Hope in the therapy room

A question I am sometimes asked by clients, usually in the first few sessions, is “Is there any hope for me?” It is a fundamental question which goes to the heart of therapy. A way of understanding the question is ‘Will I be able to grow beyond my present state? Is change really possible?’ The answer is an emphatic ‘Yes’.


It is easy to see why the question is asked. Many people go through years of carrying their burden until finally they run out of energy, and they arrive in therapy exhausted by the weight of their troubles. The burden may be anxiety (sometimes generalised), depression, stuck bereavement, low self-esteem or low self-confidence, loneliness and isolation, long-standing relationship or family issues, or work-related stress. For some people, it is as if the burden has become part of their personality and they wish to change their very self, to grow beyond the problem. This is particularly the case with someone who has unresolved trauma, sometimes called post-traumatic stress, when the same distressing events keep replaying as intrusive thoughts or negative expectations. Some clients talk about wanting the ‘real me’ back, suggesting the problem is an imposter in their life who has changed them against their will. Often clients have previously tried strategies that haven’t worked. While wishing they could release their burden, they are so used to carrying it that they cannot conceive how it can ever be put down – hence their arrival in therapy to seek help.

The aim of this article is to briefly outline why hope in the therapy is not just a comforting idea. Hope is a reality and a necessity. Hope is the fuel for personal change, and it has a solid strategic basis.

The key factors in change

Hubble, Duncan and Miller (1) conducted important and extensive research about what works in therapy, how and why positive change happens. Among their findings, they concluded that the quality of the therapeutic relationship and “extratherapeutic change” – constructive change outside the therapy room – together account for 70% of positive factors. The therapeutic relationship and extratherapeutic change are inextricably linked, one providing feedback for the other, together creating forward momentum. When a client is listened to, understood, their experience validated and their wish for change supported, it creates a catalyst for change in the client’s life. The quality of the therapeutic relationship and the client’s need for change are together the drivers of transformation.

The therapist is not like a surgeon who operates then sends the patient home cured, doing things to the patient on their behalf. The therapist is more like a midwife, providing support and expertise to assist the client in their own work, bringing forth something new, which only the client can achieve, but for which s/he needs assistance. The key to change is that the client sees it happening as a result of their newly-gained insights and efforts, something they did (with the therapist’s support) and can repeat.

This is what Alfred Adler (2) called “encouragement”, building up the client, believing in them, putting power in their hands; what today is commonly called empowerment. The key component is hope, the belief that the past is not a guide to the future, that patterns can be broken and new patterns made, that with increased self-knowledge and self-discovery comes increased power to make new choices.

The making of new choices needs practice. Like a child learning to dance ballet, or an adult learning to play guitar, the moves are unfamiliar and new habits need to be formed. In this process, it is the hope and support in the therapeutic relationship which sustains the new until the new becomes established and familiar.

Removing the blocks to change

On this road to change there may be blocks of resistance which prevent us moving forward. Our role together, as therapist and client, is to recognise them and remove them.

There are many possible examples, depending on the person and their experience. One pattern is aptly illustrated by Charles Schulz in his Peanuts cartoon. Charlie Brown is depicted throughout the series as anxious and depressed, and the strip below illustrates why he is stuck. Charlie Brown justifies and reinforces his stuckness with his beliefs about himself: he prides himself on being a sensitive, tender-hearted person, and so he believes he is ‘bound’ to be prone to anxiousness and depression.

Such beliefs are a way of preventing hope by putting a block in front of change. There are many such beliefs. ‘I am always angry because people always let me down.’ ‘I can’t stay in a relationship because I always get hurt.’ ‘I can’t stop worrying because I know everyone will leave me.’ ‘If I leave this relationship no one will ever love me again.’ What all these beliefs have in common is that they are passive. They come from a fixed position of being helpless and hopeless. They are the beliefs of a passenger, not a driver.

Such beliefs are not truths and they are not inevitable: they are beliefs about oneself, usually learned through early formative experiences, relationships in our earliest years which form our view of the world and ourself. These beliefs implicitly direct the path of someone’s life and that is why, in transactional analysis, such beliefs are known as life-scripts. A life-script, once revealed and understood, can be changed, given the right support.

Giving you what you need to change

Sometimes removing the limiting beliefs, the blocks to hope, is enough. More commonly, for a life-script to change, something needs to be added as well as taken away. A life-script creates a familiar pattern, habits and expectations which are reinforced through experience. To build something new, we need first to understand the familiar, but then be curious, see the bigger picture, and look in some unexpected places.

This involves exploring deficits, what was and is missing in a person’s life. Everyone has deficits in their life. Some people have never felt truly accepted by others. Some have never felt enjoyed just for being who they are. Others have never felt safe enough to let their guard down. In my experience, a client being able to experience acceptance, or being enjoyed by another, or gaining a sense of safety, is a powerful igniter of hope, a window onto a new world. Such new experiences can enable someone, not only to hope that it can be repeated beyond therapy, but to seek it from others, and understand for the first time that such experiences really are available to them. In other words, we work cognitively, emotionally and practically on changing the script.

The reality and necessity of hope

Sometimes we cannot create change alone: to be the change we want to see in our own lives, we may need assistance. In therapy, this involves a relationship of care and trust; the removal of blocks to change; the encouragement of growth through new experiences of support; and, as the underlying foundation, the very practical hope and anticipation of a better life ahead.


About Ian Pittaway

Ian is a psychotherapist and writer with a private practice in Stourbridge, West Midlands. Ian’s therapy is integrative, chiefly comprising key elements of transactional analysis, object relations, attachment research and person centred therapy. Ian has a special interest in trauma recovery and bereavement.

To contact Ian, call 07504 269 855 or click here.



(1) Mark A. Hubble, Barry L. Duncan, & Scott D. Miller (1999) The Heart and Soul of Change. What works in therapy. Washington D. C.: American Psychological Association.

(2) Alfred Adler (1927/1992) Understanding human nature. Oxford: Oneworld Publications.


© Ian Pittaway Therapy. Not to be reproduced in any form without permission. All rights reserved.