Hope, the neglected common factor

Dr Denis O’Hara, researcher at Universities in Scotland and Australia, stresses that the fourth common factor “hope” deserves much more attention than it currently receives. In Therapy Today, vol 21, issue 9 he writes the following:

As most therapists know, there are four common factors in therapy which determine the effectiveness of the therapy. The first common factor is extra-therapeutic support (social support which the client receives), the second is the therapeutic relationship (the relationship between the therapist and the client), the third is the theory and method used by the therapist and the fourth common factor is hope and a positive expectation.

O’Hara defines hope as “the optimistic expectation of a good future”. Without the conviction that good things and good experiences are available to us, we lose hope and get desperate. One of the main reasons why people seek help from a therapist, is because they are confused whether or not there is still hope for them in their situation.

Researchers of the Hope Foundation in Canada therapists define hope in three different ways:
1. Hope as something tangible that one person can give to another. De role of the therapist is then to give hope to the client
2. Hope as a process of discovery. The role of the therapist is then to help the client discover there is hope in his narrative. Hope which the client could not see any longer, but which is actually there to be discovered
3. Hope as co-construction. The role of the therapist is to create hope, together with the client. Through a process of co-construction in therapeutic conversations, the therapist co-creates hope which is relevant to the client.

Many therapists indicate that evoking hope is an important part of their work with clients, but that they normally don’t address the concept of hope directly. Instead their approach is more implicit. Others do address hope explicitly. Hope is a necessary to live and strengthening hope is one of the essential goals of therapy. The current practices in therapy balance between implicitly and explicitly addressing the hope of the client. Hope as the fourth common factor deserves much more attention and research, O’Hara states.

Creating a positive expectation that the change that will happen will be beneficial, can be done very subtle. These sorts of interventions prove to be effective:

Reframing the language of the client (e.g. I will never succeed to I am not succeeding yet)

Evoking detailed own positive behaviour descriptions, by asking questions which imply a positive change will happen (e.g.“What will you be doing different once the problem is solved?)

Implying a better future (e.g. “Soon, when things start to improve between the two of you, what are the first signs that will tell you this is happening?”)

Analysing positive behaviour in the past (e.g. “When were you able to manage……, how did you do that then?”)

Scaling questions which address the process of change (e.g. “on a scale of 0 to 10, where 10 means “I know I am on the right track” and 0 means “I have no idea if I’m on the right track, where are you now on that scale?”) or scaling questions which address the desired future of the client (e.g. “on a scale of 0 to 10, where 10 means you have achieved your desired situation and 0 means you have not achieved anything yet, where are you now on that scale?”

Analysing progress (e.g. What is better? How did you achieve that?”)

Normalising (e.g. yes, many people experience depressive thoughts at some point in their life’s”, or “under these circumstances lots of people would feel the way you feel now”.).

If you are interested to read more about subtly eliciting hope, read this article: