Relational rehabilitation: competencies and qualities needed in psychosocial rehabilitation when responding to hope and hopelessness

This study explores how rehabilitation professionals engage with the dynamic nature of hope in acquired brain injury rehabilitation, identifying the qualities and competencies needed to respond with care. Using a qualitative design, data were collected through focus groups and individual interviews with cross-disciplinary professionals at a Danish rehabilitation centre. Reflexive thematic analysis revealed four distinct episodes of hope, each demanding a different response. Drawing on the concepts of 'relational caring' and 'practicing presence', and engaging with empirical data, essential qualities and competencies were revealed: being present, attuned, giving and sharing time, moving along, faithfully staying with, and embracing powerlessness and uncertainty. We conclude that current rehabilitation competency frameworks, such as Wade (Clin Rehabil 34(8):995-1003, 2020) and the Rehabilitation Competency Framework as reported by World Health Organization (Rehabilitation Competency Framework, World Health Organization, Geneva, 2020), fail to capture the more nuanced competencies required to address hopelessness in rehabilitation practice. This indicates that acknowledging and validating the full dynamics of hope and hopelessness within the frameworks shaping rehabilitation practice is essential to recognising the comprehensive range of qualities and competencies needed by rehabilitation professionals. This encompasses the capacity to navigate the shifting nature of hope as well as endure and 'stay with' the person in need during hardship. Specifically, education of rehabilitation professionals could gain from integrating the theoretical framework from relational caring and presence theory as a supplement to the International Classification of Functioning, disability and Health (ICF), enabling professionals to effectively navigate the psychosocial and existential dimensions of hope in their practice.