hope, illness and counselling pratice

8/14/2019 Hope, Illness and Counselling Pratice

1/8

44 Canadian Journal o fCounselli ng/Revuecanadienne decounseling 2003, V o l .37:1

Hope,Illness,andCounsellingPractice:MakingHopeV isibleWendy EdeyRonnaEJevneHopeFoundationofAlberta

B S T R C TNormally hope operates as a silent factor in counselling, playing a subordinate role todiscussion of the problem. However, hope can be consciously ttacked and given attention as a central feature. Through the use of hope-focused questions, and languagewhichconveys hope, counsellots can capitalize on opportunities to make hope visible tothemselves and their clients.Thisarticle draws on some of the literature from the fieldsofnursing and psychologywhich links counselling practice, hope, and illness. The authors address the issue off lse hope and the challenge of being a hopeful counsellor.Twoworking examples are used tosuggestand bfiefly demonstrate interventions counsellors might make if they choose to reflect on hope as they do their work.R S U M Engeneral, l espoir constitue un element tacite du counseling etjoueun rle secondairepar rapport la discussion du p r o b l m e Toutefois, il est possible de dce le t l espoir defaon consciente et de leconsidrer comme un facteur centtal. En posant des questionscenttes sur l espoir et en utilisant un langage qui transmet ce sentiment, les conseilletspeuvent profiter des occasions qui se prsententde le mettre envidencepour e u x m me set pour leurs clients. Cet atticle s appuie sur des crits dans les domaines des soinsinfirmiers et de la psychologie qui tablissent un lien entte la pratique du counseling,l espoit et la maladie. Les auteutes abordent le p r o b l m e du faux espoir et le dfi ded m o n t r e r de l espoit en tant que conseiller. Deux exemples pratiques sont prsents entant quesuggestionset dmonstra t ions brvesd interventions auxquelles peuvent recourirles conseillers qui choisissent d accomplit leur ttavail tout en rflchissant sur l espoir.

Hope in thecontext o fcounsellingisrelevanttoboth clientsandcounsellors.Therearethingsclientsdon't wanttohear becauseitbringsout thehopelessnessin them.Theydon'twanttohear, Y o u w i l lhavetoacceptyour chronic painandlearn todeal with it."They don't want tohear, Y o u need toadjust to this i l l -ness."They don't want tohear, Y o u have to ignore thesymptoms andhaveagood l i fe . Theydon't wanttohear,"Iwon'tbeabletohelpyoubecauseyouarenothelpingyourself."Theywant tohear messageswhich givethem areasontohope."Ibelievethere ishopeforyou. Ihave some ideaswemight try.Listeningtoyou makesmehopeful because. . . "

Therearealso thingswecounsellorsdon't want tohear becauseitbringsoutthehopelessnessin us.Wedo notwant tohear, "I'vealready tried that.""Thatwon't work." "That doesn't help." Itmakes us feel hopeless.Wewant tohear,

Y o u aredifferent from allother counsellors." Y o u seem tounderstandme."Y o uhavegivenmesomenewideas." Y o u havegivenmehope."


2/8

Hope & Counselling 45

Illness brings with it a need for hope. Hope helps us l ive with a difficultpresent and an uncertain future. What is the role of hope in counselling thosewith illness? Since the myth of Pandora, scholars have argued whethet hope is ablessingor a curse. The views have ranged from Nietzsche ( 1878) who declaredit,"The worst ofevilsfor it prolongs the torment of man" to Menninger (1959)who was adamant it is, "An indispensable factor in . . .treatment." NotmanCousins (1989) offered the position wesimplyknow too little not to hope.

Indeed, science is just beginning to understand this thingcalledhope. We canpoint to many authots who have associated hope and successful copingwithillness (Barnum, Snydet, Rapoff, M a n i , & Thompson , 1998; Buehler, 1975;Carson, Soeken, & G r i m m , 1988; E l l i o t t , Witty, Herrick, & Hoffman, 1991;Irving,Snyder, & Crowson, 1998; M i c k l ey ,Soeken, & Belcher, 1992; M i l l e r &Powers, 1988). In the field ofcounselling,we accept hope is important, andthatitis core to thewell-beingof both clients and counsellors.Talley (1992) reportsin ThePredictorsof SuccessfulVeryBriefPsychotherapy that the most unexpectedfinding was that the single item that best predicted satisfaction with treatmentwas, "The counsellor encouraged me to believethat I couldimprove my situation." This item accounted for 68% of the variance. One might interpret this asthe client reclaiming hope about the situation.

Hope makes things happen when counsellors workwith people whose livesare influenced by illness and physical pain. It can be the spark that brings theclientfor help, the fuel thatkeeps the counsellor going, the thrust that helps theclienttry, the outcome ofasuccessful effort. It can also be the seedthatblossomsinto interesring and inspiring counselling interventions.

This article draws on some of the literature from the fields of nursing andpsychology which links counselling practice, hope, and illness. It addresses theissue o ffalse hope and the challengeo fbeing a hopeful counsellor. Itsuggestsandbriefly demonstrates interventions counsellors might make i f they choose to reflectonhope as they do their work.

The suggested interventions are currently in use in an on-going program ofcounselling studies at The Hope Foundation ofAlberta, a centre for hope research. The process, known as hope-focused counselling(Edey,Jevne, & Westra,1998) has been refined in an on-going program of counselling and counsellortrainingwhich began in 1992. The clients, in their efforts to cope with illness,had experienced the hopelessness of filling out forms, talking to receptionistswhen they wanted doctors, waiting months for appointments with specialists,receiving diagnoses, and being told to accept their illness. They had personalcollections o fself-help books. They had taken medication, been helped by medication, been overwhelmed by side effects, changed medication and developedallergies.They had fought fordisabilitybenefits, declared themselves unemployable in order toqualifyfor government programs. Theirs were complicatedlives,lives with many features whichchallenge and diminish hope. Both experiencedcounsellors and trainees found that the hope-focused approach pleased the c l i ents.They also found that theirability to workwith theseclients was enhancedwhen they consciously drew attention to hope.


3/8

46 Wendy Edeya nd Ronna F. Jevne

Perspectivesonhopein thecounsellingsettingBoth client and theiapist must possess hope in order for the thetapeutic

process to be successful (Edey et a l . ,1998; Snyder, 1995).Thisvery idea can bethreatening, discouraging. We all want to be effective in our work, and it isdifficult to be hopeful in the presence of those clients who don't change, don'ttry, and won't take advice. Nonetheless, Snyder (1995) maintains that therapists who evaluate their levelof hope are evaluating theirability to be effectivehelpers.

Hopeis anindividualthing, as personal to each ofusas the clothes we choose.Different perspectives are reflected in the litetature. Snyder (1995) emphasizesthe relevance of hope in the context o fdoing,pointing to success, and the capacityto achieve goals.Drawingon a broader approach born of their work in illnessand palliativecare, Herth (1990), Petakyla (1991) and Jevne (1993) conceptualizehope in the realmo fbeing, rather than ofdoing.They emphasize the value ofacknowledging hope, and de-emphasize its relationship to realistic goals.Benzein (1999) reports both a being and a doing component to hope.

Dufault and Martocchio (1985) identify two kinds of hope, generalized andparticularized.Particularized hope is directed toward a goal or awish.Generalized hope is not specific to any given situation. It is the expectation that thefuture w i l lbe good. The twooperate together, feeding each other.

Our particular hopes are embodied in our history of success. Hope has beenassociated with success at many levels including: successful problem solving(McGee, 1984; Snyder, 1995) superior performance in sports (Curry, Snyder,Cook, Ruby, & Rehm, 1997), and academic achievement (Curry et al., 1997;Irvinget al., 1998). It has been shown to be related topsychological w e l lbeing(Carson et al., 1988; Dufrane & Leclai r , 1984; E l l i o t t et al., 1991; M i l l e r &Powers, 1988;Rabkin, W i l l i am s , Neugebauer,Remien, &Goetz, 1990; Snyder,1995; Yarcheski, Scoloveno, tic Mahon, 1994), physical health (Benzein ticSaveman, 1998; Carson et a l . , 1988; Herth, 1990), and the successful resolutiono fgrief (Herth, 1990).

But hope also has the capacity to act in mysterious ways. Dufault andMartocchio(1985) observethatit does not necessarily vanish in the face ofchallenges such as untreatable illness. It most certainly endures despite poverty andwarand famine. Those of us who have experienced the fulfillment o fwishesandthe successful attainment of goals may find it easier to be hopeful, to expect agoodfuture. Those who have experienced defeat, failure,and suffering may needsomeone to help them look to the future withhope. Our challenge, as counsellors,is to find the hope, to coax it out ofhiding.

Can we reach into the experiences of our clients and find it there? Can wenurture it in ourselves even as we face those situationswhichare most apt to takeitaway? Can we say more of the things clients want to hear, and hear from themmore o fwhat we want to hear? Can hope come to our aid i fwe strive to make itvisible?


4/8


OP POR T U N I T I E S T O M K E H O P E VISIB LE

Normallyhope operates as a silent factor incounselling, playinga subordinateroleto discussion of theproblem.But hope can beconsciouslytracked andgivenattention as a central feature. Here is one counsellor's account ofasessionwhichsettled on a problem fordiscussion,and also centred on hope:

Sitting opposite me is a middle-aged man with a case of mul tipl e sclerosis and a warehousef u l l of anger. M y hope is somewhat threatened by my inability to cure mul tipl e sclerosis anda fewfailed attempts to address the anger. W o u l da question about hope shed some new light?"What is it that most thteatens your hope when you look to the future?" I ask.H e snaps to attention. I ' l l have to think about it," he says. "Nobody has ever asked me thatbefore." Both of us have just heard something we want to hear. It is l i k e l y that many thingsare threatening his hope, but he chooses to t e l l me about his current expetimental medication, how itarrests further development of the disease more effectively than any othets, howit makes him suicidal, a side-effect, the doctor says. The doctor has said he is free to decidewhether to continue with the experimental medication.Facing this decision threatens hishope. H e observes the hopelessness ofgiving up an effective medication, the hopelessness o fchoosing to continue with an effective medication which makes him suicidal. He observesthat his futute may not be a l i v i n g future i f he cont inue s to take this stuff. " I'm going off it ,"he says. "There's more hope thatway." He issmiling He has made a hopefuldecision. Hopeis visible to both of us.Thisconversation beganwitha hope-focused question: What is itthat threat

ens your hope when youlookto the future. There are other strategies a counsello r might have used to draw attention to hope (Edey et al., 1998). She mighthave asked him how hopeful he was on a scale of zero to ten, then asked why hewasn't at zero, wasn't at ten. She might have asked what hewoulddo i fhe were ahopeful person, or what would be the smallest change that could increase hishope. Any ofthesequestionswould l i k e l yhave drawn the same i n i t i a l response:

I ' l lhave to think about it.Nobodyever asked methat." A n y ofthesequestionswould l i k e l y have led him into previously unexplored territory, opening newpaths for him and the counsellor

There are so many places we can look if we want to make hopevisible.If weask, " Who taught you about hope?" or "Who comes to mindwhen you thinkabout hope?" we w i l l get some useful information. We w i l lhear a story about ahero, a leader, a bravesoul.Wew i l lhear about someone who, by example, can bea leader to the petson we want to help. If we say, "Choose a picturethat wouldremindyou of hope when you wake in the morning," we w i l l begin a process.T h e client w i l l envision a picture, get that picture, and put it in a prominentplace.The picture w i l lbe a permanent invitation to think about hope. It is notdifficult to persuade clients to think and talk about hope. W h y , then, do we notmake better use of hope?

T H E P R O B L E M O F F L S E H O P E

W e don't make more use of hope," some counsellors say, "because we don'twant to raise false hope. So many people have unrealistic hope." They fear that


5/8

48 Wendy Edeyand Ronn a F. Jevne

clientsw i l lactunwisely i fthey pay attention to hope. They wonder i fitis unethicalto raise hope without having aspecificgoal or outcomewithin easy reach.

Those of us who understand these doubts and fears might also notice thatmany people have unrealistic hopelessness, false despair. This prevents themfrom seeking solutions and listening to advice. We might also noticethatclientsfrequently find workable solutions,which were not first suggested by us. Previ ouslyunseen opportunities sometimes appear when we open the door to hope.

McGee (1984) assetts that unrealistically high levels of hopefulness orunjustifiable hopelessness can be detrimental to the healing process, bur does notsuggest that we should intervene by trying to crush unrealistic hope. O n theother hand, we do not have to giveunlimited support to unsupportable hopes.McGee maintains that the first step in i n s t i l l i n g realistic hope in patients is tovalidateand empathizewiththeir experiences of either complete hopelessness orunjustified high levels of hopefulness. The least we can do is to stand in the shoeso faclient for a moment, experience the hope or the hopelessness. Ifwediscoverthatour hope is not necessarily the same as their hope, we can ask outselves whyweare more or less hopeful than our clients. We then have the opportunity forhonest communication.We can say, "I am more hopeful than you because . . ."or "I am less hopeful than you because . . ." Our clients have a right to know. Ifwesay we are less hopeful, it gives them the opportunity to decide whether wecan be helpful. If we are more hopeful, then perhaps we cansharesome ofthathopewith them.

C O N V E Y I N G H O P E

"The counselling relationship offers a partnership that has the potential toinspire hope and to develop courage to deal with life transitions" (Dufrane &Leclair , 1984, p. 34). It is natural thatclients shouldlook to us for hope, andchallengingfor us to be hopeful for them.Challengingas it may be, it is important that we position outselves to be as hopeful as we can. The senseof hopeexperienced by counsellors can be transferred to clients (Beavers and Kaslow,1981; Edeyet al., 1998; Snyder, 1995). For those whowish to foster hope, thefirst step is the development of supportive relationships, (Carson et al., 1988;Dufault & Martocchio, 1985; Gaskin & Forte, 1995; Haase, Britt, Coward,L ei d y ,& Penn, 1992; H a l l , 1994; M i l l e r& Powers, 1988;Morse& Doberneck,1995; Raleigh, 1992;Yarcheski et al., 1994) because supportive relationshipsprovide a place where hope can be both borrowedfrom and instilled in others(Dufault & Martocchio, 1985;Morse& Doberneck, 1995).Whenthe counsell i n grelationship is truly a partnership, then the transfer o fhope is not a one-wayprocess. Clientsalso transfer their hope to us. They convey it in their gratitudeforour understanding, our respectful behaviour, and our ideas. They convey itwhen they identify their stories of hope, their descriptions of things and peoplethatmake them hopeful.


6/8


W e, in turn, can fostet hope by intentionally using language which conveyshope. We can help them experience a glimmer of hope based on the theory thatit just might be reasonable to expect a good future. Language, honed and caref u l lydirected, is a powerful hope-giver.

Three linguistic tools are particularly effective when we want to convey hope.They are: the language of "yet," the language of "when," and the language of "Ibelieve."Clients tend to respond wi th surprise and pleasure to counsellors whouse them. Here is a brief example illusttating how this language might be used:

A woman isboiling with anger and chronic pain, the leftovers of afailed surgery. Her ragingis dr iv in g me to hopelessness. She talks of suing everyone and is showing no sign of actual lysuing anyone. I listen to her for what seems l i k e an eternity. F i n a l l y , we reach a point ofagreement. We agree that things woul d seem more hopeful i f only people wou ld pay attention to her complaints. I t e l lher I lose hope when I listen to herbecauseher speech radiatessomuch anger.Soon we are able to agreethat it woul d be important for her to get control of heranger. Using the language of "when" to suggest that she w i l l get control of her anger, I say:"People w i l l l i k e l y be more w i l l i n g to takeyour complaints seriously 'when' you get control ofyour anger."She says the pos sibil ity ofcontrolling the angerseemshopeless to her. Using thelanguage o f ye t' to encourage her, I say: " Whe n we first met I saw you as an angry person, butnow I see you as a person who hasn't learned to conttol her anger 'yet'." " Do you really thinkIcan do it?" she asks. A shift is occurring. Some of my hope is being conveyed to her. Wishingto b u i l d on this hopeful mo me nt um, I turn to the language of' I believe'. I say: '"I believe' youcan control your anger. 'I believe' thisbecause 1have seen othersdo it." As I say these words,and observe how they soften her, I find mysel f becoming more hopeful.

B E I N G H O P E F U L C O U N S E L L O R

What then can we say about the challenge of being a hopeful counsellor?What stepscan we take if we want to be more hopeful in our work?

Perhaps it is not possible for counsellors to always be hopeful in their work,but we believethat paying attention to hope can help counsellors as much as ithelps clients. If we see value in attending to hope, we simply have to start thejourney and see where it leads us.

Eachof us has the option of remembering to notice whether we are expectinga good future, and acting as if we expect one. Each of us can begin turning ourthoughtstowards the people who make us hopeful, the pictures thatremind us ofhope. Then, when we struggle, and things aren't turning out as w e l las we wouldwish, each of us can pause to think the k i n d of thoughts that steer us towardhoping,away from blaming, the k i n d ofthoughtswhichsuggestto usthat thereis hope.

W e need not dec te a situation forever hopeless just becausewe cannot address it now. A seemingly unsolvable problem can sometimes be solved whenmore knowledge is available. A problem which cannot be solved now can sometimes be solved later. A problem which cannot be solved by one person can sometimes be solved by another. A problem which cannot be solved one way cansometimes be solvedanotherway. At a different time, in a different place, withdifferent help, or more knowledge, something hopeful can s t i l l be expected.


7/8

50 Wendy Edey and Ronna E Jevne

C O N C L U S I O N

Inconclusion, we should saythata hope focusdoes not stand alone in counselling. It runs in the background,periodicallymoving to the foreground, givingdirectionand power to a counsellor's basic ski l l s .Attending to hope is a learningprocess which develops with practice and reflection. It requires us to accuratelydiscern the difference between our hope and the hope of our clients. It is notadvisable to begin the learning process by practicing on thetoughestclients, or togiveup entirely if earlyattempts falter.

S t i l l , the challenge oflearning to pay attention to hope is an endeavour worthembracing, for hope is capable of changing lives,enabling people to envision afuture inwhich they are w i l l i n g to participate. Its potential applications in thecontext of counselling remain largely undiscovered because hope has, at thispoint, been under-researched and under-utilized.Although there is recognition that hope is an essential thread which runsthrough many situations of adversity, hope has not been a conscious focus ofpsychological interventions. Mostof the scholarly work in the field o f hope hasfocused on either developing a conceptual understanding of hope and/or translating such understandings into assessment measures of hope. M i l l e r (1989)points towards a neglected area of research when shestates, "The importance ofhope is univetsally accepted. However, despite its wide acceptance, the domainso f hope and how persons maintain hope while confronting adversity are notwell-known" (p.23).Counsellorshave the opportunity to learn about hope by studying themselvesand their clients. Their learnings have the potential to enhance the quality oftheir practice.ReferencesBarnum, D . D. , Snyder, C. R. , Rapoff, M . A . , M a n i , M .M . , & Thompson, R. (1998). Hope and

social support in the psychological adjustment of child ren who have survived burn injuriesand their marched controls. Children s Health Care,27(1), 15-30.

Beavers, W. R., & Kaslow, F. W. (1981). The anatomy of hope.Journal ofMarital and FamilyTherapy, 7(2),119-126.

Benzein,E. (1999). Tracesof Hope. U npu bli shed doctoral dissertation, U meanUniversity, Umea,Sweden.

Benzein, E . , & Saveman, B . I. (1998). On e step towards the understanding of hope: A conceptanalysis. International Journal of Nursing Studies, 35, 322-329.

Buehler, J. A. (1975). Wha t contributes to hope in the cancer patients? American Journal ofNursing, 75(8), 1353-1356.

Carson, V . , Soeken, K . L . , & G r i m m , R M . (1988). Hope and its relat ionship to spirit ual w e l l -being.Journal of Psychology and Theology, 16(2), 159-167.

Cousins, N . (1989). Head First: The Biology of Hope. New Y o r k, N Y : E.R Dutt on.Curry, L. A. , Snyder, C R . ,Cook, D . L . , Ruby, B. C , & Re hm, M . (1997). Role of hope in

academic and sport achievement.Journal ofPersonality and Social Psychology,73(6), 1257-1267.Dufrane, K . , & L e c l a i r , S. W. (1984). Using hope in the counseling process. Counseling and

Values,29(\), 32-41.Dufault, K . , & Ma rt occhio , B. C . (1985). Hope : Its spheres and dimensions.Nursing Clinics of

North America, 20(2), 379-391.


8/8


Edey,W. , Jevne, R . E , & Westra, K . (1998).KeyElementsof Hope-Focused Counselling: The Art ofMaking Hope Visible. Hope Foundation ofAlberta, Edmonton, A B .

E l l i o t t ,T. R.,Witty,T. E . , He rr ick , S., & Hoffman , J. T. (1991). Negot iat ing reality after physic al loss: Hope, depression, and disability.Journal of Personality and Social Psychology, 61(4),608-613.

Gaskin, S., & Forte, L . (1995). The meaning of hope: Impl ications for nursing practice andresearch. Journal of Gerontological Nursing, 2/(3), 17-24.

Haase.J. E.,B r i t t . T , Coward, D . D. , L e i d y , N . K . , & Penn, P. E. (1992). Simultaneous conceptanalysis of spi ritual perspective, hope, acceptance, and self-transcendence. IMAGE: Journal oNursing Scholarship, 24(2), 141-147.

H a l l , B. A. (1994). Ways of mainta ini ng hope in H I V disease. Research in Nursing and Health,17, 283-293.

Herth, K . (1990). Relationship of hope, coping styles, concurrent losses, and setting to griefresolu tion i n the elder ly widow(e r).Research in Nursing and Health, 13, 109-117.

Irving, L. M . , Snyder, C. R . , & Cr ows on , J. J . (1998). Ho pe and cop ing wit h cancer by collegewomen.Journal of Personality, 66(2), 197-214.

Jevne, R. F. (1993). E nhancin g hope in the chroni cally i l l .Humane Medicine, 9(2), 121-130.M c G e e , R. F. (1984). Hope: A factor influencing crisis resolution.Advances in Nursing Science,6(4), 34-44.

Menninger, K . (1959). The academic lecture: Ho pe . The American Journal of Psychiatry, December,481-491.

M i c k l e y , J. R., Soeken, K . , & Belcher, A . (1992). Spi ritual well -be ing , religiousness and hopeamong women with breastcancer. IMAGE: Journalof Nursing Scholarship, 24(4), 267-272.

M i l l e r , J. F. (1989). Hop e- ins pi rin gstrategiesof the critically i l l Applied Nursing Research, 2(1),23-29.

M i l l e r , J. F., & Powers, M . J. (1988). De vel opme nt o f an instrument to measute hope. NursingResearch, 37(1),6-10.

Morse, J. M . , & Doberneck, B. (1995). Del ineatin g the concept of hope. IMAGE: Journal ofNursing Scholarship, 27(4), 277-285.

Nietsche, F.W (1878). Human All-too-Human, I.Perakyla, A. (1991). Hope work in the careo f seriously il l patients. Qualitative Health Research,

1(4), 407-433.Rabkin,J. G. ,W i l l ia m s , J. B. W , Neugebauer, R., Remein, R. H . , & Goetz, R. (1990). Maint e

nance of hope i n HlV -S pe ct tu m homosexual men.American Journal of Psychiatry, 147(\0),1322-1326.

Raleigh, E . D . (1992). Sources of hope in chronic illness.Oncology Nursing Forum, 19(3), 443-448.

Snyder, C. R. (1995). Conce ptu ali zing, measuring, and nu rtu ring hope.Journal of Counselingand Development, 73, 355-361.Talley, J.E. (1992). The predictors of successfulverybriefpsychotherapy: A studyofdifferencesbygender,age, and treatmentvariables. Springfield, I l l i n o i s :Thomas C . C .

Yarcheski, A. , Scoloveno, M . A. , & Maho n, N . E. (1994). S o c i a l supp ort and well-bei ng inadolescents: The media ting role of hopefulness. Nursing Research, 43(5), 288-292.

About the AuthorsWendy Edey and Ronna F. Jevne study the in tentional integration o f hope and practice at theHope Foundation o fAlberta. Wend y maintains a reflective practice, ap ply ing hope concepts andstrategiesacross a broad rangeof counselling situations. Ron nateachescounsell ing in the department of educational Psychology at the Uni vers ity of Albe rta, manages a program of hope research and counsels on a limited basis. Together they serve as a hope resource team for clients,students, and professionals .Address correspondence to Ho pe Founda tion o f Alberta, 11032 89 Avenue, Ed mon to n, Albe rtaT 6 G 0Z6. E - m a i l : or .
mailto:[email protected]:[email protected]:[email protected]:[email protected]

hope, illness and counselling pratice

Documents