Table Of ContentS EdiTEd by
‘Peter Cockersell’s psychodynamic model of understanding social exclusion
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gives us a better way of understanding why some homeless people seem to c
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reject help – and some real clues as to how we can change our practice to work a
more effectively for such people.’ l Social ExcluSion,
– Dr Philip Timms, FRCPsych, Honorary Senior Lecturer, King’s College London E
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‘By drawing on modern psychoanalytic thinking, developmental neurobiology l
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and current ideas of therapeutic environments, [Cockersell] presents the most
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complex problems in an accessible and engaging way.’ i
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– Rex Haigh, Consultant Psychiatrist in Medical Psychotherapy, n
Berkshire Healthcare NHS Foundation Trust ,
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‘This book will help colleagues right across the homeless sector (and beyond) m
reflect on the central importance of building and modelling good quality p
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relationships.’
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– Alex Bax, Chief Executive, Pathway n applying pSychology, pSychoThErapy
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T and piE To homElESSnESS
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Responding to the growing number of psychologically informed services for people a
and complEx nEEdS
experiencing social exclusion and, in particular, homelessness, this book gives u
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professionals the information and understanding they need to be fully informed in
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their practice with this client group. It begins with theory, looking at the psychology
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of social exclusion and the processes that underlie it, and considers the relationship
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between trauma, complex needs, homelessness and social exclusion. Presenting d
practical interventions and case studies, the authors then describe what makes for r
effective psychologically-informed services in practice and client perspectives on E
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social exclusion and recovery are also provided.
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Peter Cockersell is a psychoanalytic psychotherapist, lecturer in Psychodynamic
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Theory and Practice at the University of Surrey, UK, and Chief Executive of y
Community Housing and Therapy. He was previously Director of Health and
Recovery at St Mungo’s Broadway, London, and a founding member of the Faculty
of Homeless and Inclusion Health. p
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Cover design: Adam Renvoize JKP
SOCIAL EXCLUSION, COMPOUND
TRAUMA AND RECOVERY
of related interest
Working with Young Homeless People
Phil Robinson
ISBN 978 1 84310 611 1
eISBN 978 1 84642 815 9
Service User Involvement
Reaching the Hard to Reach in Supported Housing
Helen Brafield and Terry Eckersley
ISBN 978 1 84310 343 1
eISBN 978 1 84642 745 9
A Practical Guide to Therapeutic Work with Asylum-Seekers and Refugees
Angelina Jalonen and Paul Cilia La Corte
ISBN 978 1 78592 073 8
eISBN 978 1 78450 334 5
The Theory and Practice of Democratic Therapeutic Community Treatment
Steve Pearce and Rex Haigh
ISBN 978 1 78592 205 3
eISBN 978 1 78450 483 0
The Reality of Recovery in Personality Disorder
Heather Castillo
ISBN 978 1 84905 605 2
eISBN 978 1 78450 071 9
Comparative Psychology for Clinical Psychologists and Therapists
What Animal Behavior Can Tell Us about Human Psychology
Daniel C. Marston and Terry L. Maple
ISBN 978 1 84905 743 1
eISBN 978 1 78450 161 7
SOCIAL EXCLUSION,
COMPOUND TRAUMA
AND RECOVERY
Applying Psychology, Psychotherapy and PIE
to Homelessness and Complex Neeeds
Edited by PETER COCKERSELL
Jessica Kingsley Publishers
London and Philadelphia
Lists on pp.18–19 are reprinted with kind permission of the author, Maguire.
Figure 1.1 is reprinted with kind permission of St Mungo’s.
Table 14.1 is reprinted with kind permission of the authors, Hendry and Dorney-Smith.
Figure 14.1 is reprinted with kind permission of CDC.
The epigraph on p.248 was originally published in Borderline Welfare: Feeling and Fear
of Feeling in Modern Welfare by Andrew Cooper and Julian Lousada (published by
Karnac Books in 2005), and is reprinted with kind permission of Karnac Books.
First published in 2018
by Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Jessica Kingsley Publishers 2018
All rights reserved. No part of this publication may be reproduced in any material form
(including photocopying, storing in any medium by electronic means or transmitting)
without the written permission of the copyright owner except in accordance with the
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Warning: The doing of an unauthorised act in relation to a copyright work
may result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
Names: Cockersell, Peter, editor.
Title: Social exclusion, compound trauma and recovery : applying psychology,
psychotherapy and PIE to homelessness and complex needs / edited by Peter
Cockersell.
Description: London ; Philadelphia : Jessica Kingsley Publishers, 2018. |
Includes bibliographical references and index.
Identifiers: LCCN 2017040231 | ISBN 9781785922848 (alk. paper)
Subjects: LCSH: Social work with the homeless--Great Britain. | Social work
with people with social disabilities--Great Britain. | Homeless
persons--Mental health services--Great Britain. | Homeless
persons--Services for--Great Britain. | Post-traumatic stress
disorder--Great Britain. | Marginality, Social--Great Britain.
Classification: LCC HV4545.A4 S63 2018 | DDC 362.5/92860941--
dc23 LC record available at https://lccn.loc.gov/2017040231
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 78592 284 8
eISBN 978 1 78450 588 2
Contents
Preface. . . . . . .. . . . . . . . . . . . . . . . . . . 7
1 Understanding the Problem
1. Social Exclusion, Complex Needs and Homelessness . . . . 13
Dr Peter Cockersell
2. Compound Trauma and Complex Needs . . . . . . . . . . 26
Dr Peter Cockersell
3. The Process of Social Exclusion . . . . . . . . . . . . . . 37
Dr Peter Cockersell
2 Solutions: Principles of Practice
4. A Psychological Perspective on Recovery. . . . . . . . . . 61
Dr Peter Cockersell
5. Applying Psychology as a Response to the
Impact of Social Exclusion: PIE and Psychotherapy
in Homelessness Services . . . . . . . . . . . . . . . . . . 80
Dr Peter Cockersell
3 Solutions: Practice and Experience
6. Pre-treatment Therapy Approach for Single Homeless
People: The Co-Construction of Recovery/Discovery . . . 109
John Conolly
7. Psychotherapy with Homeless Women . . . . . . . . . . . 134
Nicola Saunders
8. PIE-oneering Psychological Integration in
Homeless Hostels. . . . . . . . . . . . . . . . . . . . . . 149
Dr Emma Williamson
9. PIE: What the People Say . . . . . . . . . . . . . . . . . 160
Dr Catriona Reid
10. Streetlight: Homeless Psychotherapy in
Britain’s Happiest Town . . . . . . . . . . . . . . . . . . 175
Dr Sally Read
11. I Held the Ticket in My Hand . . . . . . . . . . . . . . . 192
Terry Hutton
4 Conclusion: Contextualising the Problem
in the Culture and System of Care
12. The Problem and Potential of Complexity . . . . . . . . . 209
Dr Peter Cockersell
13. The Treatment of Multi-morbidity . . . . . . . . . . . . . 227
Dr Peter Cockersell
14. The Dependency Paradox . . . . . . . . . . . . . . . . . 242
Dr Emma Williamson
Authors’ Biographies . . . . . . . . . . . . . . . . . . . 254
Subject Index. . . . . . .. . . . . . . . . . . . . . . . 257
Author Index. . . . . . .. . . . . . . . . . . . . . . . 261
Preface
The question this book is directed towards is ‘How do we understand
and effectively work with people who have experienced/are exp-
eriencing social exclusion and/or compound trauma?’
These people are found disproportionately among homeless people,
rough sleepers, people in psychiatric institutions or services, people in
the criminal justice system, people with drug and alcohol dependencies,
asylum seekers, refugees, and ethnic, religious and sexual minorities.
There are a lot of them.
There are also a lot of services involved with them. Yet, despite this,
they continue to be there, and they continue to need the services, and
in fact their numbers continue to rise, with many of those in the system
staying in the system, and new people coming into it all the time.
I once asked a young rough sleeper what ‘home’ meant to him;
he said, ‘Home means my mother’s blood sprayed across the walls.’
The idea that somebody coming from a place like that could be given
somewhere to live and then have a ‘home’ is simply absurd. ‘Home’ has
to be a place of psychological and emotional safety to be somewhere
we want to be: it cannot be a place of oppression, fear or terror.
It has been my privilege to work with homeless people and rough
sleepers – people of enormous courage and resourcefulness who have
often faced the most horrendous difficulties and experiences – for some
25 years now. I have worked as a volunteer, in resettlement, supported
housing, and as a ‘frontline’, middle and senior manager; I have also
worked for nearly 20 years as a clinician, providing formal psychotherapy
to homeless people, rough sleepers and people experiencing high
levels of mental distress including diagnosed and undiagnosed drug
and alcohol dependencies, psychoses and ‘personality disorders’.
7
8 SOCIAL EXCLUSION, COMPOUND TRAUMA AND RECOVERY
The more I have worked in these fields, the more it has become
obvious to me just how important it is to work with the experience of
trauma and exclusion and what that experience means to the individual
affected. How someone sees the world, and the relationship between that
and their real experience of the world, is critical to understanding what is
going on for them, and to working with them to help them make changes
in their lives. Without recognising this interactivity between someone’s
past and ongoing experience of the world and how they think, behave
and live now – which means at the very least acknowledging the hostile
interventions of the external world as well as the reactive perspectives
of the individual – it is very difficult to help them change anything else
in their lives. It is also important to recognise the legitimacy of their
aspirations: just like the rest of us, they aspire to have somewhere to
live, something meaningful to do, someone to love and be loved by. In
the case of socially excluded people who have experienced compound
trauma such as chronic rough sleepers, they sometimes never had these,
and sometimes have had them often violently ripped away. What these
ordinary people with very difficult life experiences need in order to
achieve these ordinary but life-critical aspirations are emotional and
psychological support and access to opportunities to participate in
society, including stable housing. This book is about the emotional and
psychological support side of the deal.
The book is written mainly by clinicians working with homeless
people and rough sleepers in a variety of settings including hostels,
drop-ins, primary care and women-specific services; the authors
combine a huge wealth of experience and understanding from their
training, their clinical work and from years of learning from the socially
excluded people they work with. It is the latter part that illuminates
the theory and practice in this book. It is a book full of practice-based
evidence: this is not about academic theory applied in rarefied research
methodology situations, it is real-life practice-based evidence built on
practice-honed theory.
There is also a chapter written by a non-clinician, who had moved
on from homelessness. He gives a vivid account of the experience of
homelessness. It is deliberately not about histories of compound trauma,
though it could have been; rather, it illustrates the degree to which
homelessness and rough sleeping themselves are traumatic. One of
the reasons that most people experiencing rough sleeping and chronic
homelessness also experience compound trauma is simply because of this:
PREfACE 9
homelessness and rough sleeping are themselves episodes of exposure to
traumatic emotional and psychological experiences, very often as well as
physical trauma of various kinds.
The main body of the book is about psychologically informed
interventions and the value they bring to enabling people experiencing
social exclusion and compound trauma to embark on their recovery
journeys. The vivid experience of the homeless and ex-homeless
authors gives a real perspective on where the psychologically informed
interventions properly sit: they are a part of the person’s experience,
and a part of their recovery journey – an absolutely critical part, but
still just a part. The majority of the work with the socially excluded is
not clinical in nature, and is provided by the often tremendously skilful,
compassionate and caring staff in outreach teams, hostels, shelters and
day centres. Psychologically informed interventions and psychotherapy
are an important, and often critical, part of the mix in enabling socially
excluded people and people affected by compound trauma to embark
successfully on sustainable recovery journeys, but they are an adjunct
to the services provided by the (largely) voluntary sector agencies who
support the people that statutory agencies let fall through the net.
This book is about understanding the psychological processes behind
compound trauma and its relationship to social exclusion, and about
the practical application of psychologically informed interventions to
help break that relationship; it is not arguing that there is a purely
clinical solution to social exclusion.
What the book is intended to do is give readers ideas, to stimulate
thinking about, and support and encourage taking action on, psychological
and emotional support for homeless people and rough sleepers. It
offers a theoretical perspective in the hope of stimulating thought and
discussion about why we need to offer psychological and emotional
support and how that works in enabling and supporting recovery. It
offers a practical perspective in the hope of stimulating and supporting
those who are developing or implementing psychological, psychotherapy
or psychosocial services for people affected by social exclusion and/or
compound trauma. And it offers an experiential perspective from both
clinicians and clients/patients in the hope of stimulating thought and
discussion about the experience of social exclusion and the experience
of working with people who have been or are socially excluded and/or
who have experiences of compound trauma.
