Despair: what is “despair,” what does it mean, and why is it important?
The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.
There are a lot of therapy buzzwords, which at times can be useful, but also at times seem nebulous or hard to incorporate into actual therapeutic praxis. A few words that fit into this category for me are “acceptance” and “forgiveness.” If you tell me that you have accepted something, or have forgiven someone, I understand what you mean, but I’m not sure there is a concrete way to achieve these states of being or understanding.
Some therapy buzzwords become significant, therapeutic trending topics. The popularity of Bessel van der Kolk’s The Body Keeps the Score appeared to catapult the treatment of “trauma” into the therapy zeitgeist. It is worth noting that Judith Herman’s seminal Trauma and Recovery discussed historical periods in which this was also the case: the advent of psychoanalysis (over 100 years ago); related to wars, foreign conflicts, and soldiers who experienced “shell shock”; and the rise of feminism in the 1960s and 1970s, as women were more able to discuss and find support for intimate partner violence and sexual assault. Parts of me are on board with the importance of helping clients treat their trauma. I am currently reading Avgi Saketopoulou’s Sexuality Beyond Consent, and other parts of me somewhat align with her view of “traumatophilia.” Saketopoulou posits there is no return to the prelapsarian moment before the trauma occurred, that there is a current, cultural obsession with “overcoming” trauma, and it is worthwhile to examine what people do “with” their trauma, instead of pursuing ways to champion past it. I hope to finish her book in the very near future. It is a truly fascinating book, and I’d recommend it to you while the caveat that reading it has been somewhat triggering for me.
Other trending therapy topics which feel current, that have not quite reached the ubiquitous level that trauma treatment has, are “experiential avoidance” (an important topic, to be sure) and “interoceptive awareness” (a fifteen-dollar word for ‘’inner’ awareness, which, if you’d read any of my blog entries, one that is really important in my own therapy practice.)
A topic which I feel is underrepresented in clinical literature, and certainly at the level of any modern therapy trend, is the concept of “despair.” I recently (in about the last… two years) read a handout written by the IFS therapist Mike Elkin, and when I read it, it blew my socks off. Why? It resonated significantly in my mind with a subjective 75% of my then caseload. In other words, it appears to be a very common clinical concern. I believe Elkin wrote that handout in the 2000s. I will quote Mike in his definition of despair. If you look at his handout, you will see I copied and pasted half of it here:
“It is very common for parts to learn to embrace despair as a resource, and therefore, to
begin to see hope as a trap to be avoided. This can occur when a part is experiencing
unrelenting pain. At first the part makes determined attempts to find and execute
strategies to relieve the pain, but as these continually fail, the part begins to experience
these attempts as making things worse.
Every try at improving the situation fails, thus adding to the already excruciating chronic
situation the added pain of disappointment, and the shame of failure. Because a major
component of trauma is the feeling of helplessness, the part is desperate to feel that it
can have some impact on its situation. At some point, it discovers a way to feel some
sense of instrumentality: it decides to stop trying to make things better!
While the chronic pain remains, this decision lets the part experience the ability to end
the pain of disappointment, and the shame of failure. Cold comfort though it may be, it is
important to understand how much relief it can be for the part to feel that can effect its
circumstances. Once the part makes this decision, then hope and possible solutions will
be perceived as a trap exposing it to the danger of disappointment and shame.”
I would imagine that most therapists, and many clients have experience with despair, without perhaps naming it outright. Many clients report a core belief, or speaking from parts of them that are depressed, “things will never get better.” When a helpful therapist asks “have you considered alternative [x]?” or “have you thought about trying [y]?”, a client might immediately swat away consideration of the perspective or behavioral response. “That isn’t going to help (or work, or matter at all), nothing will!” Imagine having some version of that conversation every session, once a week, for a year, or longer. I’ve had clinical experience getting stuck in a polarization between my client’s despair, hopelessness, and negativity versus my “helpfulness.” Frankly, it is a tough place to be in as a clinician, which makes me stagger when I consider it from the client perspective. Imagine if any effort you think about making to improve your circumstances just brings more inner criticism, pain, and shame. I am reminded a bit of Pete Walker’s book Complex PTSD: From Surviving to Thriving; Walker describes clients he has worked with, with extremely abusive and invalidated childhoods, for whom even the thought of expressing a want or preference can trigger panic and emotional flashbacks.
It can be challenging to sit with our own and others’ hopelessness. As therapists, it is or can become vitally important to accept our clients just as they are. You are who you are, and you are bringing what you are bringing. More than that, the therapist Mike Elkin suggests Internal Family Systems therapy can be effective at helping our clients “unburden” their despair strategies. Their despairing parts don’t have to hold onto their despair ad infinitum. This can crucially important, because if we are successful at scraping layers off of that despair, it might just give clients the opportunity again to try and improve their circumstances. What a gift that could be.
