Working with hope ? Definitions/descriptions of Hope Background - PDF document

3/8/2010 Denise J. Larsen, Ph.D., R. Psych. Associate Professor University of Alberta and Director of Research Hope Foundation of Alberta Centre for the Study of Hope in Practice Health Ethics WeekTalk March 5, 2010 Hope Research, Applications, and Education 11032-89 Avenue – U of Alberta Campus Outline Working with hope …? � Definitions/descriptions of Hope � Background research on hope Before beginning the presentation … B f b i i th t ti � Hope as folk ‐ term: Additional understandings of hope � Common clinical dilemmas when working with hope What are you wondering about hope? � Implicit and explicit use of hope � Unshared hope/Unrealistic hope 1

3/8/2010 What is Hope? Hope Research Hope-Lit Database � A process of anticipation that involves the interaction of thinking, acting, feeling and relating, and is directed www.hope ‐ lit.ualberta.ca/ toward a future fulfillment that is personally meaningful f f f p y gf (Stephenson, 1991) ( ) Approximately 3500-4000 research and theory articles on hope, a large number of which are � Hope is the ability to envision a future in which we located in the health sciences. wish to participate (Jevne & Edey) Most of my focus today will center on emerging � The ability to envision a tolerable future (Hanna) findings of research on hope during therapeutic conversations. Considering the Role of Language: Importance of Hope Additional Understandings of Hope Scale and Survey Studies � Is a comprehensive definition of hope is possible? (Eliott & Olver, 2002) � Positive relationship between hope and mental health indicators. � E.g., significant relationship between hope and increased serotonin levels in the � Meaning of hope is situated in culture, history, and brain – which may decrease the likelihood and extent of depression (Udelman & Udelman, 1991) social contexts. � Language is fluid – hope functions as a noun, verb, Language is fluid hope functions as a noun, verb, � Lower hope is predictive of depressive symptoms (Kwon, 2000) p p p y p ( , ) adjective, and adverb � Hope/expectancy accounts for 10 ‐ 15 % of change in psychotherapy � Do ‐ not ‐ resusitate conversations � In a large scale survey, hope was the character strength most consistently and � 12/23 spontaneously spoke explicitly about hope robustly associated with life satisfaction (Park, Peterson, & Seligman, 2004) � Looked at how participants used the word hope. � Levels of hope predict which people are likely to improve most with counselling (Gottschalk, 1995) � How did the word “hope” function in the conversations? � Belief that it is worth engaging in change process � Hope is beneficial in virtually every circumstance which has been measured (Cheavens, Michael, & Snyder, 2005) – educationally, psychologically, physically 2

3/8/2010 Discursive Functions of hope Hope as verb (HV) � Hope as a Noun (HN) � Here hope is subjective – � Hope as thing/possession Objective perspective on hope – determined by doctor � � “I hope that …” Here patients believe that the physician decrees whether there is reason for hope � Individual decides what is hoped for … � Influenced but not decided by the physician I fl d b t t d id d b th h i i E E.g., T here is no hope. T h i h There is no cure. � HV lends itself to several possible positive outcomes Important recognition for the practitioner � � “To Hope” is to undertake a more active process Subjective perspective on hope – held by the individual patient � � Person becomes active in the present but focused on the Hope as a possession of the patient � future May be independent of “objective” hope offered by doctors � � That future may be shorter or longer E.g., There’s a glimmer of hope. � The hopes may range from serious to light ‐ hearted Miracles do happen. Where there’s life there’s hope. Considerations for Practice Addressing Hope: Based on Discourse Research Recent Research Examining Common Dilemmas in Professional Interactions � Patients can switch between different versions of hope � Listen carefully and respond accordingly � The presence of hope can make a difference in engagement, Implicit and Explicit Approaches to Working with Hope well being and possibly outcome (Snyder et al.) well ‐ being and possibly outcome (Snyder et al ) � Use various types of language to access hope � E.g., Not “Is there any hope?” (HN) Unshared Hope Between Client and Health Care � “For what are you hoping?”(HV) “And, what else?” Provider � What would a hopeful person do? (HAj) � Hope and no hope can coexist The Hope of the Care Provider E.g., “There is no hope” (Objective) ‐ “One can always hope” (Subjective) 3

3/8/2010 Background to the Study: Data Collection The Participants � Videorecord – early therapy session � Interpersonal Process Recall Interviews (IPR) � Therapists � Interview participants individually while viewing � 5 Psychologists – 2 ‐ 16 years exp videorecorded psychotherapy session – 3 R. Psych., 2 Prov. R. Psych � Participants comment on any salient in ‐ session p y ‐ Female, aged 28 ‐ 53 years Female aged 28 53 years experiences with a specific focus on hope � Eclectic – narrative, CBT, � Interviewers humanist, feminist, emotion ‐ focused � 2 M.Ed. Counselling Psychology � Clients graduates trained in IPR � 11 recruited thru advertising at a community service and research � 1 interviewed clients only facility 1 interviewed therapists only � 5 men, 6 women, aged 31 ‐ 60 years � Issues – depression, grief, cancer, marital, physical disability, substance use, & employment concerns Implicit Use Of Hope: Is it possible to respectfully and Caregiving Relationship explicitly address hope? “making a place for hope to nest” (Dolan) Implicit and Explicit Approaches to Hope - Approx 13 Hours of Therapy Caregiving Relationship ‐ most common means of fostering hope. � 76 Hope-focused interventions Relationship was seen as both hope fostering itself and as the foundation � 50 implicit, 26 explicit for fostering hope. � Implicit: � IPR permitted psychotherapists to identify interventions which they intended to target client hope but which did not employ the word “hope” directly t t li t h b t hi h did t l th d “h ” di tl � Hope intentionally addressed by therapists by: � Previously this has been a matter of interpretation by the researcher � Witnessing Client Hopelessness � Explicit: � Highlighting Client Resources � Interventions employed the word “hope” � Hope experienced by clients in : Instances of low client hope were associated with discussions of the � Relational Safety “problem” � Feeling Heard and Understood Clients reported only positive or no impact when being invited to discuss � Evidence of Therapist Investment hope explicitly during therapy � May be employed when explicit use of the word “hope” would feel disrespectful or potentially leave the patient feeling unheard � E.g., Early in the therapeutic relationship Addressing crises � 4

3/8/2010 Implicit Use of Hope in Therapy: Therapist Explicit Use of Hope Practical Futures “To prepare the soil to plant seeds of hope” � Entails explicitly using the word hope in therapy and focusing on hope directly. It is about finding a way to carry on. Here hope can be simple, serviceable, mundane. � Based on idea that putting hope experiences into It is not necessarily the flowery or winged thing that poets sometimes language can help the client be more intentional language can help the client be more intentional write of … i f about accessing hope in various ways. Explicit use � What do you need to do next? – airplane story of hope helps to make hope visible when it is hard � Create a small behavioural plan for getting through (a life to find. raft) – J story � If introduced carefully, explicit use of hope can be � Important to talk of the future – even immediate future respectful of the patient’s experience. (Milton Erikson) � This approach to working with hope has been less � To not talk about the future is potentially damaging common and is the focus of current research. because it can imply that “your future is not worth talking about”. Do Patients Invite Hope Conversations?: Examples of Explicit Use Listening For and Responding to Hope of Hope in Therapy Client: I wrote back to him after he, you know, he turned Introducing Hope Explicitly: me down, and I actually – I’m pretty sure I used the word Sometimes people find it helpful to talk about hope in therapy. Would it “hope” in my response, ‘cause I said, “You know, out of all be alright with you if we explored some of your experiences and this,” I said, “ for the first time in a really long time, I y g understandings of hope, today? understandings of hope today? actually feel hopeful that I can – that I can trust ll f l h f l h h somebody again . … And yet, the other side of me thinks, “Yeah, but I would really wish that it was him.” I really do. But, his heart is not with me. I completely understand that. Sample Hope Focused Questions: He’s gotta do his thing � Given [this situation] who do you hope to be? � What do you hope for? What else might you be hoping for? (* bolded text added) � Given this [problem issue], where is the hope for you? � What is the smallest thing that gives you hope? 5