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Jill Presnell
Nov 01, 2012

The Inpatient Therapist: Don’t give them hope

Many individuals who come to our floor express feelings of hopelessness. Often, these feelings have a future orientation with the focus being primarily external or internal. The person may be immersed in thoughts about the pressures around them in which they feel trapped and see no viable way past. The future is a continuation of the present. Current circumstances and their consequences are eternal, becoming worse over time.

Alternatively, for some folks their thinking is focused on a lack of internal strength, doubting their ability to cope with changes occurring in their lives. They fear that their feelings of sadness, loneliness, rage, or fear will continue long into the future. They may fear “falling apart,” though exactly what this means is unclear, and they don’t believe that they have the strength to prevent it. It is the development of suicidal or other self-destructive thoughts or behaviors that leads to admission on our unit.

As inpatient therapists, and human beings, it’s uncomfortable to sit with someone in suicidal hopelessness. New therapists (and yes, those of us who have been doing it a while) may want to give them hope quickly. We want to pull them out. This attitude results in our drawing from our own view of what will work for them. In our discomfort, we can appear dismissive by telling them what they have to live for. The problem is that we are giving them OUR hope, from OUR perspective, out of OUR well of resources. But as we all know, hope must come from within the person.

I suggest that instead of giving hope, we hold hope for the patient. I realize that this may seem like a matter of semantics but I believe that there is an important difference. To give hope is to impose our own perspective on another person. It can cut short the process of personal exploration and growth which is a fundamental part of treatment. To hold hope is to express our belief that the person will find a way through their current experience. It requires us to step into their world, respecting and empathizing with the feelings of pain that exist there. We offer the power of our hope as a means of holding the person up through the process of finding their own.

The process of discovering their hope commonly begins when folks remove themselves from their surroundings into the shelter of the ward. When I meet them in the ER they may be ambivalent about being admitted, owing to a fear of dropping the balls they have been juggling. However, it’s not hard to get them to agree that they’re exhausted. They’ve been holding their breath; feeling like they are drowning. Stepping away gives them the chance to exhale.

Talking with a therapist one on one is helpful. Psychoeducation and psychotherapy groups provide important opportunities to consider thinking styles, relational problems, and tools which may work to manage stress, emotions, or triggers. But from what I’ve seen, it is the connection with others on the unit that has the greatest influence. Each person begins to see that the feelings of sadness, fear, loneliness, anger, and hopeless are not uncommon. Even when a person cannot find hope in his own life, he can see hope in the lives of others. The process of universality, altruism, interpersonal learning and group cohesion occurs not only during psychotherapy groups but also during unstructured times together in the lounge or dining room. I have seen those who have begun to heal reach out to new people in ways that might not happen out in the community. Through these unique bonds, the instillation of hope begins.

I believe that healing does not occur without hope. People in suicidal despair face the realization that the things they placed their hope in (a relationship, prestige, appearance, success, drugs, talent) did not hold them in the storm. While listening to their story of loss, I feel honored to be part of such a unique opportunity. They begin to search. Being in the emotionally and physically safe environment we work diligently to create offers the person an opportunity to reflect on what is truly meaningful to them. How rare this seems to be in the hectic world in which we live. For the people we see, the journey only begins on the unit. They are still fragile when they leave, but I frequently see a new found inner strength. If they choose to continue with a therapist through outpatient or partial program, then it is up to you to hold hope for them through their journey.

Jill Presnell is a Counselor in Northeastern Pennsylvania as well as an advocate for the provision of recovery oriented mental health services.

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