Hope: A Foundation of All Psychotherapy That Works

Most of us have heard the phrase, “Don’t open Pandora’s box." Following the ancient Greek myth, Zeus offered a jar (or box) as a gift never to be opened. Curiosity overwhelmed Pandora, who opened the container and released sickness, death, and related evils on the world, never to be recaptured.

This is the feeling of many who enter therapy. They seem to have opened “a can of worms," a Pandora’s box, with little hope of putting things back to right, despite their best efforts.

However, what most of us don’t recall is that there was one thing left in Pandora’s box, and that was Hope. Hope in the face of adversity remains a constant inspiration and motivator for us. Alexander Pope turned the phrase, “Hope springs eternal in the human breast." But, does it?

Hope vs. Demoralization

Jerome Frank (Frank & Frank, 1991), in his classic work, Persuasion and Healing, argues that demoralization is at the core of all psychological problems. Frank argues that it is demoralization that ultimately brings clients for treatment, not the emotional problem or its failed cycle of solutions per se.

In other words, “…people seek help not in response to the symptoms themselves but because their efforts to cope with the symptoms have failed” (Frank & Frank, 1991, p. 38). So, if Frank is right, the lack of hope is common to all clients seeking treatment. They are losing hope—lost in the downward cycle of their dilemmas.

The Hopelessness Scale

The Beck Hopelessness Scale, designed by psychiatrist Aaron T. Beck, is a 20-item, true-false scale measuring a person’s attitudes from the previous week. It is designed to measure three elements of hopelessness, including feelings about the future, loss of motivation, and expectations.

Combined with Beck’s Depression Scale, it has been used as a reasonable measure of clients’ degree of depression and suicidality, as well as to measure improvement in psychotherapy. It’s not surprising that clients typically enter treatment with higher hopelessness scores, and complete treatment with lower scores through the return of hope.

Defining Hope

Zen master Thich Nhat Hanh has said, “Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today."

The American political journalist, author, and professor Norman Cousins, who famously cured himself from a painful and debilitating affliction through laughter, has said, “The capacity for hope is the most significant fact of life. It provides human beings with a sense of destination and the energy to get started.”

Both of these positions on hope are significant for psychotherapy. The capacity for resilience in the face of hardship, and the energy to move in a direction to resolve those challenges are highly correlated with successful living and successful psychotherapy. But, how might we further define this often ethereal quality we call hope?

The Three Aspects of Hope

Although the term hope may sound ethereal, cognitive theorists (Snyder, et., al., 1999) have begun defining hope as a function of pathways and agency thinking. Pathways thinking relates to a client’s belief that she or he knows how to achieve a goal, once the problem has been made clear. Agency thinking involves the client’s belief that he or she is capable of achieving that goal, and has the energy to do it. Yet, how does this happen in psychotherapy? From this perspective, there are three interrelated aspects of hope:

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• A Frame or Rationale. The first aspect is an explanation of the problem that makes sense to the client and therapist.
• A Direction. The second aspect flows from the first in that the frame or explanation points to a direction for resolution.
• Energy. The final aspect is engaging one's values and energy to go in the direction of resolution.

In essence, all therapies that work offer a frame, rationale, or explanation of clients’ problems, that implies a direction for resolution, and engages clients’ energy to go that way. In a nutshell, they build a framework of hope, and hope is highly correlated with success in therapy.

The Three Parts of Hope

Source: Personal PowerPoint Slide

Goals and Hope

So, a major task of all effective psychotherapies is linking with clients, understanding their problem from their perspective, and fitting a frame or rationale to explain the problem that makes sense to both the client and therapist. This is the first step in building hope and collaborating on agreed upon goals.

Through understanding the problem and establishing mutually agreed upon goals, the client’s vision of a more desirable future is crystallized. If the client-therapist generated goal(s) seems reasonable to the client, then hope is born about the possibilities of achieving it.

Not surprisingly, from literature reviews, the more that clients and therapists agree on goals, actively engage in therapy, and are collaboratively involved in the process of treatment, the greater client satisfaction and the more positive outcomes are to be found (Tryon and Winograd, 2002). Hope may not spring eternal, but it invariably evolves in therapies that work.

Hope’s Debt to Frames and Rationales

Finally, if the first aspect of building hope in psychotherapy is a frame or rationale that makes sense to the client and therapist, then finding fitting frames and rationales for treatment is crucial to building hope and success in treatment.

Yet, there are so many approaches to psychotherapy—and each has their basic framework for how problems develop, and their rationale for treatment. Finding the best match between the therapist’s approaches to therapy, their expertise, and fitting it with clients is a key to hope and subsequently success in psychotherapy. In future posts, we will visit the relationship of what the literature now calls flexibility and fit to both hope and treatment success.

Building Hope in Psychotherapy

Hope is not ethereal. Successful therapy deliberately builds hope with the three aspects of a fitting frame, a clear direction, and the energy to go there—to achieve agreed-upon goals.

For now, let’s remember that hope is what remained in Pandora’s box. Successful psychotherapy reopens that box as clients and therapists collaborate to build new hope for a brighter future.