Hope and Placebo in Counseling

Hope and Placebo in Counseling


One of the challenges confronting health practitioners is how to deal with a myriad of health challenges non-medically. Today, due to the pressures and demands of life, many people are developing health conditions, particularly mental health problems. The most notable mental-related health complications include depression, anxiety, insomnia, and mental stress. Unfortunately, pharmacological interventions are increasingly proving ineffective in addressing these complications, calling for non-clinical approaches. In Australia, counseling has emerged as an effective non-medical approach in treating mental health problems. Today, health practitioners, besides administering medications on their patients, are employing counseling-designed approaches to treatment. Increasingly, health practitioners are using positive language, displaying confidence in the treatment plans, and facilitating therapeutic relationships when attending to patients admitted for various complications, including mental health.

In this light, the Australian medical fraternity has experimented with hope therapy and the placebo effect in patient care under the supervision of the Australian Counseling Association (Australian Counseling Association, 2012). Indeed, these therapeutic interventions have proven effective, especially in counseling sessions. In this respect, this paper argues that using hope therapy and placebo in counseling is more effective in delivering positive health outcomes than using pharmacological interventions.

The Placebo Effect

The terminology placebo effect is mostly referenced when describing changes in an individual emanating from placebo administration or manipulation (Oken, 2008). The definition of placebo holds that a placebo is any element (procedure, substance, and so on) that has no innate potential of producing any expected effect of the result (Oken, 2008). It is these indirect results or effects of inactive elements that are collectively referred to as the placebo effects (Oken, 2008). For many years now, the placebo effect has been a central issue in scientific and clinical discourse. Up until the 1930s, doctors utilized placebos either as substitutes of risky pharmacological interventions or reassurance measures when no pharmacological intervention was possible. This might seem to indicate that physicians used placebos maliciously; nothing could be further from the truth. Placebos were, in fact, part and parcel of the clinical tradition of the time. However, as clinical pharmacology developed in leaps and bounds, medical literature started referring inert control groups as placebos. From this point onward, other terms emerged describing the placebo effect. These include context effects, expectancy effects, and meaning response. The particular therapeutic intervention responsible for eliciting the placebo effect is what is known as the placebo.

Notably, there are a variety of non-specific aspects of clinical therapy that can assist in determining both the size and direction of the placebo effect. These elements include any clinical interventions, ranging from the use of positive words, pills, surgery, gesture, to devices. Each of these aspects can play a significant role when it comes to a practitioner trying to display their professional standing, empathy with their clients, and confidence in the treatment plan. In essence, placebo is no equivalent to the administration of a pharmaceutical pill. This statement is supported by Thomas (1987), who showed that there was no significant difference between placebo intervention and no intervention. However, as far as prognosis was concerned, the researcher did establish a substantial difference between positive as well as negative statements (Thomas, 1987). In essence, Thomas’ (1987) work founded the foundational basis of the positive use of language in patient care, where the use of right words could raise positivity about treatment outcomes in patients.

According to Yalom (2005), instilling hope and maintaining it in patients was a critical part of the counseling process. As the researcher noted, hope had proven a therapeutically effective element as it enabled patients to have faith in the treatment plan (Yalom, 2005). Indeed, several other research works have established that high expectations at the start of a counseling process helped in facilitating positive therapeutic outcomes. In this light, placebo effects have a strong relationship with verbal cues. The use of verbal cues by health practitioners is significant in facilitating positive or expected outcomes. It is important to note that the non-specific aspects of the placebo therapy can similarly facilitate expected outcomes. In fact, the researcher found that larger placebo effects were dependent on the invasiveness of the non-specific aspect as far as the patient is concerned.

Theoretical Underpinning of the Placebo Effect

The placebo effect finds its theoretical basis on the learning theories, specifically the expectancy theory, the conditioning theory, and the meaning theory.

Expectancy theory– According to this theory, conscious expectations is the basis of the placebo effect. In other words, having an expectation was the primary requirement for the placebo effect to take place in a patient. Apparently, this means that when patients have a genuine belief that their treatment plan will work, then the placebo response takes effect. Indeed, this element makes the placebo effect a dominant part in counseling, where a patient can experience positive health outcomes by only getting a positive comment from the physician. Naturally, individuals create expectations based on their life journeys, including experiences and observations. It is these experiences and observations that help patients develop positive expectations when under treatment.

Conditioning theory– Fundamentally, the experiment of the Pavlov dogs is probably the most notable evidence of conditioning. The Pavlov dogs learned to salivate, which was the conditioning response, by just hearing a bell ringing, which was the conditioned stimulus. Pavlov had managed to pair serving food, which was the unconditioned stimulus, and the sound of a bell. Evidence has emerged that conditioning is also possible in human beings. In an experiment involving asthmatic children, Castes, Palenquie, Canelones, Hagel, and Lynch (1998) paired asthmatic medication with a vanilla aroma. With time, by just smelling the vanilla aroma, the asthmatic children were able to experience significant improvement in the health condition of their lungs. According to Brody and Brody (2000), the early childhood experience, where after encountering pain, children recovered by just getting love and concern from their parents, is an indication of the conditioning aspect. In this respect, it is possible for health practitioners to influence positive health outcomes by just displaying genuine love and concern towards their clients.

Meaning theory– According to this theory, the meaning a patient gives to any therapeutic intervention was necessary for determining either positive or negative health outcomes. As far as counseling is concerned, the context within which a counselor and the client meet can significantly impact expected results. As such, it is critical that counselors do everything humanly possible to increase the receptiveness of the counseling process to the clients.

Utilizing Placebo in Counseling

The hypothesis that expectancy significantly influences the placebo effect stands to reason that some factors can increase the impacts of the placebo effect, especially in counseling.  Borrowing from the expectancy theory, a counselor can take charge of creating a positive relationship with the client in ways that raise positive expectations. First, it might include among other things, using a positive, welcoming demeanor of confidence in the counseling process. Indeed, it is possible for psychotherapy to achieve positive outcomes, particularly when the therapist and client share similar expectations in the treatment plan. Using this framework, counselors can achieve positive results in their sessions by impacting the belief and confidence of their clients. Instilling hope is one of the pragmatic approaches that counselors can employ in their sessions. According to Oken (2008), the personality and style of interaction that a therapist applies are critical in determining outcomes in patient care. As such, positivity and enthusiasm on the part of the therapist or counselor is important in fostering an environment of high expectations on the part of the client. As noted by Oken (2008), just believing and having confidence in the therapeutic intervention, both on the part of the therapist and patient, was significant in influencing expected outcomes.

Hope Therapy

A wealth of research studies has confirmed the effectiveness of instilling hope on patients suffering from numerous health problems, among them the mental health complications. According to Rahimipour, Shahgholian, and Yazdani (2015), hope therapy was significant in addressing mental health problems, including anxiety, depression, and stress. As far as Reisian, Golzari, and Borjali (2011) are concerned, educating women seeking treatment for drug addiction on hope therapy played a significant role in reducing depression while at the same time reducing chances of returning to substance abuse. The study by Mehmet and Michael (2009) noted that hope is learned and functions to effect positive emotions, which act as a barrier factor against depression relapse.

Certainly, hope therapy is an effective approach to fighting and overcoming depression and anxiety. For example, patients who manifest high levels of hope, as well as those who gradually become hopeful, are seen to demonstrate more knowledge as it relates to issues of health, types, and severity of stress among other factors (Rustøen, Cooper, & Miaskowski, 2011). What is more, hopeful patients demonstrate better self-care. These positives are significantly low in patients with low levels of hope (Rustøen, Cooper, & Miaskowski, 2011). Hope therapy is considered to have an incremental effect on mental health, awareness, and coping strategies as it relates to mental disorders. Moreover, this form of intervention is judged to have a significant effect as far as reducing depression, and anxiety in individuals is concerned.

The study by Rustøen, Cooper, and Miaskowski (2011) reported that hope therapy effectively caused a significant reduction in mental stress among patients receiving tumor treatment. In fact, the authors noted that the effects of hope therapy linger for three to 12 months after the introduction of the intervention. The study noted that approximately 95 percent of oncology patients claimed hop therapy as an effective measure in helping them cope with mental stress (Rustøen, Cooper, & Miaskowski, 2011). This finding was in line with the findings of Ahari, Younesi, Borjali, and Damavandi (2012), who in their study investigating how hope affects depression in parents with children suffering from cancer, found that hope therapy helped mothers cope with mental stress. Group hope therapy has been found to be significant in reducing depression levels while increasing hope in patients. While investigating the effect of hope therapy among female students, Alaeddini, Kajbaf, and Molavi (2008) found that the intervention significantly helped reduce anxiety and insomnia. As an independent personal variable, hope is significant in impacting mental health- anxiety and depression- and quality of life.

Hope Therapy in Counseling

Basing on the findings of these research studies, it is apparent that hope therapy is important in affecting both the experiences and outcomes of patients in the various aspects of health care, including counseling. Indeed, studies have shown that hope therapy significantly influences the perceptions of patients regarding their treatment plans; this has meaningful outcomes as far as limiting the progression of chronic ailments is concerned. Evidently, the significance of hope therapy finds its basis on positive psychological approach, which has proven effective compared to addressing human frailties and weaknesses. Literature has demonstrated that high levels of hope in patients can help create protection against mental health problems, particularly anxiety and depression. Moreover, studies have shown that hope therapy safeguards patients from recurring instances of anxiety and depression.


The failure of pharmacological intervention sin addressing mental health problems, including anxiety, depression, insomnia, and mental stress is the basis of hope therapy and use of placebo effects. Indeed, both of these therapeutic intervention measures have proven fundamental in helping patients cope with mental health problems that come from experience with poor health. Anxiety and depression being the most prominent mental health problems facing most chronic patients, instilling hope and utilizing placebo have proven effective in improving positive outcomes. To a large extent, as demonstrated in the literature, both the use of placebo effects and hope therapy are similar in application and effect. While placebo effects are critical in helping patients develop a demeanor of confidence in the treatment plan, hope therapy helps patients develop the strength and positive outlook that helps them cope with their predicaments.


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hope therapy on hope and depression of mothers with children suffering from cancer in Tehran. Iranian Journal of Cancer Prevention5(4), 183-188.

Alaeddini, Z., Kajbaf, M. B., & Molavi, H. (2008). The effects of group hope-therapy on the

mental health of female students in Isfahan University. Journal of Health Psychology, 1386(1), 80–82.

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Brody, H., & Brody, D. (2000). Three perspectives on the placebo response: Expectancy,

conditioning, and meaning. Advanced Mind-Body Medicine, 16, 216-232.

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Rahimipour, M., Shahgholian, N., & Yazdani, M. (2015). Effect of hope therapy on depression,

anxiety, and stress among the patients undergoing hemodialysis. Iranian Journal of Nursing and Midwifery Research20(6), 694-699.

Reisian, A., Golzari, M., & Borjali, A. (2011). The effect of hope Therapy on Depression and

prevention of treatment finder addicted women regression. Journal of Addiction Research and Therapy5, 37-38.

Rustøen, T., Cooper, B. A., & Miaskowski, C. (2011). A longitudinal study of the effects of a

hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. European Journal of Oncology Nursing15(4), 351-357.

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Yalom, I. D. (2005). The theory and practice of group psychotherapy. New York, NY: Basic




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