Walking into the future with hope.
Subject: Physician and patient (Management)
Psychotherapists (Practice)
Psychotherapists (Customer relations)
Psychotherapy (Methods)
Author: Johanson, Greg
Pub Date: 06/22/2010
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Summer, 2010 Source Volume: 13 Source Issue: 2
Topic: Event Code: 200 Management dynamics; 240 Marketing procedures Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 233501759

There has been a long-held, largely unspoken assumption in American psychotherapy that if we attend to the wounding of the past, that the future will somehow naturally and satisfyingly unfold. A consequence of this partial truth is that therapy can become an endless archeological expedition in which important aspects of life embedded in such terms as "hope," "joy," "passion," "purpose," "meaning," "aliveness," "gratitude," "potentiality," "becoming," "anticipatory consciousness," "not-yet-being," and "openness to the future" are not addressed.

While these terms are widely acknowledged as central and crucial to mental-emotional well-being, they have not received adequate treatment in the therapeutic literature. This is beginning to be remedied with recent work on hope (Lester, 1995; Scioli and Biller, 2010) and positive psychology (Diener and Biswas-Diener, 2008; Emmons, 2007; Peterson, 2006).

Another older, though still relevant, source on the importance of walking into the future with hope is the work of Lawrence LeShan. LeShan (1959, 1961, 1966; LeShan, L. & LeShan, E., 1961) was the first research psychologist to attain hospital privileges for working with cancer patients. Though no one knows to what extent mental-emotional factors affect physical disease processes, it is unquestionably one factor among others, and LeShan hoped to improve immune function through psychological therapy.

His first attempts of applying the psychodynamic methods he had learned at the University of Chicago failed. While he had meaningful encounters with patients, they died according to predictable statistical averages. This led him to question the basic Freudian paradigm followed by virtually all psychotherapies; namely, assessing a patient in terms of 1) What is wrong? 2) What aspect of this person's past is adversely affecting their present? 3) What shall we do about it?

Continued experimentation with patients who were dying according to standard medical assessments eventually led LeShan (1979, 1994) to find a measure of success through a startling reversal of the psychotherapeutic paradigm through asking instead 1) What is right with this person? and 2) How can I support it? What is right with a person translated into:

"What is their most natural way of being, relating, creating? What kind of life and life-style would make them glad to get up in the morning and glad to go to bed at night, would give the maximum zest and enthusiasm in life? Would use all of them so that on physical, psychological, and spiritual levels they would express themselves in ways syntonic and 'natural' to their entire being? What kind of life would they be living if they adjusted the world to themselves instead of--as our patients generally have done--adjusted themselves to the world?" (LeShan, 1994)

Supporting this process in cancer patients involved helping them identify their gifts and passions to not simply do affirmations, but to concretely change their lives so that more of what brought them maximum zest and enthusiasm manifested in their actual routines. After extensive work in the field, LeShan came to affirm the theory that everyone had a unique "song to sing" that was satisfying to them, and also "socially positive and acceptable" to others, through which they could make a living (LeShan, 1994).

In his 1994 work Cancer as a Turning Point, LeShan notes a number of case studies that initially challenged this theory. The one thing that had been meaningful to Pedro, a Hispanic youth raised in the South Bronx, was being a gang leader. It was after the gang had dissolved for various reasons and Pedro was alone on the streets without hope that he ended up a hospitalized cancer patient with a fatal prognosis. Though being a gang leader did not fit the socially positive and acceptable part of his theory, as LeShan inquired more deeply, it turned out that the appeal to Pedro was belonging to a tight-knit group that alternated periods of simply hanging out with adrenaline-filled life and death times of having each other's back. Together, they realized that they were describing the life of a firefighter, a work vision that Pedro could actually get excited about. It was a problematic vision, since Pedro was a high school dropout with no job history. However, as LeShan supported him in accomplishing a GED and a work history that would recommend him to a fire department, Pedro's health began to improve until a cooperating radiologist signaled he could get away with taking the required physical, which he did. Pedro's pursuit of his passion in hope resulted in fulfillment as a professional firefighter.


In another example, Harold's vision of wanting to go to medical school also seemed dubious since he was in his 50s, had only worked as a clothes salesman, and was not that intellectually gifted. However, when LeShan moved from the general to the more specific, it turned out that the appeal of being a medic was in being able to help people. That opened the door to multiple possibilities, and Harold's immune functions served him well as he moved toward becoming a world-class guide in a tourist information booth on the Atlantic Coast, helping people all day long.

LeShan (1994) outlines many methods for helping people get in touch with their passions and gifts so that a concrete vision may be constructed of walking into the future with hope:

* "What do you really like?"

* "What turns you on?"

* "What makes you want to get up in the morning and look forward to the day?"

* "Your Fairy Godmother appears and says she will make your inner and outer life exactly what you would like in the next six months, and needs instructions on exactly how that should be."

* "Let's look at your life as a novel where we get a chance for a second-edition rewrite. What do we keep and change?"

* "Let's pretend you are your own best friend and are going to give yourself the gift of organizing the next year in the perfect way in which to relate, create, nurture, and be supported."

When patients begin to take tangible steps to bring their passions into their everyday lives, it is possible they get in their own way, as historically based characterological issues arise. These barriers can be dealt with through the various psychotherapeutic therapies available, but the process has a different flavor when it is in the larger service of the horizon of hope, rather than simply attending to past wounds and patterns for their own sake.

LeShan's experience is that 50% of patients he has worked with who hold fatal diagnoses have begun to respond better to their medical treatments and not succumb to their prognosis. Many more begin to live more vibrantly and die with a greater sense of their life's meaning.

Obviously, there are implications here for clients in general, not only cancer patients as hope is fundamental to human life, and lack of hope can lead to despair (as well as weakened immune function in many areas of one's health.)

Lester offers the clinical caution that the invitation to explore the horizon of the future and hope requires sensitivity to the context. It is a clinical art to know when to weave in the future tense depending on whether one is consulting with "a 48-year-old dentist who has suffered a heart attack earlier in the day," "an 83-year-old female resident of a retirement center two days after her husband died," or "an 11-year-old boy whose parents told him the night before about their impending divorce" (Lester, 1995).

In general, LeShan would encourage us as therapists to affirm with Reinhardt (1952) that since the "future is already alive in human hopes and fears, in human planning and designing: it is a formative force and an integral part of the present" that we would do well to honor for its own sake.


Diener, E., & Biswas-Diener, R. (2008). Happiness. Malden, MA: Blackwell Publishing.

Emmons, R. (2007). Thanks! How the new science of gratitude can make you happier. Boston: Houghton Mifflin Co.

LeShan, L. (1959). Psychological states as factors in the development of neoplastic disease: A critical review. Journal of the National Cancer Institute, 22.

LeShan, L. (1961). A basic psychological orientation apparently associated with neoplastic disease. Psychiatric Quarterly.

LeShan, L. (1966). An emotional life history associated with neoplastic disease. Annals of the New York Academy of Sciences, 125.

LeShan, L. (1979). You can fight for your life: Emotional factors in the treatment of cancer. New York: Evans.

LeShan, L. (1994). Cancer as a turning point: A handbook for people with cancer, their families, and health professionals, Revised Edition (pp. 36-42). New York: Plume.

LeShan, L. & LeShan, E. (1961). Psychotherapy and the patient with a limited life span. Psychiatry, 24.

Lester, A. (1995). Hope in pastoral care and counseling (p. 107). Louisville, KY: Westminster John Knox Press.

Peterson, C. (2006). A primer in positive psychology. New York, NY: Oxford University Press.

Reinhardt, K. (1952). The existentialist revolt (p. 238). Milwaukee, WI: Bruce Publishing.

Scioli, A. & Biller, H. (2010). The power of hope. Deerfield Beach, FL: Health Communications.

By Greg Johanson, MDiv, PhD, LPC

Greg Johanson, MDiv, PhD, LPC is a Fellow of the American Psychotherapy Association and the American Association of Integrative Medicine. He is currently the director of Hakomi Educational Resources in Chicago, Illinois, and research professor in the Santa Barbara Graduate Institute of the Chicago School of Professional Psychology. Readers may visit his Web site at gregjohanson.net or e-mail greg@gregjohanson.net.
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