Pretreatment In Action (eBook)

Interactive Exploration from Homelessness to Housing Stabilization

Jay S. Levy (Autor)

eBook Download: EPUB

2021
162 Seiten
Loving Healing Press (Verlag)
978-1-61599-596-7 (ISBN)

Infos

Jay Levy's Pretreatment In Action: Interactive Exploration from Homelessness to Housing Stabilization provides the reader with a wonderfully crafted, detailed step-by-step manual with real-world scenarios on how Pretreatment and the Stages of Engagement play out in the actual work. The vignettes are rich with descriptions that clearly come from a deep repertoire of experience working in the field that gives the reader confidence they are being guided by someone who has been in their shoes. The thoughtful questions and space to reflect add a helpful workbook touch to the feel of the text, and matches the grittiness of the material being covered.
The reader will...

• Understand the 5 principles of a Pretreatment Model through their application to real-life scenarios that depict the world of homelessness, trauma and loss.
• Learn how to utilize Pretreatment Assessment and interventions to promote the engagement process and safety with highly vulnerable people.
• Effectively integrate the stages of Common Language Development with one's own practice of outreach and engagement with under-served persons.
• Experience through interactive exercises and reflecting on case illustrations the importance of facilitating the meaning-making process with both staff and clients.
• Discover an innovative approach to staff supervision based on the integration of Pretreatment principles with Psychologically Informed Environments (PIE) and Open Dialogue approaches to helping

'Pretreatment In Action by Jay S. Levy, MSW is a landmark accomplishment. For those who do street outreach and street medicine, Jay has provided a much-needed framework for navigating the largely undefined terrain of therapeutic relationships with those experiencing unsheltered homelessness.'
--Dr. Jim Withers- Medical Director and Founder of the Street Medicine Institute, Assistant Clinical Professor of Medicine, University of Pittsburgh
'By using case studies and reflective exercises, Jay Levy has created a highly readable and accessible guide to working with people who are street homeless. Levy's enthusiasm for the work shines through on each page; he does not shy away from complexity, and the stories and situations he describes are as relevant in the UK as in his native USA.',
--Dr. Jenny Drife- START Homeless Outreach Team, South London and Maudsley NHS Foundation Trust, Advisor to the Royal College of Psychiatrists on homelessness and mental health
'Levy draws on respected approaches including Motivational Interviewing, Narrative Therapy and Solution Focused Therapy. He integrates these into a clearly articulated practical approach that will also work with other significantly disadvantaged people living with trauma and marginalization.'
--Rohena Duncombe, BA, BSW, MSWAP, Social work academic & researcher, Charles Sturt University, Australia
From Loving Healing Press

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Jay Levy's Pretreatment In Action: Interactive Exploration from Homelessness to Housing Stabilization provides the reader with a wonderfully crafted, detailed step-by-step manual with real-world scenarios on how Pretreatment and the Stages of Engagement play out in the actual work. The vignettes are rich with descriptions that clearly come from a deep repertoire of experience working in the field that gives the reader confidence they are being guided by someone who has been in their shoes. The thoughtful questions and space to reflect add a helpful workbook touch to the feel of the text, and matches the grittiness of the material being covered. The reader will... Understand the 5 principles of a Pretreatment Model through their application to real-life scenarios that depict the world of homelessness, trauma and loss. Learn how to utilize Pretreatment Assessment and interventions to promote the engagement process and safety with highly vulnerable people. Effectively integrate the stages of Common Language Development with one's own practice of outreach and engagement with under-served persons. Experience through interactive exercises and reflecting on case illustrations the importance of facilitating the meaning-making process with both staff and clients. Discover an innovative approach to staff supervision based on the integration of Pretreatment principles with Psychologically Informed Environments (PIE) and Open Dialogue approaches to helping "e;Pretreatment In Action by Jay S. Levy, MSW is a landmark accomplishment. For those who do street outreach and street medicine, Jay has provided a much-needed framework for navigating the largely undefined terrain of therapeutic relationships with those experiencing unsheltered homelessness."e; --Dr. Jim Withers- Medical Director and Founder of the Street Medicine Institute, Assistant Clinical Professor of Medicine, University of Pittsburgh "e;By using case studies and reflective exercises, Jay Levy has created a highly readable and accessible guide to working with people who are street homeless. Levy's enthusiasm for the work shines through on each page; he does not shy away from complexity, and the stories and situations he describes are as relevant in the UK as in his native USA."e;, --Dr. Jenny Drife- START Homeless Outreach Team, South London and Maudsley NHS Foundation Trust, Advisor to the Royal College of Psychiatrists on homelessness and mental health "e;Levy draws on respected approaches including Motivational Interviewing, Narrative Therapy and Solution Focused Therapy. He integrates these into a clearly articulated practical approach that will also work with other significantly disadvantaged people living with trauma and marginalization."e; --Rohena Duncombe, BA, BSW, MSWAP, Social work academic & researcher, Charles Sturt University, Australia From Loving Healing Press

Textauszug

Introduction: Pretreatment Inclusion

John Conolly, MA, UKCP reg. Psychotherapist

Lead Counsellor, Westminster Homeless Health Service

Central London Community Healthcare NHS Trust

“Some of the greatest tragedies of human interaction occur when an individual misinterprets or is cut off from this language of mind and hence cannot fully grasp the many meanings of gestures of love, friendship or hostility… such a person often struggles to understand their own emotions and feels alone even when surrounded by others.”

— Linda Mayes, M.D. (2012)

“Pretreatment” is a timely reminder of just how fundamental connection is for people. When absent in infancy, it can lead to major psychosocial damage, which in adulthood can result in multiple social exclusion; homelessness being the tip of the iceberg. Pretreatment tunnels down to the very nitty-gritty, the nuts and bolts, of what it actually takes to connect with someone. This book offers the tools with which to do this. Anyone, not only in the field of homelessness, but in the field of social exclusion, will find here an invaluable toolkit with which to offer an opportunity to make good some of the paucity of connection so many homeless and excluded people have experienced on their journey in life.

Mental health experts from both sides of the Atlantic2 see connection and communication as the medium by which our very Selves come into being. In fact, disturbance of Self in adulthood, “personality disorder,” is seen as “a failure of communication... a failure of learning relationships” (Midgeley, et al., 2017, p. 23).

It is the care, communication, and connection in a stable, secure, attentive, reciprocal attachment relationship that teaches us to control, direct and share our attention with others. We only come to recognize, label, understand, and control our own emotions, as these are reflected back to us in our carers’ facial and verbal expressions. Only then can we gradually come to understand our behaviour, and other people’s, in terms of mental states, thoughts, feelings, and desires; what is known in psychology as ‘Mentalization,’ and the basis for psychological resilience and socio-emotional maturity (Fonagy, et al., 2006; Midgeley, et al., 2017). However, this sensitive, delicate process is fragile and can be derailed in the face of neglectful parenting, trauma, stress, brought on by grinding poverty, and Adverse Childhood Events, or ACEs, meaning:

“...notions of intrafamilial events or conditions causing chronic stress responses in the child’s immediate environment. These include notions of maltreatment and deviation from societal norms” (Kelly-Erving et al., 2013, p. 721).

Homelessness is known to be the end result of a long line of trauma and to be traumatising in itself. Thus a British study (Maguire, et al., 2009) estimated that 69% of single homeless people suffer from personality disorder, ‘complex trauma’ or what I like to think of as ‘traumatised personality’ (Conolly, 2018a; Conolly, 2018b). In the UK and US, this spawned trauma informed initiatives to homelessness via the Psychologically Informed Environments (PIE) model and the expansion of Housing First.

Of course, there are socio-political, structural factors involved in homelessness, as well as a whole range of physical and mental health factors. However, Pretreatment’s approach equips homelessness frontline workers to deal with what realistically is under their immediate control. That is, how to ensure that the person in front of them, who has experienced homelessness, trauma and loss, can be supported and empowered.

I remember reading Jay’s Pretreatment Guide for Homeless Outreach & Housing First (Levy, 2013), and feeling as if an Olympic torch bearer had jumped down into the dark mineshaft I had been trying to light my way through with matches only. Here was an approach that spoke to my own experience of working with homeless people in the context of a small counselling service in central London.

It offered an approach to working with people sleeping rough that respected their journeys in life, and which genuinely wanted to understand and connect with them. It also offered, in a clear direct way, the skills and practices to do this. For me, Jay, has melded some of the fundamental principles and skills of counselling, together with his extensive experience of working with homelessness. He has extended this beyond the counselling room, and connected with people sleeping rough not only literally ‘where they are at,’ on the streets, but also psychologically. This is done by absolutely respecting the challenges of, and their reactions to, the journey they have endured in life, and honouring the rhythm and pace at which they can most likely tolerate and accept the help and support available. Pretreatment makes this possible by making things relevant and meaningful to even the most excluded people.

In London, my colleagues and I had been experimenting with how best to engage and connect with people who were homeless and whose circumstances were chaotic and unpredictable. This included people who failed to attend their appointments, who had taken mind altering substances, who would lose their tempers, and were convinced that counselling wouldn’t help them. With the help of ‘Experts by Experience’ (ex-service users), and basing ourselves on Alcoholics Anonymous Groups, we had set up ‘Drop-in anger support and discussion groups,’ and established ‘Walk-in counselling sessions.’ We intuitively became much more person-centred in our counselling, more empathic, transparent, sharing our thinking, and more flexible with boundaries, like holding variable length sessions in accordance to people’s attention spans, or being readily available for urgent appointments.

We also attended trainings in ‘personality disorder’: DBT, dialectical behaviour therapy (Linehan, 1993a; Linehan, 1993b), ST, schema therapy (Young, Klosko and Weishaar, 2003), and MBT, Mentalization Based Therapy (Bateman, Fonagy, 2006; Bateman, Fonagy, 2004)). However, although evidence based, these mainstream interventions all assumed a housed, settled population group, who were in recovery from addictions. We simply could not make such assumptions regarding our clients who were sleeping rough or had experienced extended periods of homelessness.

Pretreatment doesn’t make these assumptions. Instead, it simply engages with what is, or what is presented. By basing itself on the fundamental processes of human connection, it extends the hand of inclusion and welcome into the human tribe. It is honest about where the responsibility for this lies; with the service, the workers, who, with appropriate support, are empowered to understand homeless people, their challenges, and reactions to these challenges. Counsellors are able in reflective practice to make sense of their own reactions and contributions to the cycle of misunderstanding, miscommunication and failed connection. Once they are equipped with this knowledge and language, acquired at the appropriate pace and in a non-alienating, humane manner, they can harness their clients’ motivation to change in a way that is meaningful to them. This makes their accomplishments sustainable, and does not lead to the ever ‘revolving door’ syndrome, and chronic homelessness.

Originating in practitioner based experience over tens of thousands of hours’ worth of closely observed and reflected upon experience and practice, Pretreatment is the outcome of an inductive-deductive cycle of thinking, which is why it especially spoke to the experience of my colleagues and me. Why, I believe it continues to speak to the experience of all those dedicated workers and practitioners in the field of homelessness. In the UK, Pretreatment is endorsed by the Homeless and Inclusion Health Faculty3, and increasingly being represented in various local and national conferences4, as well as having some input in the ongoing Royal College of Psychiatrists steering group for the Advancing Mental Health Equality (AMHE) Collaborative, which is a government funded quality improvement programme to address local mental health inequalities, including those experienced by people sleeping rough, nationally.

Jay has perceived and articulated that people only become fully human via connecting with others; at first their parents, then their peer group and colleagues. However, this process is fraught with obstacles, and can be derailed from the very first days of life. Subsequently, traumatic life events like unemployment, relationship breakdown, homelessness, can expel someone from their social life-space, with all of the traumatic impact on their wellbeing, ability to function and to connect.

With Pretreatment, Jay has shown that ‘Enhanced Connecting’ is us taking responsibility for reaching out, building and earning ‘Epistemic Trust’5 (Fonagy, 2017); jointly developing meaningful goals, with all of the support needed; us ‘bridging’ the diverse language cultures between services and homeless individuals; us maintaining post-referral support and transition management. All needs to be at a pace bearable for the person, who has experienced the effects of compounded trauma, undoing much of the damage and hurt.

A Pretreatment approach, with its emphasis on forming person-centered healing relationships, can alleviate many of the negative consequences...

Produkt-Details

• Erscheint lt. Verlag: 1.10.2021
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Themenwelt: Sozialwissenschaften ► Pädagogik ► Sozialpädagogik
• Themenwelt: Sozialwissenschaften ► Politik / Verwaltung
• Themenwelt: Sozialwissenschaften ► Soziologie
• Schlagworte: Australia • Homeless • Homelessness • Post-traumatic stress disorder • Poverty • Psychology • psychopathology • PTSD • Social Science • Social Work • Trauma
• ISBN-10: 1-61599-596-X / 161599596X
• ISBN-13: 978-1-61599-596-7 / 9781615995967