Strengthen Hope

As we continue our exploration of client retention and how this can decrease stress for clinicians by decreasing early termination of clients we will be looking at Chapter 7 - “Strengthen Hope,” from the book, Premature Termination in Psychotherapy - Strategies for Engaging Clients and Improving Outcomes, written by Joshua K. Swift and Roger P. Greenberg.

“We should not let our fears hold us back from pursuing our hopes.” - John F. Kennedy

Once therapy begins, hope is what motivates clients to continue on their journey.  As therapists, our voice and the assistance that we offer can give clients enough hope to continue on their journey until change has occurred.  This strategy, perhaps most of all, speaks to the anticipated benefits associated with attending therapy.  If clients have enough hope that the therapist and the treatment can bring about change, they will be willing to endure almost any perceived and anticipated cost associated with engaging in treatment.

Hope, broadly defined, is the belief that one’s goals are attainable through specific methods or routes and is paired with the willpower to make efforts to move toward those goals.  Applied to psychotherapy, hope is sometimes referred to as positive-outcome expectations.  It includes the belief that change or recovery is possible and that therapy is a promising route to bring about that change.

Given the role that outcome expectations play in therapy engagement and premature discontinuation, it is critical for therapists to make an effort to bolster clients’ positive prognostic beliefs as soon as possible.

Frank and Frank (1991) suggested two main ways to use hope in therapy: first, to arouse it through early therapy cues; and second, to strengthen it through initial progress toward the therapeutic goals.  With regard to hope-arousing cues, therapists should give consideration to how they present both themselves and their interventions.  Research indicates that interventions can be seen as more credible when the treatment rationale is logical, when it fits with the client’s beliefs, and when the therapist expresses faith in the specific treatment approach.

Strategies for strengthening and maintaining clients’ early hope generally fall into three broad categories:

1. Techniques for making therapy and the specific treatment seem more credible
   1. Sharing with clients some general research findings.
   2. Assist clients in their belief that the specific treatment will be a means to bring about change.
   3. Be specific and tailored to the client’s presenting problems, along with the client’s beliefs about why they are facing the problems that they are experiencing.
   4. Treatment rationales are also more likely to inspire hope when the therapist expresses his or her confidence in the treatment approach.
2. Methods for increasing clients’ faith in their therapist
   1. Strong (1968) originally proposed that therapists can be seen as more credible when they are perceived as being an expert, attractive, and trustworthy.
      1. The expertise of a therapist is most easily conveyed by the use of reputational cues (title, displaying degrees in the office) and demonstrations of psychological knowledge (using psychological jargon, referring to research when discussing the case conceptualization or treatment rationale).
      2. Therapists can be seen as more attractive when they are seen as similar to the patients with whom they work.  Some of the similarity may be based on demographics (age, ethnicity, gender), something over which the therapist has little control.  However, therapists can also seek to demonstrate similarity by dressing in a manner that is appropriate to the clients with whom they work.
         1. Underneath clients’ desires to have a therapist who is similar to them is a desire to have a therapist who will understand their background and situation.
      3. Therapists can be seen by their clients as more trustworthy when they seek to display genuineness, warmth, and empathy.
3. Efforts to raise clients’ self-efficacy beliefs
   1. Express faith in the client.  
   2. Therapists may choose to point out to the client how well suited he or she is for the particular treatment or mention the client’s strengths that increase the likelihood of success in therapy.
   3. Sample strength-recognizing statement you can offer to your clients:  Although difficult, taking that first step in meeting with me is a good sign.  It actually shows two important things about you: (1) that you are able to recognize when you are having problems and (2) that you are willing to take the necessary steps to address those problems. Those two things will serve you well in your future treatment.  Based on those two things, I am optimistic that you will be able to overcome your problems.

When hope is present, clients will be truly motivated to engage in psychotherapy!