IDD-MH Prescriber Guidelines

Foreword: The Importance of Hope as an Essential Part of Patient Care

Dan Tomasulo, PhD, MAPP, MFA

Many patients with intellectual and developmental disabilities and mental health needs (IDD-MH) have a history of being treated as if their presentation is “hopeless.” It is often assumed that these patients lack the resilience and character to work with the clinician to address clinical needs. This often leads to poor treatment approaches and outcomes because shared hope between the patient and the clinician is key. The cultivation of hope has been linked to psychological and physical well-being.¹ From the very beginning, pioneers in mental health have seen hope as an essential ingredient that helps people feel better. During the treatment process, Freud² himself thought his patients’ “expectations, colored by hope and faith” mostly explained treatment success or failure. Karl Menninger³ viewed hope as the essential ingredient of healing and encouraged psychology practitioners to study it. More recently, Irvin Yalom⁴, the celebrated existential and group therapist, identified the instillation of hope as a crucial factor in the therapeutic process. Today, Martin Seligman⁵, the “father of positive psychology,” and Chris Peterson⁶ have elevated hope as one of the 24 core character strengths that make human beings flourish. Additionally, Steven Maier⁷ and Martin Seligman offer specific research which suggests that hope arises when there is an expectation that future bad events will be temporary, specific, and manageable.

Other researchers, like Snyder^8,9, Cheavens¹⁰, and Lopez¹¹ suggest that hope involves having a pathway to achieve goals and the agency, or motivation, to reach these goals. Others, like Barbara Fredrickson¹², understand hope as an exception, because unlike other positive emotions, it comes into play only when our circumstances are difficult or at least uncertain. And medical researchers such as Kaye Herth¹³ have found that hope and healing happens when there is sufficient support.

What emerges from the plethora of research is an understanding that hope plays an essential role in reducing risk for distress while facilitating both physical and mental well-being. To consider implementing a treatment plan without addressing the hope factor is to limit its potentiality. To illustrate hope’s central role in patient care and its relationship to well-being, consider the following 2020 study on hope and aging.

In the first-of-its-kind study, researchers affiliated with the Human Flourishing Program at Harvard University’s Institute for Quantitative Social Science investigated the link between hope and aging.¹⁴ They found older adults (average age 66) with higher degrees of hope were more likely to have better physical, psychological, and social well-being. Those with greater hope had reduced risks of cancer, chronic conditions, sleep problems, chronic pain, and death. They also reported increased positivity, higher life satisfaction, a greater sense of purpose, less psychological distress, and better social well-being. On the other hand, those with lower levels of hope or hopelessness had an elevated risk of anxiety, depression, and posttraumatic stress disorder (PTSD). Having hope may be the best protection against a more difficult tomorrow.

Below is a partial list of findings suggesting hope and its correlates are associated with improved outcomes: