Take a good look at the photo to the left.

Do you know this person?

His name is Myron L. Fox, M.D., a graduate of the Albert Einstein School of Medicine.

Still doesn’t ring a bell?

At one point, he was the one of the highest rated presenters on the continuing education circuit for physicians, psychologists, social workers, and educators.  He delivered hour long lectures followed by 30 minutes of Q & A at major universities.  Among other topics, he spoke about the biochemistry of memory.  Those in attendance routinely described his lectures as “outstanding,” “stimulating,” “thought provoking,” and “clear and well organized.”

Only one wrinkle.  Dr. Fox was not a physician.  He wasn’t a doctor of any kind.  Neither was his name Myron Fox.  In fact, he really knew nothing about the subjects on which he spoke.  Rather, the man in the photo was a paid actor coached by a group of experimenters to present a lecture full of “double-talk, neologisms, non sequiturs, and contradictory statements” in one of two ways: straightforward or entertaining.

No surprise, in the first instance, the participants learned less and performed more poorly on a subsequent test than those who attended a similar lecture delivered by a real scientist.   However, when “Dr. Fox” adopted a lively demeanor, used humor, and displayed warmth toward and interest in his audience, any correlation between the content covered and audience ratings of the experience disappeared.   Indeed, so potent was his style, it masked a completely “meaningless, jargon-filled, and confused presentation” (Merritt, 2008).

The study has been replicated many times with similar results.   Even when participants are warned ahead of time to be on guard, the “Dr. Fox Effect” — as it has come to be known — remains in force.  Over the years, the findings have been cited as evidence against using speaker and student ratings to evaluate teachers and lecturers.  By contrast, I’ve always thought the study showed how important engagement was to effective teaching.  After all, in all versions of the study, participants exposed to entertaining versions of lectures scored more highly on subsequent knowledge tests than those hearing material presented in a “straightforward” manner.

It’s why the International Center for Clinical Excellence offers a course called, the “Training of Trainers” as part of their certification process.  Knowing that WHO you present is just as critical as WHAT, this three-day, evidence-based, bootcamp style workshop is specifically designed to help you become a better presenter/trainer, one that builds on your style and persona.  You can check out when the next “TOT” will be held on the ICCE Eventbrite page.

My family and I had a frightening experience this past Memorial Day.  While driving through Indiana on the way home to Chicago, our mobile phones began to alert.  You know the sound — part cicada, part microphone feedback, but louder.  

“Tornado warning in this area.”

Not a watch, mind you, a warning.  The difference is critical.  A watch means conditions are favorable for a tornado.  A warning means, IT’S HERE!

Looking ahead, we could see the dark, fast moving clouds.  No rotation, but menacing nonetheless.  That’s when our phones screeched the warning again.

“Take shelter now.  Check local media.”

Turning on the radio, we listened to the weather broadcast, distorted by the now abundant flashes of lightening.  We quickly learned we were heading directly into the affected area.

“What do we do?” I muttered to myself.   Cars and trucks were already pulling to the side, taking up positions under overpasses.  A few had become stuck while attempting to turn around in the already flooded ditch separating the two directions.

“Check Google maps to see where we can get off,” I barked.  I knew from prior experience that sheltering under overpasses was a bad idea.   We had to get off or risk having the Tornado hit us head on.  Problem was we were on the tollway where exits are few and far between.

“Two miles to the next exit,” my son soon replied.

That’s when we first saw it.  The clouds rotating overhead, a conical shape beginning to push downward.

Once more, our phones alerted: Take shelter now.  With my adrenaline pumping, and no other way to go but forward, I pushed on the accelerator.

Thankfully, we made it to the exit, racing northward up a country road at 85 miles-an-hour to escape the storm.  Ten or twelve minutes later, we spied a small gas station and pulled into the lot.  It was pouring rain, alternating with hail.  The sense of relief was palpable nonetheless.

Once the danger had passed, we resumed our journey.  The cabin of the car now quiet, I began running the experience over and over in my mind.  Something about it really bugged me, in particular the warnings and advice we’d received via our mobile phones and from the media.  It was clear, to be sure.  At the same time, it was absolutely unhelpful.  Yes, we were grateful for the warning.  And, of course, it was a good idea to seek shelter.  But where and how?  Absent more concrete direction, the result was people either panicked (like us) or made poor, even dangerous choices (e.g., sheltering under overpasses instead of laying in a ditch).

We have a similar problem in the field of mental health.  Google “advice and psychotherapy” and you get roughly 6 million hits many, if not most, of which are negative.  “The best advice a therapist could get,” one prominent site counsels, is “Stop giving advice.”  Another warns, telling people how to solve their problems, is “counterproductive” and potentially unethical.  A variety of reasons are given — largely having to do with the assumed nature of therapy (i.e., helping people help themselves) or client resistance to such help.

But do clients agree with such sentiments?  Until recently, no one had bothered to ask.  Now, a newly published study provides some provocative answers.  Researchers Cooper, Norcross, Raymond-Barker, and Hogan surveyed therapists and clients about their preferences, finding large and robust differences between the two groups.  Therapists, on average, preferred more emotional intensity and less directiveness.  Their clients?  The reverse!   The researcher’s advise to practitioners?  One page one of the peer reviewed article: Stop projecting your own desires onto the people you treat.

“Easier said than done” says lead author, Professor Mick Cooper.  I had the chance to speak with him about the study.  The interview provides direction for putting these importance findings into practice.

It was a curious finding.  One we stumbled on quite by accident.  Highly effective therapists were more likely to contact their clients between visits than their more average peers.  We wondered whether such behavior might account, at least in part, for their superior retention rates and outcomes?

Turns out, our serendipitous finding fit nicely with results from the field of behavioral economics documenting how very simple actions can have a dramatic impact on people’s behavior.   In one well known example, a study showed the way food is displayed in school cafeterias –it’s location and prominence–significantly impacts whether students make healthy or unhealthy eating choices.  Similar results have been recorded in other areas, such as saving for retirement, choosing the best health insurance plan, deciding whether to exercise or make positive lifestyle changes.

In all cases, the “nudge” –as researchers call such interventions — are simple, inexpensive, and require little time and effort to deliver.  A recent report in The Chronicle of Higher Education found, for example, a single email expressing compassion and support to students who had failed their first semester exam led to better classroom performance and less school drop out.  And since our original discovery, psychotherapy researchers have confirmed what highly effective practitioners have known all along.  The study by Flükiger, Del Re, Wampold, Znoj, Caspar, and Jörg found that clients who were sent a brief letter and had one follow up call between visits experienced significant and lasting improvements in the quality of the therapeutic relationship over the course of care.

Clearly, a little can go a long way.  But where to start?

It would be wrong to conclude that we should start phoning (or sending emails) to all of our clients between visits.  The research cited above and findings from our interviews with highly effective therapists show, to be effective, therapeutic nudges must interrupt “business-as-usual.”  The default choice for most practitioners is not to engage in extratherapeutic contact with clients.  We are busy enough and reaching out crosses a boundary.  Additionally, and importantly, any such efforts need to show our interest in the client while simultaneously leaving them free not to comply.  Simply put, nudges can not be shoves.  

Evidence shows using simple measurement scales on an ongoing basis to  assess progress and the quality of the therapeutic relationship can augment our ability to identify and time these types of interventions.  Indeed, as I posted last week, clients whose therapists do so are less likely to dropout and 2.5 times more like to experience benefit from treatment.   Actually, 10’s of thousands of clinicians around the world are using the tools I created nearly 20 years ago to inform their work.  If you aren’t, click here to download them for free.