The therapeutic relationship: a modified systematic literature review with clinical illustrations: hope: therapeutic friend or foe? Psychoanalytic perspectives on the development and transformation of hopes within the therapeutic relationship

Abstract

How should hope be perceived in psychoanalytic psychotherapy? Using a modified systematic review, this dissertation explores the contrasting and conflicting views that alternatively depict hope as a therapeutic ally and obstacle; friend and foe. The literature demonstrates that ‘classical’ and ‘romantic’ psychoanalytic traditions hold differing perspectives on hope, and that the arguments they present lay down the foundations for integration through the distinction between ‘needs’ and ‘wants’. From charting psychoanalytic understandings of the development of hope – which focus on infantile, oedipal and end of life stages - hope is then evaluated in terms of how it manifests within the domains of patient, therapist and the therapeutic dyad. Clinical illustrations are included to bridge understandings from theoretical to practical. Throughout the dissertation, an attempt is made to differentiate between therapeutically useful mature hopes, and defensively-orchestrated regressive hopes. The transition from regressive to mature hope is shown to entail loss and mourning, and that mature hopes inevitably co-exist with the integration of despair, and appreciation of what is realistic through the acknowledgement of limits and boundaries. In applying these principles, a generic therapeutic model for the transformation of hopes, from immature to mature is then offered, which is followed with a discussion of conclusions, limitations and suggestions for future research.