Title: Cognitive and Behavioural Therapies: How can we apply them in the field of homelessness 27th October
1Cognitive and Behavioural Therapies How can we
apply them in the field of homelessness?27th
October, 2006
- Nick Maguire
- University of Southampton
2Overview
- Psychological therapies
- Formulation
- Interventions What do we do?
- Case study
3The Cognitive and Behavioural Therapies
- Cognitive Behavioural Therapy
- Thoughts mediate feelings and behaviours
- Formulate how behaviours maintain attitudes
towards self and world - Dialectical Behavioural Therapy
- Many problems linked to attempts to cope with
emotional arousal - Teach skills, e.g. emotion regulation,
interpersonal skills
4Formulation
- A map of how the problem started and why it
isnt going away - Description of the factors which
- Predispose
- Precipitate
- Perpetuate
- Can be general (population, model of a disorder),
or specific (individual)
5Possible pathway to homelessness
Abusive childhood
Negative view of self, world and others
Survival, coping strategies
Negative ruminations
Difficult emotions
Substance misuse
Antisocial behaviours
CBT
Repeated tenancy breakdown
6Interventions Facilitating change
- Engendering hope
- Skills coaching
- Motivation to change
- Motivational interviewing techniques
- Psychological squirm
- Pros and cons
- Alcohol and substance abuse
- Harm reduction strategies
- Beliefs about use
- Seemingly irrelevant decisions
- Engagement with specialist services
- Detox psychiatric
7Facilitating change
- Tolerating difficult emotions (distress
tolerance) - Recognise and label emotions
- Coping techniques (rehearse beforehand)
- Mindfulness techniques (observe thoughts,
physical feelings) - Interpersonal skills
- Difference between assertive, aggressive and
passive-aggressive - Useful assertiveness skills
- Problems saying no
- Stuck record technique
- Problem solving skills
- Thinking through problems, generating solutions
without resorting to aggression - PTSD work
- Repeated exposure to difficult memories without
escape / avoidance
8Case study 1
- Man, 36, history of violence, constant heavy
drinking - Half to one bottle of vodka
- Ten cans strong lager
- Three prison terms for assault
- Repeated eviction from hostels because of
violence and threats of violence
9History
- Father very controlling
- Unfavourably compared to older brother
- Rebelled to be different
- Found sister comatose after suicide attempt aged
11 - Family culture of heavy drinking
- First partner left him, took son to Ireland
without telling him - Second partner left him because of drinking
10Diagrammatic formulation
Alcohol abuse
Reduce arousal
Rumination about unfairness of previous
experience
Self-harm, previous cultural beliefs
Violence to others
Consequences, negative reaction to authority
Prison Tenancy breakdown
11Intervention
- 1. Alcohol abuse
- Refused to totally give up alcohol
- Most violence associated with spirit drinking
reduced this - 2. Violence
- Addressed his perceptions of others intentions
- Looked at pros and cons of dealing with situation
in particular ways guilt - Considered readiness to change behaviours,
considering previous culture - Developed other ways of reducing emotional
arousal - Distract with friends, TV
- Sit with arousal, wait for it so subside
- 3. Ruminations
- Mindfulness, Distraction
12Outcome
13Questions?