How to Win Friends & Influence People

A seventy year old sales manual is not an obvious first choice for a therapist's bookshelf, but this is no ordinary sales manual. How to Win Friends & Influence People offers ways to make people like you, to win people to your way of thinking and to change people without giving offence or arousing resentment, achievements as useful to therapists and our clients as to salespeople.

Written in 1936 by Dale Carnegie, a public speaking coach, the book summarises twenty years of training courses and advice for salespeople and their managers. The language of the book is very much of its time, as are the examples Carnegie uses to illustrate his points (you will learn more about US presidents and 1930's gangsters than you ever wanted to know!), but the core messages are timeless.

Carnegie argues that successful outcomes arise from positive relationships, much as Carl Rogers (father of counselling) believed that unconditional positive regard for the client was an essential part of effective therapy.

Carnegie argues that successful outcomes have their roots in collaboration, much as Hubble, Duncan & Miller have identified that the rapport between therapist & client contributes as much to the outcome of therapy as the therapist's technique and apparent expertise combined.

Carnegie's message has been parodied and criticised as "Learn to be sincere...even if you have to fake it". How to Win Friends & Influence People has been characterised as a textbook for manipulation, not surprisingly for a sales manual. Throughout the book, Carnegie emphasises that the compliments, perspective taking and disclosures he recommends should be genuine attempts to achieve mutual benefit (whether closing a major contract or buying a train ticket), although the techniques could easily be applied cynically.

This emphasis upon shared benefit has a useful spin-off. Many of my clients with low self esteem and low social confidence have found traditional assertiveness books and courses too strident in their claims to "help you get what you want". Carnegie's emphasis on win-win interactions has proved much more attractive and effective.

Reference

Carnegie, D (1981) How to Win Friends and Influence People. Cedar: London.

Change occurs outwith therapy

Therapeutic change is due more to factors outwith therapy than any one aspect of therapy. Factors outwith the session are at least as important as our rapport with our clients and much more important than our years of experience or the technique we're using.

The myth of therapy is that it is done by therapists to patients and that the outcome is a measure of the therapist or of the technique employed, not of the client (unless, of course, the client is "resistant" or "non-compliant", in which case the outcome is very definitely attributed to them!).

The myth of therapy is perpetuated by research focusing upon the outcome of a given intervention on a given condition, where the therapist is merely a vessel for delivery of the treatment and the client is an interchangeable recipient of said treatment.

Research exploring common patterns across therapies and conditions has identified four factors which together determine the outcome.

• The technique employed by the therapist: 15%

• The rapport between therapist and client: 30%

• Events outwith therapy, over which the therapist has no control: 40%

• The expectations of the client, based in part upon the apparent expertise of the therapist: 15%

The reality of therapy is that the therapist has direct control over less than a fifth of the variation in outcome and is involved in less than two thirds of said variation. While technique is important, much more important is the therapist's manner and engagement with the client.

Reference

Hubble MA, Duncan BL & Miller SD (1999) The Heart & Soul of Change. American Psychological Association: Washington.

How will you know you're a better therapist?

Solution-Oriented therapists ask clients how they will know when they are better. Therapists often wish to be better in their role, but few ask the Miracle Question of themselves.

Solution-Oriented therapists often ask clients the Miracle Question:

Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? (de Shazer, 1988)

Stressed therapists might be asked a similar question:

Suppose that tonight, while you are asleep, there is a miracle and you become a better therapist. How will you know that this has happened? What will you notice has changed about the way you're working?

I've asked this question many times, of my self and of others. The answers tend to be much the same.

• Every intervention I make in therapy will work
• My clients will never try to manipulate me
• I will always be available for my clients whenever they want me
• Nothing I say will ever upset my clients
• All my clients will get better all the time
• My clients will be grateful for the help I've given them
• My clients will co-operate with my therapeutic strategies
• If I see a problem, I will be able to address it and solve it
• I will always know what to do in any situation arising in therapy
• I will not feel frustrated, angry or anxious during therapy sessions

If our clients gave such unrealistic answers, we would renegotiate more practical, achievable goals. How will you know when you're a better therapist?

Disclosure is promoted by permission not to speak

Giving clients permission not to speak encourages disclosure. Explicitly granting the freedom to subvert our power frees the client to tell us what they need.

The first time is to check out the therapist, the second is to tell you the real problem.

I was given this advice in training and for years it seemed to be true. Now, in my practice at least, it is the exception rather than the rule.

The balance of power in therapy lies with the therapist. We decide when, where and for how long is each appointment. We set the boundaries and grant exceptions. The client must work within our framework.

Clients can exercise control by withholding information or themselves. Failure to attend is the ultimate means of regaining control of therapy. More subtly, the client can, without overtly challenging the therapist, keep back important facts for as long as they choose.

Full disclosure can occur in the first appointment if the client has permission to withhold. I tell clients "if there are any questions you don't feel comfortable answering, that's OK". It is now rare for clients to surprise me in the second appointment (unless I forget my line).

The underlying process may be that, having been given permission to withhold, the client can now exercise control by disobeying you...and telling all. This appears manipulative but this accusation would be genuine only if the permission to withhold were false, given only to manoeuvre the client rather than arising from a genuine respect for their privacy.

Eye contact tells you when to speak

Steady eye contact from a client is your prompt to speak. Attending to eye contact helps us to minimise interruptions of the client's train of thought and to be more comfortable with silences.

In 1:1 conversation we spend 50% of our time looking at the other person. It is important to remember that this is an average across two distinct roles: speaker and listener.

When listening, we look for 50-90% of the time. We can see expressions and gestures, the non-verbal modulators of the spoken word. More importantly, we can see if the other person shows signs of finishing, so that we can have our turn.

When speaking, we look from 10-50% of the time. We need to know that the other person is listening, but we can reassure ourselves of this with a quick glance. When we have the floor, it is more useful to look away from the other person, minimising distractions from our train of thought.

It is difficult to be sure when someone has finished speaking. A pause may be for reflection or may be the signal that you have the floor. In ordinary conversation between equals, interruptions are inconsequential, easily remedied in the to & fro of the chat.

Interruption by a therapist can discourage a disclosure. A client who has stopped speaking may be awaiting a response or marshalling their thoughts. Speaking just as the client is about to can distract at best; at worst, it can be taken to mean that the forthcoming disclosure was unwelcome or irrelevant.

You will know it is your turn to speak when they look steadily at you. A quick glance need only be to check that you are still listening. A steady gaze indicates that a reply is now expected.