Is it harmful to have too high of an expectation for recovery?

Be more concerned about giving false hopelessness than about giving false hope. False hopelessness is more common due to a phenomenon known as the clinician’s illusion, in which mental health professionals base their beliefs about what’s possible on repeated personal experiences of seeing sick people at their worst while missing out on countless recovery successes in the community. False hopelessness is also more harmful since belief in recovery by the individual and those around them, such as family members, is vital to recovery. In fact, the establishment and maintenance of realistic hope has been demonstrated to be the most important therapeutic factor in the clinician/patient relationship. This is similar to the Pygmalion effect in education whereby students who are thought of as more capable achieve more. Hope is especially important in cases of psychosis, because we have not yet completely let go of Kraepelin’s conception of schizophrenia as inevitably degenerative, in spite of significant research to the contrary over more than a hundred years.

To hold hope for someone is not to deny the gravity of severe mental illness, which could be naïve, dishonest, and perhaps only a denial of feelings of hopelessness. Instead, it is important to recognize the suffering and challenges endured while holding an expectation for recovery. Unlike an ungrounded optimism, mature hope is linked to actionable goals with the flexibility to respond to obstacles by changing goals or methods.

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