Background: Traditionally adjustment to a serious injury such as spinal cord injury has been conceptualised as staged process of grieving. Hope in this tradition is commonly defined as denial and considered counterproductive to positive adjustment. These concepts were challenged as the author observed the strength of client's hope in the face of extremely confronting physical, social and environmental following spinal cord injury. Purpose: This paper presents qualitative data about the role of hope from the perspective of the person with spinal cord injury and then considers theoretical and clinical aspects of hope in the coping process. Method: This data presented is a subset of data from a ten year longitudinal year study of a sample of 46 people with spinal cord injury. Semi structured qualitative interviews were conducted at discharge from hospital, six, 12, 24, 36 months post discharge and again at ten years post discharge. Results: 73% of the participants identified hope as an essential factor that helped them cope following their injury. Three main foci of hope emerged from the data set: 1.Hope for a complete recovery; 2.Hope for a cure; 3.Hope for a satisfying quality of life. Conclusion: Hope emerged as a strong theme in the overall adjustment and coping process. Clinical implications for working with people who sustain spinal cord injury are discussed. It is recommended that interventions which support and facilitate hope need to be developed and tested.