Demoralization and hope in clinical psychiatry and psychotherapy

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Journal Article

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The Psychotherapy of Hope: The Legacy of Persuasion and Healing


The second edition of Persuasion and Healing (Frank 1973) defended the radical assertion that people seek psychotherapy largely because they feel demoralized, not because they have a mental illness. "Demoralization" referred to the distress felt by people aware of their failure to meet their own or others' expectations, while seeing themselves as powerless to change the situation or themselves (see chapters 6 and 7 in this volume). In linking demoralization to the common features of psychotherapy described in the first edition (1961), Frank fostered a quiet revolution. Teaching therapists how to inspire hope, mastery, trust, and expectation for change, rather than specialized techniques of particular schools, became the core of training. Recognizing demoralization rather than mental illness as the main grounds for psychotherapy also widens the scope of who should be offered such care. Demoralization is a common form of "normal suffering" for people who have chronic medical illnesses, victims of disasters, unemployed workers, or immigrants in an unfamiliar culture. All may benefit from systematic efforts to restore hope and mastery in the face of overwhelming circumstances. In the decades since Persuasion and Healing first appeared, substantial progress has been made in clinical theory and psychotherapeutic technique. The third edition (Frank and Frank 1991) suggested that psychotherapists might develop their skills by cultivating qualities identified in the study of rhetoric. Rhetorical principles suggest that therapists could build on the ethos attached to their cultural and personal status to enlist a patient's trust. As a form of rhetoric, psychotherapy arouses moderate levels of emotion through culturally resonant language, imagery, or prescribed acts. Such rhetorical methods empower therapists to offer patients convincing hope that they may counter feelings of helplessness by changing either themselves or their circumstances. © 2011 by The Johns Hopkins University Press. All rights reserved.

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