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Most research in the field of medical clowning looks at humor as the main explanation of the beneficial impact that medical clowns have on hospitalized patients. The present paper attempts to challenge this idea by applying drama therapy role theory to the work of medical clowns. First, both ‘clown’ and ‘patient’ are defined and comprehended from a role perspective. Then, using primarily Landy's role method and ideas, the authors analyze clinical examples from the actual work of “Sancho” (a medical clown from the Dream Doctor's Project) by means of role theory. The paper illustrates that besides the typical clown tools and techniques, the medical clown uses role strategies as therapeutic interventions in the interaction with patients. Thus an innovative context for conceptualizing medical clowning is provided, which expands the scope of therapeutic clowning and the use of drama therapy role theory as well.