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Expectancy: The placebo effect & the healing relationship


The word ‘placebo’ has a very negative connotation – – as in saying of something that it is ‘just a placebo’. A placebo is not a real treatment, and it only works because people are conned into believing that it does.

The sham is that the full authority of medical science is invoked in presenting the innocuous pill as a potentially effective treatment.

Paradoxically, the ineffectiveness of the placebo itself shows how powerful the ‘placebo effect’ is. If the sham treatment itself has no inherent healing power, then the healing must have to do with something like hope or belief. In other words: The innocuous pill has an effect because we have a natural ability to heal – – the power of expectancy. And this natural ability to heal is magnified by the trust we have that the pill is an effective treatment.

So it makes sense for the healing professions to tap into the power of hope, belief and trust to enhance people’s natural ability to heal.

Does this mean that, as psychotherapists, we should seriously consider conning people into positive beliefs? Such an approach would be self-defeating in the long run. How could we establish a relationship of trust if our work was based on keeping clients ignorant of the underlying con game that is undertaken ‘for their own good’?

Unlike what happens in clinical trials, we must avoid fostering false hopes or false beliefs. This may seem like a daunting task: How can a client with a negative outlook on life find an authentic sense of hope even before resolving their issues?

Somatic approaches to psychotherapy allow us to bypass this. We do not just rely on the ‘story’ that people tell. We pay attention to the whole person, including what happens somatically. Focusing on inner experience (as opposed to just thoughts and beliefs) allows the client to get a felt sense of a ‘something’ that keeps them going, even if that ‘something’ is hard to express in words.

We acknowledge that this ‘something’ may be very faint at the time. In fact, an obstacle to noticing this ‘something’ may be the expectation that hope or faith in the future are ‘loud’ experiences. They may actually be so faint as to be almost totally drowned by the loudness of the habitual ‘story’, of the negative thoughts and beliefs, of the intensity of nervous system activation.

Paying attention to embodied experience, we help our clients find in themselves the visceral experience of believing in a sense of possibility, as opposed to trying to instill in them some abstract beliefs. However faint it is, this felt sense of ‘something that keeps me going’ is an actual experience. As such, it can be felt as a grounding, an anchor, more effective in containing nervous system activation than abstract thoughts could ever be. And this personal experience has potential to grow as it is paid attention to.

All of this happens in a context. One of the fundamental principles of somatic psychotherapies is tracking. During a session, we are not just ‘objectively’ tracking what is happening to the client in order to impart a treatment to them. We are tracking the client within the context of an intersubjective relationship, where we are tracking ourselves as well. So we have a sense of the level of trust that is present in the space, moment by moment. This is not an objective measurement, but part of an ongoing process of making working hypotheses, and testing them.

In other words: We are working experientially, moment by moment, with trust, hope and belief. And, in so doing, we are working with the innate human ability to heal.

See conversations with:
Mary Charlson: Expectancy, mindfulness and chronic illness
– Linda Carlson about the healing power of expectancy
– Tor Wager about understanding the ‘placebo effect’
See also: Collective Implicit

proactive mindfulness

See also: Demystifying Mindfulness: Active Pause®



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