Hope-Focused Interventions in SubstanceAbuse Counselling

Corinne Koehn & Linda O’Neill & John Sherry

Published online: 5 November 2011# Springer Science+Business Media, LLC 2011

Abstract Hope is a vital component of psychological healing and plays a critical role incounselling. With despair so prominent for individuals with serious substance abuseproblems, the question arises as to how to foster hope in such clients. There are recentsuggestions in the general counselling literature that some of the work in counsellinginvolve moving the topic of hope to the forefront and openly approaching the concept ofhope with clients. This article describes several hope-focused interventions that can be usedto explicitly explore hope in substance abuse counselling.

Keywords Hope . Hope-focused interventions . Hope inspiration . Substance abusecounselling . Addictions counselling

Our understanding of the role of hope in psychology, healthcare, and counselling sphereshas increased in recent years due to the mounting attention hope has received in the clinicalliterature and research arenas. The nursing domain was among the first to champion hoperesearch in a serious way, with examining the role of hope for the critically and terminallyill (e.g., DuFault and Martocchio 1985; Owen 1989) and investigating how nurses inspirehope in patients (e.g., Cutcliffe and Grant 2001; McCann 2002). In her review of 52theoretical and research papers on hope, Stephenson (1991) offered the definition that hopeis “a process of anticipation that involves the interaction of thinking, acting, feeling, andrelating, and is directed toward a future fulfillment that is personally meaningful” (p. 1459).A more recent healthcare literature review found that hope has been conceptualized ascentral to life, multi-dimensional, future-oriented, dynamic, individualized, and related toexternal help and caring (Cutcliffe 2004).

In psychology, C. Richard Snyder was a forerunner of hope research, defining hope as “apositive motivational state that is based on an interactively derived sense of successfulagency (goal-directed energy), and (b) pathways (planning to meet goals)” (Snyder et al.1991, p. 287). With this cognitive-behavioural perspective, the counsellor’s hope-focusedtasks are to help clients identify goals, build motivation to work toward goals, and assistclients in strategizing for how goals might be achieved.

Int J Ment Health Addiction (2012) 10:441–452DOI 10.1007/s11469-011-9360-3

C. Koehn (*) : L. O’Neill : J. SherryCounselling Specialization in the School of Education, University of Northern British Columbia, 3333University Way, Prince George, BC, Canada V2N 4Z9e-mail: koehn@unbc.ca

In the late 1990’s, the field of “positive psychology” began to flourish. In positivepsychology, the focus is on what elements make life worth living through the study ofpositive character strengths, positive emotions, and facilitative institutions (Christopher andHickinbottom 2008; Seligman et al. 2005). Positive emotions (such as hope) “serve us bestnot when life is easy, but when life is difficult” (Seligman 2002, p. xiii). Snyder (1994,2000) proposed that inheritability is not a contributing factor in hope but rather hope islearned; parents and other caregivers teach and model a hopeful mindset. Moreover, hemaintained that a child’s solid attachment to a caregiver is vital to the hope buildingprocess. Consistent with this view, childhood trauma has been associated with a decrease inhope (Rodriguez-Hanley and Snyder 2000), a particularly relevant finding for substanceabuse clientele for whom many have trauma histories.

Practitioners who practice with a positive psychology framework assist clients inenhancing positive states through the exploration of meaning-making, activating positiveemotions and engagement, thereby spawning positivity in therapy (Peterson 2006;Seligman et al. 2005). Hope is directly linked to meaning-making and is the drivingsource of positivity, again suggesting that its motivational power needs to be harnessed inall counselling, but particularly in substance abuse counselling. Although research hasfound associations between hope and several indices of psychological health (for a review,see Cheavens et al. 2005), hope research in the practice of counselling and psychotherapy isviewed as currently “evolving,”—that is, the research has begun but is considered to be inits very early stages (Larsen et al. 2007).

In substance abuse counselling, the vital role of hope has long been recognized bypractitioners. For example, Metzger (1988) wrote:

The secret ingredient in successful therapy and major life transition is hope. Thetypical alcoholic client entering treatment is depleted and dispirited—in a word, hope-less.The caregiver must have a reservoir of hope to assure the client that change is possible,even when the present appears most bleak. (p. 87–88)

Stauffer et al. (2008) reflect on the challenging task for addiction counsellors of holdingonto hope, even when faced with clients who continually relapse: “With some clients,especially those with treatment refractory conditions (i.e., ‘non-responders’), we may havelittle hope for change or even maintenance of current status. Yet, to be effective, acounsellor must believe and cultivate what is possible” (p. 78).

Although the pivotal role of hope in substance abuse counselling is acknowledged,there has been little actual research into how to foster hope in substance abuse clients.The earliest study that could be located is from the nursing field. In collecting datafrom adolescents in an inpatient substance abuse treatment centre, Hinds (1988) foundthat nurses’ caring behaviours were positively correlated with clients’ hopefulness scores.Qualitative data revealed that adolescents were positively influenced by nurses whofacilitated their progress towards treatment goals, who did not give up but persisted intheir attempts to help the adolescents, and who participated in efforts to ensure thatnursing staff and adolescents were able to get along with each other. In other substanceabuse research, the instillation of hope was found to be the element adolescentsappreciated the most in 12 step programs (Kelly et al. 2008), and hope also was found tomediate the effects of 12 step groups for adults with concurrent substance abuse andmental health disorders (Magura et al. 2003).

In a recent study, Koehn and Cutcliffe (in press) implemented a grounded theory studyto explore how hope was inspired in substance abuse counselling. Ten participantscomprised of counsellors and clients were interviewed regarding their experiences of

442 Int J Ment Health Addiction (2012) 10:441–452

hope inspiration during counselling sessions. Findings revealed that hope inspirationin substance abuse counselling was an active process—it implied movement, shifting,and activity rather than passively waiting. It was also a creative process that entailedforming a vision that was different than the vision previously held. Moreover, hopeinspiration was a collaborative endeavour—counsellors and clients “built hopetogether.” Hope inspiration in this study was comprised of three phases, each ofwhich contained several hope-fostering practices. The first phase entailed developing anon-judgemental bond with the client. That hope can be fostered interpersonally andis central to the helping relationship is supported by other research (e.g., Cutcliffe2004; Herth 1990; Hinds 1988). Phase two was comprised of three major psychosocialprocesses which involved assisting clients in reclaiming and reconstructing their sense ofpersonhood, facilitating interpersonal and transpersonal connections, and helping clientsembrace possibilities of a changed future. These psychosocial processes were mutuallyinfluential and the order in which they occurred depended on client and stage of therapyvariables. The last phase of hope inspiration consisted of reviewing pathways to hope tofacilitate a termination to counselling, and involved summarizing accomplishments madeduring therapy and developing a plan for “next steps.” Koehn and Cutcliffe note thatalthough this theory of hope inspiration incorporates phases, the movement from onephase to another does not suggest that the hope fostering practices of prior phases arediscontinued. Rather, a movement to another phase reflects a different emphasis on therelative frequency or intensity of particular hope inspiring practices.

Recent research has shown that the facilitation of hope can occur implicitly orexplicitly within counselling sessions (Larsen and Stege 2010a, b). Edey and Jevne(2003) have suggested that counsellors consider making hope “visible”—that is, initiatingdiscussions and explorations about hope with clients. Larsen and Stege (2010b)recommend that counsellors who are well informed about hope intentionally useexplicit, hope-focused practices with clients when appropriate. The purpose of thecurrent article is to describe particular hope fostering interventions that counsellorsmight implement to make hope visible within substance abuse counselling. Theauthors, researchers as well as practitioners with several years of experience in thesubstance abuse counselling field, offer a variety of interventions for adolescents oradults, in individual or group sessions. Many of the following interventions use triedand true frameworks that have a hope-focus added to reflect recent trends in addictionwork. Interventions include the hope reservoir, hope collage, hope log, gift of hope,hope continuum, sobriety shop, empty chair exercises, the exploration of hope andhopelessness in the Stages of Change, and hope guardians mapping.

Hope Reservoir

The purpose of the hope reservoir is to be a container for hope inspiring thoughts,sayings, and affirmations that clients can “dip into” when noticing their hope levelsare faltering. On separate slips of papers or cards, the client writes something that ispotentially hope building and then places all of the items into a container. The itemsin the hope reservoir might spring from the client’s own sentiments and imagination,or they might be quotations that the client has found in books or online and whichare personally meaningful. It can also be very beneficial for friends, family members,or other support people to contribute hope fostering messages to the container—doingso affirms to clients that they are cared for, and it is also pleasant and satisfying for

Int J Ment Health Addiction (2012) 10:441–452 443

clients to read a “surprise” item with which they are unfamiliar. The counsellor mightalso write items for the hope reservoir, which is one way for clients to feel connectedwith their counsellors even in their absence. Clients might choose an item from thehope reservoir each day, or only as the need arises. For example, one client decidedto use the hope reservoir during a particularly difficult time in therapy in which shewas disclosing and working through what she called her “bad behaviour” during heraddiction. Feeling ashamed for lying, manipulating others, stealing from familymembers, and putting her children at risk, she found quotations that reminded her ofher courage and gave her hope that her work in therapy was beneficial. For example,James Baldwin’s comment, “Not everything that if faced can be changed, but nothingcan be changed until it is faced” and William Shakespeare’s “Now my soul hath elbow-room” were two quotations that she chose for her hope reservoir. The hope reservoir is anintervention that can be used with both adolescents and adults with substance abuseissues. A caution is that only those people who can be depended upon to deliver hope-based messages should be invited to contribute.

Hope Collage

A collage can add a unique feature of instilling hope and goal-setting in many areasof one’s life. Individuals can focus on what they hope for in several areas of life(relationships, jobs, education, support system, health, spirituality) or focus on onespecific area. Larsen et al. (2007) present the idea of using a collage for the explorationof hope, and this is a technique that each author of the current article has successfullyused in substance abuse counselling. The act of collecting images and organizing theminto a collage helps to solidify in clients’ minds what it is they want in their lives andprovides them with a sense of hope.

An idea or theme that emerges in a client’s collage can give a counsellor an ideaof what is needed to help a client maintain sobriety. For example, clients interested indeveloping a situation that inspires hope and encourages sobriety might includemagazine photos of loving relationships, healthy hobbies, and their ideal livingsituation (home, neighborhood, etc.). One client who believed that certain foodstriggered her substance use and was interested in losing weight gathered images ofindividuals with realistic and appealing body types, as well as pictures of peopleexercising and of healthy foods. She also collected a variety of words, phrases, andquotations that resonated with her goal. Clients can also include pictures that representcurrent items, relationships, or events that give them hope. For example, one clientchose a picture of a sunrise to reflect the possibilities offered with the onset of eachnew day.

A collage may include magazine clippings, photographs, affirming statements, bitsof colored paper, fabric, stickers, ribbons, and other found prized items, glued to apiece of poster board. Clients usually require 20–30 min, in a quiet comfortable spaceto think about their desired outcome (sobriety, healthy relationships, etc.). With theirmaterials gathered around them, clients explore the magazines and locate images andwords that are meaningful to them—ones that are empowering and provide them witha sense of hope. Instruct clients to cut out whichever images “jump out” at them,piling them off to the side and not taking too much time to think. Once clients have astack of images, they then select those they wish to include and assemble them ontotheir poster board. Clients can be reminded that there is no right or wrong way to

444 Int J Ment Health Addiction (2012) 10:441–452

create a collage, and to do whatever feels right for them during the creative process.They might want to arrange and re-arrange their images before finally taping orgluing them down. The hope collage can be completed in an extended counsellingsession (90 min), as a group activity, or as a homework exercise. Clients should hangthe collage in a place where they will likely see it frequently in order to helpreplenish their hope.

The collage experience can be processed with clients focusing on what they havelearned about their desired goal. A few questions upon which clients might reflectinclude: What does hope mean to me? What is it about these images that inspirehope? How do I see change in my life happening, and what resources are needed?What is my role in promoting change? The hope collage is an excellent tool that tapsinto hope while helping clients understand what they want or need in their lives, andcan be used with both adolescents and adults experiencing addiction issues. Clientsgenerally need to be reassured that artistic talent is not necessary to complete thisexercise.

Hope Log

One way for clients to be more mindful of the experiences that nourish hope is to keep ahope log. The hope log is a chart that includes the following items: the date; a briefdescription to a significant event that fostered hope; hope levels on a scale of 1 to 10 beforethe event; hope levels on a scale of 1 to 10 after the event; and a brief description of the“aftermath”—that is, what happened after the hope-fostering event. For example, a clientmight notice how attending an Alcoholics Anonymous meeting increased her hope levels,and that after the meeting she continued to engage in healthy activities for the day, such asattending the gym. The hope log can be shared with the counsellor and discussed.Questions for reflection include:

What themes do you notice about the experiences and events that nourish hope foryou?

Who are the key players in your hope-fostering events?

What are some of the things you are doing (or what are some of the personal qualitiesyou have) that play a part in these hope fostering events occurring?

What are some of the themes of what happens for you after the hope-fostering event?

How are your hope levels connected to your desire to use or not use substances?

A variation of the hope log is to also include events that decrease hope levels. Discussionthen revolves around identifying the themes, people, and client’s actions that are threats tohope, and problem-solving ways to either manage or avoid these threats.

Group Exercises Encouraging Hope

A major factor in recovery is instilling hope while rebuilding social and emotionalconnections that were either destroyed by the addiction process or had been poorlydeveloped prior to the addiction. Substance abuse often affects self-esteem and clients maynot be hopeful that their lives can substantially improve. Group work is uniquely suited to

Int J Ment Health Addiction (2012) 10:441–452 445

these tasks since it facilitates the development of self-esteem, and encourages hope that isessential to recovery. A few warm-up exercises are highlighted, including the gift of hope,the hope continuum, and the sobriety shop.

Gift of Hope Present a wrapped box as a “gift of hope” received. This gift is passed aroundto all group members. Allow each person time to remember a situation when theywere hopeful (felt positive, empowered, etc.). On the first go-around, ask members torecall what they were feeling as they received this gift and identify the symbolic giftin the box (courage, a supportive sponsor, supportive family member) that helpedthem feel this way. On the next go-around have group members describe why theyfelt this way, what the gift meant, and what it was like to receive. As a group,members will be able to identify themes related to hope.

Hope Continuum Have clients arrange themselves across a continuum representing wherethey are in terms of feeling hopeful in their recovery (one end of the roomrepresenting very low hope and the opposite end representing very high hope). Allowgroup members to take their positions and state reasons for their choice. Observe andsummarize commonalities and themes. Next, using the same continuum, have clientsarrange themselves in terms of where they believe they could realistically be withinthe next month. Help members identify what they need to work on and do in order toreach the desired hope level.

Group members could also be asked to locate themselves on a hope continuum thatrepresents a time in their lives when hope levels were at their highest. They thendescribe what was happening for them in that period of time that seemed to nourishhope. For example, clients might identify times when they had caring relationships,were not abusing substances, had healthy leisure activities, or were acquiring newknowledge or skills. Clients could then reflect on whether they could incorporate anyof the aspects of that hopeful period into their current living situation and if so, howthey might specifically go about doing so.

Sobriety Shop Sobriety shop was developed by Moreno’s student Hannah Weiner(Somov 2008) and is a variation on Magic Shop, a psychodrama warm-up exercise,used with a variety of clients including those addicted to alcohol and other drugs.Personal qualities that have contributed to clients’ addictive illnesses are exchangedfor desirable qualities that will help clients stay sober. The exercise grounds clients inmore positive thoughts and behaviours, often necessary for maintaining abstinence.For example, clients will easily volunteer many qualities such as depression, denial,fear, loneliness, grief, dishonesty, insecurity, resentments, anger, insanity, and shame,for such qualities as happiness, serenity, faith, friendship, joy, self-esteem, love, hope,honesty, and willingness. The counsellor makes the exchange in this make-believestore (typically little bottles labeled with these positive characteristics are placed on atable and exchanged for the no longer wanted negative characteristics). Clientssymbolically have this new quality to hold on to as they work on their recovery.Often a “bottle of hope” is exchanged for a no longer useful, outdated quality and isreferred to frequently as clients work on their recovery.

These exercises can be used in group or individual counselling situations; however,they need to be adjusted if they are being implemented in individual counselling. Forexample, clients would discuss with their counsellors what the symbolic “gift box”meant to them rather than pass the gift box around to group members. These

446 Int J Ment Health Addiction (2012) 10:441–452

exercises provide clients with opportunities to connect their feelings to their thoughtsaround the idea of hope and can be used with either adolescents or adultsexperiencing addiction issues. The exercises can be emotionally charged and clientsshould be in a phase of recovery in which they are able to experience and tolerateintense emotional feelings. Also, it is imperative that enough time is provided toprocess these exercises—any challenging feelings need to be adequately addressed anda sense of closure achieved before a client leaves the session.

The Empty Chair

There are several empty chair exercises that a counsellor can facilitate to encourage hope foradults and adolescents in recovery from substance abuse. For example, a client might recallsomeone from the past who provided hope, and imagine this person sitting in an empty chair.The client then speaks to the person, describing how he or she was affected by the person’shopefulness. Alternately, the client could imagine having received an encouraging, inspiringletter from an actual person in the past who provided hope. The client could speak to thisperson in the empty chair, thanking him or her for the letter, and describing how the letteroffered hope. The client could also write and read a letter back to the person in the emptychair, highlighting how this individual inspired hope. The written letter could be a keepsake.As with the aforementioned group warm-up exercises, clients should be at a phase in recoveryin which they can experience and tolerate intense emotional feelings. Adequate time shouldbe allowed for processing the exercise with the counsellor.

Exploring Hope and Hopelessness Within the Stages of Change

Working with adolescents who are misusing substances is a challenging undertaking incounselling. The relationship between adolescent substance use and intrapersonal factorshas been explored for decades in research, with optimism, self-esteem and hope indicated asdeterminates for avoiding substance use (Carvajal et al. 1998).

In keeping with the current harm reduction approach, psycho-educational endeavorsof presenting the latest research on the use and abuse of substances is often anintegral part of the counselling process. Transparency of the process in building trustwith youth may also benefit from the presentation and explanation of Prochaska etal.’s (1992) Transtheoretical Model of Change (also known as the Stages of Change).Researchers have long considered hope to be the key factor in the human change process(Larsen and Stege 2010a). We suggest that a discussion of what Flaskas (2007) refers toas the dialectical coexistence of hope and hopelessness be added to the discussion of thestages of change. Flaskas presents the constellations of hope and hopelessness as notreciprocating in strength, where the increase of one leads to the lessening of the other, butas “strong hope, strong hopelessness existing side by side” (p. 189). The counsellor’s jobin substance abuse counselling with adolescents focuses on increasing the level of hopeand understanding the current level of hopelessness.

Adolescents often identify with hopelessness in their existential quests for meaning,resulting in any effective discussion of hope with such clients as including the concept ofhopelessness. Adolescent clients often respond to questions of what they want to havehappen or see for themselves in their future with the classic line of “I don’t know,” yet ifasked what they don’t want, they often have an answer. This same premise applies to the

Int J Ment Health Addiction (2012) 10:441–452 447

concepts of hope and hopelessness, where adolescent clients may not easily identify wherehope exists, but many have an intimate knowledge of hopelessness. We suggest that ifhopelessness can be accessed, then so too can hope by, for example, drawing hope as acontinuum and asking adolescents to plot where they currently are on the line. The work onhope often becomes critical in working with adolescents who have expressed suicidaltendencies and are abusing substances. Counsellors may be far more effective for youthwho abuse substances through understanding their relationship to hope and hopelessnessand where the use of substances fits into that relationship. Counsellors might questionwhether the use of substances connect with feelings of hopelessness that may betemporarily countered by getting high, allowing the physical effects of substance use tohold hope when youth cannot find or identify their own hope. Such questions often lead toinsightful discussions with adolescents.

Flaskas (2007) articulates that the complexity of hope includes the thinking, feelingand doing of hope. Such a concept fits well with the stages of change with thinking,feeling and doing all components of the stages of precontemplation, contemplation,preparation, action, and maintenance (Prochaska et al. 1992). Questions that may beconnected to adolescents’ substance abuse might include whether consuming the drug isan attempt at doing hope or hopelessness when the thinking and feeling of hope becomesdifficult or overwhelming.

In using the Transtheoretical Model of Change (Prochaska et al. 1992) withconcepts of hope and hopelessness, the counsellor might start with a brief descriptionof the various stages of change, facilitating a discussion with the adolescent as towhat stage he or she believes to be at in the change process. The counsellor wouldthen open up the conversation as to how the youth would define hope andhopelessness. The dialogue might then move to where and what hope would looklike or feel like at the various stages of change. For the stage of precontemplation, inwhich the client is not considering change, simply questioning whether hope orhopelessness is connected to the lack of desire to change can provide the base for arevealing discussion. For example, Miller and Rollnick (2002) note that although thereare individuals in the precontemplation stage who do not believe they have a problemwith substance use and consequently see no need to change, there are also those inprecontemplation who recognize they have a serious substance abuse problem, but areresigned, feel hopeless about their ability to change (perhaps having failed at severalprior change attempts), and therefore are not considering change in the foreseeablefuture. In the contemplation stage of the model where the individual acknowledgesthat the behaviour is linked to various problems and is ambivalent about change,questions on how thinking and feeling hope and hopelessness might contribute toone’s awareness of the need to change may be useful. Questions for the preparationand action stages would include how hope might be a motivational factor for makingchange and what doing acts of hope might look like for youth, asking for specific detailsof action steps so that their vision of hope becomes clear. Hope is also important in themaintenance stage of the model where the individual is incorporating new behaviour intodaily interactions and sustaining the new behaviour over the long-term. Asking questionsof how hope might be sustained in the difficult process of maintaining change may beeffective, as well as suggesting the use of previously described strategies such as the hopereservoir and the hope log.

By presenting hope and hopelessness as being constantly present, the counsellorcan work with the youth to discern what stage of change would be most challengingfor finding and maintaining hope. Using a brief therapy approach that is very future-

448 Int J Ment Health Addiction (2012) 10:441–452

oriented, the counsellor might look for any opportunity where hopelessness is apredominant theme and ask the youth what it would take for hope to increase and bemade visible.

The visibility of hope and hopelessness could be made more explicit by having theadolescents use expressive media, if appropriate, to portray what the concepts wouldlook like at each stage of change. This model of hope and/or hopelessness thenbecomes the object of discussion with the goal of helping adolescents define hope andhopelessness for themselves, ultimately moving to the action stage where they cantake steps to do hope after thinking and feeling it. We have found such discussions tobe extremely effective in creating what Larsen et al. (2007) describe as the co-constructed,mutually influencing hope process contained in effective therapeutic relationships.

Hope Guardians Mapping

Life-space mapping evolved from a constructivist approach, the SocioDynamicCounselling intervention developed by Peavey (1999) for career counselling purposes.From a constructivist viewpoint, maps are seen as not only representing reality, butas tools for constructing reality, particularly when clients map their future. Theprocess for this intervention includes asking clients to imagine that a large piece ofpaper represents their world, placing themselves in that world with a symbol. Clientsthen map on the paper important people and resources such as role models andorganizations that are important to them, drawing lines out from their symbol tocircles or bubbles containing their identified resources, described with words andimages on the paper. Counsellors then use this model to ask meaning-generatingquestions that may expand clients’ understanding of their present and hoped-forfuture worlds.

In this adaptation of life-space mapping, we suggest that counsellors consider therelational and social contexts of hope (Flaskas 2007) by asking clients to identify people,places and things that hold or inspire hope and locate them with circles or boxes onlarger size paper representing their world. Lines radiating out from the client’spersonal circle or symbol are drawn, showing the connection to her or his hoperesources and helping to map the context of hope for each client. Words, drawings,and photos can be included on the map to label and describe hope resources, with themap considered an evolving work-in-progress as clients explore their relationship tohope within substance abuse counselling. The identified people, locations and objectsbecome hope guardians, tangible sources of hope for clients. Similar to the re-memberingconversations framework developed by White (2007) in narrative therapy, a person whobrought or saw hope for the client at some point in time is identified and the story ofhis or her hopeful influence on the client is explored. Clients often identify a personfrom their past who believed in a better future for the client at a time when the clientcould not visualize any future, being immersed in substance abuse.

Beyond the interpersonal realm, physical locations that hold hope for the client arealso described and portrayed through various media, leading to detailed discussions ofwhat it is about each identified location that brings thoughts, feelings, or actions ofhope. Clients will often choose a landscape found in a magazine that represents forthem a location that evokes hopeful feelings and thoughts. Other clients will bringactual photos of locations from their past that represent a more hopeful time in theirlives, allowing counsellors to ask what was different then and how those feelings

Int J Ment Health Addiction (2012) 10:441–452 449

might be accessed again. Some clients present pictures of churches, mosques, templesor other religious settings that have inspired faith and hope. Objects that representhope may also be included in the map, again helping to facilitate a very personalstory of the context of hope for the client. Personal objects that symbolize or holdhope for clients can be brought into session and serve as powerful tools forunderstanding the client’s relationship with hope.

Questions that may be effective in the mapping of hope guardians include: Howdoes this person/place/object bring you feelings of hope? What qualities does thisperson/place/object have that gives you hope? How will you use these resources tomaintain sobriety?

The webbing and linking of the hope guardian people, places, or things is a visible mapfor both client and counsellor to use, assisting both parties in identifying and extending thehopeful resources that may be available for the client as he or she works through addictionissues and treatment.

Conclusion

The activities and interventions in this article are intended to make hope visiblewithin substance abuse counselling. Strengths of the interventions include the use ofestablished frameworks adapted to find meaningful ways for clients to explicitlyexplore hope. Strength-based assessments of personal hope found in the hopereservoir, hope collage, hope guardians mapping, and hope log interventions facilitateclients in the individual process of first becoming aware of hope in their lives, thenmaking hope visual through symbol or words with the ultimate goal of feeling hopeand using it to transform unhealthy coping strategies. Group activities such as the giftof hope, hope continuum, and sobriety shop add a new focus to finding motivationand meaning in addressing problematic substance use. The exploration of hope andhopelessness in the stages of change serves as a centre of developmentally appropriatediscussion for adolescents who are often all too familiar with hopelessness and whorequire ways to find where hope exists and how to foster it.

The limitations of the interventions rest in the difficult task of clients viewinghope again after years of not allowing themselves to feel hope as a way to cope.Awareness of the strength of the therapeutic relationship, individual assessment ofclients’ current relationship to hope, and clients’ ability to creatively engage in theinterventions and discussions is critical for the appropriate use of any of theinterventions. It is very important for practitioners to reflect and validate clients’initial sense of hopelessness and pain because suffering often needs to be fullyexplored before hope can be found, seen, and felt (Larsen and Stege 2010a; Seligmanet al. 2005). The authors are also very aware of clients whose life situations hold verylittle hope and the need to avoid forcing such a search, rather the pacing of suchsessions becomes critical to monitor.

Snyder (2002) refers to hope theory as “rainbows in the mind” (p. 249). Thetranslation of such thought “rainbows” to acoustic (verbal) and visual images throughthe described therapeutic practices in this article hold great potential for accessing andunderstanding the relationship of hope to substance use. By attending to theimportance of the therapeutic relationship and then intentionally engaging in hope-focused practices to make hope explicit, counsellors and clients can begin to dialogueabout hope and its role as a touchstone in substance abuse recovery.

450 Int J Ment Health Addiction (2012) 10:441–452

References

Carvajal, S. C., Nash, S. G., & Evans, R. I. (1998). Relating optimism, hope, and self-esteem tosocial influences in deterring substance use in adolescents. Journal of Social and ClinicalPsychology, 17, 443–456.

Cheavens, J. S., Michael, S. T., & Snyder, C. R. (2005). The correlates of hope: Psychological andphysiological benefits. In J. Elliot (Ed.), Interdisciplinary perspectives on hope (pp. 119–132).Hauppauge: Nova Science.

Christopher, J. C., & Hickinbottom, S. (2008). Positive psychology: ethnocentrism and thedisguised ideology of individualism. Theory and Psychology, 18, 563–589. doi:10.1177/0959354308093396.

Cutcliffe, J. R. (2004). The inspiration of hope in bereavement counseling. London: Jessica Kingsley.Cutcliffe, J. R., & Grant, G. (2001). What are the principles and processes of inspiring hope in cognitively

impaired older adults within a continuing care environment? Journal of Psychiatric and Mental HealthNursing, 8, 427–436.

Dufault, K., & Martocchio, B. C. (1985). Hope: its spheres and dimensions. Nursing Clinics of NorthAmerica, 20, 379–391.

Edey, W., & Jevne, R. F. (2003). Hope, illness, and counselling practice: making hope visible. CanadianJournal of Counselling, 37, 44–51.

Flaskas, C. (2007). Holding hope and hopelessness: therapeutic engagement with the balance of hope.Journal of Family Therapy, 29, 186–202. doi:10.1111/j.1467-6427.2007.00381.x.

Herth, K. (1990). Fostering hope in terminally ill people. Journal of Advanced Nursing, 15, 1250–1259.doi:10.1111/j.1365-2648.1990.tb01740.x.

Hinds, P. S. (1988). The relationship of nurses’ caring behaviors with hopefulness and health care outcomesin adolescents. Archives of Psychiatric Nursing, 2(1), 21–29.

Kelly, J. F., Myers, M. G., & Rodolico, J. (2008). What do adolescents exposed to Alcoholic Anonymousthink about 12-step groups? Substance Abuse, 29(2), 53–62. doi:10.1080/08897070802093122.

Koehn, C., & Cutcliffe, J. R. (in press). The inspiration of hope in substance abuse counseling. Journal ofHumanistic Counseling, Education and Development.

Larsen, D. J., Edey, W., & Lemay, L. (2007). Understanding the role of hope in counselling. Exploring theintentional uses of hope. Counselling Psychology Quarterly, 20, 401–406. doi:10.1080/09515070701690036.

Larsen, D. J., & Stege, R. (2010a). Hope-focused practices during early psychotherapy sessions: part I:implicit approaches. Journal of Psychotherapy Integration, 20, 271–292. doi:10.1037/a0020820.

Larsen, D. J., & Stege, R. (2010b). Hope-focused practices during early psychotherapy sessions: part II:explicit approaches. Journal of Psychotherapy Integration, 20, 293–311. doi:10.1037/a0020821.

Magura, S., Knight, E. L., Vogel, H. S., Mahmood, D., Laudet, A. B., & Rosenblum, A. (2003). Mediators ofeffectiveness in dual-focus self-help groups. The American Journal of Drug and Alcohol Abuse, 29,301–322. doi:10.1081/ADA-120020514.

McCann, T. V. (2002). Uncovering hope with clients who have psychotic illness. Journal of HolisticNursing, 20(1), 81–99. doi:10.1177/089801010202000107.

Metzger, L. (1988). From denial to recovery: Counseling problem drinkers, alcoholics, and their families.San Francisco: Jossey-Bass.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). NewYork: Guilford.

Owen, D. (1989). Nurses’ perspectives of the meaning of hope in patients with cancer: a qualitative study.Oncology Nursing Forum, 16, 75–79.

Peavey, R. V. (1999). SocioDynamic counselling: A constructivist perspective for the practice of counsellingin the 21st century. Bloomington: Trafford.

Peterson, C. (2006). A primer in positive psychology. New York: Oxford University Press.Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: applications

to addictive behaviors. American Psychologist, 47, 1102–1114. doi:10.1037/0003-066X.47.9.1102.Rodriguez-Hanley, A., & Snyder, C. R. (2000). The demise of hope: On losing positive thinking. In C. R.

Snyder (Ed.), Handbook of hope: Theory, measures, and applications (pp. 39–54). San Diego:Academic.

Seligman, M. E. (2002). Authentic happiness: Using the new positive psychology to realize your potential forlasting fulfillment. New York: Free Press.

Seligman, M. E., Steen, T. A., Park, N. J., & Peterson, C. (2005). Positive psychology progress: empiricalvalidation interventions. American Psychologist, 60, 410–421. doi:10.1037/003-66X.60.5.410.

Snyder, C. R. (1994/2000). The psychology of hope: You can get there from here. New York: Free Press.

Int J Ment Health Addiction (2012) 10:441–452 451

Snyder, C. R. (2002). Hope theory: rainbows in the mind. Psychological Inquiry, 13, 249–275. doi:10.1207/S15327965PLI1304_01.

Snyder, C. R., Irving, L. M., & Anderson, J. R. (1991). Hope and health. In C. R. Snyder & D. R.Forsyth (Eds.), Handbook of social and clinical psychology: The health perspective (pp. 285–305).New York: Permagon.

Somov, P. G. (2008). A psychodrama group for substance use relapse prevention training. The Arts inPsychotherapy, 38, 151–161. doi:10.1016/j.aip.2007.11.002.

Stauffer, M. D., Capuzzi, D., & Tanigoshi, H. (2008). Assessment: An overview. In D. Capuzzi & M. D.Stauffer (Eds.), Foundations of addictions counseling (pp. 76–100). Boston: Pearson Education.

Stephenson, C. (1991). The concept of hope revisited for nursing. Journal of Advanced Nursing, 16,1456–1461. doi:10.1111/j.1365-2648.1991.tb01593.x.

White, M. (2007). Maps of narrative practice. New York: Norton.

452 Int J Ment Health Addiction (2012) 10:441–452