Wednesday, September 18, 2013


Not all of our patients reach levels of despair or profound discouragement wherein they feel a sense of hopelessness or some significant diminished of their capacity to be hopeful. More than a few clients,however, do experience that dark place at some point in their therapy or counseling.

Sometimes it's because nothing in any area of their life is going well and everyday life feels so overwhelming that they cannot see a away out. Sometimes they feel a sense of powerlessness to change any of the externals of their lives. Sometimes they feel that whatever changes need to occur are so daunting that they are beyond their own inner resources. Sometimes it's because they feel consciously or unconsciously that they are unworthy of a better life. Sometimes it's because they are over attached to certain desired outcomes or over identified with some self-concept or certain ways of being-in-the-world. Usually it is a toxic mixture of several of the above factors.

It is in these moments that our patients need us to be "carriers of hope". It is not necessary for us to offer them reasons to be hopeful,nor is it essential for our client to think of things to feel hopeful about. During these times of profound darkness any imperative to find reasons to be hopeful place too much pressure on our client or us. What we can offer though is companionship in the darkness - to be alone in the dark is more scary - and a persistent willingness to keep working with them on these issues until some light appears. What I usually say to my patients during these difficult times is,"I have experienced my own version of this place a couple of times in my life and I've been with other patients in this dark place. For now I will carry the hope until it reawakens in you."

Whenever I've said that most patients have voiced that they feel relieved and grateful. Occasionally there is some client for whom that message is no conscious source of solace. I simply accept that they are unable to take in my offer at this time and I continue the work placing no extra pressure on them to acknowledge that message.

Twice in my life I have experienced periods of sustained suicidal ideation. I have never acted on those thoughts. Because of my own toxic mixture of the feeling states that I described earlier I know what it feels like to feel that the only way out of the overwhelming darkness is death. Obviously I am grateful that I never acted on those feelings. I am also grateful that I have experienced those states. It is both an additional source of deep compassion for my patients who are suicidal and also helps me to be less fearful about being in that place with them. With most patients who are feeling suicidal I share that aspect of my personal story. It enables them to know that there is an additional source of my genuine empathy - as a human being who has suffered similar states in addition to being a professional who cares. I am also offering myself as a beacon of hope.They are usually grateful for that moment of sharing our humanity. Periodically I do not share my story because I sense for reasons that are idiosyncratic to that patient, that it would not be helpful.

Never in my training was it ever mentioned that one of our important roles was to be "carriers of hope". Increasingly I feel that it is an essential aspect of our work. I'm not sure why. Perhaps in these complicated times wherein the political, economic and environmental issues are placing so much conscious/unconscious pressure on our clients that the need for us to be a source of hope in their individual lives is greater.