A client tells you she used to look forward to Saturday mornings. She would put the radio on and spend a couple of hours in the garden. Since her partner died, she has been getting through the weekends by doing whatever needs doing and going to bed early. Her daughter keeps suggesting that she get back into the garden. “I know she means well,” she says. “I wish everyone would stop looking for signs that I’m getting better.”
It would be easy to hear the garden as something we could help her reclaim. She brought it up, and we now have something concrete to talk about. But the last thing she said tells us how it feels to be on the receiving end of other people’s hope. Before I asked another question about the garden, I’d want to understand what it has been like for her to have people watching for signs of improvement. She may be spending a fair bit of energy reassuring them, looking after their needs.
This is where I think holding hope gets interesting as clinical work. We can take seriously how little someone expects from the future and stay interested in what their life might still hold. Sometimes that interest is apparent in how we listen. Sometimes we ask a question that helps the client hear the hope that is there.
What does it mean to hold hope?
There are times when I can imagine a change that my client cannot. I might hear someone describe how different they feel around a particular friend, even as they tell me that nothing helps. I can remember what they said about that friend and come back to it when it seems relevant. I can also accept that they might feel just as bad the next time I see them. If I need them to sound more hopeful by the end of the hour, they may start giving me the version of the story they think I can bear.
There is some research on the counsellor’s hope in its own right. In a small naturalistic study of brief therapy, Coppock et al. (2010) found that therapists’ ratings of hope in their clients were associated with client outcomes. Clients’ own ratings of hope did not show the same association in that sample. The study involved 43 clients and 10 therapists, so there’s a fair bit we can’t infer from it! For instance, a therapist might feel more hopeful because they are already seeing changes. The study does give us reason to pay attention to our own expectations, including what happens to our curiosity when we start to think a client is unlikely to benefit from the work.
Listen for what still matters
There have been occasions where I've asked clients what they're looking forward to. However, if they’ve just spent twenty minutes telling me how little they look forward to, I’m unlikely to start there! I might hear them speak with affection about someone, or notice that they have a lot to say about something they’ve described as unimportant. I can follow that interest and see where it goes.
When the client talks about Saturday mornings again, I might say, “You mentioned the radio as well as the garden. What did you like about those mornings?” She tells me her partner used to bring her a cup of tea and then go inside. “He knew I liked to be left to it,” she says. “Nobody needed anything from me until lunch.”
It’s only after hearing this that I have any sense of why those mornings mattered. She might miss the ordinary affection, the company, of someone bringing her tea. She also may miss having time that was hers, which may be especially hard to come by now that people are checking on her and expecting her to answer. I could ask, “Do you get any time like that at the moment?” She can answer that question without having to imagine enjoying her life again.
Acceptance and commitment therapy (ACT) makes room for this kind of inquiry. Values describe how a person wants to live, and they can inform choices even while difficult feelings are present (Hayes et al., 2006). In practice, the client may speak more directly; “I want my Saturday mornings back” gives us plenty to work with. I’d be interested in what she means by back, especially which parts she wants to protect and which parts belong to a life she is grieving.
Work with what is actually possible
Snyder et al. (1991) describe hope in terms of a person’s sense that they can move towards a goal and can see ways of getting there. That understanding helps me ask a more precise question when someone sounds defeated. They may know perfectly well what they want and have good reasons for seeing no way to get it. If a client wants secure housing and has been repeatedly turned down, we need to understand what options are actually available. A conversation about values may clarify what is at stake for them. They may also need practical support to pursue an option they cannot access alone.
For the client who misses her Saturday mornings, something smaller may be within reach. She might decide she wants to tell her daughter that she loves hearing from her and would prefer a call on Saturday afternoon. She might also tell me she’s relieved to have worked out why the suggestions about gardening bother her and wants to leave it there for today.
Even if she makes the call and gets the morning to herself, she might spend much of it crying. If she comes back and tells me that, I’d want to know how it was for her to have the time and what she noticed about being alone. She may have wanted the morning and found it very hard. There is room in the conversation for both, and anything else.
When you find yourself losing hope
This is worth taking to supervision, especially if you find yourself repeatedly trying to persuade a client that things can change, or you’ve stopped asking what they want because you can’t see how anything will shift. Bring a specific moment. Perhaps the client said, “I’ve tried all that,” and you heard yourself offer another suggestion before asking what they had already tried. What were you hoping your suggestion would do? What might the client have been trying to tell you about the options they’d been given so far?
In this example, hearing why the client resented the gardening suggestions made it possible to talk about what she missed. If I’d opened by asking how she could get back into the garden, I might have become one more person waiting for her to pick up the secateurs.
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References
Coppock, T. E., Owen, J. J., Zagarskas, E., & Schmidt, M. (2010). The relationship between therapist and client hope with therapy outcomes. Psychotherapy Research, 20(6), 619–626. https://doi.org/10.1080/10503307.2010.497508
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., Yoshinobu, L., Gibb, J., Langelle, C., & Harney, P. (1991). The will and the ways: Development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585. https://doi.org/10.1037/0022-3514.60.4.570