This feature by Christine Dunkley, DClinP is Part 1 of 2 in a series about behavioral strategies for addressing hopelessness. In this first part, Christine begins with tips on personal relationships, loneliness, and learning how to identify what a client wants.
Our overarching goal in DBT is working to help people get a life worth living. Sadly, our clients have often been through so much pain that they lose hope of ever getting that. Once suicidal thoughts take hold of our clients, they negate any need for problem-solving. Thoughts such as, “I won’t have to deal with this” and “It won’t matter any more” are so appealing that the solution-finding cogs in their brain grind to a sticky halt. I often remind clients that these thoughts are “frenemies.”
“Frenemies masquerade as your friends, turning up in times of trouble, but actually they are trying to kill you! Don’t fall for it.”
Why not just cheerlead the client rather than create this negative image? When we are hopeless it’s easier to believe that something is out to get us than it is to hear encouragement. Cheerleading can sometimes magnify the distance between us and the client, rather than close that gap. In this blog post we will look at ways to harness both ends of this dialectical tension to help move the client forward.
The biggest component of hope is the ability to visualise a future in which things are better than they are now. When clients say they can’t do this, they are telling the truth. This is an opportunity for validation and psycho-education.
“You know, it makes perfect sense that you can’t see a better future. When an organism is under threat, it is entirely present focused, looking only for immediate relief. You might not know this, but at times of stress nature prioritises negative thinking. So if you are about to cross a field with a bull and ten rabbits in it, you are programmed to focus on the bull. Diverting your attention to fluffy bunnies would be a disaster. It seems unfair, but that’s the reason your problems loom so big and any positives seem to have disappeared. I know that everything I am saying comes under the heading of ‘rabbit’ whereas you are still focused on that bull, so you are going to have to trust me on this one. Of the two of us, I’m the one who can see the path through the field.”
In the holiday season loneliness is often more intense. It can be helpful to explain that loneliness is the best weapon nature has to prevent human extinction. If it were not for loneliness, then each of us would have ONE relationship in adolescence, it would end painfully, and we would never do that again. But we can’t use that strategy, because nature gave us an equally painful alarm that sounds when our relationships fall below the required level. Too many people infer from the pain of loneliness that there is something faulty in them. No, no, no! There is something just right in them, that jolt that says, “Don’t settle for this! You need to get out and relate, even if you do get disappointed.” This is another paradox – taking something painful and seeing the value in it.
Don’t worry if your client fights you on this. You are doing a “door in the face” by asking for a lot, but it will likely shift them a little. You can say,
“It’s a numbers game. There are 8 billion people in the world and at least one must be half decent. So we have to make a start. And it might only need half the effort, because maybe that person is also looking for you. They just can’t find you unless you make yourself known.”
If your client says they cannot identify anything they would want for their future, believe them. Wanting has been paired so often with disappointment that they have simply unhooked from it. Asking if there is anyone whose life they envy can give some clues, even if that person is a fictional character from a TV drama. I might also refer back to the biosocial theory:
“When your emotions are a problem, you push them away, and that gap feels like a void inside you. It’s hard to know who you are, which contributes to feeling hopeless. So we are in a research phase. You need a nice ledger where we can collect any scraps of information about you and what you like.”
The term ‘research phase’ is another dialectical tool. It takes a lot of pressure off the client. It implies that we don’t know the answers, but it also allows them to feel like they are doing something active. Review their research ledger at the end of the individual session. Oh and don’t forget how motivating stationery can be. Choosing that beautiful scrapbook is the first step.
Read here for part 2, in which Christine will share more tips for how to help clients address feelings of hopelessness.
Christine Dunkley DClinP is a consultant trainer with the British Isles DBT training team. She had 30 years in the NHS as a medical social worker and psychological therapist. She is a Fellow of the Society for DBT and author of ‘Regulating Emotion the DBT Way.’ Read her full bio here.