‘Healing or Harming — Harnessing the positive power of ‘relationships’ in a Psychologically Informed Environment (PIE)’
08.07.2022: As I write this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, it has been another busy week delivering PIE across the organisation. Moreover, as the country continues to ‘open up’ post the COVID-19 pandemic and the weather is generally warm and sunny, many of us are spending more time seeing family and friends; reconnecting our relationships with others. Consequently, I have been thinking more about ‘relationships’ and the importance of these for our psychological well-being and mental health, especially their role in all of our healing after the challenges of the past few years.
Relationships are a key part of any Psychologically Informed Environment or PIE, and as Keats et al (2012) argue; ‘a focus on managing relationships is perhaps at the heart of what makes a psychologically informed environment different’ (p.24). Moreover, in a PIE ‘relationships are seen as a principle tool for change and every interaction … is an opportunity for development and learning’. Relationships are powerful; therefore, I am going to use this blog to reflect on their impact further including how we can ensure that we harness their power in order to create positive change for those that we work with, whether this be our colleagues or the homeless young people we support in Centrepoint.
From the moment we are born we become impacted by relationships; our first relationships with our primary care-givers are actually critical for our survival, in that they ensure we get our basic physical as well as our emotional needs met. During childhood and adolescence, we begin to learn how to engage with others, initially our parents or family, then later our friends or peers. Within these relationships, we mimic the behaviour and emotions of those around us, this early socialisation or the development of attachments (Bowlby, 1967) shapes how we view ourselves and our wider world. Moreover, they influence how we understand and model relationship-forming behaviour throughout the rest of our lives. Psychologists are also well aware that these early attachments are also predictors for mental health and psychological well-being as well as relationship satisfaction in adulthood. As a result, changes in family structure, family conflict or family breakdown can interrupt the forming of positive secure attachments and lead to insecure attachments that impact negatively on us in later life.
Although initially the most important attachment figures are our primary caregivers (e.g. parents / carers), as we move into adolescence, our friends or peers become more significant as we become more independent and start to build our own social networks. However, as a result toxic relationships and negative experiences such as bullying or social isolation can have a significant impact on young people’s mental health. Therefore, we may need to draw upon our early secure attachments with our primary caregivers and/or positive attachments with other key figures (e.g. teachers, youth workers) to ‘buffer’ against these negative experiences and protect us as we transition into adulthood. Without such key attachment figures, we are at risk of developing mental health issues (e.g. depression / anxiety) if we experience loneliness, isolation and social rejection during adolescence.
Dysfunctional or insecure relationships or attachments are very often the source of ‘Adverse Childhood Experiences or ‘ACE’s’. Sadly, many homeless young people we see at Centrepoint have experienced ACE’s in the context of their family or key attachment figures. Research shows that ACE’s can increase our risk of a myriad of physical, psychological and social problems in later life (Anda et al, 2010). ACE’s interfere with a young person’s ability to concentrate, connect with others, and regulate their behaviour, which are all key skills for achieving both at school and later in employment or life more generally. ACE’s can permanently alter our biological systems (i.e. our brain development, body functions or hormonal systems) and as a result, the presence of ACE’s or trauma in childhood (e.g. abuse, neglect or violence) can lead to a range of negative health outcomes later in life, including mental health issues, substance use, physical health problems and premature death. Moreover, the more ACE’s, the greater the risk of later impact.
However, whilst relationships have the power to harm, they also have the power to heal. Other research (e.g. Burke-Harris, 2018) has found that healthy relationships are a key part of healing and thriving after trauma or experiencing ACE’s. Caring and supportive relationships can mitigate and even prevent the lasting effects of toxic stress and foster a sense of belonging, meaning and purpose in life (Jonas, 2018). Social relationships can even positively influence a range of biological health conditions, in other words your physical health is better if you have positive social relationships with others (c.f. Cohen, 2004; Ertel et al, 2009; Everson-Rose & Lewis, 2005; Hughes & Waite, 2009; Kiecolt-Glaser et al, 2002; Zhang & Hayward, 2006). This includes cardiovascular disease, high blood pressure, cancer, autonomic dysregulation, impaired immune function and depression.
Nevertheless, when we are thinking about the power of relationships, it is definitely quality over quantity. To put it another way, it is better to have fewer relationships that are emotionally supportive than having many but which are characterised by conflict and stress. It is perhaps obvious, but not all relationships are helpful to us. Reflecting back to conversations with staff in our supported accommodation services, one theme of reflective practice sessions is often concerns about a homeless young person’s relationships. For example, they may be involved with anti-social peer groups that increase their risk of challenging or anti-social behaviour or even engagement in illegal activities or unhelpful health behaviours. A study by Thombs et al (1997) found that perceived social norms within an adolescent peer group about drinking behaviour actually influenced alcohol consumption amongst young people in that social group.
A young person may also be involved in a relationship that is sexually, emotionally, physically or financially abusive. This can be very challenging for our supported accommodation staff to manage and support. This can be particularly an issue when the homeless young person themselves lacks insight into the toxic nature of these relationships, perhaps because it is only relationship that they have ever experienced or they hold beliefs about themselves that this is what they ‘deserve’ because others have told them they are unlovable or worthless. It can therefore be helpful to ‘map’ their social network to understand who are the influencers upon them and whether they are positive or negative, with gentle encouragement to focus on developing those relationships that have a positive impact on their psychological well-being to draw them away from those that do not. However, it can take time to support and empower that young person to move away from toxic relationships, and fill their time with more positive relationships (or activities that give them opportunities to create these) and it is rarely a straightforward process. This is where advice and support from our Healthy Relationship advisors in the Centrepoint Health Team can be invaluable; in terms of how to work with this young person as well as what support services may be available to them within their local area (c.f. https://centrepoint.org.uk/about-us/blog/breaking-the-cycle-of-abuse/#:~:text=Centrepoint's%20healthy%20relationships%20advisors&text=We%20know%20it%20takes%20time,abusive%20relationships%20on%20young%20people.).
So if a relationship has the power to heal, how can we harness this within our key-working relationships with the homeless young people we support or within our working relationships with our colleagues across the organisation? What the key PIE ‘ingredients’ within a relationship that we should be working to foster on a day-to-day basis to have the most powerful positive impact? Psychologists would argue that healing relationships are loving, kind, trusting, honest, compassionate and respectful. These create connections between individuals, which at their best benefit both parties. These are at the heart of a PIE, or trauma-informed approaches that ensure that relationships are collaborative and empowering. Specifically, being able to trust another person means that you feel emotionally and physically safe, so that you do not have to be ‘on guard’ against being hurt by the other person. Being honest means that you can reveal your true feelings or ‘authentic’ self to the other person without causing harm, and being compassionate means that you have the ability and willingness to understand and care for the other person.
To achieve these aspects of a ‘healing relationship’, psychologists would of course suggest that key to this is honest and open communication. Miscommunication can cause stress and conflict and although we do not always get our communication with another person ‘right’, being honest about this and finding ways to repair and move the relationship forward is critical. Using some simple counselling skills such as checking we have heard the other person correctly with clarifying questions, summarising what we have heard, and being active listeners (i.e. paying attention to both verbal and visual cues, and not just focusing on what we are going to say next) are helpful for good communication. The use of ‘I’ statements, such as ‘I have concerns about X’ rather than ‘you’ statements, such as ‘you are not doing X’, can also reduce hostility and defensiveness. Listening more than talking (c.f. https://drhelenmiles.medium.com/partnerships-relationships-communication-in-a-pie-83b5768705b9) can also be helpful if at times a bit tricky! Finally, utilising skills such as genuineness, empathy and unconditional positive regard (c.f. Rogers, 1951) can also help us to understand another individual’s perspective and keep us out of judging them. For example, many of the homeless young people we support are very sensitive to being judged or adults being ‘fake’, and will disengage if they feel that we are another authority figure who is doing this.
It is also important to try to value the other person, and to express this to them. Healing relationships are those in which we feel that no matter what has happened to us, there is still hope for the future and that we are of value to others. This can help undo past traumatic experiences, as we understand that we are not to blame, or that we can change even if we are. This is particularly important when dealing with challenging behaviours, as separating the person from the behaviour through understanding what might have led them to behave in a particular way (i.e. ‘explanation not excuse’) can give an individual space to change. Moreover, respecting and valuing a person’s differences to us gives that other person validation, which can be a powerful catalyst to healing and personal development. This development of our sense of self (i.e. who we are) is a critical task in early adulthood, as we separate from our primary care givers and find our own path in life. Of course, this can be hard enough for young people in a loving and stable family, with secure attachments and no significant early traumatic or adverse childhood experiences (ACE’s). This can be even more of a challenge for the homeless young people we support in Centrepoint, who may have been told that who they are unlovable or worthless, or have been rejected for their identity (e.g. sexual orientation or gender identity) by others. As a result, the support relationships that our key-workers offer can be a starting point for validation and acceptance, creating a sense of belonging rather than rejection, which enable them to heal and achieve their potential in life.
Therefore, relationships can be very powerful tools for healing. However, they need also to be empowering. Doing things for another person, can replicate feelings of uselessness and being controlled or powerless, which can be further re-traumatising. Healing relationships in contrast are collaborative, wherein we work together with another person to encourage them to do as much as possible for themselves, perhaps initially through smaller steps (i.e. a graded exposure approach) that are achievable in order to build up their confidence and self-esteem. Relationships that support another person to take responsibility for themselves and highlight their own skills, resilience and achievements (however small) can also be very healing or positive.
Finally, it is also worth noting even though our relationships can be a powerful tool for healing and psychological well-being, we need to be mindful that we will have to accept the ‘rough’ with the ‘smooth’. It is normal for relationships that we have with others to have ‘ups and downs’. However, our relationships only have to be ‘good enough’ rather than perfect. Nevertheless, periods of difficulty, conflict or challenge in our relationships can serve as a point of reflection or learning. Luckily, we all tend to have more than one relationship in our life, and can utilise these at different times and for different purposes. I have different relationships with my colleagues, my family and my friends, all of whom are part of my collective self-care and help me to get through the daily challenges of life! Humans are social creatures, we all need relationships and as Centrepoint strives to be a PIE or ‘People’ organisation, I wonder if we can all reflect on our professional relationships this week? In other words, how can we support each other when we face the inevitable challenges of working in the homeless sector? How do we utilise the building blocks of relationships outlined in this blog to build relationships and bring about positive changes? What do we need from our relationships from others and what might they need from us? Taking forward our reflections on these questions into our working relationships with our colleagues as well as the homeless young people we support, will enable us to harness the power of relationships to positive effect in our PIE…
