ABSTRACT
Hopelessness is a dysphoric state that involves the loss of expectation that adversity will yield and better days will come. It is also accompanied by sad mood, lowered self-esteem, and a pessimistic outlook on life, at least in that particular moment when one is seized by the experience. The author shares some descriptions of despair from the literature and elaborates in more detail some techniques for working with despair. This seemingly daunting task was rewarded by exploration of the rich literature in our field. Individuals come to us out of hope, but carry skepticism, worry, and dread for repeating past hurts. In summary, despair is different from hopelessness as it involves fear of unrelenting pain which the individual feels helpless to manage and hopeless to remedy. Despair enters the treatment in moments of empathic failures or misreadings. It may be fleeting: only represented by shifts in associations or retreats into defensive modes of sadomasochistic enactments, passivity, or withdrawal.
