Hope and Hopelessness in Psychotherapy

Acknowledgements

This project is the result not merely of two years of hard work, but owes its existence to the influence and guidance of the MAP program and its professors. Without the kind words of encouragement and feedback from Dr. James Risser, this project would not exist in its current form. Special gratitude and thanks must also be given to Dr. Alexandra Adame, who served as a mentor to me through the entirety of this program. I further owe an unrepayable debt to Seattle University and the MAP program for accepting me as their own and opening their space as a space in which I was able to grow and develop as a therapist. To all of you, I could never say thank you enough. Every professor, every lesson, will forever live on in my mind, and in my heart. This paper is an attempt to make good on that debt that can never fully be repaid. I entered this program after an intense period of personal hopelessness and despair. Through this program and life outside, I have been exposed to the powerful healing force of hope. You all had faith and hope in mine, and the ability of my fellow cohort to engage and excel in this difficult work that is psychotherapy. Through the friends and colleagues I have made in this program, I have seen the true essence of hope in action. To my cohort, and all the professors in the MAP program, I thank you.

Abstract

Hope and hopelessness are crucial and vital aspects of psychotherapy. It is important to understand the essence of these phenomenon, and to their importance to the work of therapy. Despair emerges out of and reinforces itself through confusion, impossibility, entrapment, and isolation. The reality of hopeless emerges within the therapeutic space, to find a holding. Through this holding, hope emerges between the therapist and patient. Hope is founded in a mutuality and waiting. The therapist that can patiently hold the hopelessness o the patient, will see the dawn of hope in the authentic and genuine relationship. Hope in therapy emerges as a healing and transformative force. This hope emerges as creative fidelity: the commitment and desire to move towards and be with the Other.

Integration Paper

On Hope and Hopelessness in Psychotherapy

Hope consists in asserting that there is at the heart of being, beyond all data, beyond all inventories and all calculations, a mysterious principle which is in connivance with me” (Marcel, 2017). Of the many mysterious forces and principles in therapy, none approaches the highest echelon like that of hope. No force is as pervasive or necessary in the therapeutic alliance. Without hope, therapy is an endeavor almost certainly destined to crumble and deteriorate. Yet, despite the prevalence and need for hope in therapy, it often goes understudied and undervalued for its significance and place in the therapeutic process. When hope is the subject of inquiry for either researchers or clinicians, it usually is stripped of its essences and mysterious qualities, favoring simple categorizations and an over-emphasis upon the subjective over the inter-subjectivity of hope. Furthermore, the relevance and importance of hopelessness is also discounted, and research on the subject is sparse. Both phenomena hold a significant relationship both in our personal lives, and as therapists working with patients. Exploration of hope and hopelessness, their relevance in therapy, and their presentation in session and in the clinic are the subject of this integrative analysis. How hope and hopelessness emerge in the clinic, and how we hold these two for our clients and ourselves will be examined through both a theoretical lens and practical application via case examples and personal vignettes.

The Metaphysics of Hopelessness

Though it may not be the most uplifting place to begin, it is easier to grasp the nature of hope by first examining its countervailing force. Understanding the essence and experience of hope, requires an understanding of how hopelessness emerges and is experienced by the individual. For our purposes here, I will use the terms hopelessness and despair interchangeably, though a case could be made that the two possess experiential differences and may be expressed as separate and distinct phenomenon. That said, despair in its etymological roots, means without hope. Thus, despair or hopelessness can be considered its opposite. Going beyond etymology, we see that despair emerges in a myriad of situations, under an infinite number of circumstances, and is unique in its expression to everyone. Despite the uniqueness of each situation in which despair emerges, common essences abound and shape the contours of the experience. Despair, though it be unique to every individual, still holds a character that reveals its underlying existential and universal qualities. Hopelessness, as we will see in hope, rests in one’s relation towards the future, the world, and is born of the intersubjective realm.

Perhaps, the best starting place for our examination is in a brief analysis of how despair emerges. A light can be shone on despair’s emergence through the work of Gabriel Marcel. All the Existentialist philosophers and thinkers of the 19th and 20th century, touch in some way upon the nature of despair and hopelessness. Yet, none directly approach or confront the topic subject with such complexity, nuanced understanding, and mastery like the Christian Existentialist and artist Gabriel Marcel. Throughout his collective works, Marcel speaks of the mystery of Being, and how the self is defined and seen through its relationship to the modern world (Marcel, 2017). Marcel observes that the person living in the modern age has become reduced to a conglomeration of functions and technics. The cashier, the office worker, the custodian, the bus driver: all reduced to their work, the output generated for society. The individual is taken out of the equation and becomes a number or a statistic. Jewish theologian Martin Buber also noticed this peculiar phenomenon in the form of the I-It mode of relation (Buber, 1971). Buber specifies that, while this mode of relation is not inherently dangerous or for that matter, unavoidable in moving through our modern society, it does carry with it a great danger and violence if it is the primary or sole way of relating to the world and others. When a person sees themselves as a conglomeration of functions, they begin to approach the world and others with a similar sentiment, evaluating and carrying out actions in terms of what they must gain or lose.

Such a reduction strips away the existential dimension, problematizes a person’s existence, and generates a disharmony within the individual. The modern world thus becomes the broken world. Having been reduced to a system of functions, other aspects of life and existence now must be met with the same level of totalization and reductionism. What was once in the firm realm of the mystery, is now believed to belong to the realm of the problematic (Marcel, 2017). We start to visualize the world in terms of problems or questions, both needing a solution, and an answer. “A problem is something which I meet, which I find completely before me, but which I can lay siege to and reduce” (Marcel, 2017, 23). We see this perspective being taken in a vast majority of areas in life, such as the biomedical sphere, the socioeconomic domain, and the geopolitical realm. Though this may be an informative and valuable way to conceive of and interact with certain phenomenon, it does not carry forward its usefulness or constructivism in other, more complex, and mysterious dimensions of existence. We can see the inefficacy of this practice when an individual reduces their mental health to a problem needing to be solved (Gutting 2019). The bulk of our approaches to mental illness are an exemplar par excellence of this reductionism and problematization. We categorize mental illnesses and reduce them to a set of symptoms to be captured in the DSM. We then respond to these categories with manualized treatments, aimed at symptom reduction, behavioral modification, and symptom management. The individual is taken out of the equation entirely, and each case, a problem to be met and laid siege to. For every problem a solution, every question an answer.

Problematization of this magnitude, generates despair within the individual and levels down the realm of the mysterious within an individual’s own life. Thus, we find ourselves in a reality wherein, “on one hand riddled with problems, and on the other, determined to allow no room for mystery” (Marcel, 2017, p. 24). Firmly ensconced in this model of a broken world that must be put a right, one quickly encounters despair when a serious, existential question or issue emerges. Face-to-face with the meaning of one’s own existence, or over-encumbered by the vicissitudes of life, hopelessness creeps in. Mental illness emerges in a myriad of contexts but is often met with solutions that cover up the matter-at-issue. When these existential concerns or mental illnesses persist, and no resolution in sight, the individual falls back upon their hopelessness. For the anxious or depressed patient, a host of therapeutic treatments and modalities are applied in service of remedying the situation, from mindfulness, to cognitive-behavioral, to rational-emotive therapies. And for every solution that fails, the hopelessness both on behalf of the patient and the therapist rises. This is not to say that these therapies and modalities do no provide efficacy in treatment. Rather, it is the uniqueness of the individual and their situation that is lost, and often left out of the therapeutic intervention. The mysterious qualities or exigencies are excluded from the context, and a solution-focused model propagates the despair it seeks to reduce or eliminate. Both the hopes of the patient, and those working in the helping professions thus rests on a solution, as opposed to the difficult reality of the mysterious tremendous to emerge. Just as a patient hoping for the outcome of a surgery to cure their condition, those who place their hopes in the cure or change on a specific psychotherapeutic intervention, are inviting in the vampire of despair and hopelessness. “Despair is on the horizon, when hope is based on a particular outcome” (Halling, 2018, Personal Communication).

Thus far, we have articulated the essential structure of how despair and hopelessness often emerge in the life of the individual. However, though the origin of a phenomenon may elucidate some of the characteristics, it does not grasp at the experience thereof. To this end we can now turn to the work of Reverend William F. Lynch, who followed in the footsteps of Marcel in examining the connections between and traits of hopelessness and hope. At the core of hopelessness, three essential features emerge: hopelessness as impossibility, hopelessness as entrapment, and hopelessness as confusion (Lynch, 1974). As with any psychological phenomenon, hopelessness finds its roots in the individual’s relationships. Starting with the primal connection, the individual learns to negotiate and move through the world by way of their primary caregiver or parental figures. In the holding space of the primary bond, the child begins to orient themselves to and in the world, through their ability to enact change and actualize potential. Power and control are manifested through the satisfaction of needs and desires by the caregiver at first, only later to for these needs and desires to be fulfilled and acted upon by the child of their own will and volition. Infants learn to walk, talk, create, and destroy through play and imagination. They learn to manage their emotions and the emotional needs of others as they mature and move through a world populated by giants. Self-efficacy, autonomy, initiative, and potentiality are all messaged to the child via the caregiving relationship. Healthy and adequate levels of these qualities can be achieved through the good-enough caregiver, the parental figure who allows for the child to grow, feel nurtured, make mistakes, and experience an appropriate level of grandiosity at a vital juncture in development. Primary caregivers who play an authoritarian, overly submissive, or neglectful role can impede or damage the development of such a healthy and self-empowering ego and sense of self. It is here that the child encounters the polarity of possibility and impossibility, which is further impacted and shaped by the influence of other significant relationships, their immediate community, and society-as-a-whole.

Venturing forth into the world, the individual is met with either a world of possibility, or a world of impossibility. The initial omnipotence the individual felt as a child meets resistance with every confrontation, every defeat, and every wounding. The role of god-like giants that the primary caregivers played, is now found, and projected into the various Others the individual encounters. The will of the I come into conflict and sharp contrast with the will of the Other, and possibility grows ever entangled with the web of relations and responsibilities incurred. While the positivizing condition of the human being is still preserved within the well-adjusted individual, it begins to shrink and diminish in the mind and heart of those struggling for control and autonomy. Impossibility emerges as a too-muchness, leading to a sense of ‘can’t’ and eventual learned helplessness or co-dependency. The landscape having been traversable before, now shifts into one of a treacherous and desolate terrain in the mind of the hopeless. What was once a small hill, transforms into a titanic mountain. What was once an inviting and welcoming pond, is transmuted into a dangerous and threatening ocean. The world is thus transfigured into a world riddled with impossibility. Impossibility imposes itself upon the individual, and the individual reinforces this belief in their perception of the impossible. The depressed patient sees no way out of their plight, or no horizon on the other side of that mountain, no new land on the far-side of that ocean. The world for the depressed grows dark and futile (van den Berg, 1974). In the heart and mind of the depressed, there is no possibility. . . no hope.

Impossibility then gives way to a feeling of entrapment (Lynch, 1974). The resistance felt by the hopeless individual manifests a prison around them. Entrapment, though it be imprisoning in its feeling, does not merely engulf the individual in restrictive and crushing boundaries. Hopelessness also emerges in a boundary-less situation, wherein one experiences the full force of open nature. The patient experiencing agoraphobia is an example of this ensnaring boundarylessness. The world-out-there for the agoraphobic is one of threat, danger, and violence. The fear of being trapped in a situation in which one cannot escape, and help is unlikely, is only magnified by the lack of structure and boundary. Lack of restriction and limitation encompasses the agoraphobic with the uncertainty and ambiguity of existence, blanketing them in terror and dread. Control asserts itself as the focal point for the individual with agoraphobia, and seeking such control dominates one’s mental energies and endeavors. The only way to escape the threat of the external world, is a withdrawal into the internal one. Though this world can be just as violent and boundaryless as the one-out-there. . . and now the double bind of entrapment is set. There is no exit, no where to turn or hide from the hopeless feelings. Hopelessness begins to overtake one’s hope, and no solutions suffice. Every corner one turns to, there is only more despair over the plight of one’s situation. Despair having mounted its offensive by the initial assault of impossibility, lays siege to mind by way of ensnaring one within a world-without-exit, a world-without-end.

Accompanying these feelings of entrapment, is a sense of confusion. Cutting across all experiences of mental illness and the human condition, is a pervasive, existential uncertainty and obsequiousness. A common experience in mental illness, is that of a dense fog setting in. As one’s feelings of despair intensify, the fog grows every murkier and obscuring. One cannot make heads or tails of their current location, nor the direction they could take. Directionless, one searches desperately for any semblance of an exit sign. The abyss grants no safe perch for one to gain bearing. Time itself elongates . . . days turning into months, minutes turning hours. Mere seconds can rest in an eternity, one in which the hopelessness only festers and metastasize. Hopelessness a key feature of trauma, is carried in a protected and perpetual limbo. “Trauma is the ultimate experience of ‘this will last forever’” (van der Kolk, 2015). The fog of despair is an endlessness that threatens to annihilate the Self. Some may experience this endlessness as a void within, such is case for those living with Borderline conditions. To stem the tide of this void, many will seek out the Other, though the endless void cannot be beat back for long. Others retreat inside, into their fortress of neuroticisms, finding refuge only in denial, disassociation, illusion, or self-betrayal. Hopelessness is thus, a smog that fills the lungs and chokes cells. When it feels as though there is no end in sight, one might take drastic measures to alleviate such a tremendous feeling of endless despair. Suicide or self-harm may serve to appeal to hope, or to reassure some signs of life and feeling. Regardless of the actions taken, hopelessness emerges as an all-encompassing force of entrapping, and endlessly confusing impossibility.

Here, we can see the emergence of a fourth essential character of hopelessness, that of isolation. Lynch refers to the isolating aspects of hopelessness but does not acknowledge it as a fundamental characteristic of despair. While hopelessness emerges as a co-constructed reality between the individual, the Other, and the World, the despair forces one to battle it alone. A defining feature amongst all mental illness, is the sheer loneliness and isolation experienced. The individual is often left to their own devices to face the demons that plague them alone. All the problems of their existence having risen out of the broken world, now are expected to be tackled by virtue of one’s own capacity for self-reliance and resiliency. Western and American society further complicates and compounds this issue by placing both the blame and responsibility solely on the shoulders of the one who is hopeless. ‘You can’t help those who can’t help themselves’ reigns tyrannical in the ears of those without hope. Lynch even notes that God is stripped out of the equation, as ‘God only helps those who help themselves’ (Lynch, 1974). Little hope is felt in the heart of those for whom not even God can reach, and huts, one is utterly alone in the universe. If no one can help us, and there truly is nowhere to turn, then it is easy to see how one falls headlong into a never-ending pit of despair. I can never truly know the pain or suffering of the Other. Yet, if I am expected to be the only one capable of helping myself, I remain frozen and paralyzed by hopelessness. Loneliness and isolation thus arrive as the emissaries of hopelessness, the true angel of death.

Towards a Metaphysics of Hope

With the essence and experience of hopelessness outlined, we can examine the character and traits of hope. Just as in the case of hopelessness, hope possesses several characteristics that distinguish it apart from other phenomenon. Concurrently, that which gives way to hopelessness, also gives way to hope. Hope occupies equally a space of polarity and companion to hopelessness. One cannot have one without the other, and one would be setting themselves up for failure only holding hope or hopelessness alone. One cannot operate or survive merely on hope. Conversely, one cannot even begin to move through the world in a state of complete hopelessness. The heart of the truly hopeless yearns solely for release from the torment of endlessness and impossibility. While the heart of one filled by a false sense of hope, only leads to a path of ruin and despair. It is by this measure, that Lynch professed a need to hold both equally, and to carry both hope and hopelessness in our hearts and minds. This issue arises, when one’s hopelessness overtakes one’s hope, and vice versa, where one’s hope anyone one’s hopelessness. s One must not allow the water to get into the wine (Lynch, 1974). Our evaluation of hope will this also pay homage to its relation to hopelessness, and not attempt to obliterate the significance and importance of hopelessness in both the work of therapy, but also in the life of the individual.

Three key components allow for the emergence of true hope: healthy wishing, mutuality, and the ability to wait (Lynch, 1974). While these do not outline the entirety of the structure of hope, they do form the bedrock upon which genuine hope and hoping can grow. The first of these, wishing, is perhaps the most integral to understanding hope that is genuine and not destructive. Wishing is not merely the act of desiring or pining for an object, nor is tied to an extrinsic goal to be achieved or accomplished. Rather, “the ideal form of wishing is absolute and unconditional (Lynch, 1974, p. 532). Wishing is absolute, not in that it seeks to absolve or determine a particular outcome. Genuine wishing is absolute, in that it is contained within itself, and derives from the Self. Genuine wishing does not find its origin or resolution in the external, though it can emerge as an intersubjective participation between two individuals meeting in an I-Thou encounter (Buber, 1971). Akin to the I-Thou encounter, genuine wishing is spontaneous, free, creative, and non-conditional. (Lynch, 1974) Wishing of this kind, is free to change, grow, and respond to new situations and circumstances unforeseen. The wish does not seek an end but seeks the way to that end, not an instrumentalizing, but in a cherishment of the road to resolution. Wishing in this way, is tied to the intrinsic power of the individual to imagine, to see a way out. The hopeless hearted cannot imagine a way out of their suffering and despair. We can see this expressed most prominently in the depressed position, where the individual feels both helpless and unable to change their situation or perception of that situation. Wishing may appear to be bound by the environment and that which we cannot control. But that which lays beyond or outside of our control, provides us the opportunity to re-imagine ourselves. “When we are no longer able to change a situation. . . we are challenged to change ourselves” (Frankl, 2015, p. 1740.

We now arrive at the nexus where healing occurs through hope and wishing: the nexus between I and thou, Me, and you, Us and Them. We are as Buber and Levinas both wrote, thrown into a web of relation from which one cannot truly escape. Consequently, the wish that finds its dwelling in the internal, must make its way into the external for the self to actualize or heal. The reality of wishing remains not an isolated event or chain thereof, but a reality of relation. The wish, as us, finds its fundamentals in the human reality of relationship. The wish thus, often involves two forms: wishing for and wishing against. The wishing for is typically viewed as a benign affectation, a desire for the Other, or a desire on behalf of the Other. Yet, this is not absolute or authentic wishing on behalf, as in wishing for, the self is conspiring once again, encapsulates a means-to-an-end. Praying for respite and release for the Other only serves to increase the sense of endlessness and hopelessness, only establishes the movement towards the Other, out of what is a Need. Even if the wish is held by both parties, it is cemented in the past, and yearns not for mutuality, but a longed future. Wishing for also presents as a desire to be Another, or to Have the Other. A wish for begets more heartache, as that which is yearned for can never be truly assimilated without destruction of both the self and Other. Similar destructive tendencies and power rests in the wish against, a wish that bleeds thievery and sadistic pleasure. The wish against places the self above the Other and denies the humanity of the one being wished against. They seek to limit the freedom of those involved and stifle the emergence of the novel or new. Their outcomes rest on a condition, that if not satisfied, sends the soul spiraling into hopelessness. The wish that truly heals is one that is unconditional and creative, a wish threaded in mutuality, a wish with and wishing together.

The third and final key feature of hope, is waiting. “The ability to wait is essential to hope. . . if hope directs itself toward good things that belong to the future and that are difficult to achieve, then it must know how to wait. The kind of wishing that can wait is the mark of growing maturity” (Lynch, 1974, p. 554). As in wishing, two kinds of waiting must be differentiated and distinguished: waiting because there is nothing else to do and waiting because one knows what one wishes and wants. One waits of the former out of boredom, despair, anxiety, or fear. This is a passive waiting that leads to stagnation and hopelessness. The second kind of waiting is positive and creative; it sublimates through patience and devotion to a central wish. It is decisive in its waiting and does chooses not to yield. “The decision to wait is one of the great human acts. It includes, surely, the acceptance of darkness, sometimes its defiance. It includes enlarging one’s perspective beyond a present moment, without quite seeing the reason for doing so” (Lynch, 1974, p. 557). What is required is a fortitude and endurance to allow for the emergence of the desired wish and future. True waiting is not driven out of fear but motivated by a patience and faith in the emergence of possibilities. Waiting is not wading through the endless sea of desperation and despair; it is the resolve to not yield or give in to the tides of hopelessness. By this, I do not mean that one cannot affirm or feel enraptured by feelings or thoughts of hopelessness. Rather, one must honor and embrace the darkness, honor and embrace the hopelessness. Such a waiting is the struggle. Such a waiting is striving. Such a waiting is creative. Such a waiting is positive. “Positive waiting is not altogether passive. It is, rather, active, in the sense that it does not yield. It confronts hopelessness, acknowledges it, grants it its rights and proper domain, but does not yield to its assaults” (Lynch, 1974, p. 565).

Turning our attention once again to the work of Marcel, what bears most pertinent on the discussion at hand is not the conceptualization of the ‘broken world’, or the realm of the problematic or mysterious. Though it is the functionalization of the self, and the reduction of the individual’s world to a problem in need of solving leads us to a place of despair. Without the space for the questioner, or the individual subject, existence only carries a flavorless and bland texture, one in which are technics and technology quells all notion of mystery and transcendence. Such a world view is a byproduct of technology and the problematizing of existence, which has grown in its intensity since the time of Marcel’s original pinning of these concepts and his overarching philosophy. What is most relevant for the topic at hand, is the notion of despair in Marcel’s terms, for through despair, we can arrive finally at hope and its practical application in life and living.

As noted earlier, we found that despair in Marcel’s position, is a denial, a rejection of the World and All Things in It. Despair is the opposite corollary to hope, its dialectic partner, as it engages not with any object, but the Whole of reality. To fall into despair, one turns away from the Other, turns away from the world. While fear and desire lay in the anticipatory relation to their objects, despair cuts the one who despairs off from the present and future. No relation matters any longer. No relation almost exists. Despair isolates and fragments the self from the world. The self can further fragment from itself into a despair greater than the highest threshold for pain. In its fragmentation, the despairing soul is confined in isolation, walled in by loneliness, and appeased only by reflective confirmation. Despair tallies up the ledger and extends no further credit to all of reality. One fears an object: I am afraid of x. Whereas, one despairs against everything: the whole of the world. And this despair emerges when one conflates Hope with Desire. When one believes that to be delivered from their current plight or situation through only one means, then one has made an unconscious preparation for the arrival of true despair.

Hope emerges as antidote to such a betrayal. The self-betrayal, and betrayal that is despair, a turning away from the world and others, can only be answered, or met with genuine hope. Though despair has the character of forlornness, being that one falls into despair over the loss of a future or reality that either could never be, or no longer can exist, it remains a polarity in relation to hope. Let hopelessness be the true questioner in response to hope, and hope be the questioner in response to the answer of hopelessness. Just as despair or hopelessness envelop us, so does genuine hope. Hope springs forth to extend credit to reality, an infinite credit that yields to no specificities or categorizations. As despair is the limiting case, the bounding, hope is the unlimiting case, that binds to the endlessness with a boundlessness overwhelming with potentiality and possibility. The limiting case of despair or hopelessness finds root in the specific desire or intended deliverance. Hope does not yearn for a certainty, for a specific way out of the present situation. Hope sees a way out but does not tally the ledger with demands and expectations or desires for said exit. Still, hope does not accept the current plight or present situation as final. The acceptance of Hope is not one of resignation (Chapter VII). In this, hope is not stoicism, for then, hope would only consist of a solitary consciousness, for which hope bears no resemblance. Stoic resignation, the acceptance of resignation is merely a spiritual fatigue, a fatigue of the soul not permitted to overflowing and enveloping nature of hope. Hope is a movement of relinquishing, wherein one embraces the Whole of reality and let us go of that which one denies and has rejected. In this way, hope is the enemy of resignation. Resignation is passive, as opposed to the active waiting and assertive patience of hope. Hope is not inert or passive. Resignation wilts the soul, and ultimately leads to apathy. “I almost think that hope is for the soul what breathing is for the living organism. Where hope is lacking the soul dries up and withers.” (Marcel, 2010, p. 158).

The ultimate reality of hope is that it is one of mutuality and participation. “There can be no hope that does not constitute itself through a we and for a we. I would be tempted to say that all hope is at the bottom choral” (Marcel 2010). The establishment of hope as a relational reality was not first pinned by Lynch, Marcel was merely the progenitor of this notion which would see its way into Lynch’s Metaphysics of Hope. Both note the importance of this to hope, as hope in isolation is not genuine or sustainable. Hope that rises from the individual in isolation, is at best a tragic case of optimism, and not a tragic optimism at best. Hope isolated in the individual cannot retain its shape or texture, as when taken out into the world or into relationship, it quickly dissolves under the pressure of exterior forces. And rare is it that hope springs from the heart of the lonely, for this is another instance of optimism dwelling in the realm of desire, counting on deliverance. “Speaking metaphysically, the only genuine hope is hope in what does not depend on ourselves, hope springing from humility and not from pride” (Marcel, 2010). Hope emerges in the space between and is held by you and me. As in the I-Thou relation, or in the Infinity of the Other, hope arises out of true openness, participation, and care. Hope that is held with the Other knows that it cannot be contained, and that it does not count upon an outcome, a specific state of events, or deliverance. It is boundless and exceeds all expectations and calculations. “Hope consists in asserting that there is at the heart of being, beyond all data, beyond all inventories and all calculations, a mysterious principle which is in connivance with me” (Marcel, 2017, p. 223).

A Case of Hopelessness

Names, places, and identifying details in the following accounts have been removed or changed to protect client confidentiality.

Feeling exceptionally good about myself, sitting in my chair, I eagerly awaited my last client of the day. I was riding high after two successive sessions that felt to me like the start of great therapeutic work. Having just finished my notes from the previous session, I was starting to wonder if my client was going to show. A few minutes past the hour, he walked in. Two weeks had passed since the intake, which had been my only prior contact with him. After greetings and the typical disclosure statements, we quickly set to task. He was unsure where he wanted to go with therapy. Having no specific goals in mind, and never having had individual therapy of his own, he accepted my invitation to start wherever felt necessary and significant. Before I even realized it, we were already diving into his family history and significant relationships. A feeling that I was in a Freudian sketch comedy or a stereotyped movie about therapy slowly began to creep over me. I sat patiently and attentively as I listened to his childhood experiences: growing up with an alcoholic and abusive father, an estranged relationship with a sibling, and a series of painful relationships. By the time we met, he was estranged from nearly all of his family. He had spent several years without housing and had been out of work for longer still. The gaps in his work history made finding employment harder with each passing year, and his experiences of homelessness and substance use had left him numb and traumatized. As the session drew to a close, a sense of overwhelm had been washing over me like a cresting tidal wave. I signaled the end of session, thanked him for his time, and walked him to the door. I was filled with both relief and excitement at the end of the session. Little did I know, this would be the first countertransferential sign of darker feelings to emerge.

Over the next few sessions, he would elaborate further on his childhood and his first long-term romantic relationship. His childhood was marked by verbal and emotional abuse from his alcoholic father. Eventually his mother saved enough to move herself and the children out of the house and away from her husband. His father did not reach out to his children, and when my client tried on several occasions to reconnect, his father rejected each attempt, culminating in a total estrangement. A similar distance grew between him and his sibling, who had borne the brunt of his adolescent frustration and anger. After high school he felt unable to reach out, and he sought affirmation and acceptance outside the family: in his studies, in the arts, and in his first significant romantic relationship. That relationship began as a passionate love affair and quickly became a long period of living together. Its early phases held promise for a bright future, but it soon devolved into a toxic and abusive dynamic.

Within the relationship, his search for meaningful work was repeatedly discouraged by his partner, who dismissed one opportunity after another as beneath them both. After years of this pattern, he gave up on the endeavor entirely. His partner reminded him at every turn how lazy and useless he was. When substance use entered the relationship, a codependent dynamic took hold. Each time he tried to leave, he was pulled back by a partner who relied on him for emotional support and for their shared substance use. The two grew entrenched in a cycle of fights that went on for years, until a crisis involving the legal system brought the relationship to an end. In a cruel twist of fate, the moment that ended the relationship also cost him his freedom for a time, leaving him with a pervasive feeling of being trapped and helpless.

Afterward, he moved to Seattle hoping to start his life anew and to find more creative and artistic opportunity in the city. His hopes were dashed within a short span of time. He could only find work that held little interest for him, drifting between jobs and never staying long. The struggle for stable, meaningful work grew fruitless, and the growing gaps in his work history made it harder still. Eventually he could no longer make rent and found himself living on the streets for several years. The trap that began with the difficulty of finding work had only tightened its grip. Finding work while homeless is more than a monumental task; at times it is a Sisyphean endeavor, one that breaks a person down again and again. He was traumatized by his experiences on the streets and was left with a pervasive numbness throughout his body and person. He had entered a transitional housing program only a few months before our first meeting, and he was now struggling to make sense of the last several years and how to move forward in the face of such suffering and tragedy.

His despair grew apparent to me within the first few sessions. He had started therapy with a positive and engaging energy, always walking in and greeting me with a smile and a handshake. As we got to know each other and went further into the work, his demeanor grew more depressed and observably despairing. His once positive way of being gave way to a negative and frustrated outlook. He began to slouch as he walked into my office and stopped dressing up, in exchange for very casual wear. He had grown isolated and withdrawn within the housing community, choosing not to make friends with other residents or his roommates. He stopped reaching out for connection with others, seeing it as pointless, since they would only part ways in the end anyway. Every attempt at a solution for any minor problem, or any attempt to shift perspectives on his current situation, was met with denial and outright rejection. I could listen to his woes and plights, but I never seemed able to reach him in terms of shifting his thoughts or elucidating thought distortions. Any movement toward the positive was met with refusal. I began to feel hopeless, as if I could not help him. I exhausted every suggestion from my supervisor, only to be met with the same level of hopelessness and despair. It began to feel as though this therapeutic endeavor was impossible, and that I was trapped in a situation with no hope for a better future or a positive outcome. There appeared to be no exit from the hopelessness and the suffering, and I grew confused as to which direction to take in each session. It was halfway through internship that the realization hit me: these were the feelings he may have unconsciously wanted me to feel. My options felt limited, especially given my placement as an intern. But I did have a way forward. I could either give in to the hopelessness, or sit with him patiently, waiting for the emergence of a sliver of hope. His past may have been ruled by hopelessness and helplessness, but his future could break this chain. Neither of us could see the horizon yet. All we needed to do was sit and engage in dialogue, waiting for the sun to rise once more on his future.

A Case of Hope

One unsuspecting afternoon, I was walking into my office at the housing program when a distressing scene was unfolding at the front desk. A woman was cursing under her breath while declaring that ‘they’ were treating her unfairly. My nerves suddenly on edge, I signed in at the desk and followed her out into the hall. The tension had been so palpable that I was already off my game. Despite this, I asked her if she was okay, and she responded with an emphatic no. She explained that the residents’ council was trying to move her into a room with a roommate, which would reopen her wounds at a time when she was just trying to get by and heal. We shared the elevator up to the same floor, and as we approached my office, I offered her some time to decompress after what had happened downstairs. The afternoon was already filled with appointments, but this felt like the right thing to do. She enthusiastically agreed and asked if she could bring her dog into session. I shared the office with another staff member, and I was unclear whether this was within my limits as an intern. Rather than erring on the side of caution, I erred on the side of the person in front of me and welcomed her dog in with open arms.

Returning to my office a few minutes later, she introduced her dog, a rescue who had also known mistreatment. After a few minutes of getting acquainted and small talk, we moved back into the matter that had distressed her and prompted this session in the first place. Before I knew it, we were diving headlong into history I had no way of preparing for as a budding therapist and intern. Years earlier, she had moved across the country to be with someone she believed was the love of her life, a man she trusted to be kind and gentle. The honeymoon phase was short-lived. Over time, he brought dangerous people into their home and became increasingly erratic and violent. Between the gaslighting and manipulation, the emotional abuse began to disintegrate her spirit. She was isolated, financially dependent on him, and kept from leaving the house, and hopelessness and a feeling of entrapment settled in. Over several years she endured severe and repeated abuse, including sexual violence, which ended with an attempt on her life. She survived, though with lasting injuries and severe trauma. That attempt was also the turning point that allowed her to escape.

Her escape brought with it a new set of challenges. She continued to struggle with substance use while trying to survive on the streets of Seattle, which is hard for anyone and was harder still given her injuries and trauma. After a few years of this struggle, she was able to obtain temporary housing through the program after being chronically homeless. Residents were expected to look for work and permanent housing, help with chores around the building, and attend weekly meetings with a residents’ council, which could vote on evictions. The council tended to stir up conflict, and people carrying the trauma of the streets often became targets of its aggression, as she had. Constant stress over potential eviction, combined with her difficulty finding work, drove her into isolation in her room. Her injuries kept her from sustaining ordinary work, and finding permanent housing in Seattle was and is a monumental effort for anyone. Her only solace was her dog.

Taking all of this in, I was both unprepared and shocked by the level of trauma and violence shared in this first session. Little time remained to debrief, so I extended the already unplanned session an additional ten minutes to try to end on a more grounded note. My head reeling, it took a week of time and space, both with and without supervision, to process what had unfolded in that single session. I asked her to return and begin weekly individual treatment with me, to help provide emotional support during these difficult times. She was enthusiastic at the prospect, and we began working in earnest from that point forward. The next few months were spent processing past trauma and developing healthy coping strategies for the stress of the present. She began to leave her room more often and started striking up conversations and friendships with other residents, despite the threats of eviction, the conflict, and other social challenges. For years she had felt trapped, yet she began to find release and sanctuary in her faith. The confusion that had clouded her mind began to lift, and a vision for her future emerged over the limited time we spent together. Though other traumas and past wounds surfaced, what grew stronger with every meeting was a feeling of hope. In the beginning, she spoke to herself with harsh self-talk and found little she liked about herself. Over the course of treatment, she began to see her strengths: her sense of humor, her compassionate spirit, her enormous capacity for empathy, and her ability to endure and persevere in the face of Sisyphean adversity. Toward the end of my internship, she was finally able to secure stable housing for herself and her dog. This meant an end to the conflict and a new chance to heal and start living again. Not all of her problems were addressed in our work, but hope for a new beginning and a better life was on the horizon. Rarely did I feel that I had the answers, or the skill to work with trauma this intensive. Yet, by sitting with her and leaning into the suffering and hopelessness, we were able to wait long enough for hope to emerge once again. Rather than hoping for her, or placing the whole of that labor on her, I sat with her in patience and held on with her through great pain and despair. Hope is a mutual reality that emerges with patience, between two people engaged in genuine dialogue and encounter.

Hope and Hopelessness in the Clinic

Hope and hopelessness also find their way into the very foundation of the clinic. Locating these aspects in treatment can be difficult, but tracing them in the environment itself is harder still. Yet in my clinic, hope and hopelessness lived in the structure and history of the building itself. The mental health program and its clinicians were based in a historic building in downtown Seattle that was once a grand hotel, a refuge for wealthy and famous guests. Located in what was once the shining heart of the city, it attracted power and money, a haven for pleasure and dreams. The building survived two world wars, a pandemic, and the hardships of the first half of the twentieth century. Enduring that societal despair bred a resilience into its walls and ceilings, preparing it for its eventual mission of housing people who had been homeless and impoverished. It transitioned from a beacon of prosperity into a beacon of hope for the downtrodden, the suffering, and the wounded. After its days as a high-class hotel had passed, it was purchased by a social service organization and, over time, devoted to housing people experiencing homelessness as part of that organization’s mission to end poverty, hunger, and homelessness.

Over time, the building became home to a church and accompanying faith-based programs and services. What was once a bar and lounge was transformed into a meeting room named for hope, an obvious bid to and for hope in a building that has endured and survived much trauma and hopelessness. This room hosts most staff and clinician meetings while also providing space for group therapy for clients who have lived in states of hopelessness for many years. Residents carried the hopelessness of the streets into their rooms, but now have space to work through that hopelessness and allow hope to re-emerge. Many residents tend to isolate in their rooms, having little trust or faith in the outside world and feeling safer in their own inner sanctums within the building’s many floors and halls. This presents both a challenge and an opportunity for clinicians: to engage clients in these spaces and try to bring a sense of hope back into their life world. The building and its clinicians and staff provide community, congregation, dialogue, and care, aspects that had faded from the lives of those coming in from the harsh reality of the streets. Each resident is given a second chance to find their way and meaning in life, to find meaningful work, and a chance to live and love once more. Down to its pillars and marble floors, the building is a structure built on a foundation of hope, one that holds space and time for hope to come back to life.

Hope and hopelessness also emerge in less tangible areas of the clinic. Clinicians must learn to navigate complex systems, both on paper and electronically. These systems are in place to help track treatment, bill insurance, and protect patients. As helpful as these programs are, they pose a series of problems for clinicians trying to respect autonomy and confidentiality. Many of these forms and programs demand the violation of the patient’s experience and personal narrative. The individual is lost in exchange for cookie-cutter templates: checklists, pre-filled forms, and selection-based screens and criteria. The patient is thus totalized, with the whole of their experience and life lost in the ones and zeroes. Furthermore, individual treatment plans demand the same fore-structure that other insurance forms require. The individual treatment plan becomes more of a group plan for the individual, based on the needs and desires of the insurance company and the community mental health center. State regulations also demand progress markers following each session, an aspect that should be held in high esteem in any therapy. However, progress is marked in oversimplified terms of some progress, much progress, and no progress. Little room for variation is the modus operandi of these billing and treatment forms, leading to a possible sense of hopelessness when little progress is made over a long period of time. Setbacks become the main measure of negative progress and can create pressure and a loss of hope within the clinician. All of this can create a dynamic of isolation and hopelessness, which is often then passed on to the client in session. Hope only makes its way into the patient’s files by way of protecting their confidentiality and respecting their stories, through session notes and treatment plans derived directly from the client’s voice and the dialogue in session.

Personal Experience

The foundation of my life prior to the program was built on the tension and relationship between hopelessness and hope. Before moving to Seattle, and before entering the MAP program, I had lost much of my eyesight, due to a rare degenerative retinal condition that I had inherited from birth. My vision had held steady until after graduating university with a degree in philosophy, and after attempting to establish a life for myself abroad. Sent spiraling into the abyss of despair, I desperately searched for a cure to my progressive blindness. The next several years consisted of failed attempts to treat my condition, and much wallowing in sadness and fear. My final attempt at a cure, was an experimental surgery using stem cell regenerative medicines as a means of possibly restoring eyesight, or at least slowing down the progression of the disease. The surgery would result in the total loss of eyesight in my right eye, and would not improve the sight in the left. The despair reached a fever pitch, mutating into a hopelessness unbearable; my only way out I believed, at the time, was through suicide. Living life blind was not an attractive option for me; there appeared to be no future, or at least not one that I wanted to participate in.

After my suicide attempt, I spent the next eighteen months in intensive individual therapy. During this time, I came to accept myself as the person I was, and the person I could become. I learned to let go of that which I could not control, and embrace that which I had power over in my life. Though my future was not what I had originally envisioned to be, there still was a future worth fighting for. I had placed all my desires on the hope for a cure; this was not genuine hope, this was a desire disguised as hope. Despair was on the horizon, as my hopes had been placed on a particular outcome (Marcel, 2017). For years I had isolated myself, felt confused by the why of my condition, and felt trapped in an impossible situation. I thus decided to take a chance, and try my hand at a new life. I could have continued to let my progressive blindness ruin my life, or I could be an active participant in my life’s ruination. No longer would my degenerative retinal condition make decisions for me; I would be the one making decisions. I shortly thereafter picked up and moved from southern Indiana, and settled in Seattle. I knew through my experience in therapy, that I wanted to do the same for others. I wanted to take my suffering and channel it to provide sanctuary and refuge to those seeking help. So I began undergraduate studies in psychology, working towards the eventual goal of applying for graduate school for therapy.

Through my undergraduate studies at Seattle University, I was introduced to the MAP program, to which I immediately applied upon graduation and was graciously welcomed into. The program was everything I dreamed of, and I have come to understand myself in ways I thought not possible before. Making it through the first stressful year, I attained an internship at CCS with their Crisis Recovery and Wellness program. And I have spent the majority of the second year managing the stress of both internship and graduate school. At times, I felt lost, confused, trapped, and helpless. Many times I felt as though I had gotten myself into an impossible situation, both inside and outside of internship and graduate school. Yet, through holding on and waiting, hope would emerge time and time again. I learned through patience with my patients how hope is a co-created reality that occurs between two individuals engaged in meaningful dialogue. Both of the clients described here taught me the importance of holding space for hopelessness, while holding on for the horizon to show the way. Never was it the consequence of direct intervention or behavioral techniques; rather, it was the care, empathy, and listening that allowed for the dawning of hope anew. And all of this culminated in the unprecedented time we are living in currently. The coronavirus pandemic has created a situation that feels both hopeless and desperate. The hope for a cure in the form of a vaccine is strong, and signs of positivity are few and far between. Fear and anger surface daily, as the masses grow increasingly frustrated and scared about their future prospects. In many respects, the future does not seem as bright as it once did before graduate school, before starting life anew. Yet, despite the confusion and entrapping feelings, hope does rest on the horizon. But it is not just a mere matter of waiting and being patient. Rather, this pandemic, and the cases examined here, showcase the virtue of creativity and fidelity. I believe that these two combined, as Marcel so eloquently coined, are the true manifestations of hope in actual living.

Creative Fidelity: Hope Made Manifest

Hope emerges in the playful and open dialogue between a pair partnered in engagement. Hope is not passive or inert; it is active and powerful. Hope rests in the creativity and imagination, and this imagination breaks all limitations when expressed through a genuine I-Thou relation, or in the fusion of horizons of Gadamer (Buber, 1971) and (Gadamer, 2013). Hope is spontaneous, not constrictive in its structure and essence. Genuine hope calls for commitment, not blind faith or disavowal. I move towards the Other in a movement of hope, when I relinquish myself, accept them as they are and are becoming, and listen and speak with care. There were many juncture points wherein my faith and hope began to waver in the therapeutic process. Yet, I never gave in or relented, never did allow for the hopelessness to overtake the hope. I held the hopelessness for my patients, as my therapist held the hopelessness and despair for me. There was no rejection of the darkness or pain, only an embracing of both the dark and the light. The ultimate move of hopelessness is turning away. The ultimate move of hope is turning towards. Before beginning my journey to become a therapist, I made a promise to live life as if I were living for the second time. And when starting the program and my internship, I made a similar promise to never give up on the Other, and to never give up on myself. All may appear hopeless at times. The world may feel as though it is doomed, as it has the past few months. But despite this, there is a horizon worth waiting for. If only we can make a devoted commitment to creativity, openness, and acceptance. And if we make a devoted commitment to relationship, can a new and hopeful reality emerge.

References

Buber, M. ((1971). I and thou. Touchstone Press. 1st Edition.

Frankl, V. (2015). Man’s search for meaning. Beacon Press. Digital Edition.

Gadamer, H. J. (2013). Truth and method. Bloomsbury Academic. 1st Edition.

Gutting, G. (2019) Foucault: A Noticeably short introduction. OUP Oxford Press. 2nd Edition.

Halling, S. (2018, October 6). Lecture. Personal Communication.

Levinas, E. (1969). Totality and infinity: An Essay on exteriority. Duquesne University Press.

Lynch, W. F. (1974). Images of hope: Imagination as healer of the hopeless. University of Notre Dame Press. 1st Edition.

Marcel, G. (2010). Homo viator: An Introduction to the metaphysics of hope. St. Augustine’s Press. 1st Edition.

Marcel, G. (2017). The Mystery of being. Andesite Press. 1st Edition.

Van den Berg, J. H. (1974). A Different existence: The Principles of phenomenological psychopathology. Duquesne University Press. 1st Edition.

Author: James Nole

Related: depression therapy and existential psychotherapy.