Psychologist Nick Maguire on cognitive behavioural therapy for homeless people

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”