Hope, Expectancy, Therapeutic Alliance, Solution Focused Therapy & Chronic Pain Management

     It's wonderfully satisfying when patients enter the office in despair, and leave with happy smiles. This dramatic change results from forging a successful therapeutic alliance, and replacing desperation with genuine hope and expectancy. These are challenging YET essential components of effective chronic pain management.

     Solution focused therapy (SFT) practitioners adopt "a respectful, interested, non-blaming, non-judgmental and cooperative stance. The assumption in SFT is that the client is competent to figure out what they want and need, and is willing to do something about it. The practitioner's responsibility is to assist the client to discover these competencies. Any notions of client 'resistance' are dismissed by SFT as professionally self-serving. Instead anger, resistance and a lack of motivation or 'insight' are viewed simply as indications that the practitioner has yet to find a way of working with the client.
     (SFT) is not simply a psychotherapeutic approach but an alternative way of thinking and working with people."

       Wand T. Mental health nursing from a solution focused perspective. International Journal of Mental Health Nursing 2010; 19(3): 210-219.


     Change from psychotherapy "comes from four main sources. The first is extratherapeutic change, which accounts for 40% of the variance of change. These are personality characteristics of the client as well as factors in that person’s environment that lead to positive change. The second strongest influences are common factors or what might be known as the therapeutic alliance. Accounting for 30% of the variance, these include empathy, warmth, and acceptance. A third component of improvement is technique, which includes the specific routes a psychotherapy theory utilizes, such as dream analysis or thought stopping. This accounts for 15% of the variance. The fourth component is hope and expectancy, which accounts for 15% of the variance of change. Expecting that going to therapy will help actually helps. It provides hope for symptom relief as well as other positive changes in one’s life. ... 'At the same time, an emphasis on possibilities and a belief that therapy can work will likely work to instill hope and a positive expectation for improvement'.
     ... therapists need a cognitive set that expects change and conveys hope. It is this focus on the future and possibilities instead of the past and problems that helps lead to hope."
 
       Reiter MD. Hope and expectancy in solution-focused brief therapy. Journal of Family Psychotherapy 2010; 21(2): 132-148.

Photo: Tony Tomlin   www.dpreview.com