhD

Annapolis, Md.

On the president's column

I TOTALLY AGREE WITH DR. Suinn's statement in the March "President's column," "As psychologists we have identified ourselves well as mental health professionals, but not well enough as primary-health-care professionals."

For decades, we have talked about mind-body connection, but as practitioners we have insisted on being specialists of the mind at the expense of being integrated into the health-care system.

The research has clearly documented that 50 percent to 70 percent of patients seen in a primary care office have a major psychological component to their presenting illness. The importance of psychologists becoming primary health-care professionals is clear. Approximately two years ago, I was invited to speak at the mid-winter conference of the National Council of Schools and Programs of Professional Psychology. I, along with one of the clinic's family physicians, talked about how psychology and primary-care providers can work well together.

Unfortunately, our presentation received a lukewarm response. Their response was consistent to what I have seen in our profession over the last five years. Rather than figuring out how to be integrated into the health-care system, we have spent more energy in figuring out how we can continue to be specialists and independent practitioners. Although we don't need to abandon our psychological roots, we need to take a hard look at what we are trying to achieve as health-care providers. It is our responsibility as psychologists and as an organization to work consistently toward that goal, including making sure that what we say and do are consistent.

Norm R. Fluet, PsyD

Waco, Texas

A contrast

I WAS PARTICULARLY INTER-ested in two articles in the February Monitor: "Science and health care," by Richard McCarty and "HFCA decision narrows reimbursement gap," by Lisa Rabasca.

Both articles are excellent, but they are particularly interesting to me because they draw somewhat of a contrast. Richard McCarty is describing a somewhat ideal future with the relationship between clinical psychology and the health-care system. Lisa Rabasca is describing actual events as they relate to clinical psychology and a government agency.

In my review, the ideal situation described by McCarty is not likely to be realized in the context of the present health-care system (that is, predominantly private sector and managed care). He refers, for example, to work in the area of psychoneuroimmunology, which most clinicians are excited about. However, I cannot imagine using a term like that in my discussions with the managed-care people we have to deal with day in and day out. I doubt that most have the vaguest idea what psychoneuroimmunology is, let alone endorse a treatment method that might enhance the patient's psychoneuroimmunology. And I have no reason to believe that will change, and have outlined my reasons in the accompanying analysis (enclosed).

In contrast, Lisa Rabasca's article describes how the HFCA (a government agency) was at least amenable to reason, and eventually changed its position to recognize the work of clinical psychologists. I think this contrast is very instructive, and it is consistent with my thesis in the attached analysis.

John McDonough, PhD

Cold Spring Harbor, N.Y.

What about gay men and lesbians?

I WAS OFFENDED BY THE "Newsline" article "For romantic couples, love increases over time" (March Monitor). I was certain by this time that the APA would no longer condone research that expressly excluded homosexual couples. Do the researchers really believe that gay couples are any different in their levels of love, satisfaction and commitment?

Isn't it time that APA came to its senses and maintained a standard about what types of studies are acceptable? Research focused on heterosexuality alone deprives the public and professionals of the full scope, and is a tacit indictment of the gay community.

S. Timothy Floyd

West Hollywood, Calif.



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