Relational Theoretical Foundations and Clinical Practice Methods with People Experiencing Homelessness

Chapter
Part of the Essential Clinical Social Work Series book series (ECSWS)

Abstract

This chapter explores the multiple meanings of homelessness and the clinical social worker’s interventions based on a postmodern relational framework. It begins by discussing macro etiologies and their deleterious effects of being homeless. The chapter then provides specific and nonspecific interventions with people who experience homelessness. A case example is utilized to highlight the challenges of the clinical social worker’s ability to stay attuned to the multiple meanings of experiences in a life of homelessness and the management of countertransference in the face of extreme duress. It argues for the realignment of how the clinical social worker frames an understanding of homelessness, shaping the relational stance with a client suffering from this abhorrent social condition.

Keywords

Migration Income Assure Stein Arena 

References

  1. Abel, M. H., & Cummings, P. (1993). A demonstration program for homeless male alcohol and other drug abusers. Journal of Mental Health Administration, 20(2), 113–125.CrossRefGoogle Scholar
  2. Addams, J. (1910). Twenty years at hull-house with autobiographical notes. New York: The MacMillan Company.Google Scholar
  3. Angell, B., & Mahoney, C. (2007). Reconceptualizing the case management relationship in intensive treatment: A study of staff perceptions and experiences. Administration and Policy in Mental Health and Mental Health Services Research, 34, 172–188.CrossRefGoogle Scholar
  4. Benda, B. B., Rodell, D. E., & Rodell, L. (2001). Relative contribution of familial factors to comorbidity among homeless veterans. Journal of Family Social Work, 6(2), 3–24.CrossRefGoogle Scholar
  5. Berzoff, J., Flanagan, L. M., & Hertz, P. (Eds.). (2011). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary and multi-cultural settings. Lanham: Rowman & Littlefield.Google Scholar
  6. Best, R. (2010). Situation or social problem: The influence of events on media coverage of homelessness. Social Problems, 57(1), 74–91. doi: 10.1525/sp.2010.57.1.74.CrossRefGoogle Scholar
  7. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16(3), 252–260.CrossRefGoogle Scholar
  8. Bromberg, P. A. (1996). Standing in the spaces: The multiplicity of self and the psychoanalytic relationship. Contemporary Psychoanalysis, 32(4), 509–535.Google Scholar
  9. Bruck, E., Winston, A., Aderholt, S., & Muran, J. C. (2006). Predictive validity and therapist attachment and introject styles. American Journal of Psychotherapy, 60(4), 393–407.Google Scholar
  10. Buck, P. W., & Alexander, L. B. (2006). Neglected voices: Consumers with serious mental illness speak about intensive case management. Administration and Policy in Mental Health and Mental Health Services Research, 33(4), 470–481. doi: 10.1007/s10488-005- 0021-3.CrossRefGoogle Scholar
  11. Buck, P. O., Toro, P. A., & Ramos, M. A. (2004). Media and professional interest in homelessness over 30 years (1974–2003). Analyses of Social Issues and Public Policy, 4(1), 151–171.CrossRefGoogle Scholar
  12. Chinman, M. J., Rosenheck, R., & Lam, J. A. (2000). The case management relationship and outcomes of homeless persons with serious mental illness. Psychiatric Services, 51, 1142–1147.CrossRefGoogle Scholar
  13. Coalition for the Homeless. (2008). Off target: A progress report on Mayor Bloomberg’s five- year homeless plan. Retrieved from http://www.coalitionforthehomeless.org/pages/policy-briefs-archive
  14. Culhane, D. P. (2002). New strategies and collaborations target homelessness. Washington, DC: The Fannie Mae Foundation. Retrieved from http://content.knowledgeplex.org/kp2/img/cache/documents/14775.pdf.
  15. Culhane, D. P., Metraux, S., & Hadley, T. R. (2002). Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. Housing Policy Debates, 13(1), 107–163.CrossRefGoogle Scholar
  16. Draine, J., Salzer, M. S., Culhane, D. P., & Hadley, T. R. (2002). Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatric Services, 53(5), 565–573.CrossRefGoogle Scholar
  17. Early, D. W. (2005). An empirical investigation of the determinants of street homelessness. Journal of Housing Economics, 14, 27–47. doi: 10.1016/j.jhe.2005.03.001.CrossRefGoogle Scholar
  18. Elvins, R., & Green, J. (2008). The conceptualization and measure of therapeutic alliance: An empirical review. Clinical Policy Review, 28(7), 1167–1187. doi: 10.1016/j.cpr.2008.04.002.Google Scholar
  19. Farrell, D. C. (2010). The paradox of chronic homelessness: The conscious desire to leave homelessness and the unconscious familiarity of the street life. Journal of Human Behavior in the Social Environment, 20(2), 239–254. doi: 10.1080/1091135090326975.CrossRefGoogle Scholar
  20. Farrell, D. C. (2012). Understanding the psychodynamics of chronic homelessness from a self psychological perspective. Clinical Social Work Journal, 40(3), 337–347. doi: 10.1007/s10615-012-0382.CrossRefGoogle Scholar
  21. Forchuk, C., MacClure, S. K., Van Beers, M., Smith, C., Csiernik, R., Hoch, J., & Jensen, E. (2008). Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelter and ‘No fixed address’. Journal of Psychiatry Mental Health Nursing, 15, 569–575. doi: 10.1111/j.1365-2850.2008.01266.x.CrossRefGoogle Scholar
  22. Fosshage, J. L. (2003). Contextualizing self psychology and relational psychoanalysis. Bi-directional influence and proposed syntheses. Contemporary Psychoanalysis, 39(3), 411–448.Google Scholar
  23. Friedman, D., & Hechter, M. (1988). The contribution of rational choice theory to macrosociological research. Sociological Theory, 6(2), 201–218.CrossRefGoogle Scholar
  24. Gamache, G., Rosenheck, R., & Tessler, R. (2003). Overrepresentation of women veterans among homeless women. American Journal of Public Health, 93(7), 1132–1136.CrossRefGoogle Scholar
  25. Gladwell, M. (2006). Million Dollar Murray: Why problems like homelessness may be easier to solve than manage. The New Yorker, 13, 96–107.Google Scholar
  26. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster.Google Scholar
  27. Graybar, S. R., & Leonard, L. M. (2005). In defense of listening. American Journal of Psychotherapy, 59(1), 1–18.Google Scholar
  28. Harnet, H. P., & Postmus, J. L. (2010). The function of shelters for women: Assistance or social control? Journal of Human Behavior in the Social Environment, 20(2), 289–302. doi: 10.1080/10911350903269948.CrossRefGoogle Scholar
  29. Hart-Shegos, E. (1999). Homelessness and its effects on children. Minneapolis: Family Housing Fund. Retrieved from http://www.fhfund.org.Google Scholar
  30. Henderson, C., Bainbridge, J., Keaton, K., Kenton, M., Guz, M., & Kanis, B. (2008). The use of data to assist in the design of a new service system for homeless veterans in New York City. The Psychiatric Quarterly, 79(3), 3–17. doi: 10.1007/s11126-007-9060-0.Google Scholar
  31. Hoffman, L., & Coffey, B. (2008). Dignity and indignation: How people experiencing homelessness view services and providers. The Social Science Journal, 45(2), 207–222. doi: 10.1016/j.soscij.2008.03.001.CrossRefGoogle Scholar
  32. Hopper, K., Jost, J., Hay, T., Welber, S., & Haugland, G. (1997). Homelessness, severe mental illness and the institutional circuit. Psychiatric Services, 48(5), 659–664.Google Scholar
  33. Iwamoto, T. (2007-2008). Adding insult to injury: Criminalization of homelessness in Los Angeles. Whittier Law Review, 29, 515–539.Google Scholar
  34. Johnson, T. P., Freels, S. A., Parsons, J. A., & Vangeest, J. B. (1997). Substance abuse and homelessness: Social selection or social adaptation? Addiction, 92(4), 437–445.CrossRefGoogle Scholar
  35. Jordan, J. V. (1995). A relational approach to psychotherapy. Women and Therapy, 16(4), 51–61.CrossRefGoogle Scholar
  36. Kanter, J. (2010). Clinical case management. In J. Brandell (Ed.), Theory and practice of clinical social work (pp. 561–585). New York: Columbia University Press.Google Scholar
  37. Kertesz, S. G., & Weiner, S. J. (2009). Housing the chronically homeless: High hopes, complex realities. Journal of the American Medical Association, 301(17), 1822–1824. doi: 10.1001/jama.2009.596.CrossRefGoogle Scholar
  38. Klinkenberg, W. D., Calsyn, R. J., & Morse, G. A. (1998). The helping alliance in case management for homeless persons with severe mental illness. Community Mental Health Journal, 34(6), 569–578.CrossRefGoogle Scholar
  39. Kuhlman, T. L. (1994). Psychology on the streets. Mental health practice with homeless persons. New York: Wiley.Google Scholar
  40. Kusmer, K. L. (2002). Down and out, on the road. The homeless in American history. New York: Oxford University Press.Google Scholar
  41. Lee, B. A., Link, B. G., & Toro, P. A. (1991). Images of the homeless: Public views and media messages. Housing Policy Debate, 2(3), 649–682.CrossRefGoogle Scholar
  42. Lee, B. A., Tyler, K. A., & Wright, J. D. (2010). The new homelessness revisited. Annual Review of Sociology, 36, 501–521. doi: 10.1146/annurev-soc-070308-115940.CrossRefGoogle Scholar
  43. Levy, J. S. (1998). Homeless outreach: A developmental model. Psychiatric Rehabilitation Journal, 22, 123–132.CrossRefGoogle Scholar
  44. Levy, J. S. (2000). Homeless outreach: On the road to pretreatment alternatives. Families in Society: The Journal of Contemporary Human Services, 81, 360–368.CrossRefGoogle Scholar
  45. Luhrmann, T. M. (2008). “The street will drive you crazy”: Why homeless psychotic women in the institutional circuit in the United States say no to offers of help. The American Journal of Psychiatry, 165(1), 15–20. doi: 10.1176/appi.ajp.2007.07071166.CrossRefGoogle Scholar
  46. Martin, D. J., Garske, J. P., & Davis, K. D. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Counseling and Clinical Psychology, 68(3), 438–450.CrossRefGoogle Scholar
  47. McKinney-Vento Homeless Assistance Act of 1987, 42 U.S.C.§ 11302et seq. General definition of homeless individual.Google Scholar
  48. Morse, G. A., Calsyn, R. J., Miller, J., Rosenberg, P., West, L., & Gilliland, J. (1996). Outreach to homeless mentally ill people: Conceptual and clinical considerations. Community Mental Health Journal, 32(3), 261–274.CrossRefGoogle Scholar
  49. National Alliance to End Homelessness. (2012). The state of homelessness: A research report on homelessness in America. Washington, DC: Homelessness Research Institute. Retrieved from http://www.endhomelessness.org/section/_search/?q=The+state+of+homelessness%3AA+research+%09report+on+homelessness+in+America
  50. National Coalition for the Homeless (2009). How many people experience homelessness? Retrieved from http://www.nationalhomeless.org/factsheets/How_Many.pdf
  51. O’Flaherty, B., & Wu, T. (2006). Fewer subsidized exits and a recession: How New York City’s family homeless shelter population became immense. Journal of Housing Economics, 15, 99–125. doi: 10.1016/j.jhe.2006.08.003.CrossRefGoogle Scholar
  52. Orange, D. M., Atwood, G. E., & Stolorow, R. D. (1997). Working intersubjectively: Contextualism in psychoanalytic practice (Psychoanalytic inquiry book series, Vol. 17). Mahwah: Analytic Press.Google Scholar
  53. O’Toole, T. P., Buckel, L., Bourgault, C., Bluman, J., Redihan, S. G., Jiang, L., & Friedmann, P. (2010). Applying the chronic care model to homeless veterans: Effect of a population approach to primary care on utilization and clinical outcomes. American Journal of Public Health, 100(12), 2493–2499. doi: 10.2105/AJPH.2009.179416.CrossRefGoogle Scholar
  54. Padgett, D. K., Stanhope, V., Henwood, B. F., & Stefancic, A. (2009). Substance use outcomes among homeless clients with serious mental illness: Comparing housing first with treatment first programs. Advance online publication. doi: 10.1007/s10597-009-9283-7.
  55. Phelan, J., Link, B. G., Moore, R. E., & Stueve, A. (1997). The stigma of homelessness: The impact of the label “homeless” on attitudes toward poor persons. Social Psychology Quarterly, 60(4), 323–337.CrossRefGoogle Scholar
  56. Pollio, D. (1990). The street person: An integrated service provision model. Psychosocial Rehabilitation Journal, 14, 57–69.Google Scholar
  57. Quigley, J. M., Raphael, S., & Smolensky, E. (2001). Homelessness in California. Working papers, Berkeley program on housing and urban policy, institute of business and economic research, UC Berkeley. Retrieved from http://escholarship.org/uc/item/2pg3f4ns
  58. Redko, C., Durbin, J., Wasylenki, D., & Krupa, T. (2004). Participant perspectives on satisfaction with assertive community treatment. Psychiatric Rehabilitation Journal, 27(3), 283–286.CrossRefGoogle Scholar
  59. Rew, L., Fouladi, R. T., & Yockey, R. D. (2002). Sexual practices of youth. Journal of Nursing Scholarship, 34(2), 139–145.CrossRefGoogle Scholar
  60. Ringwalt, C. L., Greene, J. M., Robertson, M., & McPheeters, M. (1998). The prevalence of homelessness among adolescents in the United States. American Journal of Public Health, 88(9), 1325–1329.CrossRefGoogle Scholar
  61. Rowe, C. (2005). Treating the basic self: Understanding addictive, suicidal, compulsive, and attention-deficit/hyperactivity (ADHD) behavior. New York: Psychoanalytic Publisher.Google Scholar
  62. Rowe, M., Fisk, D., Frey, J., & Davidson, L. (2002). Engaging persons with substance abuse disorders: Lessons from homeless outreach. Administration and Policy in Mental Health, 29, 263–273.CrossRefGoogle Scholar
  63. Shern, D. L., Felton, C. J., Hough, R. L., Lehman, A. F., Goldfinger, S., Valencia, E., et al. (1997). Housing outcomes for homeless adults with mental illness: Results from the second-round McKinney program. Psychiatric Services, 48(2), 239–241.Google Scholar
  64. Shier, M. L. (2010). Perspectives of employed people experiencing homelessness of self and being homeless: Challenging socially constructed perceptions and stereotypes. Journal of Sociology and Social Welfare, 38(4), 13–37.Google Scholar
  65. Siegal, D. J. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight”, and neural integration. Infant Mental Health Journal, 22(1–2), 67–94.CrossRefGoogle Scholar
  66. Slavin, M. O. (2002). Post-Cartesian thinking and the dialectic of doubt and belief in the treatment relationship. A discussion of Atwood, Orange, and Stolorow. Psychoanalytic Psychology, 19(2), 281–306.CrossRefGoogle Scholar
  67. Smerud, P. E., & Rosenfarb, I. S. (2005). The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: An exploratory prospective change study process. Journal of Counseling and Clinical Psychology, 76(3), 505–510. doi: 10.1037/0022-006X.76.3.505.CrossRefGoogle Scholar
  68. Snow, D. A., & Anderson, L. (1993). Down on their luck. Berkeley: University of California Press.Google Scholar
  69. Stablein, T. (2011). Helping friends and the homeless milieu: Social capital and the utility of street peers. Journal of Contemporary Ethnography, 40(3), 290–317. doi: 10.1177/0891241610390365.CrossRefGoogle Scholar
  70. Stec, J. (2006). Why the homeless are denied personhood under the law: Toward contextualizing the reasonableness standard in search and seizure jurisprudence. Rutgers Journal of Law and Urban Policy, 3(2), 321–353.Google Scholar
  71. Stein, J. A., Dixon, L. D., & Nyamathi, A. M. (2008). Effects of psychosocial and situational variables on substance abuse among homeless adults. Psychology of Addictive Behaviors, 22(3), 410–416. doi: 10.1037/0893-164X.22.3.410.CrossRefGoogle Scholar
  72. Substance Abuse and Mental Health Services Administration (2012). Retrieved from http://store.samhsa.gov/facet/Treatment-Prevention-Recovery/term/Assertive- Community Treatment
  73. Supportive Housing of New York (2006). What is supportive housing? Retrieved from http://www.shnny.org/documents/Whatiss.h.NYC_000.pdf
  74. Teicholz, J. G. (1999). Kohut, Loewald, and the postmoderns: A comparative study of self and relationship (Psychoanalytic Inquiry Book Series, Vol. 18). Mahwah: Analytic Press.Google Scholar
  75. Tessler, R., Rosenheck, R., & Gamache, G. (2003). Homeless Veterans of the all-volunteer force: A social selection perspective. Armed Forces and Society, 29(4), 509–524.CrossRefGoogle Scholar
  76. Tolpin, M. (1986). The self and its selfobject: A different baby. In A. Goldberg (Ed.), Progress in self psychology (pp. 115–142). New York: Guilford.Google Scholar
  77. Tsembaris, S., & Asmussen, S. (1999). From streets to homes: The pathways to housing consumer preference supported housing model. In K. J. Conrad, M. D. Matters, P. Hanrahan, & D. J. Luchins (Eds.), Homeless prevention in treatment of substance abuse and mental illness (pp. 113–131). Binghamton: The Haywood Press.Google Scholar
  78. Tsemberis, S. J. (2004). Housing First. In Encyclopedia of homelessness (pp. 277–280). London: Sage.Google Scholar
  79. Tsemberis, S. J., Moran, L., Shinn, M., Asmussen, S. M., & Shern, D. L. (2003). Consumer preference programs for individuals who are homeless and have psychiatric disabilities: A drop-in center and a supported housing program. American Journal of Community Psychology, 32(3–4), 305–317.CrossRefGoogle Scholar
  80. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656.CrossRefGoogle Scholar
  81. U.S. Department of Housing and Urban Development. (2010). The 2009 annual homeless assessment report to Congress. Retrieved from http://www.hudhre.info/documents/5thHomelessAssessmentReport.pdf
  82. U.S. Department of Housing and Urban Development. (2012). Retrieved from http://www.endhomelessness.org/content/article/detail/3006
  83. U.S. Interagency Council on Homelessness. (2010). Opening doors: Federal strategic plan to prevent and end homelessness. Retrieved from http://www.usich.gov/PDF/OpeningDoors_2010_FSPPreventEndHomeless.pdf
  84. Varcarolis, B. (1990). Psychiatric mental health nursing. Philadelphia: W. B. Saunders.Google Scholar
  85. Wenzel, S. L., Leake, B. D., & Gelberg, L. (2001). Risk factors for major violence among homeless women. Journal of Interpersonal Violence, 16(8), 739–752.CrossRefGoogle Scholar
  86. Williams, J. C. (2003). A roof over my head: Homeless women and the shelter industry. Boulder: University Press of Colorado.Google Scholar
  87. Witkin, A. L., Milburn, N. G., Rotheram-Borus, M. J., Batterham, P., May, S., & Brooks, R. (2005). Youth and Society, 37(1), 62–84. doi: 10.1177/0044118X04272811.CrossRefGoogle Scholar
  88. Wright, B. R. E. (1998). Behavioral intentions and opportunities among homeless individuals: A reinterpretation of the theory of reasoned action. Social Psychology Quarterly, 61(4), 271–286.Google Scholar
  89. Wright, R. G. (2007-2008). Homelessness and the missing constitutional dimension of fraternity. University of Louisville Review, 46, 437–471.Google Scholar
  90. Zeber, J. E., Copeland, L. A., Good, C. B., Fine, M. J., Bauer, M. S., & Kilbourne, A. M. (2008). Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder. Journal of Affective Disorders, 107(1), 53–62. doi: 10.1016/j.jad.2007.07.026.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.NYU Silver School of Social WorkNew YorkUSA

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