The Three Keys to Change

Change or Die began as a cover story for Fast Company debunking what I called our most common "myths" about how to motivate change, especially our reliance on facts and fear. I had strong notions about what failed to promote profound change, but I still needed a guide to what really worked and why. Ultimately, the best one I found was a book, first published in 1961, called Persuasion & Healing by Jerome D. Frank, MD, who had been a professor of psychiatry at Johns Hopkins University.

That's right: Hopkins. It's sadly ironic that I could attend a prestigious conference in 2004 and hear the dean of the medical school and chief of the hospital at Hopkins bemoan that we still don't understand how to inspire people to change. The truth is that psychologists know exactly how to do it, and they've known how for a long time. The breakthrough insights sprang from research conducted half a century ago by Dr. Frank at that very institution. Frank was still alive and in his nineties when the new dean publicly revealed an ignorance of his brilliant work.

Jerome Frank ran the psychiatric outpatient clinic at the university's hospital in the 1950s. His fascinating research began with a fairly simple, small study. His team wanted to learn what really worked in psychological therapy (which literally means "mindchanging" and is better known simply as "psychotherapy"). So they decided to compare "three forms of therapy as different as we could make them," he wrote. The first method was the classic approach, made famous by Sigmund Freud himself, where the patient meets with the therapist in intensive private sessions. The second method was group therapy, a newer strategy that was just starting to attract interest at the time. It gathered a bunch of patients together for long conversations moderated by a professional. The third method was an even more experimental idea of "minimal" therapy with the patient meeting with a doctor for sessions that were unusually short (only half an hour) and infrequent (once every two weeks).

The researchers asked the patients to fill out ratings about how much the therapy had helped them overcome their symptoms, such as anxiety and distress. The therapists scored their patients' progress as well, as did independent third- party experts (social workers, who also interviewed the patients). When the numbers were added up, Frank and his Hopkins colleagues felt "astonishment and chagrin," he recalled, because the results weren't anything like what they had expected to find. It turned out that all three kinds of therapy worked just as well even though they were so different from one another. The researchers had been looking for a clear winner, but all three had won.

Frank's initial study was small and relatively crude. But in the following decades the psychology profession put an impressive amount of energy, money, time, and brainpower into studying the effectiveness of the more than four hundred different schools of psychotherapy, and the results were still the same: Every kind of psychotherapy was helpful to patients, but no particular kind was significantly more helpful than others. By the 1970s psychologists had begun calling this finding the "Do- Do Verdict," after the scene in Alice's Adventures in Wonderland where the Do-Do bird declares, "Everybody has won and all must have prizes."

But Jerome Frank had already correctly guessed this finding soon after his own initial study way back in the 1950s. Frank had the notion that the whole point of his study was wrong: What if various kinds of therapy worked because of what they had in common with one another, not what made them different? What if it was deceptive that they looked so different because they actually shared the same "active ingredients" that made them effective? If so, then what was the secret sauce in these different recipes?

The common denominator, it turned out, was that going to therapy inspired a new sense of hope for the patients--the belief and expectation that they would overcome their troubles. The key factor was the chemistry of the emotionally charged relationship formed by the patient and the therapist or the group, not the specific theories or techniques that differentiated the particular school of therapy.

Frank was interested in anthropology, and he applied these ideas not only to Western medicine and psychiatry but also to religious and shamanic healing, which he identified as psychotherapies from different cultures. The same principles also applied brilliantly in those traditions. A preacher and a congregation, a shaman and the assembled tribesmen of an Amazon village, or a therapist and a group therapy meeting could equally inspire a distressed person.