Making Peace with Placebo

A couple of weeks ago, while at dinner with my husband and another couple, all of whom are in the helping professions,” shared my enthusiasm about a new therapy I had recently learned which seemed to be yielding positive outcomes. Much of my clinical work, including this new method, might be categorized as energy psychology, a term used loosely to define a mind-body approach to healing. As I explained the technique, called Image Transformation Therapy, I could see the expressions of my comrades change from enthusiasm, to confusion, to disappointment. Then, the dreaded words: Well, you know, if they think it works, then it works, and thats great. Theres a lot to be said for the placebo effect.” Interpretation: Lets move on to something real. Something evidence based.

Later that evening, as I tried to move the disturbance of feeling angry, dismissed and misunderstood out of my own body, I realized they might be right, but for the wrong reasons. The placebo effect is generally understood as a positive response to a fake or sham treatment, due to a belief the treatment would work. Attributing a positive client outcome to placebo, just because we dont understand the mechanism for healing, is dismissive of the practitioner as well as of the treatment. If positive expectations account for a more positive outcome, then this would be the case whether the intervention was fake, flawed or even perfect. What is the mechanism of healing? How important is a clientreceptivity to the intervention? If someone is receptive to treatment, is it possible they are able, through any seemingly viable technique, to access their internal healing response much the way the body performs many other autonomic processes on the physiological level? The beauty of this homeostasis is that it is not necessary for us to understand how it works, because the system is self-regulating in an appropriate environment.The wisdom of the body to heal the mind is no different. Set up the appropriate environment through interventions such as CBT, DBT, exercise, diet, increased human connectedness, a loving or therapeutic relationship, healing rituals, energy psychology, etc, and if the right elements are present, then the conditions are adequate enough for the mind to heal itself.

Do we ever really know the interventions or circumstances that create just the right environment for person to be receptive to an intervention? Perhaps we are giving ourselves too much credit for our clients’ outcomes, both positive and negative, if all we are doing is setting up the conditions for clients to be able to tap into their own healing mechanisms. No matter our role, or our clients’ expectations, the healing processas well as the practitioner who set up the conditions for healing, are worthy of a celebration rather than skepticism and disregardI need to remind myself to honor how powerful and wonderful positive expectations are, not only in the treatment room, but as well in all we wish to create and hold for ourselves and for each other. So heres to the placebo effect- cheers!


Elizabeth Guarnaccia, LCSW works in private practice in Cary, where she specializes in treating trauma. She is involved on the Board of the NCSCSW as a Programs Committee member and Membership Chair.

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