Yes, and … improv can be therapeutic

By Lindsey Phillips

September 2021

Two of the main rules of improv are that you must agree with the other person and add to the conversation. One of the most commonly used improv games “Yes, and …” illustrates these principles. 

Two people face each other. One person starts by voicing a single statement. The other person accepts this idea and builds on it by responding, “Yes, and ...” For example, if someone says, “The lake is full of alligators,” the other person could respond, “Yes, and one of them is swimming toward us.” 

“In a lot of ways, improv is like a therapist,” says Andrea Baum, a licensed professional counselor (LPC) in Texas. “It’s giving that unconditional positive regard but also reflecting, tracking, and conveying empathy and understanding.” 

Baum discovered improv when she started looking for more playful counseling modalities. She decided that to enhance her role-playing, which she was using with clients, and to help herself focus more on being in the moment, she would take an improv theater class. In the process of having fun, she also observed several parallels with counseling. 

“I noticed that what I was trying to teach my clients to do, improv was organically doing,” she says. “Things like keeping them in the present moment, accepting themselves, finding their voice, expressing their authentic selves [and] connecting with other people. There were so many risks people were taking because they felt safe in [the improv] environment.”

Later, she learned about how improv could help caregivers better communicate with their loved ones, and this hit home for her. When Baum was 15, her father suffered a brain injury, which led to early onset dementia. Improv now served another purpose for Baum: “I started using these techniques that I had learned in improv with my dad, and our entire relationship just completely changed for the better. It was life-changing.”

Her experience with improv inspired her to partner with an improv educator and open Stomping Ground Comedy Theater in Dallas. She serves as the director of Improv for Life, a series of therapeutic improv classes and workshops that she designed for several populations with unique needs. 

Building connections 

In preparing to transition his counseling practice online a couple of years ago, Gordon Smith, a licensed clinical mental health counselor with a virtual private practice based in Asheville, North Carolina, began researching ways to build intimacy more effectively and efficiently in online spaces. His search led to him taking improv classes at the comedy club Second City. After participating in four online sessions, Smith was hooked. Immediately thereafter, he signed up for an improv group for counselors at the Improv Therapy Group, an organization that provides improvisation training with the goal of improving mental health. 

“I was immediately struck by how this modality allowed for practically instantaneous levels of trust, intimacy, risk-taking and laughter among total strangers,” Smith says. “I realized that I’d found what I was hunting for and was also having a really good time cutting up with a bunch of therapists.” 

Smith, who now serves on the Improv Therapy Group’s advisory board, has created improv groups tailored to working with gifted adolescents, adults and families. In a recent improv group, many of the participants reported that they felt mirrored and seen in the group in a way they didn’t often experience in their daily lives as neurodiverse individuals.   

Improv can also help disrupt toxic patterns in relationships, Smith says. He once worked with a family whose members all felt unheard and unseen by one another. The dynamic was so toxic that the family constantly argued in session, Smith recalls. While counselors can try to engage family members in therapeutic activities during therapy sessions, these activities may elicit only eye rolls or hurtful comments when the relationship is so badly damaged, Smith observes. He finds that the spontaneity of improv activities often interrupts these toxic patterns and opens the possibility of the relationship looking different. 

“All it takes is that first moment of spontaneity where something new happens and toxic patterns are disrupted, if only for a moment, which is what we’re going for in family therapy,” Smith says. Family members can explore how their relationship might look different by breaking out of an assumed role such as “mean mom,” for example. The mom can instead pretend to be “fun mom” for a few moments. Improv allows clients to play with the family narrative and “break” it in fun, nonthreatening ways, Smith explains.

Baum points out that mirroring is a great way to teach empathy and for people to connect with others. One of the first games she uses, especially when working with caregivers of people with Alzheimer’s disease, is having group members introduce themselves by saying their name and doing a silly gesture that expresses themselves in some way. The rest of the group then repeats this gesture three times before moving on to the next person.

When introducing improv games to clients, clinicians need to provide sufficient detail for how to play and show examples from across the spectrum. With the gesturing game, a counselor could exhibit both a small way to gesture, such as barely raising one’s hand, and a big way, such as jumping up and down and waving. 

“It seems like a simple icebreaker, but really we’re giving people the experience of being silly, being themselves, and then everybody accepting and supporting that by mirroring them,” Baum says. “There’s so much that benefits us when we mirror one another. We naturally mirror people when we’re connected to them. It helps us to listen and stay in the moment … and it’s a type of empathy … [to] really listen and repeat what you’re hearing.” 

Caregivers can also apply this skill in their own work, Baum says. They can mirror the ones they are caring for, matching their tone and volume of voice and what they are doing nonverbally. “That can help you connect and create mutual trust quickly,” Baum explains.  

Improv can also be a fun way to end a difficult processing session, says J. Claire Gregory, an American Counseling Association member who is an LPC and a licensed chemical dependency counselor in Texas. She presented on how improv can foster connection with clients and counseling students at ACA’s Virtual Conference Experience this past spring. 

One game she sometimes uses at the end of a process group is “Place, Hobby and Reason to Leave.” The game involves two people acting out a scene. One of the two leaves the room, while the others in the group determine a place (e.g., Texas), hobby (e.g., ballet) and reason to leave (e.g., stinging bees). The first individual returns to the room, and the second person acts out the place, hobby and reason to leave using only gestures and gibberish. The point of the exercise is to get the clients laughing and end the group on a fun note, Gregory says.   

Incorporating improv into counseling 

Comedic improv itself can be beneficial because it teaches communication, connection and acceptance in a supportive environment. So, counselors could recommend that clients who are struggling with social anxiety, confidence issues, self-esteem or relationship issues take a general improv class, Baum says. 

Therapeutic improv, however, differs in two ways: 1) It tailors the improv games to address a specific mental health need or population, and 2) it allows participants to process and apply the skills they learn in the games to their own lives. 

Alison Sheesley, an LPC and play therapist with a private practice in Denver, uses improv to create experiential activities that help group members learn skills needed to overcome some of the mental health issues confronting them. Although general improv classes are about being present, listening, being receptive, building connection and having fun, they are not as focused on helping participants connect what they do in class with their own personal lives, she explains. That’s one of the biggest differences between general improv and therapeutic improv. Sheesley’s focus is never on having clients be funny. She uses improv as a method for imparting life skills, but the humor often still happens intrinsically.

At Stomping Ground Comedy Theater, Baum has created therapeutic improv programs focused on anxiety, autism, caregivers, dementia/Alzheimer’s, kids and anxiety, health care professionals and physicians, and stress management. When working with an improv therapy group, Baum selects or adapts improv games based on the needs of the group population. 

One game she often uses for clients with social anxiety is to have them create a character — either someone they know or have made up — and imagine that character’s most distorted thought about themselves or the world. For instance, maybe the thought is “I’m stupid.” The person then acts out a scene with another person in the group who is also thinking their character’s most distorted thought. For example, the person whose character thinks they’re “stupid” may order a cup of coffee at Starbucks from the other person’s character, who is thinking, “The world is out to get me.” The first person may act nervous while ordering and stumble over their words, while the other person eyes them suspiciously.  

After acting this scene, Baum teaches the group how thoughts, emotions and behavior influence each other. They also learn to reframe thoughts using cognitive behavior theory. Baum asks the group how the characters could change their thoughts to neutral ones. They aren’t allowed to create a new thought, she explains. Instead, they must reframe the current one. The two members of the group assume these new, neutral thoughts and replay the same scene, noticing how things flow differently. 

Improv games such as this one have real-world benefits, Baum says. They give clients tools to communicate so that they won’t feel so lost or self-conscious, she explains. In the process, clients learn how to express themselves or how to position their hands or eyes when they first meet someone.

Baum has also used improv games to help people with dementia or Alzheimer’s learn how to better express their emotions. After playing the game, she briefly processes with them by asking, “How did that game make you feel? What did you learn from it? How could you use this in your life?” Her goal is to have clients come up with their own conclusions because then they are more likely to apply these lessons outside of session. 

Improv games are similar to techniques that many counselors already use, Smith observes. For example, clinicians may have clients externalize their feelings: “If your feeling could talk right now, what would it say?” That is a form of improv, he points out. This activity helps clients consider how their experience can go differently depending on subtle changes in how they think or act, he explains, which is in line with cognitive behavior theory.  

Reducing anxiety

Improv games work well with people who have anxiety, especially social anxiety, Sheesley says, because it allows them to lean into their social discomfort in a safe — and often humorous — way. Sheesley and her colleagues discussed how comedic improv therapy can treat social anxiety through group cohesiveness, play, exposure and humor in a 2016 article published in the Journal of Creativity in Mental Health. 

Sheesley, an ACA member who holds a doctorate in counselor education and supervision, runs a therapeutic improv comedy group in Denver that incorporates skills from acceptance and commitment therapy (ACT). At the beginning of a recent group session, she explained the concept of defusion, an ACT skill that involves creating space between a client’s sense of self and their thoughts and feelings to lessen their negative impact. This skill helps empower clients to make choices that align with their life values. Sheesley then asked group participants to identify a self-critical thought that contributed to their feelings of social anxiety so they could work on defusing it. In a circle, they repeated the self-critical thought multiple times using different silly voices, which is a well-known ACT defusion technique, Sheesley notes. 

However, she had the participants take it a step further by incorporating aspects of improv. They created characters to represent this self-critical thought and acted out how these characters spoke, walked, dressed and interacted with others. After getting comfortable in these roles, group members performed improvised scenes of inviting these self-critical characters to a party. One person pretended to be the self-critical character, while another person pretended to be the “self” that is negatively affected by this character. Sheesley instructed them not to reject the character but to treat it with acceptance, kindness and empathy. If she noticed a group member was not fully in the moment or was making a T sign (a sign Sheesley taught them to use when they needed a timeout), she would pause the improvisation to allow group members to process their feelings using a feelings chart. At the end of this exercise, group members told Sheesley they were able to view their self-critical thoughts and feelings through a different, more helpful, lens.

Improv can also help reduce anxiety among gifted individuals. This population often lives in a state of overwhelm because of all the cognitive, sensory and emotional information they are processing, which can cause them to be more guarded and less trustful of the moment, Smith says. 

“The improv space allows for the rule for the room [to be] spontaneity and presence,” he notes. “It allows [gifted individuals] to come into the present and learn more about trusting … and feeling safe in the present. … They have time to practice going with their intuitive sense … and seeing how it works out in a no-stakes way.”

Smith once worked with a 13-year-old client who, like many gifted individuals, presented with asynchronous development (uneven intellectual, physical and emotional development). The client would overthink social situations, and by the time he figured out what to say, the moment had passed. His peers judged him negatively for his awkward and delayed responses. 

When the client first came to see Smith, these rejections had caused him such anxiety that he found it difficult to even open his mouth to speak. Their first few sessions together were only 20 minutes long because it was so painful for the client to talk. “His anxiety was so high,” Smith recalls. “I could see him so bottled up and having difficulty getting words out.” 

Smith knew the client enjoyed playing games, so he asked the client if he would play a game with him. The client agreed. Smith chose the improv game “Energy Ball” because he was also working on building the client’s emotional vocabulary. The game involves passing a ball that can transform into any feeling. Smith began the game by pretending to hold a ball of despair in his hands. Then, he threw it to the client. 

At first, the client played it safe by naming emotions such as happiness or fun, Smith recalls. He would also describe a feeling when he wasn’t sure of the emotional word, and Smith would “catch” the ball and name the appropriate feeling. But after about eight or nine passes of the energy ball, the client relaxed and started talking.

After playing this and other improv games, the client started doing hourlong sessions and grew confident enough to attend summer camp, where he made several friends. 

In improv, “everything that happens is a gift to be taken … and built upon versus some sort of threat. It’s just opportunity after opportunity after gift after gift,” Smith says. “And that can be a cognitive shift: The story I’m telling of what others are expecting of me or how they’re judging me … [changes] to ‘Well, here’s what they’re giving me.’”

Creating a safe space 

Counselors also need to cultivate a safe, supportive space when using improv. Baum and Gregory recommend establishing clear guidelines at the beginning. Gregory makes it clear that inappropriate or offensive words are not allowed, and she tailors her guidelines to the population. When she runs groups for individuals dealing with addiction, for example, she asks participants to avoid referencing drugs or drug use. 

The Stomping Ground theater has an oops/ouch policy, Baum says, that encourages group members to let others know if they are uncomfortable or offended by another’s actions or words.

“With improv, you can’t prepare for all things,” acknowledges Gregory, a doctoral candidate of counselor education and supervision at the University of Texas at San Antonio. “There’s going to be times where maybe a client gets over-triggered, but that can turn into an individual session” or learning experience, she says.

Smith had his own awkward moment in which he felt he crossed a line when acting out a scene in his personal improv group. The game involved group members destroying fear with an imaginary object. Smith picked up a “lamp” and proceeded to aggressively beat the fear out of it. At the end of the scene, he worried he had been a little too violent and may have triggered another group member, so he asked the group, “Was that too much?” 

The improv teacher responded in a supportive way, Smith recalls. She acknowledged that the performance could have been triggering, and she advised him to redo the scene in slow motion, which took the threat out of it. So, the group laughed while he slowly replayed the scene. 

Smith recommends that counselors also apply the “Yes, and …” principle to situations that create discomfort in their sessions. Acknowledge what the client was doing, he says, and show them another way to approach it to ensure that others feel safe. 

The need for proper training 

To successfully incorporate improv into their practice, Baum recommends that counselors take several improv classes and get training. She also stresses the importance of partnering with a highly skilled improv instructor. 

“The person who’s leading the group has to be able to build rapport and trust really quickly and in a playful way to get the buy-in,” she says. “If a therapist tries this once for the first time [without training], it could flop very quickly.” After doing improv for seven years, Baum says she just now feels she could lead a class by herself.

It was through an improv class that Sheesley met Stephanie Jones, an experienced improv coach and therapeutic improv consultant. Sheesley decided to partner with Jones and start an improv comedy play-based therapy group for social anxiety. Jones leads the improv activities, and Sheesley operates as a group facilitator, observing the group through a therapeutic lens. 

Before Gregory started using improv techniques with her in-patient group, she spent time training and discussing the ethical implications with her clinical director. She also sought consultation with other mental health professionals, all of whom advised her to continue learning by going to improv and psychodrama workshops. 

Smith has learned a substantial amount from Improv Therapy Group’s trainings, which allow him to play improv games with other mental health professionals and reflect on how best to use them with clients. Later in training, clinicians learn to create their own games tailored for the populations with which they work, he says. 

What counselors can learn from improv

Sheesley was working in a coffee shop in New Orleans when she first learned about improv from a friend. She started going to the local comedy theater and immediately loved it. Later, when she entered a master’s in counseling program, she noticed the parallels between the two. She recalls thinking, “Improv is exactly what we’re learning in my counseling classes about being receptive and present, listening and responding in the moment.”

She believes improv has also improved her skills as a counselor because it has given her confidence in her ability to handle whatever arises in session. “I’m much more accepting and less reactive to whatever comes up because I’ve practiced that in improv,” Sheesley says.

Smith agrees that in many ways, clinicians are already using improv skills by actively listening and being present with clients. Counseling sessions unfold naturally just like an improv scene, he says. In fact, some of the things he loves about both improv and counseling are “the immediacy, intimacy, uncertainty [and] mystery of how things are going to unfold,” he says.

Smith has also benefited from improv because he now has a deeper vocabulary to explain counseling concepts. He constantly uses “Yes, and …” with clients to build on what they are saying in session. Improv also allows him to crystallize therapeutic language in a casual way. For example, he can talk about “being in the moment” through these games and not from a Gestalt, psychoanalytic perspective. 

Baum thinks improv classes have made her more perceptive. “I’m able to read people really well nonverbally and verbally and pick up on cues. My intuition has improved on what might be going on with someone,” she explains. 

Gregory often found herself in her own head in sessions. She feared saying the wrong thing, and her focus on adhering to a specific counseling theory sometimes caused her to feel less connected with the client. Improv taught her how to step aside from that strictly clinical, structured mindset, she says.

Learning to be spontaneous and in the moment has allowed her to move past her own anxieties and fears to focus more on what her clients need. Spontaneity in improv “doesn’t mean being impulsive,” she adds. “It’s about being tuned in and being authentic to yourself and to the group.” 

Improv has also taught Gregory how to “fail.” She once tried an improv activity with a group, and it completely fell apart because no one wanted to participate. She had the group sit in silence for a few moments while she collected her thoughts about how to proceed. Finally, she asked the group what had happened, and she discovered some tension existed between two group members. 

“You’re going to fail with it,” Gregory admits. “There’s going to be times where you will try [an improv game] … and [clients] are just not really into it. And that’s OK because it leads to a different conversation, which can be therapeutic in itself.”

Learning to laugh again 

Gregory, Sheesley and Baum all agree that improv is a form of play therapy for adults. “At some point when we are becoming adults, we become self-conscious, and we stop playing. We stop expressing ourselves, and we start hiding parts of ourselves,” Baum says. “Improv is helpful because it’s a type of play that adults and children can have to express themselves.”

Sheesley finds that counseling frequently revolves around theories, mainly developed by white men, that are serious and often unapproachable. This isn’t the type of therapy that she wants to cultivate with her clients. She wants to make counseling a safe, playful space. “Laughter is just as therapeutic as crying, and yet we focus so much on crying as the ultimate cathartic expression,” she observes. She argues there is room for both. 

Smith recently led an improv workshop at a Supporting Emotional Needs of the Gifted mini-conference. He noticed one woman who looked like she wanted to participate but kept hesitating. So, he invited her to play in the next game. She reluctantly said yes, but a few minutes after playing, she was cracking herself up. 

Later, when they were processing the game with the group, she admitted that it was the first time she had laughed since her husband died two years earlier. “And it wasn’t because we were doing grief work,” Smith points out. “We were just playing and being supportive.” 

“Part of our job is helping people become aware of their own patterns, habits, scripts and narratives. … And improv is a way to disrupt those habits and patterns in a very safe way that allows for new perspectives,” Smith asserts. “So much of our work as therapists is just trying to help clients grow and broaden their perspectives on their own lives and to see opportunity and possibility. And that’s what [improv] is.”

People often think counseling must be serious all the time. They incorrectly assume that “if it’s fun, it’s suspicious somehow; if it’s fun, it’s not ‘real’ work,” Smith says. “We need to go to those other places that are sad and scary. [Yes,] those things can happen, and we can play.”