Some time ago I badly offended and upset a participant on a four-day foundation programme in SF practice. And I really didn’t see it coming. I was talking about the placebo effect. I guess that I wasn’t thinking too hard about what I was saying since it had not occurred to me that anything that I was saying could be seen as controversial or as ‘sensitive’. I truly assumed that the whole group would accept what I was saying as ‘taken-for-granted’, nothing new. And what I was talking about was increasing the effectiveness of psychotropic medication by making the most of the placebo effect that, I stated, is a part of the effect of pretty well every drug, by asking Solution Focused questions. While I was giving an example of what I thought was a useful question this particular participant responded angrily, disagreeing with me and obviously offended and very upset.
Somewhat surprised I may not have responded particularly well, continuing to press my point with the support of a number of relevant, and to me, rather amusing examples taken from the body of research evidence. This approach, hardly surprisingly, did not work and the participant far from being convinced increasingly withdrew from the programme and did not attend the final two days. I still feel embarrassed and ashamed.
However this uncomfortable story returned to my mind this week when I read an article in the Guardian entitled ‘Many common operations may be unnecessary, say researchers’, by Hannah Devlin, Science Correspondent. Reporting the research and the thinking of Professor Andy Carr ‘an orthopaedic surgeon at Oxford University Hospitals’, she claimed that the prime therapeutic effect of some operations may have nothing to do with the actual ‘physical’ intervention and everything to do with a ‘placebo effect’. She then cites Prof Irene Tracey ‘a specialist in the neural basis of pain’, saying ‘there (is) a common fallacy that the placebo effect (is) about “deception and fakery”. (Tracey’s) research (shows) expectation can hijack brain systems involved in pain perception and produce physiological effects. “We have to recognise that expectation is a completely normal part of our treatment . . . In the modern world where we’re trying to limit the amount of time physicians spend with patients we’re going in the opposite direction of what the science is telling us, which is that (expectation) is really important”.
The participant on my course was angry that I was somehow undermining medication, demeaning or attacking or devaluing something that she knew in her experience had made a huge difference in the lives of so many of the patients for whom she clearly cared deeply and to whose welfare she was completely committed. I thought that I was merely trying to make ‘medication’ even more useful to her patients and yet my attempts to argue my case seemed increasingly to convince her that I thought that medication was all about the self-same ‘deception and fakery’ that so many associate with the ‘placebo effect’ itself.
Leaving that unhappy episode aside I suspect that one of the huge advantages of SFBT is the way that it harnesses the power of expectation, the placebo effect. As we ask our questions, questions which shift the client’s habitual patterns of attention, we invite the client to focus on those things which fit with the inevitable logic, with the inevitability of change and progress. We invite the client to expect progress and the research which points us to the association between the client’s expectation and outcome is, I believe, well-established. I sometimes still show a piece of work with a reconstituted family, a family that has been through tough times. At the end of the session as the father stands up he punches the air and says ‘we can do it, we can do it’. I always point out that this does not happen by chance. The worker has to work hard for the client to leave the session expecting that change is not only possible but likely if not indeed inevitable but the Solution Focused approach makes it easier!
‘Many common operations may be unnecessary, say researchers’. Hannah Devlin Guardian Monday 12th June 2017