Abstract
This paper provides an intersubjective viewpoint on the challenging and disturbing clinical phenomenon of hopelessness, and suggests that therapists' careful balancing of accurate empathy for patients' profound despair with a belief in their ability to overcome it can help such patients develop and maintain a more hopeful state of mind. Clinical literature on hope and hopelessness is reviewed, as are pertinent countertransference issues related to working with this population so often erroneously viewed as “treatment resistant”. The author presents two case examples to highlight her ideas.
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References
Adler, G. (1972). Helplessness in the helpers.British Journal of Medical Psychology, 45, 315–326.
Bloom, V. (1967). An analysis of suicide at a training center.American Journal of Psychiatry, 123: 918–925.
Brandchaft, B. (1988). A case of intractable depression. In A. Goldberg (Ed.)Progress in self psychology vol.4, Hillsdale, New Jersey: Analytic Press.
— & Stolorow, R.D. (1984). The borderline concept: Pathological character of iatrogenic myth? In J. Lichtenberg, M. Bornstein & D. Silver (Eds.)Empathy II, Hillsdale, New Jersey: Analytic Press.
Coolidge, J. (1969). Unexpected death in a patient who wished to die.Journal of American Psychoanalytic Association, 17:2, 413–420.
Frank, J. (1968). The role of hope in psychotherapy.International Journal of Psychiatry, 5:5, 383–395.
Feud, S. (1953). Psychical (or mental) treatment.Standard Edition, Vol.7. London: Hogarth Press and the Institute of Psychoanalysis.
Fromm-Reichmann, F. (1950).Principles of intensive psychotherapy. Chicago: University of Chicago Press.
Goldberg, A. (1971). On waiting.International Journal of Psycho-Analysis, 52:4, 413–421.
Goldstein, A. (1968). Maximizing expectancy effects in psychotherapeutic practice.International Journal of Psychiatry, 5:5, 397–399.
Kissen, M. (1987). The reluctance to experience positive affects. In D. Milman & G. Goldman (Eds.)Techniques of working with resistance. Northvale, New Jersey: Jason Aronson.
Kohut, H. (1977).The restoration of the self. Madison: International Universities Press.
Mendel, W. (1982). The non-specifics of psychotherapy.International Journal of Psychiatry, 5:5, 400–402.
Mintz, R. (1971) Basic considerations in the psychotherapy of the depressed suicidal patient.American Journal of Psychotherapy, 25:1, 56–73.
Orne, M. (1968). On the nature of hope.International Journal of Psychiatry, 5:5, 403–410.
Ornstein, A. (1988). Optimal responsiveness and the theory of cure. In A. Goldberg (Ed.)Progress in self psychology, Vol. 4. Hillsdale, New Jersey: Analytic Press.
Searles, H. (1979). The development of mature hope in the patient-therapist relationship. InCountertransference and related subjects. New York: International Universities Press.
Shneidman, E. (1980).Voices of death. New York: Harper and Row.
Tabachnik, N. (1961). Countertransference crisis in suicidal attempts.Archives of General Psychiatry, 4:6, 64–70.
Wheat, W.D. (1960). Motivational aspects of suicide in patients during and after psychiatric treatment.Southern Medical Journal, 53:273–278.
Winnicott, D.W. (1958).Through paediatrics to psychoanalysis. New York: Basic Books.
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Ruvelson, L. The tense tightrope: How patients and their therapists balance hope and hopelessness. Clin Soc Work J 18, 145–154 (1990). https://doi.org/10.1007/BF00756475
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DOI: https://doi.org/10.1007/BF00756475