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86 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 8 Placebos You Already Use (and Could Use Even Better) Placebos (or contextual effects) derive their power from many well- studied therapeutic phenomena. Some of these include: RAPPORT • Listen • Empathize • Remember that the interaction itself can be therapeutic AUTHORITY AND TRUST • Only say things you believe • Keep appointments and agreements • Don't be afraid to say I don't know CONDITIONING • Your clients have habituated responses to all aspects of their visit to you • Keep in mind that your workspace itself has effects • Repetition, routine, and ritual can strengthen beneficial contextual responses EXPECTATION • Reassure, reframe, and educate • Practice realistic and honest optimism • Communicate that what you offer has value Further Information and Learning • Fabrizio Benedetti: Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford University Press, 2nd edition, 2014. • Brian Fulton: The Placebo Effect in Manual Therapy: Improving Clinical Outcomes in Your Practice. Handspring Publications, 2015. In other words, from this second point of view, though placebo effects may not always be physically "real," the question is, does that really matter? Isn't it sometimes enough (in fact, isn't it sometimes great) that our clients can feel better from their treatments' context and interaction alone? Or that we can leverage what we learn from placebos and contextual effects to help all our ministrations be even more effective? Both views are of course true, and necessary. "The placebo effect is the most interesting phenomenon in all of science," says Jeffrey Mogil, a McGill University pain researcher. "It's at the precise interface of biology and psychology." 13 ETHICAL PLACEBOS? This is where ethical considerations come into the conversation. One placebo-related concern is that by causing someone to feel better in the short term, or by reinforcing what some would see as too much faith in the power of belief alone, placebo-only treatment might delay or replace crucial medication, treatment, or behavior changes that could help with longer-term recovery