‘Being ‘seen’ — A psychologically informed reflection on the value of even brief interactions’…

21.01.2022: As I write this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, I am on a train back from Manchester after my regular monthly trip to support the amazing teams delivering ‘frontline’ homelessness services in the city. As I was waiting outside the station for my train (having a quick cigarette!) and reflecting on the day, wondering what topic I would write this week’s PIE blog on, I was approached by a young woman who was clearly homeless and rough sleeping. She asked me for a light for a cigarette, which I gave her. At, which point, she looked me directly in the eye and thanked me for ‘noticing her’. This struck me initially as an odd thing to say, before she went on to say that she had approached several people smoking outside the station and all of them had ignored her as if she did not exist or in her words: “like I wasn’t a person”. I replied to her obvious surprise that of course she was a person, with just as much value as all those people passing by on their way home from work or out for the evening in the city centre.

It then seemed that at that moment there was just the two of us standing there. Whilst we were on different paths, we were nevertheless, just two people in Manchester at that moment connected by our shared addiction for nicotine. What she told me next, whilst not surprisingly given my discussions earlier in the day with the staff in our reflective practice sessions, was about the challenges she was facing as a young woman sleeping rough in Manchester. For example, she told me the night before she had been assaulted (which was evident on her face) and how hard she had found life since the death of her parents a few years ago leaving her “alone in the world”. I expressed my sympathies to her for her loss, which was clearly still difficult for her and she thanked me again for ‘noticing’ her grief. We then spoke further for a few brief moments about where she could get help before I had to catch my train. I was relieved (and proud of our organisation) when she commented that she was aware of Centrepoint and that they tried to help her, although she admitted she found it difficult to engage with the help on offer. Whilst it was not appropriate to go into detail about this at that point, I encouraged her to reach back out to our team in Manchester and to work with the support on offer to change her circumstances. I noted nothing was impossible to change, although it may of course be very challenging, and that I hoped she knew that she was ‘seen’ and was worth being supported to take a different path in the future.

So why am I sharing this interaction in this week’s PIE blog? There are many things this week I could have focused upon but for me this simple interaction with this homeless young woman highlighted some key reasons why taking a psychologically informed environment or PIE approach to addressing homelessness is so critical. Firstly, without acknowledging the depth of trauma that often underlies why a young person becomes homeless, and the subsequent impact on them, the provision of a hostel bed can be just like sticking a plaster on a gaping wound. You might stop the immediate bleeding, but the person will not just suddenly and spontaneously ‘heal’ sufficiently to function in the wider world. The impact of traumatic experiences do not just stop when the trauma does. Rather trauma can be a profound experience that shapes the way an individual sees themselves, others and the world for quite some time afterwards. Research highlights that a significant number of people who become homeless have experienced complex trauma in their earlier lives (Johnson & Haigh, 2012) and that ‘complex needs’ among those experiencing homelessness are often associated with early traumatic experiences (Maguire, 2006).

Consequently, this is why the ‘support’ aspect of our housing offer in Centrepoint is so critical. Moreover, this is why there is such a pressing need for the work of our Health Team to be widely available across our organisation (c.f. https://centrepoint.org.uk/what-we-do/health/) in order to provide interventions to address the mental health issues so prevalent amongst homeless young people (Centrepoint, 2020 — https://centrepoint.org.uk/media/4650/prevalence-of-mental-health-need-report.pdf). In addition, we can provide a ‘home’ as a starting point, but the ‘job’ aspect of our work (e.g. through our CP works team — https://centrepoint.org.uk/what-we-do/centrepoint-works/) will be what breaks the cycle of homelessness in the future. However, in order to do this, we often need to first address any barriers (e.g. mental health issues) that can stop a young person engaging in education, training and employment.

Moreover, as discussed in one of the reflective practice groups today, this is why ‘early intervention’ is so important. We need to support young people who are at risk of homelessness / newly homeless as quickly as possible, before they end up rough sleeping / ‘sofa surfing’ in inappropriate accommodations for prolonged periods and risk suffering the associated additional trauma that can follow. In a sense, this is also ‘prevention’ in its broadest sense. We may traditionally view prevention approaches as focusing on just stopping a young person from becoming homeless in the first place, but prevention can also be about intervening early enough that we ‘prevent’ additional harm, including the development of mental health or substance use issues that can arise from the experience of homelessness. Whilst it is important to prioritise and support homeless young people with ‘high support needs’, actually ensuring we are also ‘catching’ and intervening with those young people who are newly homeless means we can actually ‘prevent’ further harm. After many years of working in previous roles with older more entrenched rough sleepers, I know how difficult it can be to reverse the psychological impact of long term homelessness. I would therefore argue it is always far better to prevent that damage in the first place.

Secondly, as I was reflecting on this interaction, I was also struck by what the homeless young woman noted of ‘being seen’. It reminded me of the quote (in the picture at the start of this blog) from psychologist Brené Brown — “never underestimate the power of being seen’. It cost me nothing to lend her my cigarette lighter for a moment, and perhaps for most members of the public that might ask me for this favour, it is just a simple interaction that means as little to them as it does to me. However, in this case, because I did not turn away from her (as others were doing) or judge her on her appearance (that clearly showed she was rough sleeping) this simple interaction was clearly more powerful for her that I could perhaps have ever imagined. I doubt that there was anything specifically special about me in that moment for her, other than simply that I ‘saw her’ when many others did not.

This reminded me of those core therapeutic skills that underlie a PIE, such as listening, empathy, non-judgement and unconditional positive regard that can perhaps seem so basic, but actually can carry such a powerful weight in enabling connection to others. Moreover, it reminded me of how powerful and reinforcing to us it is to ‘just’ be noticed by another person. Perhaps this is something that most of us take for granted? After all, the majority of us are not alone as we have family or friends that care for us (and sometimes, especially those of us with younger children, actually what we might want is some space or to be left alone occasionally!) However, now imagine if you are alone in the world, even in a crowd of people outside a busy station, and no one actually sees you when you are just asking for something as straightforward and low cost as to borrow a cigarette lighter. Given that much of our validation and sense of self comes from our interactions with others, how invalidating would it be to be ‘invisible’ to the world? How low and worthless might we feel if no one ever sees us? For those reading this blog, who can we ‘see’ that might need to be seen? Maybe that might be our colleagues at work or a homeless young person we are supporting, maybe someone in our family or friendship group, or even maybe that person who lives on our street that we know is coping alone right now?

Finally, this also led me to thinking about how this sense of disconnection to the wider world might then make it difficult to want to connect with others. If our experience has just been to be ‘ignored’ or to be rejected when we are trying to get attention, it is perhaps not surprising that we may struggle to engage with those that actually do want to ‘see us’ and perhaps even help us. This central challenge of engaging the homeless population is also a key part of any PIE. Unlike perhaps more traditional approaches to health and social care wherein you are referred to a provider, expected to attend an appointment and discharged if you do not, PIE acknowledges that engagement is not this straightforward when working with a potentially traumatised homeless population. It can take time, as our ‘PIEineers’ (the homeless young people who advised the development of our Centrepoint PIE) note — “it takes time to build trusting relationships, especially when we have been hurt before”. Traumatic experiences are healed within the context of supportive relationships, but if that trauma has occurred in relationships, it can act as a barrier to forming the very relationships you need to utilise in order to recover. Therefore, engagement and building relationships is argued to both be the biggest challenge but equally the ‘bread and butter’ of work in this area (c.f. Keats et al, 2012), from which all else follows.

As a result, it did not surprise me when this homeless young woman stated that she was struggling to engage with the Centrepoint team in Manchester. I also know that this team are full of compassionate, passionate and dedicated staff that will keep trying, because they understand that ‘pre-engagement’ (the work you do with a person to get to them to engage in subsequent interventions) is some of the most difficult but important work they undertake. I do not know her name, or whether the staff team already knows her, but I do know that if this homeless young woman goes to North Parade services in the future, the team will open the door and try to support her. They will not give up on her. They will ‘see her’.

On reflection, I wished I could do more in that moment but I had to rush to catch my train or risk having a buy a further very expensive ticket home! All I could do, in that moment was be the ‘face’ of Centrepoint, and encourage her to reconnect with where I knew she could get the help I could see she clearly needed. I can only hope that our brief psychologically informed interaction, and the mere act of me ‘seeing her’ when no-one else was at that moment, highlighted to her that she is worth helping and may result in her seeking support again in the future. Most importantly, I hope she can internalise this sense of ‘being seen’ as indicating she is of value, so just like many of the vulnerable homeless young people we work with in Centrepoint, she can create a better future for herself and #changeherstory…