Hope and Hopelessness in Therapy

Hope and hopelessness in Psychotherapy

James P. Nole
Seattle University

Acknowledgements

This project is the result not merely of two years of hard work—but the 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 hanks must also be given to Dr. Alexandra Adame, who served ass 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 outside0 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

Feeling exceptionally good about myself, sitting in my chair, I eagerly awaited my last patient of the day. I was riding high after having two successive sessions, that felt to me as the start of great therapeutic work. Having just finished my notes form the previous session, I was starting to wonder if my client was going to show. At about five minutes past, in walks Henry, -- a tall, heavier set, broad shouldered man. Two weeks had passed since the intake, which had been my only prior contact with him. I had forgotten how long his hair was, and the rather youthful, boyish features of his face. Aside from his older styled frames, the only thing that distinguished him as an older man was his fully-grown goatee and accompanying facial hair. After shaking hands, greetings, and the typical disclosure statements—we quickly set to task. Henry was unsure where he wanted to go with therapy. Having no specific goals in mind due, due to his never having his own individual therapy—I invited him to just start wherever he thought necessary and significant. Before I even realized it, we were already diving into his family history and significant relationships. A feeling as though I was in a Freudian sketch comedy or a stereotyping movie about therapy, slowly began to creep over me. I sat patiently and enthusiastically, as I listened to Henry’s childhood experiences—growing up with an alcoholic and abusive father, an estranged relationship with his brother, and a toxic relationship with several women. Henry was now 41 years old, and was estranged from his entire family, except for that of his mother. He had lived the last four years on the streets in Seattle and had been unemployed and on the job hunt for the past seven years. The gaps in his work history had created an emergent problem with seeking future employment, and his experience of homelessness and substance abuse had left him numb and feeling traumatized. The little hand on the clock struck ten till four, signaling the end of session. A sense of overwhelm and overload had been washing over me like a crestfallen, tidal wave. I signaled the end of session, thanked henry for his time, and walked him to the door. I was filled with both relief and excitement for the end of the session. Little did I know, this would be the first counter-transretinal sign of darker feelings to emerge.

Over the next few sessions, Henry would begin to elaborate further upon his childhood and first long-term romantic relationship. Henry’s childhood was marked by verbal, emotional, and mental abuse from his alcoholic father. Eventually, his mother had enough, and saved the appropriate funds to move herself and the children out of their house and out of the grasp of her toxic and manipulative husband. Henry’s father would not attempt to reach out to his sons, leaving Henry to make the effort on several occasions. His father would reject the advances for re-establishing communication and connection, culminating in Henry’s total estrangement and disconnection from his father. This estrangement would also emerge between Henry and his brother, for whom Henry had been the generator of anxiety and aggression. Having been the target of Henry’s adolescent frustration and anger, would create a vast, distance between the two. Henry felt it impossible to reach out to his brother post high school, leading him to seek affirmation and acceptance outside of the family unit. Henry would find this affirmation and acceptance both in university, through the arts, and in his first significant romantic connection. Henry met his first partner through theater, as they played the leading roles in a small-town production of Les Miserable. The two quickly fell into a passionate love affair, that abruptly breaking the engagement of Henry’s soon-to-be partner. Only a few months would pass, before Henry’s girlfriend would ask him to move together leading to a seven-year co-habitation. The beginning and initial phases of the relationship held promise for a bright and hopeful future for the two but would quickly devolve into a toxic and abusive relationship.

After a year of living together, Henry had desperately been searching for work that not only fit his qualifications, but also possessed a level of desirability. With every interview and potential hire, his girlfriend would protest and proclaim that the work was beneath him, and by extension, her. This pattern would repeat time and time again, until after several years of unemployment and unsuccessful job acquisition, Henry gave up entirely on the whole endeavor. Henry’s partner, worked in a high position at their town’s sole bank—a position that had been occupied by other members of her family, and brought a certain level of status and prestige. Henry never need to worry about money, t though his partner would remind him at every turn, how lazy and useless he was both outside and around the house. This combined with the introduction of opiates into the two’s relationship, created a dynamic of co-dependency. Henry unable to move out on his own, was pulled back at every attempt to leave by his girlfriend who needed him for emotional, moral, and substance use support. The two grew entrenched in a toxic dynamic, that burst into fights and shouting matches. This would carry on for over six and half years, before exploding into an episode involving the police. Upon the discovery and realization that his girlfriend had been embezzling money to help pay for the two’s opiate addiction, Henry’s conscience goes the better of him, leading to him attempting to throw away all related contraband. This would culminate in a confrontation, wherein Henry would be arrested for not only possession of the drugs, but also felony by entrapment—having stood between his girlfriend and the door, preventing her from escaping from the police and the situation. In a cruel twist of fate, Henry’s move to keep his girlfriend from running away, would lead to his imprisonment and a perpetual feeling of being trapped and helpless.

Upon release from jail, Henry made his way to Seattle in hopes of starting life anew. Henry having grown up in a small town in Idaho, realized that he might stand a better chance for creative and artistic opportunities in the big city. Unfortunately, Henry’s hopes were dashed within a short span of time, as he could only find work in areas for which he had little to no interest. Henry drifted between a few jobs, working with each for no longer than a year, and always finding himself in an uncomfortable situation in his various positions. The struggle for stable, consistent, and meaningful work grew frustrating and fruitless—giving way to his inability to find any work, due to the patchy and gap-filled work history. Henry eventually found himself out on the streets, being unable to make rent. Henry would spend the next four years, homeless and in absolute poverty. The trap had been set with the difficulty seeking and attaining employment, and now that trap had only tightened its grip on Henry. Finding work while homeless, is more than a monumental task—it is at time as Sisyphean endeavor, one that breaks the person down repeatedly. Henry would be traumatized by his experiences living on the streets and was left with a pervasive feeling of numbness throughout his body and person. He had only just entered the Aloha Inn housing program through Catholic Community Services six months prior to our first meeting. And he was now struggling to make sense of his life over the lasts few years, and how to move forward in the face of such suffering and tragedy.

Henry’s despair grew apparent to me within the first few sessions. He had started therapy out 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 dive 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 perspective and outlook. Henry began to slouch as he walked into my office, and stopped wearing more formal attire, in exchange for extreme casual wear. Henry had grown isolated and withdrawn within the community of the Aloha Inn, choosing to not make friends with others and his various roommates. He stopped reaching out for connection with others, as he saw it as pointless, since they would only part ways in the end anyways. Every attempt at a solution for any minor problem, or any attempt to shift perspectives and ways of seeing his current situation were met with denial and outright rejection. I could listen to Henry’s woes and plights, but I never seemed to be able to reach him in terms of shifting his thoughts or elucidating thought distortions. All moves towards the positive, or anything resembling such a movement would be met with refusal. I began to feel hopeless, and as if I could not help him. I exhausted all suggestions 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 that had no hope for a better future or a postage outcome. There appeared to be no exit from the hopelessness and the suffering, and I grew confused as to even which direction to take each session. And it was halfway through internship, that the realization that these were the feelings he subconsciously may have wanted me to feel hit me. Though my options felt limited, especially considering my placement as an intern. But I did have a way forward. I could either give into the hopelessness, or sit with Henry patiently, for the emergence of a sliver of hope. His past may have been ruled by feelings of hopelessness and helplessness—but his future cold break this chain. Neither henry nor I could see the horizon yet. All we needed to do was to sit, and engage in dialogue, waiting for the sun to rise once more on his future.

A Case of Hope

One unsuspecting Wednesday, I was walking into my office at the Aloha Inn. When at the front desk, a distressing scene was unfolding. A middle-aged woman was cursing under her breath—simultaneously, pronouncing how ‘they’ were royally facing her over. My nerves suddenly on edge, I signed in at the desk and followed the woman out into the hall. The tension in the room had been so palpable, that I was already off my game. Despite this, I asked the woman if she was ok—to which she responded with an emphatic no. Following this, she expounded upon how the Resident Council was trying to move her into a room with a roommate, which would ignite and reopen her wounds , at a time when she was just trying to get by and heal. We shared the elevator ride up to the same floor, and as we were approached my office, I offered her some time to decompress and try and distress after the occurrence downstairs. The afternoon was already filled with appointments, but I felt as though this was the right action to take. She enthusiastically agreed, introduced herself as Michelle, and asked if she could bring her dog into session. I shared the office with another member of Catholic Community Services—and despite their absence on the days I worked, I was unclear as to whether this was within my limits as an intern. Rather than airing on the side of caution, I aired on the side of the patient and welcomed her dog in with open arms.

Returning to my office a few minutes later, Michelle introduced her chocolate Labrador, Sadie. Sadie was a three-year-old rescue, who had been the victim of physical abuse and neglect from her previous owners. After spending a few minutes getting to know Sadie and engaging in small talk—we quickly moved back into the matter that had distressed Michelle and prompted this session in the first place. And before I Knew it, we were diving headlong into historical content I had no way of preparing for as a budding therapist and intern. Michelle had moved to Washington from St. Louis five years back, to be with the e love of her life, Robert. At the time, Michelle believed Robert to be a kind and gentle man, who cared deeply for her. She had taken his last name in the hope and belief that they would be together forever, and that their love and bond were genuine. The honeymoon phase was short lived though, as Robert’s demeanor took a downward shift. Robert began inviting strangers into their home, without Michelle’s consent. The strange men that were invited into the home were engaged in illegal and illicit= activities, such as drug trafficking. Robert’s behavior grew increasingly erratic, eventually leading to severe physical abuse of Michelle. Between the gaslighting and manipulation—the emotional and mental abuse that Michelle incurred, began to disintegrate her spirt. Unbeknownst to her at the time, she was being drugged and sedated—and thus, unable to escape her tormentors. Michelle felt trapped, as she was economically dependent on Robert, and was always forced to remain in the house. Under no circumstances was Michelle to leave the premises, and hopelessness and the feeling s of entrapment and impossibility settled in. The strange men who Robert had allowed to stay, continued in the breaking down of Michelle’s spirt and body, as they engaged in individual and group rape of her. This lasted for several years before finally culminating in the attempt upon her life by her husband via a hired killer. The attempt was carried out with a lethal dosage of Strict Nine. The attempt was unsuccessful and resulted in brain damage and severe trauma for Michelle. Though, this was also the turning point which prompted Michelle’s escape from Robert’s clutches.

The escape to Seattle, bore wit it a new set of challenges and trials for Michelle. Her trouble not yet over, she continued to struggle with substance use while trying to survive on the streets. Life on the streets of Seattle is hard for many, and it was additionally challenging for Michelle in lieu of her recent injures and trauma. After a few years of this struggle, a beacon of light and hope shone on Michelle. Seemingly to her favor, Michelle was able to attain temporary housing at the Aloha Inn, because of her having been chronically homeless for over two years. During her stay, she was expected to find and attain work and housing. Simultaneously, Michelle was to perform chores and tasks around the Aloha Inn, as is the tradition of all residents. Further still, all residents were required to attend weekly meetings with the Resident Council, which comprised its membership from various residents. This council I, tended to stir up drama amongst the residents as it was responsible for making summons and voting on the evictions of various tenets. Due to the natural trauma hat is brought in from living on the streets, many individuals become the target of aggression by those on the Council—as was the case for Michelle. Constant stress from potential eviction combined with her inability to find work drove Michelle to isolation and reclusion in her room. Her injuries prevented her from performing normal work for long periods of time and finding more permanent housing was and is a monumental effort for anyone living in Seattle. Her only solace was her newfound furry friend, Sadie.

Taking all of this in, I was both unprepared and shocked by the level of trauma and violence that had been unloaded in this first session. Little time remained to debrief, to which I extended the already unplanned session an additional ten minutes to try and shift towards a more positive tone to end on. My head reeling, it took a week of time and space both with and without supervision to process what transpired and unfolded in that single session. I had asked Michelle to return for another session, and to begin a weekly individual treatment with me as an attempt to help provide emotional support during these difficult times. Michelle was enthusiastic at the prospect, and we began working in earnest from that point forward. The next few months were spent processing the past trauma and developing healthy and positive coping strategies to deal with stress in the present. Michelle began to leave her room more frequently and started striking up conversations and friendships with various residents—despite the threats of eviction the drama, and various other social challenges. For years she had felt trapped, and had been the victim of entrapment—yet, she began to find release and sanctuary in her belief in God. 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 emerged, what grew stronger with every passing meeting was a feeling of hope. In the beginning, Michelle had always addressed herself with negative self-talk, and had little that she liked about herself. Over the course of treatment, she began to see her positive traits and qualities—her sense of humor, her compassionate spirt, her enormous capacity for empathy, and her ability to endure and persevere in the face of Sisyphean adversity. Toward the end of internship, Michelle was finally able procure stable housing for both her and Sadie. This would mean the end of the drama, and a new chance for her to heal and to start living again. Though not all her problems were addressed in our treatment—hope for a new beginning, and a better life was on the horizon. Rarely did I ever feel that I had the answers, nor the skill to work with Michelle’s intensive trauma. Yet, through 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 pinning the sole of such labors on Michelle- I sat with her in patience and held onto her through and during great pain and despair. Hope is a mutual reality that emerges with patience, and between two individuals engaged in a 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 and identifying these aspects in treatment can be difficult—but the opaqueness of such phenomenon in the environment is greater in difficulty to trace. Yet, in my clinic, hope and hopelessness existed in the structures and history of the buildings themselves. The base of operations for the mental health program and it clinicians, was located in the Josephinum, in downtown Seattle. The Josephinum was once a popular hotel, that provided refuge for wealthy and famous denizens. Located in what was once the shining glory of Seattle, the Josephinum attracted power and money—a capitalist haven for pleasure and dreams. The Josephinum would survive through both World Wars, and a pandemic and famine through the first half of the 20th century. Enduring societal despair, bred a resilience into the fabric of the walls and ceilings of the Josephinum, preparing it for its eventual mission of housing the formerly homeless and impoverished civilians of Seattle. The Josephinum transitioned from a beacon of capitalistic and American greatness into one of a beacon of hope for the downtrodden, the suffering, and the wounded. After losing its integrity and influence as a high-class hotel and entertainment hub—the Josephinum was purchased by Catholic Community Services to provide housing for its workers. Eventually, the purpose of housing would shift to a focus on the homeless in Seattle, as a means of carrying out CCS’s mission for ending poverty, hunger, and homelessness.

Over time, the Josephinum became home to a Catholic church, and accompanying Christian oriented programs and services. What was once a bar and lounge, was transformed into the Christ Our Hope meeting room—an obvious bid to and for hope in a building that has incurred and survived much trauma and hopelessness. This meeting room is the center for the bulk of meetings for staff and clinicians—while also providing the space for group therapy sessions for clients who have lived in states of hopelessness for many years. The residents of the Joe, carried the hopelessness from the streets into their rooms—but now have space to sublimate that hopelessness, and allow for the re-emergence of hope. Many clients and residents tend to isolate in their rooms, having little trust or faith in the outside world—feeling safer in their inner sanctums within the many floors and halls of the Josephinum. This provides for a challenge and an opportunity for clinicians to engage clients both in these spaces, and to try and bring a sense of hope back into their life world. The Josephinum and its clinicians and staff provide community, congregation, dialogue, and care—aspects that had faded away from existence in the lives of those coming in from the harsh reality of the streets. Each resident is given a second chance for finding their way and meaning in life—to find meaningful work and a chance to live and love once more. Down to its ivory pillars and marble floors, the Josephinum is a structure built on the foundation of hope, that holds space and time for hope to come back to life.

Hope and hopelessness also emerge in less tangible and physical areas of the clinic. Clinicians must learn to navigate complex and intricate systems both on paper and electronically. These systems are in place to help track the treatment, bill for insurance, and protect the patients. As helpful as these programs are—they pose a series of problems for clinicians trying to respect the autonomy and confidentiality. Yet, 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 via 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 level of 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 community mental health center. State regulations also demand progress markers following each session—an aspect that should and must be held in high-esteem with any therapy. However, the level of progress is marked in sover-si9mpliefied 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. Incrementally, setbacks are the main form of negative progress, and can create a dynamic of pressure and loss of hope within the clinician. All the spirit of these manipulations can create a dynamic of isolation and hopelessness, which are often then passed onto 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 the therapist’s notes of the sessions and treatment plans that are 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 managed to attain 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 an 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 Henry and Michelle 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 corona virus 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 for positivity are far and few between. Fear and anger surface daily, as the masses grow increasingly frustrated and scared at their future prospects. In many respects, the future does not seem as bright as 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 examine 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 commitment00 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 many juncture points wherein my faith and hope began to waiver 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 I my therapist held the hopelessness and despair for me. There was no rejection of the darkness or Spain—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.