Holding hope and hopelessness: therapeutic engagements with the balance of hope
Abstract
Hope and hopelessness are coexisting and powerful experiences in the human condition. The dynamics of hope and hopelessness within intimate relationships are complex, and individual and family experiences of hope and hopelessness are embedded within historical contexts and wider social processes. This article rests on a relational set of understandings about hope and hopelessness, and offers a dual exploration. It focuses first on the complexities of the patterns of hope and hopelessness within families, and then on the complexities of the therapist's relationship to hope and hopelessness and the family's experience. Orienting to the balance of hope in constellations of hope and hopelessness provides one compass point of therapeutic practice. Reflective practice enables the use of the therapist's involvement in the therapeutic relationship, and helps the therapist to witness the coexistence of hope and hopelessness in a way that nurtures hope and emotionally holds both hope and hopelessness.
Introduction
Hope and hopelessness can be powerful lived experiences. The dynamics within intimate relationships can be complex, and individual and family experiences of hope and hopelessness are often embedded in family history, and in wider community and social contexts and circumstance. Engaging with, and being engaged by, the family's constellation of hope and hopelessness presents challenges for the therapist and the therapeutic relationship.
The momentum for this article comes primarily from practice, both from my work with clients and my experience as a supervisor. Although negotiating hope and hopelessness is part of the daily currency of practice, the topic has received surprisingly little direct discussion in the family therapy literature, or indeed in the forums of training and conferences. Yet in the research investigating common factors associated with positive therapy outcome, the ‘placebo effect’, which is effectively clients' capacity to hope for change, weighs in as one of the main four groups of factors (see Hubble et al., 1999; Sprenkle and Blow, 2004). The first two groups of factors are the strengths and resources in clients' lives, and factors associated with the therapeutic alliance and therapeutic relationship. The remaining 30 per cent of the outcome variance is shared equally between the choice of techniques/models and clients' capacity for hope. This is a staggering comparison if one then compares the full attention our field has given to issues of techniques/models with the lack of attention we have given to the topic of hope.
Indeed, naming the explicit discussions within the family therapy literature is a short task. There is one very recent edited collection (Flaskas et al., 2007), which when added to a collection on narrative practice (Monk et al., 1997) comprise the only books which name hope as a central concern. Two thought-provoking articles – one by Amaryll Perlesz (1999), the other by Kaethe Weingarten (2000)– plus a book chapter by Paulette Moore Hines (1998) complete the list. However, despite the brevity of this list, one could argue that the themes of hope and hopelessness are implicit in a much broader range of family therapy discussions, especially in relation to work with adversity and abuse, and in the aims of some of the practices of narrative, solution-focused and Milan-systemic approaches.
This article is quite specifically about the experience of families and therapists in the territories of hope and hopelessness. I will begin with some brief descriptions from practice and then lay out a set of understandings about the nature of hope and hopelessness to serve as an orientation point for the exploration that follows. The first part of this exploration focuses on the complexities of the relational dynamics of hope and hopelessness for families, and the way in which the two experiences are balanced in relationships, for better or worse. This leads to an examination of the complexities of therapists' engagements with families' experience and the task of holding hope and hopelessness in the therapeutic relationship. The article will conclude with reflections on the pieces of practice that are used to prompt the theory discussion.
Practice pieces
First piece
I see a boy aged 8, and his family, which includes his mother, his grandmother, and his older twin sisters, who are 9. The presenting problem is aggression and oppositional behaviour, yet in the first session I am taken aback by the ferocity of the mother's attacks on her son. The grandmother attempts to mediate, but all members of the family share a very negative view of the boy. On a daily basis he physically hurts his sisters. The charge that he is just like his father is made within twenty minutes of my meeting the family and, over the next couple of sessions, I hear the history of the father's physical abuse of the mother, and the way he left the family when she was pregnant with her son.
Second piece
In a supervision group one of the therapists discusses a family, which consists of a mother and her 5-year-old daughter. The child has a complicated set of physical problems, which affect her coordination and make physical activity tiring. She is in her first preschool year, and comes home exhausted every afternoon from the sheer energy of holding up her little body during the school day.
The mother has come because she wants help in handling visits with the father. The girl likes seeing her father, but is unsettled and distressed before and after she sees him. The mother left her partner in the wake of domestic violence. She had been beaten badly during the pregnancy, and believes that her partner would deliberately aim at kicking and punching her in the stomach, and that her daughter's physical difficulties are a result of these attacks. Meanwhile, when asked who she would take to a desert island, the girl has nominated her mother, her cat, and a laser gun so that no one can hurt them.
The group finishes, and I go off to teach at a university. I walk past the Faculty of Law, and hear myself go into an enraged internal monologue about the injustice of the father's assault on his unborn child. On and off for the next few hours, I register a sense of bleakness around the image of the child's exhaustion from holding herself up.
Third piece
Another supervision situation, and the group hears of a family with a child who has a physical condition that makes him vulnerable to broken bones. The effects of the condition may become worse as he grows older, and in the meantime there is a constant struggle between the mother and son as he wants to race around with his mates, climb trees and play football. The mother is anxious on an everyday basis and worries for his future. The father tells her not to worry, it isn't such a big deal, and in the mother's view, he encourages the son in activities that quite simply risk physical damage. The parents argue a lot. The therapist presents the mother's story with compassion, and a ripple of disapproval towards the father spreads around the group, all of us women, most of whom are also mothers.
Fourth piece
An adolescent team, engaged in difficult work with a number of young people and their families where the presentation is serious self-harm and suicidal tendencies. Like many community mental health services, the intensity and sheer volume of this kind of work ebbs and flows. There is a limit to the team's resources, and there is limited area access to more intensive treatment services. In situations where the young person's self-harm is escalating, the fear of suicide often drives blame and counter-blame in the professional system. The parent/s often alternate between powerless distress and anger, and the beginning blank despair of anticipatory grief. Hope and hopelessness become cycles in the way in which the young person herself is related to by the many professionals, as well as the way in which the family is related to. Meanwhile, in this team, one therapist tries to hold continuity for the family through the trauma, with the support of colleagues.
A set of understandings about hope and hopelessness
These practice descriptions can now sit in the background, as the spotlight shifts to developing theory ideas that might meet this experience. This article relies on four ideas about the nature of hope and hopelessness, which when taken together provide a foundational set of understandings for the exploration to follow. This set of understandings is more fully elaborated in a recently published chapter (Flaskas, 2007), and here I will simply lay out the ideas one by one.
The first idea challenges the assumption that the experiences of hope and hopelessness exist as opposites and in inverse proportion – so that when hope is high, hopelessness is low, and vice versa. An alternative understanding is to think of hope and hopelessness as coexisting experiences, and to allow for the possibility of strong hope and strong hopelessness existing side by side. This alternative understanding is more finely tuned to some difficult human experiences that are often part of the landscape of presentations in therapy. One could think here of the territories of loss, abuse, trauma and tragedy, all of which can simultaneously call forth both strong orientations to resilience and hope as well as strong experiences of hopelessness. The Irish family therapists Nollaig Byrne and Imelda McCarthy (2007) write of the relationship of hope and hopelessness as being a dialectical one, and there are many very fine descriptions of practice that plot patterns of strong hope and strong hopelessness (see e.g. Perlesz, 1999; Weingarten, 2000, 2007; Coulter et al., 2007; Shuda and Just Anna, 2007). These descriptions resonate with the comment by critic and writer Nikos Papastergiadis: ‘of course hope is the other side of despair – and being closer to one reminds you of the need for the other’ (Papastergiadis in Zournazi, 2002, p. 82).
If thinking about hope and hopelessness as being coexistent experiences forms the first part of this set of understandings, the second idea concerns the experience and expression of the state of hope and hopelessness. To frame hope and hopelessness as (simply) internal emotional states, intimate and powerful as they may be, makes it harder to see the force of the thinking and doing of hope, alongside the feeling of hope. Kaethe Weingarten has written very beautifully about the importance of ‘doing’ hope (Weingarten, 2000, 2007), and indeed the elaboration of ways of ‘doing’ hope has been a strong theme in the family therapy literature to date (Hines, 1998; Ingram and Perlesz, 2007; Jenkins, 2006; Wade, 2007). But if there is the thinking, feeling and doing of hope, there is also the thinking, feeling and doing of hopelessness. And though it is a powerful constellation (for better or worse) if thinking, feeling and doing run in parallel in a family's or individual's experience of hope or hopelessness, human complexity allows for disjunctions between these different levels of experience. Sometimes people can feel hopeless, but still do hope, or one can act destructively, but still have hopeful beliefs about self-in-relationship.
The third idea concerns an appreciation of the relational and social contexts of hope and hopelessness. These states are not experienced in isolation and indeed, in the connections of intimate relationships, the sharings and crossovers of the experience of hope and hopelessness can be complex. Families facing adversity, or dealing with chronic and seemingly unending struggles, usually divide up the labour. Patterns develop around who is undertaking – and when – the thinking, and feeling, and doing of hope and hopelessness. Different family members may experience different levels of hope and hopelessness, and some family members may be better at doing hope than feeling hope. At times, it can be critical that family members do hope for someone who is not in a position to do this.
Yet though the nature of the activity of family therapy means we primarily explore the leeway for change in the family context, the intimate individual and family experiences of hope and hopelessness are always embedded in wider social contexts. These wider contexts, which include the family's intra- and inter-generational history, can either support or undermine hope, and support or undermine hopelessness. Poor housing, impoverished neighbourhoods, family poverty, racism, and abuse and adversity across generations are all contexts that make it much harder for families to hold hope.
These three ideas together lead to a conclusion that becomes the fourth idea in orienting to hope and hopelessness. If we set aside an oppositional understanding of the relationship of hope and hopelessness, we move beyond the language of either ‘too much’ hopelessness or ‘too little’ hope. An appreciation of the different forms of experiencing and expressing hope and hopelessness, and the complex and multilayered relational and social contexts, leads us more to imagine instead a constellation of hope and hopelessness. Thus the fourth and final idea is that it is the balance that matters in the constellation of the family's experience and their wider contexts, and so in therapy it is useful to orient to the balance of hope and hopelessness.
But how then in therapy might we orient to the balance? How do we engage with (and become engaged by) the family's experience? And how does the therapeutic relationship itself factor into constellations of hope and hopelessness? These questions now become the subject of exploration, beginning with a further discussion of relational constellations, and moving to a consideration of therapeutic engagements and the challenge of holding hope and hopelessness in the therapeutic relationship.
Relational constellations
From the first meeting of therapy, the therapist begins to relate to the family's constellation of hope and hopelessness. How one engages with this constellation is especially significant in some therapies – for example, circumstances of chronicity of the presenting problem, present experiences of serious adversity, family histories of tragedy and abuse, and presenting problems that hold within themselves the capacity for further tragedy. These are exactly the kinds of situations in which families have often developed quite complex patterns of hope and hopelessness, and in which the effects of social context and wider relational resources weigh in.
Hope and hopelessness may be experienced and expressed very differently by different members. This can partly depend on the position and role taken by different members of the family, and different members may be better at holding on to hopefulness or at bearing a sense of hopelessness. It has also been noted that, in the pattern that evolves, some family members may also be better at doing hope than feeling or thinking hope, while others may find it easier to sustain beliefs around hope and a feeling of hope, and yet not be good at ‘doing’ hope in a concrete and pragmatic way. Patterns around hope and hopelessness can come to be gendered within and across generations and there can be stuck and invisible patterns as well as more flexible and open movements between family members around hope and hopelessness. For example, for families facing the serious illness or disability of one of its members, there can be a ‘swapping’ of positions in the constellation. In the situation of illness of a child in two-parent families, one notices patterns of the parents almost taking it in turns to feel hopeful or hopeless. When one parent moves from feeling hopeful about the child's future to feeling more hopeless, the other shifts to feeling and acting more hopeful.
These more flexible patterns in constellations of hope and hopelessness can both hold and build considerable resilience within families (see Walsh (2006) for a discussion of the relationship between family flexibility and resilience), and are also more accessible to being noticed and known by family members. However, in other situations, patterns can be more fixed and sometimes more invisible and family members can be left holding ‘extremes’ of hope or hopelessness. In couple relationships, this division can come to be experienced as deeply unfair by one or other person. There can be a progressive corrosion of connection within the couple relationship, a difficulty in understanding the other's experience as something other than invalidation of one's own position, and a loss of intimacy that comes with experiencing a feeling of not being known by the other. With children, sometimes one child comes to occupy a spot that is seemingly untouched by the anxiety and concerns, while another child comes to be acutely aware of a particular parent's struggles. In situations where there are two parents, one sometimes sees different children dividing up roles in terms of parental monitoring. In the very different territory of working with families bearing the legacy of intergenerational histories of abuse, it is not uncommon to see a pattern of hopelessness being centred on one particular child.
The kinds of patterns that develop in the most intimate layer of family relationships are embedded in wider family and social constellations, and the effects of these wider contexts on the family's pattern are sometimes only too predicable and at other times surprising. The predictability is underlined when one sees a family struggling with a difficult situation which is compounded by living in circumstances that make it far more difficult for them to hold on to a balance of hope and hopelessness in favour of hope. Yet tensions and contradictions are also possible which allow some surprises in the balance of hope.
The situations in which the wider contexts and circumstances support and embed hopelessness are part of the landscape of some of the most difficult work we face as therapists. These situations range from families who have experienced extraordinary levels of social injustice, sometimes across generations and even centuries, to families who have experienced extraordinary levels of what seems to be ‘just’ bad luck. There can also, of course, be a potent combination of the two. The resilience literature points to the human capacity to survive and indeed grow from even the most adverse circumstances (Rutter, 1999; Walsh, 2006). The argument in this article is in harmony with the resilience research, which suggests that risk and protective factors are best understood as a constellation rather than a hierarchy of determining factors. The resilience research itself provides a source of professional hope, and one reading of its findings is that overall it is people's capacity to develop resilience that is surprising, rather than the less surprising ‘expected’ level of negative outcomes. This research helps us as therapists to stay alive to possibilities for clients in even the grimmest of circumstances, and gives a compass to orient our work in nurturing clients' resilience. However, only a very distorted reading of this literature would deny the potential and actual damage of multiple risk factors of social and intra-familial injustice and adversity.
So far I have been exploring the constellations of hope and hopelessness both within and beyond family patterns, which families bring with them alongside the request for therapy. The act of the request for therapy itself becomes another aspect of this constellation. From one angle, psychotherapy could be framed as an act of hope on the part of both family and therapist. Yet all families do not approach therapy with the same capacities to hope for change, all families do not request therapy in the same way and, within families, the constellation of hope and hopelessness means that different family members have different relationships to hope for the therapy itself. For therapists, as we begin to relate to a family, we too come to the meeting with a particular relationship to hope for change. Does it go without saying that our occupational location as therapists speaks to a constellation we each bring about our own relationship to hope and hopelessness? Or that although we ‘perform’ an occupational orientation to hope, the nature of our work and what we bring to that work allows a number of possibilities in our engagements with clients? The attention now will be turned to the therapist's involvement in therapeutic engagement, and the therapeutic task of witnessing and holding hope and hopelessness in the therapeutic relationship.
Therapeutic engagements and therapeutic holding
At the risk of saying something that may not need saying, I will begin this section by underlining the mutuality of the process of engagement in therapeutic work. I could offer a shorthand definition of engagement as the formation and development of a ‘good-enough’ therapeutic relationship: ‘good enough’ for therapist and family members to hold and sustain the work of a particular piece of therapy (Flaskas, 1997). To add to this definition, I could emphasize that engagement is a continuous process and that, similar to any other relationship, the therapeutic relationship emerges in the ‘space between’ therapist and family (Flaskas, 2005a).
Sigurd Reimers (2006) has recently invoked the metaphor of therapist ‘default’ positions, developing the idea of the routine ways in which we tend to relate to clients. His argument is not that we should somehow rid ourselves of these automatic fallback positions. Rather, he stresses their place in everyday practice, and argues that we should stay attuned to their appearance in our work with clients and approach our use of them with the discipline of reflective practice. From a different angle, Peter Rober (1999, 2005) has written on the process of reflecting on, and using, our own ‘inner conversation’ as therapists in our work with clients. Still effectively circling the territory of the therapist's involvement in the therapeutic relationship, I have been interested in the pragmatics of the interactional sequences we enter into with clients, as well as the way in which these sequences and our use of self can speak to unconscious processes within the family's relating (Flaskas, 1997, 2002, 2005b).
In trying to think about the therapist's engagements with the family's constellation of hope and hopelessness, the first point to note is that we engage with these constellations whether we mean to or not. Here we could borrow from structural family therapy and the idea that a failure to engage with all family members inevitably leads to the therapist sliding towards the most powerful position in the family.1 This remains a useful piece of clinical wisdom, though I would extend the possible outcomes to allow for a broader range of therapist default positions beyond a slide towards power. The precise form that the default position takes emerges in the space between the therapist's own counter-transference, her initial automatic response to the family's way of relating to her, and the emotional and cognitive sense she makes of the way she sees them relating to each other and to her.
Thus, before we draw on the compass of reflective practice, it is very easy to find ourselves in a lopsided engagement with one person's position around hope and hopelessness. Sometimes this may be just an occupational reflex – we slide towards aligning with the person who seems most hopeful about the outcome of therapy. At other times, our own counter-transference settles us into an alignment with the position that we personally understand, and relate to as most familiar, within our own landscapes.
Oddly enough, the occupational choice of therapy itself may travel with a personal vulnerability to hopelessness. I know I am on shaky ground to simply claim that those of us who choose to be therapists are more likely to have quite intimate personal and family experiences of despair, alongside strong personal repertoires of hope. Many years ago a colleague observed that all members of her counselling team in a service for war veterans and their families had fathers or grandfathers who had been in wars. Since then, I have taken note of the personal intersections that crop up for many of my colleagues and students, as well as for myself. Perhaps it is just that as an occupational group we reflect the ‘ordinary’ frequency of trauma and tragedy that tends to be masked by reified notions of ‘normal’ family experience. Yet still my sense is that as an occupational group committed to hope for change, therapists are also quite vulnerable to embracing hopelessness. This seeming paradox is reinforced by the conditions of our work, where we are often in a position of witnessing abuse, trauma and tragedy alongside inspirational resilience and survival. At times, though, the balance can lead us to be more quickly attuned to hopelessness than to hope. Managing to hold hope, in the face of witnessing the family's hopelessness and carrying our own hopelessness, can be a difficult task.
Two images have been floating in my mind as I have been writing this. One is the recent scene of a rather classic therapist joke: I walked into a team for supervision on a morning when the newspaper was full of terrible things, yet it was a stunningly beautiful blue day, and I had to admit I was ‘perversely happy’ when asked how I was – the joke immediately followed: ‘Oh don't worry, we'll soon change that for you.’ The other image is of a therapist who was seeing a 10-year-old boy and his foster family – his mother and then grandmother had already died, and his foster-mother had just received news of an illness with a very poor prognosis. One part of our collective responsibility as a group was to witness the therapist's feeling of pain and hopelessness, while in a realistic way discussing practices that might help the child and family in the next period and protect the child in the long run. As a piece of work, it was a long way away from any notion of cure or happy endings. It was hard to pathologize the child's symptomology, so much in proportion to his context, yet also almost indecent to attempt any positive connotation or glib narrative of hope in relation to his position. In a sense, the doing of hope by both therapist and the group was to hold on to a vision of possibility for the child and his family, without taking away from the enormity of the child's pain and loss, and the family's pain and impending loss.
This last example also gives a sense of how the therapist's struggle with hope and hopelessness can mirror the family's struggle. In the same way that it can be hard within families to honour the doing of hope while holding and knowing the feeling of hopelessness, this can prove hard for therapists in their engagements with families. One pattern in engagement with complex family constellations is to ping-pong between two extremes. One can be overwhelmed by a sense of hopelessness. Alternatively, the therapist effectively denies the painfulness of the family's experience of hopelessness by taking up a position of hopefulness that is unmediated by holding the knowledge of the coexistence of hopelessness. Noticing this ping-pong movement in oneself as a therapist can provide a useful barometer of the family's struggle.
However, coming to be stuck on either side of the polarity is likely to lead to anti-therapeutic sequences, which are patterns of relating between therapist and family that are not in the interests of therapeutic movement (Flaskas, 2005b). Hearing yourself defaulting to sounding falsely hopeful with a family, or alternatively taking up a routine position of warning against a family's hope (‘yes, but …’), are two ways in which we may find ourselves heading towards anti-therapeutic sequences. These kinds of patterns in our own relating are fuelled by our own counter-transference, our reaction to the family's constellation of hope and hopelessness, and our involvement with the family. Of course, the family, and different family members, will make their own sense of the therapist's way of relating, and will respond one way or another within the therapeutic relationship and within the family therapist system.
In short, in the same way that family constellations of hope and hopelessness can be complex, therapeutic engagements with the family's experience can also be complex. This section has charted some of the challenges for therapeutic engagement, concentrating on the therapist's position and patterns of response. A number of potential difficulties have been identified which, though they may take different forms, all threaten processes of therapeutic engagement.
At a foundational level in our work with clients, we struggle to remain open and curious about their experience, we try to witness in a way that both acknowledges and emotionally holds the family's experience, and we attempt to build compassionate connections both between family members as well as within the therapeutic relationship. Alhough these generic processes are languaged in different ways in different models of family therapy, and in different psychotherapy frameworks, they are core to the activities of therapy. Specifically in our engagement with family constellations of hope and hopelessness, we try to remain open and curious about the complexity of the family's patterns around hope and hopelessness, we try to witness the coexistence of hope and hopelessness in a way that nurtures hope and emotionally holds hopelessness, and we attempt to build compassionate connections both in the way we relate to the different family members' positions and in the way the family members relate to each other's positions in their own constellation. Reflective practice becomes both a compass and a safety net in monitoring our own use of self in therapeutic engagement.
Returning to practice
First piece
My dismay at the trenchant negative framing of the 8-year-old boy turns quickly to anger at his mother for her attacks on him. Yet the reality of the child's own abusiveness to his sisters, and even his continuous difficult behaviour in sessions, means I feel myself slide into a sense of hopelessness for him. The boy has triple jeopardy – he is the only son of an abusive father; it was while his mother was pregnant with him that his father's violence was at its worst, and then the father left; there was violence in his mother's own family, and also reports of uncles with drug and alcohol addictions. I find myself coming to feel quite hopeless both about the possibilities for him and the possibilities for his mother (and grandmother and sisters) to relate to him differently.
However, I cannot tackle the therapeutic work with the family unless I work towards a different balance of hope within myself. I will need to challenge my own reluctance to appreciate the difficulty of the mother's history of being abused. My anger with her is also making it hard for me to appreciate the evidence of her capacity to mother in a good way, and this capacity shows itself in her relation to her daughters, the way she and her own mother relate, and the conscientiousness of her self-referral and therapy attendance. I also need to find a position to engage with the boy where I remain clear-sighted about his aggressive and abusive behaviour to his sisters as well as his acts of love and connection, and his own desire to find a more secure and hopeful space in his family.
Second piece
It is a gift, though at times a nuisance, that as a supervisor you take up a place in the emotional sequences of the therapy, even at two steps removed. I leave the group carrying an image of the 5-year-old child who becomes exhausted, her mother's dilemmas around access with the father, as well as the therapist's questions. I have to ‘own’ my enraged internal monologue on the steps of the Faculty of Law about the injustice and effects of the father's abuse. Yet still its sudden appearance surprises me, as does the bleakness of the image of the exhausted child that hangs around like an afterglow. When I think about it, the anger is in the material presented, particularly the little girl's desire for the laser gun in her fantasy. But the bleakness feels like an attunement to a more unconscious communication, perhaps a parallel process from the family to the therapist to the group and to me. On reflection, I am also interested that I have no picture of the father in my head. I start wondering about the force of the daily reminder the child's exhaustion gives of the largely unspoken history, about the hopelessness embedded in beliefs about irreparable damage, and about the complexity of the child's and the mother's desire for a relationship with the father who hurt them both.
Third piece
As a group of women, it is only too easy for us to feel for a mother's protectiveness of her son and her anxiety for his future. Like the therapist, we are all immediately irritated by the image of the father's refusal to take on board the reality of his son's physical vulnerability and his minimizing actions towards his wife. Yet the interactional sequence we are hearing is marked by the polarity of the parents' positions in relation to their son, and the stories they are coming to have of each other as parents and as a couple. The husband feels very hopeful about his son's future – the wife finds it very hard to feel hopeful. There is certainly a balance of hope and hopelessness between them as parents. However, the constellation of the current balance is corrosive of their relationship. It also leaves the boy in a difficult position as he witnesses his parents fighting over him, and he finds it hard to have the space to take developmental steps towards control and care of his own activities and his own body.
Fourth piece
Every so often you set yourself puzzles: is it harder to weather the fear of a small child being unprotected and seriously hurt, or to face the possible tragedy of a young person committing suicide, or to witness a devastating long-term sequel of racism and persecution? These truly bizarre kinds of musings sit beside the wonder at the human capacity to survive and thrive and the power of relationships. Neither set of thoughts cancels out the other.
I sit on the very edge of the challenge a team faces in working with young people with presentations of serious self-harm and suicidal tendencies, and the complexities of the systems that surround such situations. Again and again, there is reflection on work with particular young people and their families, and reflection on the strain for the therapist and the team in trying to hold the work. It is very much a territory of hope and hopelessness, and indeed the constellation of hope and hopelessness can be powerful in either driving protection or escalating danger. Among all the other aspects of therapeutic service in these situations, thinking about hope and hopelessness is one resource in the therapeutic repertoire. It serves as a subject of reflection on one's own counter-transference and pattern of relating to the young person and family and colleagues – it also serves as a subject of containing reflection with the family.
Conclusion
Finding a balance of hope in constellations of hope and hopelessness is at times very difficult for families and therapists. This article has been framed by a set of contextual and relational understandings of the individual and family experience of hope and hopelessness. It has explored family patterns as well as the therapist's relationship to hope and hopelessness, and the patterns that construct and affect our therapeutic engagements and the therapeutic relationship. The exploration leads me to advocate in equally strong measures for an attention to the coexistence of hope and hopelessness in families' experience as well as our own; for an orientation to the balance of hope; for an appreciation of the importance of witnessing and holding hope and hopelessness in the therapeutic relationship; and for the benefits of the discipline of reflective practice.
Although rarely named, the constellation of hope and hopelessness has inevitably and always been part of practice. My project has been to throw a spotlight on this territory and to develop some useful understandings. While doing this work, I have found myself reassessing the range of contemporary family therapy practices. I have come to appreciate even more the repertoire of practices of hope offered by systemic, solution-focused and narrative ideas, and I have come to appreciate the different ways in which practices within other therapy frameworks attempt to meet this part of human experience. But I have also found myself uneasy about the way in which specific therapeutic techniques have the potential to factor into anti-therapeutic sequences in engagements with hope and hopelessness. Of course, it is always easier to see the potential dangers in the use of techniques in ‘other’ frameworks, and harder to see the potential dangers in one's own practices. I know really that my final point belongs to a different article, but could I end with a plea that we take care to think about the way in which a default to ‘practices of hope’ can sometimes be a defence against engaging with the constellation of hope and hopelessness, and that a technique only becomes a practice of hope when it speaks to the family's experience and emotionally holds hopelessness as well as hope?
