Hope and expectation in the psychotherapy of the long-term mentally ill

Despite growing research on the treatment of severe mental illness, little attention is devoted to the internal experience of therapists who strain to ward off disillusionment and despair as they try to hold out hope and reconfigure expectations over a course of therapy that may extend many years. The first-person literature of recovery points repeatedly to the importance of maintaining faith in the face of resignation, yet much less appears in the professional literature about the struggles of therapists who live with apprehensions about the meaning of their work. The relative disappearance of commentary about this phenomenon, a legacy of the biological revolution in psychiatry, shields practitioners from self-examination and prevents a more penetrating look at the inner workings of psychotherapy in the treatment of long-term mental illness.