What is the value of hope in therapeutic treatment?
Ross: Typical treatment neglects the concept of hope, and because it neglects hope, it fills in the blanks with a lot of diagnoses. Treatment today is looking much more at the person’s traits — what’s wrong with them as far as mental health issues — than their state in life — how they’re experiencing the world, their aspirations, and what’s happening around them. For me, one big aspect that gets missed when we don’t look at their state is the interplay between hope and disappointment, and what big and repeated disappointments do to a person when they’re afraid of being disappointed again. This is especially true for clients who have been in the mental health system for long periods of time. They’ve had traumatic experiences with disappointment in terms of how they thought their lives would turn out. And it’s that issue — the anxiety about trying again after profound experiences of things not working — that I call “fear of hope.”
Please describe what you mean by fear of hope.
Ross: Let’s start with hope. When you hope for something, you yearn for it, but you don’t know if you’ll actually get it. That makes it different from optimism, which is a strong belief that you’ll get it. When you hope for this something, you’re giving greater importance to it than you did before you began hoping. As a result, your potential disappointment over the loss of that thing becomes more intense the more you hope for it. The higher you go up the hill of hope, the farther you could fall because you’re making that goal more and more important as you pursue it.
Kent: I think of hope as a kind of investment. If you have a goal, you have to invest in that hope or goal for it to be realized. That means you have to invest time, maybe money, maybe social capital to convince other people to help you. Then you have to invest your faith that the world will support your hopes; that it will be stable enough and big enough and benevolent enough. Then you also have to risk your own feelings of self-worth because if you risk moving toward an important goal, there’s a chance your investment might not turn out the way you want, and then you end up feeling bad about yourself.
Ross: The example I give is you’re a kid and your parents ask you what you want for your birthday and you have no idea. Then, the minute you say “bike,” all of a sudden you have to have a bike in your life. Before you said “bike,” you didn’t even know you needed a bike. It becomes this thing that overwhelms you because you’ve got to have that bike and you see that you’re lacking this important thing.
Where does the fear of hope come from?
Ross: I think it comes from the experience of deep helplessness. Someone has identified something important they feel they need and lack, but then they don’t get that thing. As this happens repeatedly over time, they develop a deep sense of helplessness, an entrenched belief that they can’t get their needs met – not only in one or two specific cases, but in all. Naturally, they want to avoid this painful feeling. The best way to do that is to not hope, because hope takes them back to the possibility of losing something again. The experience is traumatic, in a sense.
For our clients, my general sense is that most of them have had an astronomical amount of these kinds of experiences and so they’re really terrified of hoping again.
Please discuss the research.
Ross: It’s basically researching something we’ve been thinking about at Ellenhorn. I created a concept called “Ten Reasons Not to Change” about 20 years ago, which explores why people resist change. Interestingly, each of those ten reasons has its roots in the fear of hope. It wasn’t until I lectured for Kent’s class at Rutgers, and he and I got to talking, that the concept became clearer. It became something greater than those ten reasons not to change; it started edging toward a theory.
Kent: After Ross and I got talking, I formed a research team and developed a fear of hope measure. The measure went through a series of tests to be proven reliable and valid. Using the measure, we’ve been able to show that fear of hope is an experience different from other things that are similar to it. Fear of hope is not simply fear of success or fear of failure. It’s not anxiety and it’s not depression. We performed tests to make sure it’s separate from those things. Fear of hope is related to them but it’s not the same thing.
And what did you find out, once you were able to prove fear of hope is a distinct psychological condition?
Kent: We found that people who have a fear of hope have a wide range of psychological difficulties. They are more depressed, have greater anxiety, have a hard time controlling emotions, have low self-esteem, and low optimism. They lack positive resources while they have a surplus of negative states.
Ross: I think one of the most important aspects of the research is our discovery about the relationship between hope and fear of hope. We learned in our work that what often seems like hopelessness is actually fear of hope, and that fear of hope and hopelessness are two different things.
Can you expand on that, please?
Kent: Some of the most painful situations are when both hope and fear of hope are high. The kid who is now really invested in getting a bike or a person who is invested in getting a particular job or promotion or relationship, then develops almost a phobia about feeling fear. They want to both move forward and pursue this goal but also run away from it because of the hazards of disappointment. That combination leads to heightened anxiety. We’ve proven that high hope and high fear of hope are more strongly corrolated with anxiety than low hope and high fear of hope, or—obviously — high hope and low fear of hope.
We’ve also shown how the combination of high hope and high fear of hope affects what are called “counterfactuals.” These are the way we look back at decisions we’ve made in our lives. To elicit a person’s counterfactuals, we ask what they think about something that didn’t turn out well in their life, how much they ruminate on it, how much they think “God, I screwed up” or “other people messed me up.” That kind of rumination is especially high for people who both have hope and fear hope. People who don’t fear hope and don’t have hope don’t do that kind of rumination.
We also asked people to think about their future. How many positive things can they imagine happening? The number is the highest for people who have a lot of hope and lowest for people who have fear hope. It’s as if they can’t allow themselves to think about positive events.
So what does this all add up to? They’re living their lives preoccupied by all the things that could have turned out differently if only they had acted differently. They’re filled with those kind of thoughts. It’s hard for them to generate goo positive images of their future.
Ross: The thing you’re describing actually sounds a lot like what people call depression. You could look at the DSM right now and it would list these things as the basic criteria for that diagnosis. I do think there’s a legitimate condition called major depression that does have to do with a person’s psychological traits. But we might be missing out if we only see this issue as a trait, and not also as the state of someone dealing with profound experiences of disappointment. It’s not just “depression”; it’s situationally based.
Kent: Well, we actually controlled for depression, so fear of hope is different from that mood. I would call it a defensive attitude towards life. People with fear of hope are kind of living in a bunker.
Ross: Oh, I totally agree. I’m just saying that, based on a person’s behavior, fear of hope might be perceived by a professional as more a mood thing than a situation thing. But the ‘bunker’ idea is exactly right. The metaphor is that a person fearing hope tends to play possum: They’re shutting down their existence. This is what the great psychiatrist, R.D. Laing, called “petrification.” It’s like they’re shutting down everything because they can’t take the risk of being a person in the world, since any kind of motivation leads to the possibility of something bad happening.
Kent: The metagoal is to not get hurt rather than to live productively and run the risk of getting hurt.
Ross: Yes! And that leads back, in some ways, to the origins of the whole thing: The Ten Reasons Not to Change.
What other research has been done on fear of hope?
Kent: As far as I know, we are the pioneering group looking at fear of hope. We conducted four experiments to make sure that our measure is reliable and valid. We conducted an additional two studies in which our measure projected interesting outcomes having to do with how people see their own path and how much they ruminate.
Ross: And you did a thorough literature review. You couldn’t find anything that looked like this. The closest you could find were fear of success and fear failure, but they didn’t end up being the same thing. You proved it’s not fear of success, it’s not fear of failure, it’s not depression, it’s not anxiety. It’s real life. It’s related to those things but it’s separate, too. It’s its own entity. This is what Kent has been able to show.
How does this research apply to therapeutic treatment?
Ross: Fear of hope isn’t just about hope, it’s also about faith. Faith is the sense that you can achieve things despite uncertainty. When a person fears hope, they don’t have faith in themselves that they can achieve the things they want to achieve. In treatment with someone with a high fear of hope, you have to help them rebuild a sense that they can make things happen in the world. Until they have that sense of faith, they’re not going to be able to hope and transcend fear. They have to have some sense that they can actually master their lives.
So what’s the treatment for that? The treatment is doing work in the community, not necessarily in the office. It’s about having them learn how to keep their apartment clean, how to get a job, how to go back to school. Anything that gives them a greater sense of mastery will lead them to feel less fear of hope, and then to hope again. It has to start with rebuilding their faith. From faith, comes hope, and from hope comes a sense that it’s possible to dream again about a fulfilling and meaningful future.
What interests you in this topic?
Kent: For one thing, I’ve done a lot of work on what I call “psychosocial resources” and how important resources are for coping. It never occurred to me that people would have a fear of something that seems so desirable as hope. I saw this and was intrigued. It felt almost like a psychological autoimmune condition where what is nourishing for most of us becomes distressing for some people.
Also, in psychology, we typically look at a person’s emotions, but I think people also have feelings about their own feelings. There is a wonderful statement by Franklin Roosevelt: “The only thing we have to fear is fear itself.” Fearing fear, having a phobia about being fearful. There is a second level of something happening with the emotion, being troubled by having the emotion. That’s what’s interesting.
Ross: For me, having developed the Ten Reasons Not to Change, it feels right to explore the center of this concept. The validated fear of hope theory really helps me ground what we do at Ellenhorn already: build faith in order to build hope in individuals who have experienced signficant trauma regarding disappointment.
I’m currently writing a book on the Ten Reasons Not to Change for Harper Collins, which will be out next May, and it’s great to have scientific support for some of my ideas.
I’m also very interested in the relationship between hope, disappointment, and what goes on in infancy. There’s a lot of talk right now among mental health professionals about “attachment.” As people take a new look at this old concept, we’re seeing that a lot of who we are has to do with our early attachments to our caretakers. It’s an exciting time of exploration and discovery, and I think the issue of hoping for something you feel is life-sustaining and then not getting it, and being disappointed, is a key in all this.
Kent: Ross’s idea that fear of hope might be linked to attachment is supported by some of our data thus far. There is a correspondence between faulty adult attachment and people who have more fear of hope: People who fear hope are more anxiously attached and more avoidantly attached at a strikingly high level. It’s a really great question but not an easy one to answer, in part because I think Ross’s intuition is correct that the faulty attachment happens at a very early age. It would take an intensive longitudinal research study to show a later link to fear of hope.