Enhancing Hope in Psychotherapy

The enhancement of personal hope is a key part of successful psychotherapy practice. Some view this requirement as a foundational aspect of the therapeutic alliance; others do not hold the same view.  In the case of serious co-occurring disorders, especially trauma and substance misuse, initiating, developing, and sustaining a hopeful future-view is highly important in client motivation and faith in beneficial change. In the client’s personal world of hopelessness (possibly helplessness), pain and suffering, a common expectation is that this “hell realm” will not end.  Therefore, to enhance hope in the intersubjective space of psychotherapy, therapists need to implement certain on-going hope-based strategic interventions.  Here is a list to consider.  Do you routinely do these things in your sessions?

1. Be highly mindful of maintaining a strong therapeutic alliance, and counteracting our own conscious countertransference. To understand your unconscious countertransference, mindfully notice your emotional and behavioral reactions to your clients.
2. In gentle and hearable ways, reframe psychological suffering as challenges and possible opportunities for creative experimentation. Use of metaphors may be helpful.
3. The reality that suffering and non-suffering are both aspects of the same consciousness may be helpful here. Gently encourage the client to practice being more conscious of times when suffering may be less dominant and, especially, any times when it is non-existent in consciousness.
4. Promote positive self-understanding through careful uses of attachment history and the client’s pros/cons of their attachment experiences with parents/care-takers, etc.
5. Help the client understand the nature of their suffering.  Some of it may be based on their attachment history, and some of it may be based on their habitual habits in life – as ways to escape/improve the outcomes of their attachment history. Often self-medication is an example of self-defeating behavior in the client’s effort to improve the moment.
6. Maintain a positive presentation of healing from suffering; do so without making any promises you cannot keep.
7. Reinforce and celebrate concrete symptom reduction as experiential episodes of self over suffering. The augmented identity of a “healing self” is important here.
8. Teach and practice in-session various intervention skills for stress reduction. Mindfulness-based stress reduction is a good starting point. Use SUDs scores (0-100) for changes in levels of suffering/stress reactivity as the client learns and uses these skills. The scores should go down! Celebrate positive improvements.
9. Be a model for paying attention to positives – any small significant “difference that makes a difference” in one’s personal experience of suffering.
10. Cooperate openly in-session with the client to foster positive expectancy (some placebo here) about any and all improvements in the present moment.  Help to extend these practices/experiences into the client’s life beyond their therapy time. Admittedly, this is difficult to do.
11. Specific mindfulness-based practices have been shown (when practiced regularly) to improve emotion regulation (reduce reactivity) and open up sense-doorways to pleasant bodily experiences – even more happiness. Learn and practice forms of self-regulated calm breathing, brief meditation, yoga or stretches, tai chi, qi gong, and walking meditation as part of your hope-enhancing practice. Note and discuss any client responses to practice that may enhance hopefulness.
12. Guide clients with guarded optimism. Practicing the above-noted interventions and skills may produce inner, more intrinsic, self-healing. Enhanced HOPE is our target.
13. For most (not all) psychotherapists, using cognitive-behavioral therapy may be the most common approach to integrate hopefulness into clinical practice.
14. If you consider yourself an advanced psychotherapist, you may want to take each area of my CABS-VAKGO-IS-Rels system and practice your own creative hopeful interventions for each area of human processing.  Note: CABs = cognition, affect, behavior – sensory-based; VAKGO = visual, auditory, kinesthetic, gustatory, and olfactory sensory processing – all sense doors that may be opened via hopefulness interventions.  CABs-VAKGO-IS-Rels mechanisms operate in past, present, and future orientations. Use intuition and spirituality when possible and appropriate. And, keep in mind that all these human functioning pathways operate in a relational sphere of being. These are complex formats for psychotherapy. Outcomes are worth the effort.

For more information refer to Briere, J. N. and Scott, C. (2015 End.). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Washington, DC: SAGE Publications, pp. 101-102. See also Quintiliani, A. R. (2014). Mindful Happiness…Shelburne, VT: Red Barn Books, pp. 3-9, 20-34,  75-81.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

New Edition of Mindful Happiness in Production…Coming soon!