eNewsletter - January 2016
Behavioral Health Partners
Be a Hope-giver in the New Year: The Importance of Hope in Behavioral Health
Terry Ciszek, LCSW, CSADC
It is the New Year. A time for renewed as we hope to make and pledge to keep those resolutions we’ve been thinking about over the holidays. We, in the helping professions, know all about resolutions; those behaviorally-specific goals of change meant to recover our true self. You know, those goals that last until Valentine’s Day because, “Come on, you have to have some chocolate on Valentine’s Day!”
No matter what our resolutions entail, we must never forget how difficult it is to change for those we serve; our clients. They often come to us without hope due to the depth of their depression or the height of their anxiety. They may tell us they are hopeless. When our patients express hopelessness, we need to pay special attention to these statements.
Aaron Beck identified hopelessness as a ‘cognitive style’, not an emotional state. He describes it as a set of beliefs that one’s situation will not improve regardless of what one does to change the situation. Hopelessness is a lack of willingness to endure the discomfort of a situation one believes will never get better. It permeates one’s sense of self, of others and of the future.
This is critical for us, as helpers, to understand because hopelessness is the number one factor that correlates to the risk of suicide. As client safety is always our number one concern, assessing our client’s degree of hope for change must be a high priority in all the work we do.
Yet, the literature in our field barely addresses hope as a meaningful concept. I could not help but notice in the 2016 Norton Mental Health Complete Catalog of Professional Books, there are 528 books listed and not one has the word "Hope" in its title.
Which begs the question: where do we turn for guidance in helping our clients increase their sense of hope for change in their recovery process?
We turn to C.R. Snyder’s seminal work of 2000, Handbook of Hope. Snyder defines “Hope” as a positive motivational state based on the interaction of specific goals, pathway thinking (how are we going to get there), and agency thinking (assessing our own skills and willingness to use them). In addition, we must also assess barriers to change, which often shows itself in avoidance behaviors.
Let’s break down this definition into a hope equation to better utilize it in our everyday work. (HOPE = Goals + Pathway + Skill/Willingness – Barriers)
Most of all human behavior is goal directed. Goals need to be specific and of sufficient value to produce sustained attention and focus. We talk with our clients about making S.M.A.R.T. goals: specific, measureable, achievable, relevant, and time focused. We set our clients and our work up to fail if our mutually determined goals do not meet these criteria.
Pathway thinking helps provide the map and directions to follow for goal obtainment. It generates possible means and methods to reach the desired outcome. Unlike Yogi Berra’s famous quote, “If you come to a fork in the road, take it”; these pathways need to be clear in both strategy and sequence. Our field is full of just such pathways.
The self-help community of Alcoholics Anonymous (A.A.) gives us 12 steps to follow and 'honesty, openness, and willingness' when asked how one follows the steps.
Cognitive Behavioral Therapy (CBT) has given us the direction “Change your thinking, and change your life”. It is backed up with specific methods of identifying cognitive distortions, use of a Thought Record, and the Downward Arrow Technique, to name just a few.
Marsha Linehan introduced us to Dialectical Behavioral Therapy’s (DBT) core dialectic of ‘Acceptance and Change’ and then spelled out the pathways of her five key sets of skill acquisition: Mindfulness, Distress Tolerance, Emotional Regulation, Interpersonal Effectiveness, and the Middle Path.
Steven Hayes gave us Acceptance and Commitment Therapy (ACT) with its pathways to change in the six areas of the hexaflex: Defusion, Acceptance, Contact with the Present, the Observing Self, Values, and Committed Action.
Regardless of our theoretical underpinnings, it is important to understand the strong connection between the “pathway of treatment” and the degree of the client's hope for change.
The agency thinking part of the hope equation is the client’s self-appraisal of his or her internal skills and the ability to use them to successfully to obtain his or her goal. This motivational energy is strengthened when the goal for change is in line with the client's core personal values, which helps the client stay focused on his or her efforts. Helping our clients name and clarify their core values greatly adds to successful goal identification.
The final component of the hope equation is helping the client to name their own maladaptive coping strategies and be willing to challenge them. The most common strategy is experiential avoidance. Whatever thought, feeling, or behavior is being avoided, once it is accepted, expressed, or acted upon hope begins to build in spite of some discomfort.
We must be the bearers of hope for our clients as they struggle to find their own way in recovery. When our clients get stuck along the way, we can use the Hope Equation to assess trouble spots.
Hope begets recovery and recovery begets hope. It is cyclical in nature. Be the bearer of hope for your clients and watch the New Year bear new life. Best wishes for a year full of Hope!
- Is the goal specific enough, attended to with focus, and does it have valued meaning for the client?
- Are the pathways clear, the direction understandable, the sequence and pacing adjusted to the client’s needs?
- Is the client accurately self-appraising his or her skills and willingness to use them effectively?
- Have we both taken into account the internal and external barriers blocking progress?
C.R. Snyder, Handbook of Hope – Theory, Measures, and Application, 2000, Academic Press)
Terry Ciszek, LCSW, CSADC
Terry has been the Director of Outpatient and Social Services for Linden Oaks Behavioral Health for over nine years. He has thirty-five years experience in the behavioral health field. He has been an outpatient therapist, clinical supervisor, and director in both inpatient and outpatient hospital settings in both mental health and addictions.