What causes real change — inside a person?
It’s a fascinating question for any of us who coach, mentor, or do any kind of therapy or influence:
Why does x work some of the time but not at others?
In our best-selling book The Journey Inside: Coaching to the Core I wrote about “framing”. The theme was how to create the context or frame in which ideas are more likely to be be impactful, and acted upon? Framing has been described as the “black magic” of influence. That’s an apt description because its power is invisible yet tangible in results.
Often it is what you don’t see or isn’t said that has real impact on a person. What’s inferred or presupposed can more powerful than what we say. It’s black magic when it’s used for nefarious purposes by politicians of marketers. It’s white magic when it’s used to help a person achieve their person coaching outcomes.
Why so effective?
Because there is nothing to resist. Nothing to fail at. And nothing to notice inside well-presented frames.
A few years ago, I coined the term Priming Placebos. I had written a book proposal based on a lit review, but only approached one publisher. Their feedback was the idea was “too research heavy” for their audience. I kept the idea on the back burner.
Both the placebo effect and priming have potential power to move, to change, to transform. They are important psychological concepts. Reflecting on them has enriched my professional practice. It has deepened my ability to connect with clients in a meaningful way. I hope this way of thinking may be useful for colleagues too.
The placebo effect
Much has been written about this. I’ve noticed a numbness that comes over many people: “Oh, that’s sugar pills. That’s all it is”. There can be a sense that there is something weak-willed in the person who “succumbs” to the placebo. That somehow it is inferior to regular conscious thinking or decisions.
Defining the placebo effect
Here are some definitions of the placebo effect:
“an improvement of symptoms is observed, despite using a nonactive treatment.”
“a bodily change due to the symbolic effects of a treatment or treatment situation”
“a person’s physical or mental health [that] appears to improve after taking a placebo or ‘dummy’ treatment”
“a positive placebo response is most likely to occur when the meaning of the illness is altered for the patient in a positive direction”
The placebo effect and coaching
Let’s look at this, and see how to apply it to coaching. First off, let’s explore the power of the placebo.
When a person is at high altitude, oxygen becomes an issue. There are specific biomarkers for key changes in oxygen saturation levels. Researchers discovered evidence of physical changes when a person has fake oxygen. i.e. participants believe they have an oxygen canister on their back but they in fact do not.
When they carried out blood tests, scientists discovered that volunteers show responses as if oxygen was present. There is a genuine neurophysical response. Now, of course, there are limits. Even David Blaine has limits with underwater stunts.
The fact this effect happens is intriguing though.
Another example.
A person with Parkinson’s Disease may show significant improvement in mobility when taking sugar pills. This occurs even when they know they know it is a placebo. Their brains (temporarily) experience an increase in dopamine as a result of taking sugar pills. This leads to more movement for a period of time.
The mechanism behind this always seemed to me to be crucial for therapists and coaches.
If pain and mobility can increase, shouldn’t we able to use the same mechanism to change minds?
My experience based on 22 years is that this is how major shifts in hypnosis, therapy, coaching take place. You trigger the same response as the placebo effect to create sense of certainty.
Enter priming
A few years ago, I was speaking to a colleague at Oxford University who specialises in the nocebo effect. I mentioned the relationship of priming and placebo effect. He replied it was fascinating and novel. He hadn’t heard of that connection, and I’ve not seen it discussed in the literature yet.
The reason I made the connection is that in my study and training as a hypnotists I realised something. For a placebo to work, there needs to be a frame of reference or “priming” for that to happen.
Priming defined
Priming is “a phenomenon whereby exposure to one stimulus influences a response to a subsequent stimulus, without conscious guidance or intention.”
Priming is a way of activating associations inside your mind. This tends to make you more receptive to ideas, suggestions, ways of thinking or ideas later on. Supermarkets, for example, play certain types of music that have specific associations. These can be to meals, and types of wine or food.
They play relaxing classical music as you are walking up and down aisles. This is because researcher have shown how powerful the association is. It is enough, for example, to prime shoppers to buy more wine. The music associated with relaxing meals tends to influence them without conscious awareness.
A true story
A friend of mine ended up in hospital. He was in extreme pain. “100 out of 10” as he describes it. He was in the most discomfort he has ever had. He required an urgent invasive procedure, but rejected it as he was in too much pain. None of medication was working. Morphine only made him more anxious.
At one point, a nurse tried to explain why it was critical. She looked shaken at the distress he was in. She explained what needed to happen, and displayed signs of nervousness and anxiousness. My friend sensed mild irritation that he wouldn’t “take his medicine”.
My buddy was desperate. By chance, a consultant came on duty and was doing rounds. Something interesting happened.
The consultant greeted him with a smile, asked him how he was. Then proceeded to nod in sympathy. He asked my friend about his life, his hobbies, what he was passionate about. As my friend described it, he felt elated that he was being listened to. He felt heard, and enjoyed a stimulating conversation.
After a while, the consultant said, “Well, it’s been good speaking. I have to go now. Be careful of the tubes as you go get up to walk.” The patient realised that the consultant and nurse had carried out the procedure. With no medication, no pain, and zero discomfort or anxiety.
How could this happen when he felt terrified and in extreme pain only moments before?
Answer: Good bedside manner primed (created associations of safety, warmth, care and comfort) for the placebo effect (no conscious experience of pain or discomfort).
62% metaphor rule
Let’s see put this into a wider context of what I call the 62% rule. This is a figure that is consistent in many placebo studies related to pain. When working with pain control, sham surgery, sham needles or sugar pills, here is what happens. Around 42% of people will receive some kind of pain relief anyway in the course of time. 62% of volunteers experience a shift as a result of the placebo. This became a metaphor for me. A metaphor for anticipating and priming for change in the coach’s mind, and the mind of the client.
Coaches have a 62% chance of triggering a placebo effect (for better of worse) every time they ask a question. Every time they frame a new idea. Every time they introduce a concept.
Certainty in coaching
So that has become the living metaphor. Each glance, each question, each idea you pose has the potential to trigger more certainty. It is possible that your in-the-moment communication is neutral. However, coaching tends to take a client or mentee closer to or further away from an outcome.
You play the long game with the 62% metaphor when your session is framed (primed) correctly. Each moment is an opportunity to trigger a new sense of awe, wonder, certainty and inspiration.
In other words, a coach needs to be vigilant. They need to observe what they trigger. Is it a greater sense of trust that a client can solve this problem, achieve an outcome or that they can’t? Pay rigorous attention to the client to notice the effect of your work.
When you frame with precision, you prime a client for success. there is a greater likelihood that they will accept that change is possible for them. You prime for the placebo effect.
Think of the placebo effect like a conversation that goes on inside a person’s head.
It marks a transition. Clients typically begin with “I am not sure I can this” or “This is daunting”. There is a transition where their self talk shifts. It becomes “I think something might happening. No way! I CAN do it now. It IS happening now.” In other words, it is that point where certainty aligns inside to the neurological opposite. They move from doubt to certainty. It will also cause biochemical changes with a release of dopamine. And self-talk and feelings lead to action.
Coaches look to structure opportunities for a sense of certainty and resilience. They create a strong sense of expectation (placebo effect) and frames of reference and opportunities (priming).
A placebo effect is a “meaning response”.
Typically, clients have become certain of a limitation or block. So it is important to get them to a point of certainty where they internalise “I can do it”. Without self-efficacy, no change is likely to happen. No action. No attempt at changing things.
Mastering the art of framing primes for certainty inherent in the placebo effect. If the placebo effect can cause a person not to feel pain, notice pain or increase oxygen saturation, imagine what it can do for a client. Our job is to create the context, or set of frames, for them to begin to internalise a new expectation. This occurs through the full range of unconscious communication:
tonality
behaviour
body language
language
questions
words
Your very being helps prime them for that moment where certainty kicks in. At that moment, the amygdala in their brain is triggered and their self-talk — their very being — changes. What this metaphor highlights is the effect of context and nonverbal communication. Your expectations as a coach and communicator affect other people.
It is not so much that people are being tricked as a deeper part of their psyche and their brain chemistry makes that shift to “I can do this.” When that is aligned with values, motivation and purpose clients become more empowered.
The key to priming placebos is to create a context of psychological safety, kindness, listening, and feeling heard. Ask questions in the right way, while observing your client. The metaphor of priming placebos makes coaching conversations more effective. It helps important ideas to be “sticky” long enough for change to occur.
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