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June 20, 2018
Volume 15 No. 6

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Hope: A Clinical Catalyst (November 20, 2013)

(Editor’s Note:  This article was originally published November 20, 2013.)

As spiritual care practitioners we work frequently with meaning-making at both the cognitive and emotional levels of the human soul. Therefore, from the clinical interests of our profession, the following words from one of the 20th century’s more prominent theologians, could not be more important. “What oxygen is to the lungs, hope is to the meaning of life” – Emil Brunner.

The insights of theologians like Brunner need to be proven in the field. When I worked full time in Mental Health, our institution conducted a survey in which we asked patients what they considered to be most important in their care and treatment. The highest percentage of patients reported hope as their # 1 need. This is a very strong message to care providers about the significance of this dimension of the human spirit. I believe it deserves such a high ranking, because hope acts as a catalyst for the emergence of other aspects of the human self, necessary to health and wholeness.

But hope can be a tricky thing. People speak of true hope and false hope. None of us want to facilitate in the promulgation of false hope for our patients or clients. What then is true hope, and how does it promote health and facilitate healing?

At the outset, we need to acknowledge that hope is not convincing yourself that only good things will happen to you in the future, or even that one particular good thing will happen to you. It is true that hope is an attitude that looks upon possibilities with expectation and desire. But it does not require the murder of one’s intelligence. As Rabbi Kushner reminded us back in the 70s, bad things do happen to good people. Pretending otherwise, is only setting up our self and others for disappointment.

Is hope then the belief that we will “perhaps” dodge the bullet? That does not exactly seem adequate either, but the use of the word “perhaps” in the sentence is a step in the right direction. When we say the word “perhaps”, we indicate our realization that we cannot control future events. But what some people call hope, appears much like an attempt at such control through predicting (a close relative of denial). Although predicting can masquerade as hope, it is actually an attempt to reduce fear through the illusion of control.

True hope is not at all about control but about its opposite, namely openness. It is about being open to possibilities instead of needing to predict outcomes. There is power in such a belief, because it opens us up to feelings of excitement associated with sitting on the edge of the unknown (clinical use of the concept of the edge of the unknown may be found in the writings of Yvonne Agazarian. Hope is excited by the unknown and is therefore characteristically an energized state of mind, not a fearful one. Simply put, it is precisely not being able to predict what will happen next in a novel or in a motion picture, that keeps us interested.

So, we can see how confessing our belief that we may or may not dodge the bullet provides a legitimate challenge to the despondent or depressive thinking that tells us to expect only the bad. But hope involves more than the above openness to possibility as important as that is. For hope is not only that which connects us to the excitement of the unknown, it is also that which connects us to the excitement of that which is known, but from which we are often separated when we are not hopeful. I am speaking of our desires.

When we have no hope, we tend to shut down our desires because they only remind us of that which we believe we will not posses. But we need our desires in order to feel vital and alive. With hope, we can dare to feel our desires as there is a chance that they may be fulfilled. In this way, hope leads us to more than the realization that we may indeed dodge the bullet, for it stretches us to believe that even more may be possible. In opening us up to possibilities, hope connects us to those deeper parts of our self where the longing of our heart resides. This is a good example of how hope is a catalyst that brings into play other aspects of self.

In addition to connecting us with our deeper self that is the place of desire and longing, hope also has an interesting connection to trust. Human beings tend to regard the future much as they have regarded the past. Hope in the future is largely based in our belief that what has been true of our past, will be true of our future. This is of course not always correct (and at times thankfully so) but there is a certain degree of validity to it, inasmuch as we all develop trust based upon previous experience.

For example, to be realistically hopeful about our own impending surgery we do not need to know the future any more than we need to know how to perform the surgical procedures that will be employed on us when we are the one lying on the table. Perhaps the surgery will not work, and it is important for us to be in touch with that possibility as part of having a realistic hope. But if we are truly hopeful, it is likely because we trust our surgeon. We place ourselves in her/his hands because we trust the person based upon her/his past successes. This is what makes it a realistic hope and not a false one based in wishful thinking stemming from the need to predict.

Hope is not falsely certain about outcomes for hope is not certainty. On a spiritual level this is experienced not as a trust that things will work out the way we want, but a trust that there is something or someone beyond us who is trustworthy. We trust that we are somehow not totally on our own, nor in hostile hands. This stems from an acknowledgment of how we have experienced our past as meaningful. We know things have not always gone our way, but we sense that we have been part of a larger more transcendent connection. This sense or feeling of being connected gives us hope that we can approach the future with the same sense of trust, and it is this hope that sets us free to live in the present moment with little fear. So hope and trust beget each other.

Although people certainly can and do lose their hope and their trust, it is also true that some individuals and some communities maintain hope and trust in the transcendent, even when some of their previous experience has included a sense of abandonment. Such is the potential of the human spirit and its need for hope. Indeed, long term Mental Health patients have taught me the most about such hope and trust amidst adversity.

Such trusting in the presence of the transcendent can also lead us to act on this trust. This is to risk taking action without any guarantee of success, but to risk it because of our hope. This is the true exercising of faith and it is hope that provides the condition for it to exist. Born of true hope, faith is indeed an acting “as if” but it is not acting as if we will certainly achieve what we want. On the contrary, a faith born of such hope acknowledges that it is not at all certain of outcomes. Instead, it acts upon the belief that we do not act alone. Of this too, we cannot be certain in any absolute sense of knowing, but we take action as if we were. It is our belief, and that is why we need hope and faith to accompany it. The integrity of faith acting “as if”, is based in our previous experience of the transcendent in the past. The value of faith acting “as if ”, is that it makes life worth the act of living.

The clinical implications of hope are indeed impressive. It is a catalyst for excitement, desire, trust and faith, and perhaps for much more, One can easily imagine what such a hopeful progression of attitude could mean to someone on a post stroke rehab ward, or to an inmate preparing for release back into the community, or to someone recovering from the loss of a loved one. In all these instances, motivation to live, to act, and to have ones being, begins with hope.

To summarize, to be hopeful is not to convince ourselves of falsely positive affirmations that do not come close to resembling the truth. It is instead to accept the energizing reality of our human condition, and within our situation, to claim a place for ourselves as those who have faith that we do not walk alone.

I close with the thought that it does our soul good to have a little hopeful imagination born of the stuff of life, the lived reality of our journey. Tolken says it well.

All that is gold does not glitter, not all those who wander are lost, the old that is strong does not wither, deep roots are not reached by the frost. From the ashes a fire shall be woken, a light from the shadows shall spring: renewed shall be the blade that was broken, the crownless again shall be king. JRR Tolken (from Lord of the rings)


Questions for Dialogue


  • Spiritual Care/Chaplaincy has evolved to the point where our professional associations have now produced scope of practice and competency documents. It is now becoming apparent that in addition to these we are in need of articulating an actual model for our profession in keeping with other professions like social work or nursing. Such a model will require the delineation principles of best practice which will need to stem from premises that we collectively consider universal to spiritual health. It would be useful to consider whether hope might indeed be one of those premises on which to build our model. Do our colleagues consider hope pass the litmus test in this regard?


  • Although there may be no final conflict between true hope and acceptance of one’s medical condition there is frequently turbulence within individuals over denial vs acceptance.  How one can assist a patient to turn the energy of denial into hopeful energy is often no easy task. Based upon our experiences at bedside, what principles of practice and strategies may be helpful to chaplains when attempting to effect such a movement from denial to hope?




Doug Longstaffe is the Profession Leader and CPE supervisor for Spiritual Care and Multi faith Services for Vancouver Coastal Health Authority in Vancouver, British Columbia. His previous work experience includes appointments in Acute Care, Corrections and Mental Health, as well as running his own private counseling practice. Doug has extensive experience advocating at various levels of governance for greater recognition of the importance of Spiritual Care. He is passionate about the humanization of institutions as well as integrative mind/body approaches to health care. He can be reached at





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