Psychologist Nick Maguire tells Simeon Brody how
cognitive behavioural therapy can change the lives of some homeless
people
Cognitive behavioural therapy is the flavour of the month in the
mental health field. But use of the talking treatment with
long-term rough sleepers is more surprising.
Dr Nick Maguire, clinical psychologist and deputy director of
Southampton University's CBT diploma and MSc course, says work with
homeless people has historically centred on meeting their housing
and practical support needs.
"That's fine for a lot of people," he says, "but there is a
group of people for whom that's not enough."
Maguire worked until last year with a Southampton homelessness
project, running a small four-bed project which used CBT with rough
sleepers who had failed repeatedly to maintain their tenancies.
Maguire describes CBT as providing a map to help you think about
how a situation influences your feelings and actions. Linking
previous, often negative, experiences with current perspectives and
behaviour gives you a chance of changing the behaviour, he
says.
Alongside the related dialectical behaviour therapy, which
provides emotional management skills, it is considered an effective
tool for working with people with some personality disorders, who
are thought to make up part of the rough-sleeper population and may
be quick to become angry and aggressive.
Maguire monitored the first four people to use the homelessness
service over 18 months and found a reduction in action harmful to
themselves or others and antisocial behaviour, the biggest cause of
failed tenancies. The therapy helped the men understand what
happened just before violent or aggressive incidents and the key
was often their perception of others' intentions.
"Some of the guys would assume people were about to be rejecting
or violent to them and get in there first," Maguire says. "We
enabled people to see for themselves what it is they are doing that
keeps getting them kicked out, and help people describe the
patterns they get into."
The therapy also taught them to deal with difficult situations.
Twenty-three men went through the project, 12 of them then entering
steady accommodation - a good starting point, says Maguire, for a
group which had been unable to hold down a tenancy.
He accepts that these findings are limited and must be
investigated further but the therapy has been recommended by the
National Institute for Health and Clinical Excellence as a
treatment for anxiety and depression. Maguire believes it can be a
helpful framework throughout social care for understanding how
thoughts "dictate everything".
And he believes it could help professionals as well as service
users. "We as professionals get fed up and frustrated in clinical
situations," he says. The frustration is often about service users
not doing what you expect, but if you can look at the situation
differently and realise they may not have the skills to meet your
expectations, frustration levels fall.
Despite CBT's support in the mental health field, some delegates
at last month's Mind conference claimed it was edging out more
long-term therapies. Maguire says choice is important but available
treatments must follow the evidence and CBT is the talking
treatment Nice has approved.
He hopes to extend access to CBT among homeless people and is
running courses for staff in Southampton and, nationally, with
Homeless Link.
Nick's picks
Favourite film: "Pink Floyd's The Wall."
Ideal Saturday night: "A Chinese takeaway and a
film with my other half."
Who would you like to be stuck in a lift with?
"Clive James might be someone who would be quite
interesting."
Further information
Homeless Link
courses
Contact the author
Simeon Brody
This article appeared in the 12 April issue, under the
headline "Maguire's calming influence"