The Secret Role of Hope in Psychotherapy

512px-Moon_in_Sunrise_Sky

I am always amused when a TV pitchman offers to sell a secret “they won’t tell you about,” promising to make you a million dollars. Well, the “secret” I’m about to disclose is something rarely discussed, but not intentionally hidden: a form of hope. This type of optimism, however, is not what most imagine when they think of such words.

The standard well-acknowledged place of hope in therapy is for the therapist to communicate that the future can be better. His authority and experience are implied and therefore increase the chance of belief in him. They tell the patient, in effect, “I’ve seen others recover. People can overcome depression and anxiety. This is also possible for you.”

For some of his clients, however, his cradling of hope takes an additional form. Too many of us live in a psychological concrete canyon, like ones found in the narrow avenues bordered by tall buildings in major cities. We cannot witness what is behind these skyscrapers, nor a sunrise that is the gift of the horizon. Less metaphorically, we cannot recognize what role we might occupy in the world, beyond filling an unsatisfying, modest or disadvantaged place similar to those in our past. Dr. Seuss gave this encouragement:

You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose. You’re on your own. And you know what you know. And YOU are the one who’ll decide where to go…

Oh the places you’ll go! There is fun to be done! There are points to be scored. There are games to be won. And the magical things you can do with that ball will make you the winning-est winner of all.”

This is not meant to be fanciful. As one of the founders of the Zeolite Scholarship Fund at an inner-city public high school in Chicago, my friends and I met too many youngsters who, by age 16, couldn’t imagine themselves achieving a life past what was available in a dead-end community. For some, a hopeful future died aborning. Imagination died, as well.

A therapist faces this, too, in the blinkered vision — the crumpled expectation — of the person sitting opposite him. His patient might not be able to conceive of a different, more adventurous life of high level skill, romantic abandon, achievement, and abundance. He is, in a sense, like a child who hears early she can be President of the United States, but discovers this has never happened — not yet anyway —  in the USA’s 240-year history and therefore crosses off the goal. Yes, some individuals periscope beyond the concrete canyon, their parents’ bleak lives, and their country’s prejudice without a counselor’s help. Yet others need their therapist’s belief to develop an x-ray vision piercing invisible barriers, the walls so taken-for-granted one might not even be aware of them.

Hope of this kind is not simply founded in the counselor’s confidence you can overcome symptoms. Rather, it is aspirational — the hope beyond hope to a world of possibility your peers laugh at if you are one of the 16-year-olds I mentioned.  For those who never beamed at a respected person’s consistent belief in them before, the words come as a revelation.

Therapy is an enterprise driven by heartbreak in the direction of hope. “I’ll try anything,” you say to yourself, “even this.” Usually, however, the wish is to remove the negatives, not obtain a sense of fulfillment in life. Make no mistake. The two may not be mutually exclusive. Envisioning a future worth living is more than encouragement to wellness, but a step toward it.

What Robert Kennedy said on several occasions applies no less to changing the world than changing ourselves:

Some men see things as they are and say why.

I dream things that never were and say why not.

 The top photo by Jessie Eastland is described as 72 Seconds Before Actual Sunrise, Southern California, USA. It comes from Wikimedia Commons.

9 thoughts on “The Secret Role of Hope in Psychotherapy

  1. Hope is an essential contribution to the success of any therapeutic endeavour, its hard to see any accomplishment without it. But for hope to really have any power in a persons life it must be backed up by proof and truth, it cant be a simple platitude. I’ve had people tell me I’ll get through it but when asked how I’m going to get through they say they don’t know or because I’m a strong person. That’s not effective enough especially when I cant see any more what to do. The therapist needs to hold the hope with confidence for the times when I can’t. It’s also hard to hold hope when along your journey you see others fail or give up and fall by the wayside for hardships less than your own (in saying that I’m not trying to minimise any persons hardship) and also your own failed previous attempts. Belief in a person’s strength and ability isn’t enough, you need to have the techniques and strategies that the patient needs to learn and become skilled at. For someone to dream of the possibilities of a happy and fullfilled life they need to fly on the wind of a real hope based on educated truth and someone holding a clear path of how to get there.
    Its a big ask of a therapist but when such a therapist is found they are worth their wieght in gold and diamonds.

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    • Well said, Claire. Therapists do need to come with more than a Pollyanna attitude, one which discredits them to a patient who knows better. And, as I’ve noted before, the number of empirically validated treatments is growing. As to the comparisons with those whose burden is smaller, I think making those comparisons is part of the problem. It would be like an excellent football (American soccer) player feeling himself a failure because he was not Pele’ or David Beckham.

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  2. They tell the patient, in effect, “I’ve seen others recover. People can overcome depression and anxiety. This is also possible for you.”

    Hope and depression are mutually exclusive; they do not live side by side. Depression erases every ounce of hope from the landscape. Depression can well be defined as “hopelessness”. Knowing, or being told by a therapist, who is well aware that others have gotten better and have recovered from depression, offers no solace to someone who does not believe THEY will improve. Most wouldn’t be in therapy if they hadn’t already tried to wish (and hope) their way out of their personal darkness. There has to be something more concrete than “hope” that a therapist can offer to help a person recapture some small aspect of their former life which enables them to climb out of their despair. I’m not sure that “hope” is the way out. When you “hope” (the verb) then all “hope” (the noun) really becomes impossible since the verb prevents action and leaves one with nothing but a wish that gets you nowhere.

    “The tragedy of life is what dies inside a man while he lives” (Albert Schweitzer). It is the “hope” that dies. The “hope” of therapy is that something else inside a person can take the place of that dead hope.

    One last thought, therapy dictates that you “live in the present”, but hope usually has to do with the future. If you live in hope, you are wishing away today for some kind of magical tomorrow that very rarely comes.

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    • There is a difference between having some, albeit not very much, hope and being hopeless. The people who come voluntarily to treatment are not without a reason to live, even if the light that comes from that candle is sometimes dim. People stay alive for their children, for dead relatives, to fight for an idea, to keep their self-respect, etc. In this piece I was writing about a therapist’s hope of a very particular kind: a vision of what might yet be possible for his patient in the way of surpassing his expectations for his life. As I mentioned to Claire, to see what is yet possible for your client must be more than being Pollyanna. If your patient is 40-years-old and a grade-school dropout, the therapist knows the Presidency isn’t in the cards. As to living in the present, do not take it completely literally. Otherwise, you won’t get to work on-time tomorrow! Thanks for your comment, Brewdun.

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  3. First of all, Dr. Stein, I love the colors of the sunrise and sunset. Each day begins and end in glory.

    Thank you for another inspiring and informative post. Hope, as you point out, is that “secret ingredient” that can make all the difference in moving forward towards a better life. For me, such hope has to be taken in daily doses. One day at a time. Escaping that “concrete canyon” of our limitations, self-imposed or otherwise, requires daily engagement of all of our internal forces. Hope is a vital ingredient.

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  4. Glad you liked the photo, Rosaliene, and thanks for your praise. If one hopes for an appropriate thing and is willing to work, then much is possible.

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  5. morning Dr G

    you mentioned above the claustrophobic cement cage of towering buildings that cast paranoid shadows over the pavement so you end up stumbling down dead ends and beating your fists on unscalable walls – so you just sink down and read the graffiti instead

    maybe add some of your own instead

    but you don’t mention that many of those concrete canyon buildings are bombed out shells, huge craters spewing up mountains of rubble and you don’t mention that it’s not just a walk down this canyon on a nice paved road, it’s an endless crawling and climbing and exhaustive battle, fingernail shredding, concrete chunk by concrete chunk climb out of the craters and over yet another pile of rubble

    and those concrete buildings have faces that mock and shame and belittle and judge and tell you it’s not possible and those rubble piles have word memories written all over them and you just have to stop and read and you get lost – you never mention the lostness, the aloneness, the greyness of all that concrete

    this is what I wrote one day when the crater got too deep…

    today is not a day for love…

    just sometimes, an arbitrary day chosen by fickleness, just sometimes you get to re-boot your internal processors, your hard drive of x-rated porn experiences

    no-one is letting you press the delete button, why should they allow it, allow you to live pain free, it’s not allowed

    but they do allow you, just once, to make a u-turn in that cul-de-sac alley and let you shuffle out, if you remember how

    if you are lion enough to stroll past the junkie needles, yesterday’s coffee highs, tragedies painted in an achingly raw black and white, the stench of hopeless, kicking through broken bottles like your mind

    no-one cares and if they do you’ve already slashed through their faces so that their souls hang out, their love touch burns like acid through your skin and pools and decays in the depths below the sewer line

    inhaling the stench of alonenes you kick down and smash the sandcastles you built with such childish enthusiasm, you rip skin from bone to release the torment, your mind a receptacle of fire ant chaos

    today is not a day for love

    today is a barbed wire present bulging with the lost, the tormented, the amputated, the wind strewn debris swept along the paving stones chiseled out of the coagulated, petrified remains of your resolve, today is not a day for re-booting or for cul-de-sacs

    today is not a day for love…

    but you do mention the hope – it’s doesn’t run river-like all over the grey and colour in the spaces – it’s more like a single daisy, growing madly, tenaciously, unstoppable through a crack in all that concrete – it somehow finds the nourishment, the soil, the water to survive and it’s the only yellow stain of colour in all the grey – what you don’t mention above is that the journey to find that tiny, little yellow daisy is just as painful, skin shredding, hopeless, hungry, needy, exhaustive as the the journey you’ve just abandoned trying to get out on your own

    and you don’t mention the voracious need to rip that daisy out of the ground and crush it to you trying to infuse the yellow from the crushed petals into your soul – so many of us do that with tiny shreds of hope – we kill it, ambush it as soon as we find it

    what you don’t mention above is that it takes every ounce of willpower to just sit down and look at that daisy, that it is our tears that waters it, the stories from the deepest depths of our souls that give that daisy the food it needs to grow

    you mention the therapist that waits patiently holding out the daisy hope, and yes Like Dr Seuss describes ( I just love him to bits don’t you?) we have all the means at our disposal to reach out and take the daisy hope and move on and forwards and upwards, but it’s hard to see just one tiny daisy in all that grey, it takes couraging and changing and so much more hauling ourselves out of craters and over rubble heaps but it’s all that and more and digging deep and flinging about our emotional compost that one day as we sit vagrant like on the pavement, next to that one tiny daisy, we look up and see an entire daisy field dancing in the wind

    it takes patience, all those painful, I don’t want to be here I’m cancelling minutes of sitting in the pavement like safe space of a therapist’s room, waiting, not cancelling sessions, doing the hard work of crater climbing and rubble mountaineering, sitting in silence, watching one single daisy that tells you one day it will be different, you will be different, it does work, those agonizing minutes waiting for the daisies to grow

    thank you for being a daisy Dr G – going to go thank my psychologist for being a daisy too

    huggz, Rosie

    On Sun, Sep 4, 2016 at 2:00 AM, Dr. Gerald Stein – Blogging About Psychotherapy from Chicago wrote:

    > drgeraldstein posted: ” I am always amused when a TV pitchman offers to > sell a secret “they won’t tell you about,” promising to make you a million > dollars. Well, the “secret” I’m about to disclose is something rarely > discussed, but not intentionally hidden: a form of hope. Thi” >

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    • I didn’t say it, Rosie, because I lacked your linguistic gift and your experience. Happily, you added what I couldn’t say — what wasn’t in me to say. Your writing is dazzling. Thanks for allowing me to read it and for your praise.

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    • Rosie what a gift you have just given to those of us who are trying to wade through our own concrete mess.
      We feel so alone in this insurmountable journey but sometimes when we look up and see the field of daisies we also see some one in the distance waving at you from their concrete mess. Thank you for taking the aloneness away. That gives me hope to.💔💔

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