How do we use CT-R in homeless individuals who are chronically mentally ill?
1. Evoke the individual’s interests and form a practical working relationship: “I have some recordings of music and would like your opinion of each song”, “You look as though you would like a manicure and I have a set here. Can I see your nails?”, “I understand that you like fishing (pets, movies, good food, etc.) and I am looking for somebody to join me in fishing (shopping, looking at dogs, etc.)”.
Note/Example: Molly Finkel just informed me that when she worked with the Atlantic City Rescue Mission, she established a makeshift “nail salon” for the homeless women living there. The individuals took to this and looked forward to coming to the salon to be pampered, heard, and respected as women and not stigmatized as homeless in this setting. The women would talk to Molly and the other women waiting to get their nails done about their doings for the week and their aspirations for when they leave the shelter. In this setting, the important point about the meaning of the activity being the most therapeutic aspect rings true. The women felt they were worthy of being paid attention to and pampered (even just the importance of being physically touched). They felt “normal “again saying that “homeless women don’t get to care about their nails”. The “salon” also became a place of social community and safety. Finally, a few of the women expressed their talent in doing nails and Molly allowed them to help with the manicures. This led them to feel in control and efficacious and helpful towards others.
2. Once a satisfying working relationship is established, it may be possible to ask about aspirations. For some individuals, this may help to get them into the adaptive mode. Other individuals may need to be in the adaptive mode before they can talk realistically about aspirations.
3. To get individuals into the adaptive mode, there are a variety of experiences that may facilitate this: engaging in sports, playing games, listening to music together, going shopping together, etc. When the adaptive mode is more or less securely in place (even though temporary), it may be feasible to talk about their aspirations and how to get there.
4. Two main themes among the homeless:
-Fear from any kind of restraint: Being in a structured residence or homeless shelter with all its risks is objectionable to the individual.
-Community (which Ellen pointed out to me): The individuals get a sense of belonging from being part of the homeless community. The therapeutic aim is to provide an opportunity involving living conditions that will provide a sense of independence and the sense of community. I believe that the sense of independence can be nurtured through individual pursuits such as fishing and the use of clubs, sports, games, etc. which provide a sense of community.