Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.     

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Psychiatric treatment of the homeless in a group-based therapeutic community: a preliminary field investigation

This preliminary study investigated the effectiveness of a group-based therapeutic community for the homeless. Thirty-seven individuals residing at a homeless shelter participating in a therapeutic community were assessed across time on several variables: psychiatric symptoms, social functioning, and substance abuse. Significant initial improvements in overall distress, psychiatric symptoms, and substance abuse were found. Improvements in social functioning were exhibited in the therapeutic community participants after six months.     

Psychiatric Treatment of the Homeless in a Group—Based Therapeutic Community: A Preliminary Field Investigation

This preliminary study investigated the effectiveness of a group—based therapeutic community for the homeless. Thirty—seven individuals residing at a homeless shelter participating in a therapeutic community were assessed across time on several variables: psychiatric symptoms, social functioning, and substance abuse. Significant initial improvements in overall distress, psychiatric symptoms, and substance abuse were found. Improvements in social functioning were exhibited in the therapeutic community participants after six months.     

Loss of Control,Attributions, and Helplessness in the Homeless1

Control has emerged as an important psychological variable. The purpose of this project was to extend the concept of environmental control to the homeless shelter environment. Data from interviews conducted with residents of a homeless shelter supported the hypothesis that perceived loss of control over the shelter environment would be positively related to giving up on finding a home and employment. The hypothesis that the helplessness created by low control environments is consistent with the external, stable attributional style of “universal” helplessness was partially supported. Suggestions for future research are provided. Changes in the shelter environment are recommended for the treatment of helplessness in the homeless though helplessness is expected to persist as long as poverty, expensive housing, and prejudice against the homeless make efforts and outcomes noncontingent.     

Homelessness and strategies of identity maintenance: a participant observation study

In order to investigate identity maintenance strategies used by a low status group, a covert participant observation study was conducted in a shelter for the homeless. From Social Identity Theory and previous research on the homeless, it was hypothesized that the identity maintenance strategies used would differ as a function of longevity of homelessness: the short‐term homeless (<2 years) would be less likely to identify themselves as homeless (social mobility), while the longer‐term homeless (>2 years) would identify themselves as homeless but engage in various types of social creativity to mitigate their situation. In addition to the strategies described in SIT, it was conjectured that some of the longest‐term homeless would have given up making any intergroup or other social comparisons. Of the various strategies found, some were beyond SIT. The pattern of strategy use was best interpreted mainly as a function of longevity of homelessness, but this was moderated by both experience and personality. A trajectory of change in identity strategies with longevity of homelessness was offered as a plausible frame of reference for further research. Methodological limitations, implications for Social Identity Theory and recommendations for improving the situation of the homeless were discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Self-help efforts in a squatter community: Implications for addressing contemporary homelessness

This analysis addresses the nature of contemporary homelessness in the United States, the historical foundations of the shelter system, and survival strategies utilized by homeless persons in meeting their physical, social, and psychological needs. A framework that examines the degree of publicness/privateness and permanency/temporariness of spaces utilized by homeless persons is applied to a case study of a self-help squatter community living on an empty lot in New York City. By looking at the members of the group, their relationship to their neighbors and the local community, and their approaches in dealing with their needs, an assessment is made of this labor-intensive, self-help effort for providing shelter. Implications of self-help approaches are related to policy development and further research.     

Homelessness Is Traumatic: Abuse,Victimization, and Trauma Histories of Homeless Men

Homelessness is traumatic, and trauma-informed care is an emerging best practice. Using structured interviews with day shelter clients (N = 152), this study examined trauma among homeless men. The PTSD Checklist (PCL–C) was used to assess for posttraumatic stress disorder (PTSD). Participants’ pattern of PCL–C responses suggested that 23% to 30% screened positive for PTSD. Those with positive PTSD screens had been homeless longer and were more likely to have met time criteria for chronic homelessness. They were significantly more likely to be veterans and to report violent attacks, abuse histories, and mental health problems. Importantly, only 69% of those with positive PTSD screens acknowledged current mental health problems. These individuals were much less likely to report mental health counseling in the prior year.     

Homelessness as psychological trauma. Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.     

Self-determination in relation to quality of life in homeless young adults: Direct and indirect effects through psychological distress and social support

The self-determination theory emphasizes the importance of satisfaction with autonomy, competence, and relatedness for a person’s psychological growth and well-being. This study examines associations between autonomy, competence, and relatedness with quality of life in homeless young adults; and whether possible associations are mediated by psychological distress and perceived social support. By means of face-to-face interviews, 255 homeless young adults who receive care from 10 Dutch shelter facilities for homeless young adults have been interviewed (M age = 20, 77% male, 51% Dutch Nationality) shortly after entering the facility. Autonomy, competence, and relatedness are all associated with quality of life, with competence as the highest correlate. Psychological distress mediates both competence and autonomy, and social support mediates competence as well as relatedness. These findings emphasize the importance of intervention programs for homeless young adults, focusing on the enhancement of self-determination, especially competence, to improve their quality of life.     

A Descriptive Study of Single Adults in Homeless Shelters: Increasing Counselors' Knowledge and Social Action

This article is intended to help counselors increase their knowledge and social action for single adults who are homeless. Findings from a period‐prevalence study of 71 single adults in a homeless shelter over 2 years reveal demographics, mental health needs, and sociopolitical issues of this population. Implications including social justice action strategies for counselors are discussed. Este artículo se piensa ayudar consejeros aumentan su conocimiento y la acción social para adultos soltero que son sin hogar. Las conclusiones de un estudio del período‐predominio de 71 adultos soltero en un refugio sin hogar sobre 2 años revelan las necesidades demográficas, la necesidades mentales de la salud, y las aplicaciones sociopolíticas de esta población. Implicaciones incluyendo las estrategias sociales de la acción de justicia para consejeros se discuten.     

Successful Transitions of Runaway/Homeless Youth from Shelter Care

Previous research indicates that runaway and homeless youth often achieve positive outcomes after shelter stays however few studies have examined how these outcomes are achieved. This study employs qualitative methods to explicate this phenomenon. Twenty-five providers and 21 youth from four shelters participated in this study. Youth were recruited who had completed shelter care and returned home for minimally six months. Multiple raters identified themes and created a conceptual model. While in shelter, youths experienced structure and freedom, and the family experienced respite. Once youth became involved in treatment, the family re-connected and the youth returned home. After returning home, youth and family become involved in follow-up services. Results from our study provide insight into the process through which runaway/homeless youth return home after a shelter stay. Our findings emphasize the need for continued change by all members of the family system, highlighting the need for continued intervention to maintain positive changes.     

The Interplay Between Housing Stability and Child Separation: Implications for Practice and Policy

Greater understanding of how residential stability affects child separation and reunification among homeless families can guide both child welfare and homeless policy and practice. This article draws upon two longitudinal studies examining services and housing for homeless families and their relationship to family and housing stability. Both studies were conducted in the same state at roughly the same time with similar instruments. The first study, examining families’ experiences and outcomes following entry into the homeless service system in three counties in Washington State, found that at 18 months following shelter entry, families that are intact with their children were significantly more likely to be housed in their own housing (46%) than families that were separated from one or more of their children (31%). The second study, a quasiexperimental evaluation of a supportive housing program for homeless families with multiple housing barriers, found that the rates of reunification for Child Protective Services (CPS)‐involved families receiving supportive housing was comparable to that for families entering public housing without services, but significantly higher than the rate of reunification for families entering shelter. Taken together, the findings from both studies contribute to the evidence underscoring the importance of housing assistance to homeless families involved in the child welfare system.     

The care-system for homeless youth in The Netherlands: perceptions of youngsters through a peer research approach

The aim of this study was to examine the perceptions of homeless youth of the care they receive. Since we wanted to involve homeless youth as participants in this project, we adopted the approach of peer-research. This form of collaborative research has a major role for homeless youth in making an inventory of the problems. A parallel is drawn between the parent-adolescent relationship and the relationship between social worker and homeless adolescent.     

Describing Trajectories of Homeless Service Use in Hawai‘i Using Latent Class Growth Analysis

The State of Hawai‘i, like many other areas across the United States, has large numbers of individuals and families experiencing homelessness, many of whom seek support through statewide shelters and services. This study explored the diversity of ways in which individuals and families moved through Hawai‘i's homeless service system. Using administrative data, a cohort of new service users was tracked across time to trace the developmental trajectories of their homeless service use. The sample consisted of adults who had entered the service system for the first time in the fiscal year (FY) of 2010 (N = 4655). These individuals were then tracked through the end of FY 2014, as they used emergency shelter, transitional shelter, and outreach services. A latent class growth analysis was conducted and identified four distinct patterns of service use: low service use (n = 3966, 85.2%); typical transitional shelter use (n = 452, 9.7%); atypical transitional use (n = 127, 2.7%), and potential chronic service use (n = 110, 2.4%). Multinomial logistic regression models were then used to determine if select demographic, family, background experience (e.g., education, employment), or health variables were associated with class membership. The distinct profiles for class membership are discussed.     

NAVIGATING SEX, SEXUALITY, AND CHRISTIAN VALUES

This is an autobiographical essay that attempts to illuminate the cultural factors (e.g., race, religion, social class, gender, and sexuality) that shaped the author's efforts to embrace herself, including her non-conforming sexuality in a context that was quite rigid about most things. The reader is invited to experience some of the author’s grapplings about Christianity, growing up black and female in a changing America, and the constant longing to please others that many people from non-dominant positions express. This essay also hopes to provide at least one point of entry into an academic and/or personal exploration of culture and sexuality in America, including discussions about how morality, social class, race, and gender socialization may interact to shape choices and personal expressions of who one is.     

Psychological Groups and Political Psychology: A Response to Huddy's "Critical Examination of Social Identity Theory"

In a recent article in this journal, Leonie Huddy (2001) asks whether the social identity approach developed by Tajfel, Turner, and their collaborators can "advance the study of identity within political science" (p. 128). She concludes that "various shortcomings and omissions in its research program" (p. 128) hinder the application of the approach to political phenomena. This paper presents a response to Huddy's evaluation of the social identity approach. Several aspects of her account of social identity work are challenged, especially her suggestion that it ignores subjective aspects of group membership. The interpretation of the minimal group paradigm is discussed in detail, as are issues of identity choice, salience, and variations in identity strength. The treatment of groups as process in social identity theory and self–categorization theory is given particular emphasis.     

A Geographic Analysis of Chronically Homeless Adults Before and After Enrollment in a Multi-Site Supported Housing Initiative: Community Characteristics and Migration

The current study examined the community characteristics and migration of chronically homeless adults before and after entry into a multi-site supported housing initiative. A total of 394 participants were geocoded at baseline and 12-month follow up. Data from geographic information systems indicate that the median distance participants traveled from their last residence to their residence 1 year after program entry was 4.6 miles and 12% of participants traveled more than 100 miles. Participants moved into communities with higher population densities, larger proportions of Whites, and smaller proportions of Blacks following their entry into supported housing, but continued to live in communities with higher crime rates, lower education levels, and lower income levels then the state average. At 12 months, Black participants residing in communities with higher population densities and larger Black populations reported higher social support and lower subjective distress. This underscores the importance of considering client preferences in housing. Together, these findings suggest that supported housing programs may be successful in finding housing for homeless clients, but are not placing them in improved communities. Special attention may also be needed for some clients who travel long distances between residences.     

Escaping Homelessness: The Influences of Self-Efficacy and Time Perspective on Coping With Homelessness1

This study explored whether self-efficacy and time perspective of homeless adults (N= 82) living in a shelter affected their coping strategies related to obtaining housing and employment. Participants with high self-efficacy searched more for housing and employment and stayed at the shelter for a shorter duration, whereas participants with low self-efficacy were more likely to request an extension of their stay at the shelter. Those high on future orientation had shorter durations of homelessness and were more likely to enroll in school and to report gaining positive benefits from their predicament, whereas those with a high present orientation had more avoidant coping strategies. Despite the predictive power of self-efficacy and future orientation of proactive search behaviors, there were no predictors of obtaining stable housing, which is a scarce resource in the area. However, a high present orientation predicted obtaining temporary housing. A present temporal perspective may be adaptive in finding short-term solutions to an unstable situation, such as homelessness. The role of time perspective in crisis situations is discussed, as well as the severe environmental constraints on the exercise of personal control over reality dictated by social, economic, and political forces.     

Just for Women? Feminist Multicultural Therapy with Male Clients

Feminist multicultural therapy is an integrative approach to psychotherapy that emphasizes a systems-level understanding of psychological distress and the process of therapeutic change. In the present exploratory study, the experiences of feminist multicultural therapists working with male clients were studied using Consensual Qualitative Research (CQR) (Hill et al. 1997). Phone interviews were conducted with eight female practicing licensed or license-eligible therapists who had worked with at least one male client in the past 6 months. Consistent with the theoretical approach, all of the therapists interviewed expressed their belief that psychological symptoms can be seen as a reaction to a loss of power or related to the effects of an oppressive system. Additionally, the therapists believed that this theoretical model is broad enough to be used with varying types of intersecting social identities. The findings illustrate the ways in which the counseling approach may work similarly across genders, as well as ways in which one’s therapeutic approach may be altered when working specifically with men. Implications for therapists who work with male clients (both the rewards and the challenges) as well as for researchers who wish to study the application of therapeutic interventions with men are discussed.