This article was published in Worldwide Coaching Magazine on 30 October 2020. It describes how coaches should be aware of the placebo effect and use it intelligently to help their clients. To download a PDF version click below, or for plain text with no illustrations see bottom of page.
Published in Worldwide Coaching Magazine: ** October 2020 pp 13-16.
Going to a play
It is a Friday night and you are going to the theatre. You and your partner get home early and dress smartly. You remember to pick up the tickets, printed on shiny white card. You walk to the theatre, through the entrance, then up the carpeted stairs to the bar where you order your interval drinks and buy a program. You find your seats while the usher takes your tickets, tearing off the stub. You relax into the comfortable seats, waiting for the lights to dim and the curtain to rise.
This, or something similar when going to a restaurant, concert or exhibition, may be familiar to you. It illustrates just how many things form part of the experience of going to play, more than just what the actors are doing on stage. I have not mentioned the costumes, make-up, music, lights, scenery. While what the actors are doing on stage is the central event, this penumbra of other things is also critical.
These things all form part of the theatre, helping set your expectations for the play. If they are done well you will not only have a better evening, but you will enjoy the play more. If the ushers are discourteous, the carpet threadbare, even if the tickets are badly produced then that will diminish what you get out of the play.
The importance of placebo
In medicine a similar effect is seen; the placebo effect. This can be defined both as the benefit that the patient receives when they receive an inert treatment (for example a sham drug), and as the additional benefit that they get from an active treatment that is not as a result of the active component. The effectiveness of many interventions, including surgery, talking therapies and drug treatments, can be enhanced by skilful use of the placebo effect.
Many things are known to influence the placebo effect. These include price, the relationship between the practitioner and the client, the perceived competence of the practitioner, the colour and size of pills as well as the nature of the therapy. These factors operate to induce an expectation in the patient. There may also be a conditioning effect (if associated with a previous good outcome). There can be emotional coregulation and social engagement, as well as the induction of hope.
In medicine, doctors and nurses are increasingly consciously using the placebo effect to enhance the effectiveness of their interventions. The same should be true of coaching.
Much of what would be seen in medicine as the placebo effect (such as the relationship between the patient and therapist) are a key part of the active ingredient of coaching. In these areas coaching may be able to help conventional medicine understand how to increase the placebo effect.
Importance of expectation in coaching
However, there is more to the coaching than the conversations that happen between two people sitting in a room together for an hour or so. The client and the coach will have been introduced. They will have agreed a contract (possibly with the client’s employer) and a coaching agreement. The client will have looked at the coach’s qualifications and expertise and browsed their website. The price would have been agreed. The timing and location of the first session will have been arranged. They will have entered a room that may be smart and professional or small, cramped and untidy. The coach may come across as competent and supportive, or chaotic and cold. They may be dressed smartly or casually. All these things are important in the success of coaching. They will set up an expectation in the client of success or failure.
Coaches should think about how to deliberately consider how to employ these ancillary factors to enhance the effectiveness of coaching for their clients.
One way to think of this is to think about the theatre of coaching. If the coaching session is a play, with two actors, then thinking about how to enhance the show by making sure that everything (on the stage, back stage and front of house) is done in such a way as to set up an expectation in the client of success. This will mean that, without deceiving anyone or behaving unethically, the web pages, the contracting, the location of the coaching session and even what the coach wears should be considered.
A major factor in the placebo effect is the expectation of the individual, but other facts such as conditioning can be important. A coach could consider how their client may associate a location or approach with an important ‘breakthrough’, or the negative impact of bad experiences (either in or out of coaching). As an example, I went to a pantomime at our local theatre where I was chosen by the comic as their victim, and so was lightly humiliated over the course of the evening. It took several years before I could enjoy plays at that theatre!
As in theatre, it is important to think of the context. The coach should not always use smart offices and wear business attire. When you go to the Royal Opera House you may expect the ushers to wear black tie or a smart dress, and if they were in jeans and a T-shirt that will reduce your experience. If, however, you go to a small play in a room above a pub then the same outfit would be incongruous. In some settings coaches should wear suits, in others jeans.
Coaches have a duty to do the best by their clients. To do this they have to take care of the theatre of coaching and all that goes on around the actual session. No amount of theatre will make a bad coaching session work, but good theatre will enhance good coaching.
Andrew George MBE PhD DSc is an executive coach and consultant. He has contributed to biomedical research as an immunologist, and holds a variety of non-executive roles in healthcare and education, including chairing Imperial College Health Partners and being on the board of the Health Research Authority, Health Education England and a local NHS mental health Trust. He was awarded an MBE for his contribution to research ethics. www.ajtg.co.uk/coaching and firstname.lastname@example.org