04 August 2022
Homes have been at the heart of the response to the COVID-19 pandemic. The government has instructed us to ‘stay at home’ to save lives. The importance of a home for an individual’s physical and psychological wellbeing has long been recognised in our society, and this appears to have been highlighted even further during the pandemic. So what happens during a pandemic when you are homeless or the concept of home evokes disturbing memories or emotions of fear and distress? Homelessness can be defined as ‘not having a home’, which includes rough sleeping, as well as not having permanent or secure housing, such as staying in a hostel, living in unsuitable accommodation, or sofa-surfing. In March 2020, the government took unprecedented action, insisting that local authorities bring ‘Everyone In’, providing accommodation for all homeless people.
However, it was reported that at the end of June these contracts for emergency accommodation ended. Some authorities extended the provision, while others reverted to applying the exclusion criteria for housing that was in place before the pandemic. The government has announced further funding for rough sleepers, but there are concerns about when this provision will be available and who will be helped. Individuals with challenging behaviour can be deemed too ‘high need’ or not ‘suitable’ for certain schemes. Homeless organisations, such as Crisis and St Mungo’s, have campaigned for the government to fund further emergency accommodation to prevent lives from being lost over the winter. Yet as the pandemic continues it seems to become more apparent that the idea ‘we’re all in this together’ applies to some more than others, based on socioeconomic status.
Physical and psychological notions of ‘home’
Responses to homelessness are often based on political agendas and focused on physical provision, without acknowledgment of the intrapsychic factors which cause social exclusion. There is a range of research linking homelessness to complex trauma and interpersonal difficulties (National Mental Health Development Unit et al, 2010), but in many areas there is inadequate funding for resources and a lack of access to specialist services. Gaining a safe place to live is often viewed as an essential first step, as advocated in Maslow’s hierarchy of needs and the Housing First movement. Yet many individuals are involved in repetitive cycles of gaining accommodation and then losing it, or refusing to accept accommodation altogether. My colleagues working in outreach roles said that during the initial lockdown some individuals chose to leave emergency accommodation, returning to life on the streets. It is crucial to take into account that the notion of ‘home’ for many people consists of both physical and psychological elements, such as shelter, safety, comfort, identity and belonging. Literature has explored the ways that a home can be seen as a metaphor for the body and mind, consisting of an external physical structure and an internal private dwelling space. An individual’s first experience of home usually consists of their early environment, which builds expectations and beliefs about the nature of a home and one’s relationship to self and others. A child who grows up in a disturbed and uncontained environment may associate ‘home’ with feelings of danger or abandonment. Campbell (2019: 58) suggests that for some, ‘home is a dangerous place whose meaning is laden with anxiety, through trauma and memory, and whose form, in the shape of a house, is constantly sought, and constantly lost, abandoned, or destroyed’.
People who are homeless tend to experience marginalisation, deprivation, isolation, and suffer from physical and mental health problems. The nature of the pandemic is likely to compound these issues, especially with a reduction in support services and closures of night shelters and soup kitchens. People defined as homeless are not a homogenous group, but present with diverse histories and needs. My work has been predominantly with individuals described as chronically homeless, who have complex needs and experiences of compound trauma. I am currently employed by a charitable housing organisation to work as a counsellor within a residential hostel for people who are homeless. I offer counselling to individuals living in the main hostel, as well as those who have moved on to shared or independent housing through the resettlement scheme. The clients that I work with often describe childhoods lacking in physical and emotional safety, where experiences of abuse, neglect, and rejection were common. These homes were not havens for protection and comfort, but places of harm, distress and loneliness. A lack of mirroring and attunement from caregivers, in conjunction with traumatic experiences, results in the development of extremely fragile and fragmented senses of self. My clients often present with insecure attachment strategies, usually with characteristics of the disorganised unresolved state of mind. I believe that trauma in the early environment can be seen as one of the key contributory factors in the lives of many individuals experiencing homelessness. According to Brown (2019: 122) homelessness can be seen as a ‘psychic solution, where preoccupations of daily survival, addiction, criminality and ‘revolvingdoor’ homelessness become attempts at self-cure and mastering early trauma’.
Social distancing – the loss of a therapeutic home
The hostel is a high-risk environment similar to a care home, housing 31 residents, many of whom have weakened immune systems and multiple health issues. Recovery, creative and social groups, as well as faceto- face counselling, have largely been suspended due to concern over risk of transmission. Consequently, I have been predominantly working from home since the start of the pandemic, offering telephone and Zoom sessions. A number of my clients do not own smart phones or have access to the internet, so phone calls have been the only option. Many counsellors and therapists have experienced a sense of loss with remote working, including the absence of non-verbal communication, the lack of embodied presence, and impairment of the transference. The importance of a therapeutic space, traditionally in the form of a consulting room, has long been seen as an essential component of therapy. Yet, in work with individuals with disturbed and fragile senses of self, the physical environment can take on even greater significance.
Homeless people have been described as being ‘psychologically unhoused’, or having an ‘unhoused mind’, as the inability to secure a physical home can mirror not finding a psychological home in the mind of another during development (Scanlon and Adlam, 2006: 10). Difficulties with containment, boundaries and self-regulation can be seen to be demonstrated in behaviours such as self-harm, addiction, and self-neglect. The clients that I work with can exhibit powerful transferential enactments and defensive strategies of projective identification, splitting and acting out. I have found that creating a ‘secure base’, physically as well as psychologically, is crucial to work with this client group (Bowlby, 1988/2005). The counselling service is housed within the hostel, offering psychological containment in conjunction with the physical containment of the building. The hostel staff offer support for generic and practical issues, which enables my focus to be on the individual’s inner world. In this way, there is the opportunity for clients to have their physical and psychological needs met ‘under one roof’. I have a designated counselling room within the hostel, which can be seen as a ‘holding’ environment. The consistency of the space helps to facilitate feelings of reliability, while the physical boundaries of the room help clients to feel contained. The pandemic has taken away the security provided by the walls of the consulting room; therapists and clients have been evicted from their therapeutic homes. The loss of this accommodating space is likely to have a greater impact on individuals who find it challenging to feel housed within their own minds and practitioners who feel housed within organisations.
Technology can enable communication, but from a therapeutic perspective, it can be seen as a barrier to deeper connection. Signal problems, causing time lags, frozen images and sound distortions, impact on the flow of the session, the level of attunement, and the intensity of responses. Telephone sessions rely on verbal communication and pauses can be interpreted as absence, prompting the question ‘are you still there?’. Winnicott (1971/1974) spoke about the importance of the maternal mirror, where an infant begins to develop a sense of self through seeing their reflection in the mother’s gaze. A similar process of mirroring and attunement is offered in the therapeutic setting. So what is the impact when the maternal mirror is seen through a flat screen or not visible at all? I have noticed that, compared to those who engaged before the pandemic, newly referred clients, or clients who have not been engaging in counselling for very long, have tended to drop out fairly quickly. Clients themselves have cited remote working as being the problem or a barrier, preferring to wait for face-to-face sessions. The clients that I work with often have severe issues with trust, intimacy and dependency; the act of engaging in counselling can be extremely challenging, triggering fight-or-flight reflexes and defensive strategies. Consequently, there is a need to sensitively adapt responses and contain enactments to help clients establish a sense of safety in the therapeutic relationship. I believe that new clients have not had the opportunity to establish this sense of security, leaving them unable to sustain the impingements of remote working. The absence or disrupted maternal mirror is likely to emulate traumatic early experiences with unavailable or unresponsive caregivers, potentially leaving the individual feeling abandoned and annihilated.
Coping with the disruption oftherapeutic boundaries
Remote working has resulted in changes to the therapeutic frame and additional pressures on the client, such as managing the challenges of having therapy within their home environment. These changes can be seen as requiring mentalisation, in terms of holding the therapeutic relationship and boundaries in mind. Many of my clients have difficulties understanding their own and others’ mental states and at times of stress can revert back to early developmental stages. Some clients have struggled with the concept that I am ‘working from home’; apologising for not coming to see me, perhaps unable to imagine me anywhere else than ‘in my room’ as it is often referred to, or asking if I have been bored at home ‘doing nothing’. Clients have found it difficult to maintain appointment times, requesting that I ‘call them back later’, as if I am available all the time. The pandemic has evoked traumatic feelings of fear, helplessness, isolation, uncertainty and mortality; the external structures appear unstable and the people in charge seem inconsistent and unreliable.
These experiences have been difficult for many, but are more challenging to manage when they trigger early trauma and primitive defences. My clients have increasingly presented in states of avoidance, hypervigilance, despair and confusion, and have had thoughts of suicide or returning to using drugs and alcohol. Routines have slipped away, with individuals neglecting to eat regularly, wash, dress, take exercise, or access healthcare. Some clients feel unable to speak about difficult subjects due to the distance between us and others are unable to enact their distress in the same way, such as revealing self-harm or bringing strong odour into the room. I have noticed, in terms of countertransference, that it has seemed more challenging to contain projections and enactments from a distance, rather than in an intimate, shared setting. Despite the challenges of remote working, it has felt crucial to continue to offer some consistency to my clients during this turbulent time.
Conclusions
My experiences have reinforced my beliefs about the importance of a facilitating environment, physically and psychologically, to enable the growth of an integrated and resilient sense of self. The current climate has provoked discussions about the potential of psychotherapy to affect social and political issues. I believe that relational and psychoanalytic theories have significant value in conceptualising the intrapsychic world of homeless individuals and guiding psychotherapeutic interventions, in conjunction with the provision of practical support. However, support and care for the most vulnerable in our society is dependent on funding, governed by political ideologies, which may not be aligned with the values of therapy such as helping all people to actualise their potential.
References
Bowlby J (1988/2005). A secure base. London and New York: Routledge Classics.
Brown G (ed) (2019). Psychoanalytic thinking on the unhoused mind. London and New York: Routledge.
Campbell JM (2019). ‘Homelessness and containment’. In: G. Brown, ed. 2019. Psychoanalytic thinking on the unhoused mind. London and New York: Routledge. pp56–68.
National Mental Health Development Unit and Department for Communities and Local Government, Meeting the psychological and emotional needs of homeless people: Mental Health Good Practice Guide. 2010, London: Department for Communities and Local Government.
Scanlon C and Adlam J (2006). ‘Housing ‘unhoused minds’: inter-personality disorder in the organisation?’. Housing, Care and Support [e-journal], 9 (3), pp9–14. https://doi.org/10.1108/14608790200600018.
Winnicott DW (1971/1974). Playing and reality. Middlesex: Penguin Books.
Jenny McCann has worked in various roles with individuals who are homeless for the last 19 years. She is currently employed by Herring House Trust in Norfolk to provide a counselling service to homeless people supported by its services. She is an integrated psychotherapeutic counsellor accredited with UKCP. She is also completing a psychoanalytic MSc degree by research exploring the theories of Winnicott, Bowlby and Rogers and the application of these to her therapeutic work with people who are homeless.
