The Psychodynamics of a Clinician's Hope: A Delicate Balance

A clinician's sense of hope is not easily maintained in the therapeutic situation. Exploring the psychodynamics of hope in two interviews—one focusing on a community mental health psychotherapist and the other on a school social worker—this paper proposes that maintaining hope requires an intense affect state, an active blend of emotional and intellectual reflections in the mind of the clinician. Ongoing hope is the product of a delicate balance between a clinician's tolerance for the tragic in life and the expectations of positive treatment outcome. These reflections occur in an intrapsychic space, a point of juncture between the clinician's primary process longings/fears and secondary process thoughts. Hope is constructed in this space. It gains its language, form, and substance from the integration of personal experience, client observation and clinical theory. Reflective activity helps a clinician avoid disabling transference to a client and promotes identifications that lead to realistic treatment goals.