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 fundamentalconnection 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 toconnect 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’sPretreatment 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