Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

Abstract

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.

Keywords:

• Homelessness
• therapeutic frame
• supporting frames
• containment
• countertransference

Acknowledgements

I would like to thank the staff of the North Dublin Psychology Service and of the Clinical Psychology Training Programme, University of Dublin, Trinity College, for their support in completing this paper. I would also like to thank Alice Leahy, Director of Trust, and Geraldine Kane from the multidisciplinary homelessness team for their enthusiasm in thinking about homelessness from a variety of perspectives.