Part of the challenge of working as both a psychiatrist and a psychotherapist is that you never know what to expect in a session. Patients present with curve balls all the time and, with years of training and experience, you get better and better at catching those curve balls through the work of processing conflicts and distress, but that element of surprise within the therapy hour is always there.

But what happens when you, the predictable, safe therapist goes off script? When your usual, practiced, and thoughtful response is replaced with a spontaneous reaction. This was exactly the situation I found myself in the other day, when, in the midst of my patient humorously answering a question, I found myself hysterically and uncontrollably laughing, to the point that tears were streaming down my face. I was laughing so hard I was actually crying! And, as we all know, laughter is contagious, so within seconds of my outburst, my patient too became hysterical. It was a moment frozen in time wherein I knew my patient’s pain and sadness had dissolved, her worries, stressors and mind chatter had ceased, and my own weariness from the long work week also enjoyed a brief respite. The levity of the moment had lifted us both up.

While I had certainly been known to chuckle and be emotionally responsive with patients, (I had never subscribed to the more traditional, neutral analytic style), there was something different about this moment of laughter and my patient knew it too.

It was so out of character and frankly surprising, that I started to apologize for the outburst, when my patient stopped me mid-sentence; “Dr. Pearl,“ she said, coughing a little after the strain from laughing, “Why are you apologizing? Laughing with you is what I really needed today.  And besides,” she said, leaning in closer to the iPad she used to see me during our virtual session, “it looks like you could use a good laugh yourself.” I smiled back and thought about the therapeutic impact of laughter, whether with patients, friends and family, or even a stranger, and how, when we are truly in the moment with another person, being spontaneous and unscripted is connection at its best.