Including hope in occupational therapy practice: a pilot study.

This article was acceptedfOr publication November 11, 1996 T he concept of hope as a component of occupational therapy intervention has been left virtually unexplored in the literature. Writings from theology (Schweitzer, 1959), philosophy (Fromm, 1968), psychology (Stotland, 1969), sociology (Murphy, 1990), medicine (Buchholz, 1990), and nursing (Miller, 1985), as well as lay literature, have long acknowledged a relationship between hope and survival (Frankl, 1959), hope and recovery (Cousins, 1979; Price, 1994), and hope and the will to overcome (Murphy, 1990). The Bible makes frequent references to the importance of hope, for example: "For to him that is joined to all the living there is hope" (Eccles. 9:4). The occupational therapy profession incorporated in its foundation values of healing through engagement in occupations "which anyone can hope to achieve" (Meyer, 1922/1977, p. 641). In the first edition of Principles of Occupational Therapy, Fay and March (1947) acknowledged that communicating hope to the patient belonged in the repertoire of the occupational therapist. They provided a list of do's and don'ts concerning the therapeutic relationship. The therapist was told to "be encouraging and hopeful and foster a desire in the patient to get well" (p. 125). None of the subsequent seven editions of Willard and Spackman's Occupational Therapy offered similar explicit guidelines about including hope in therapeutic interventions. More recently, carefully crafred portrayals of patienttherapist interactions were created by Fleming (1991) and Mattingly and Fleming (1994) in their examinations of the narrative nature of clinical reasoning. These authors spoke about the therapist's focus on the patient's possibilities, including a hope that the solutions provided for the patient would make his or her life a little easier or more meaningful. However, these authors did not address the manner in which hope is conveyed ro the patient. The silence surrounding that aspect of therapeutic interventions provided the impetus for this pilot study. The purpose was to explore the manner in which occupational therapists reported using hope as a component of their therapeutic interventions and how they reflected this in their documentation of treatment.