Hope has been defined as the belief that pathways exist towards our desired goals and that we have the motivation and skill to pursue those pathways. Hope is the belief in a preferred future.
A positive psychology researcher, Charles Snyder (2002), summarised the research in this area. Hope is a major component of well- being and adjustment to adversity. High hope individuals have greater self-reported wellbeing and health. They are actually less likely to get ill and cope better if they do (Unwin et al, 2009; Billington et al, 2008). They consult less. They even live longer. Hopeful people are happier and happy people do better on a whole range of metrics related to health and wellbeing (Diener and Chan, 2011; Unwin and Dickson, 2010).
Perhaps that is not too surprising. However, what is surprising is that the powerful effects of hope on wellbeing are so rarely talked about in terms of how to get more of it. How can we be more hopeful? In fact, it is often the exact opposite. We tend to focus on ‘problems’ and shortcomings rather than preferred futures and strengths. This applies to our struggles with food addiction as much as anything else.
A simple model to enhance hope: GRIN (Goals, Resources, Increments, Noticing)
My husband and I developed a simple conversational model which is based on enhancing hope by using questions from a solution-focused approach (O’Connell, 2012) and positive psychology. This approach assumes that people already have the knowledge and skills to move towards their goals or ‘preferred future’ and that the helper’s role is to uncover that confidence and motivation by asking useful questions. You can use it on yourself too!
The approach we developed initially for doctors, has four stages that can be pursued in any order but always keep in view an understanding of the ‘preferred future’. We have used the techniques described in direct patient work, groups and even remote digital interventions to help people with type 2 diabetes achieve significant improvements in control (Unwin and Tobin, 2015; Unwin and Unwin, 2014; Saslow et al, 2018). We also use them on ourselves, each other and occasionally friends and family!
Step 1 Goals
The first and most important step is establishing what ‘better’ would look like.
‘What are your/my best hopes for today/this situation/6 months’ time?’
‘If in six months’ time, things were how you/I wanted them to be, what would that look like?’
‘Are there any particular ways you/I would like your/myhealth/life to improve?’
Usually, people come up with concrete goals such as ‘I want to breathe better’ or ‘I want to have no pain in my knees’ or I want to lose weight, or get a new job. So, follow up with…
‘What difference would that make to your/my life?’
For example, you might say ‘then I can help with my grandchildren more’ or ‘I could keep walking the dog’.
We have learned something we can focus on. For example, ‘It sounds like family is really important to you’.
A very useful question in this approach is ‘what else?’ allowing more rich information to emerge.
‘You/I would be able to keep walking the dog. What else?’ ‘What else would you/I like to be better?’
Step 2 Resources
The second stage is to explore what is already working in your/the person’s life that is going to help them make progress. This enhances a belief in an ability to make changes. An alternative is to ask for an example from the past, e.g. ‘Have you/I ever managed to lose weight in the past? Have you/I ever given up sugar in the past? What seemed to work then?
‘Who is supporting/helping you/me right now? Or might do so?’
‘What helps your/my <problem > now? When are things even slightly better?’
‘What has helped you/me in the past?’
‘What personal strengths do you/I have that could help?’
‘What else?’
Sometimes the strengths question is difficult for us to answer. A different slant can be to give the person/yourself a sincere compliment based on what you already know, or to ask what a loved one would say.
‘I know you are/I am a very determined/organised/ positive/caring person and that this will help you/me to make good progress.’
‘What would your/my wife/best friend say are your/my best qualities?’
‘What else?’
Step 3 Increments
So many people have goals they never realise because they fail to take those first small steps towards their better future. So, the third stage of the conversation is either about what would be happening if the person/you first started to make progress and what they/you might notice when they do, or committing to some specific ‘small steps’ they/you think would be helpful.
‘What will be the next small sign that you/I am are making progress?’
‘What will your/my wife/best friend notice that will tell them you/I are making progress?’
‘What will tell me you/I are/am making progress?’
‘Bearing in mind your goal, can you/I think of a small change you/I can easily make before <date>? ‘
‘What else?’
Step 4 Noticing
So often we noticing negative things like pain or depression and how bad it is you noticed about any improvement. These questions are very useful as ‘follow up’ or to focus on regularly.
‘What is better since last week/we last spoke?’
‘What difference has that made to you/me? Who else in the family noticed?’
‘What seems to be working well for you/me right now?’
We should also be attuned to noticing progress and giving positive feedback.
‘I have noticed that you/I are/am smiling more/walked without your/my stick/are/am breathing better this week.’
‘The <test><scales><measurement> tells me that you/I have been successful in making important changes…’
‘Wow! You/I have lost 3″ off your/my waist. How did you/I do that?’ (get details)
In a nutshell noticing supplies feedback. Progress should be noticed and celebrated!
Wider application of the model
The process of shared goal setting, acknowledging what is already working, identifying the next steps and noticing progress is a simple model that can also be applied to meetings, supervision, appraisal, family and personal goals.
‘What are our best hopes for this meeting today?’ ‘Where do I/we hope to be this time next year?’
‘What is already going well in our team/family/relationship?’
‘What strengths do we have in the team/family/relationship?’
‘What will tell me I am managing you better?’
‘When have I noticed myself being at my best recently and how did I do that? ‘
‘What have I/we been pleased to notice in the last week?’
‘What else?’
Using a solution-focused approach challenges the traditional model that any ‘problem’ must be understood and analysed in detail before progress can be made. It gets away from ‘diagnosing’ the problem to envisioning the solution. Understanding the origins of the problem isn’t always necessary. In this way progress can be fast and sometimes surprisingly so. Have faith in hope! Remain happy, resilient and well.
References
Billington E, Simpson J, Unwin J, Bray D, Giles D (2008) Does hope predict adjustment to end stage renal failure? British Journal of health Psychology 13 (4) 683–700.
Diener E, Chan M (2011) Happy people live longer. Applied Psychology: Health and Well-being 3 (1) 1–43.
Frank J, Frank J (1993) Persuasion and healing. Baltimore, MA: John Hopkins University Press.
Malpass T (2018) The hope that I have: to remission and beyond. Print2Demand. www.print2demand.co.uk.
O’Connell B (2012) Solution-focused therapy. London: Sage Publications Ltd.
Saslow L, Summers C, Aikens J, Unwin D (2018) Outcomes of a digitally delivered low-carbohydrate type 2 diabetes self-management program. JMIR Diabetes, 3 (3) e12.
Snyder C (2002) Hope theory: rainbows in the mind. Psychological Inquiry 13 (4) 249–275.
Unwin D (2005) SFGP! Why a solution-focused approach is brilliant in primary care. Solution News 1 (4) 10–12.
Unwin D, Tobin S (2015) A patient request for some ‘deprescribing’. BMJ 351 h4023.
Unwin D, Unwin J (2014) Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes. Practical Diabetes 31 (2) 76–79.
Unwin J, Dickson J (2010) Goal focused hope, spiritual hope and well-being. Social Scientific Study of Religion 21 161–174.
Unwin J, Kacperek L, Clark C (2009) A prospective study of positive adjustment to lower limb amputation. Clinical Rehabilitation 23 1044–1050.
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