Sitting in silence in an anonymous hotel room in Vancouver, I contemplated my presentation for the 5th International Experiential Dynamic Therapy Association Conference (IEDTA). I planned to present a videotape of work with a patient with chronic, sometimes vegetative and ego-syntonic depression, and I was looking for a central theme. Suddenly, a key factor in the session jumped out at me: the emergence of HOPE. By “hope,” I refer to hope that is generated by a heightened sense of one’s own capacity to act or feel in an entirely new way as opposed to a passive stance of hoping for something to happen without our active engagement. This patient lacked hope in his ability to feel, to relate, and also to overcome his avoidant and depressive character traits. He also lacked hope in the healing aspects of relationship.

There was a startling moment, occurring in a millisecond and easily undetected, when hope as defined above arose within this patient and shifted the entire course of the initial session. It illustrated that hope is not as an end point but rather a dynamic process that both initiates and propels therapeutic movement. In J. Weinberger’s review of hundreds of outcome studies validating key curative factors in psychotherapy, “revival of hope” is among the most important.

Treatment success requires that the patient first be able to declare what he wants, then to experience hope in the possibility of achieving these desires. As hope grew in this patient, he risked greater emotional intimacy with me and there was a positive impact on his mood. The ability to self-reflect is one factor that is central to the development of hope. Jon Frederickson, MSW, whom I admiringly refer to as the “Maestro,” demonstrated the process of strengthening the observing ego in his transformational work with “A Man with 17 Therapies”:

Th. As soon as you say what you want, it’s like this worry station, this channel, comes on. You become anxious. This internal anxiety and guilt channel drowns out everything else. Some sadness comes up around differentiating yourself from this channel. It’s been your whole life.

(It’s not enough that the patient recognize his defenses; it’s his healthy desires that will win the battle).The doubt channel, doubting me, doubting you. You’re not liking what your mind is doing. Your brain has an automatic doubt circuit… Is this what you want?

When Jon’s patient could connect with his will and also observe the sabotaging part of himself, he was empowered to overcome it. The Impact of Desire and Hope in Defeating Resistance will be the focus of my presentation with Dr. Thomas Brod at the New Center of Psychoanalysis on Nov. 13, 2010. Register at http://www.n-c-p.org/edu-event.asp?id=160&the_type=Course. Thanks to NCP and also the Southern California Society for ISTDP for sponsoring this event.

This is also the topic of my article in the September, 2010, issue of “The Ad Hoc Bulletin of Short-Term Dynamic Therapy.” Subscribe to this excellent journal at http://www.iedta.net/.

This entry was posted on Tuesday, September 28th, 2010 at 2:27 pm and is filed under Treatment Process. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.