‘When is a ‘behaviour’ not a ‘behaviour’?’
01.11.19: Since I first started training as a Psychologist over 20 years ago, one of the questions that I wish I had had a pound for every time someone asked me it, is “Can you read my mind?’ Psychologists are not psychics, so the answer to this is always a resounding ‘no!’; something I am sure my partner and children are very pleased about! Consequently, because psychologists can’t ‘read’ minds, we observe ‘emotions’ in others (although these can also be hidden), and pay attention to verbal (i.e. what we ‘say’) and non-verbal (i.e. what we ‘do’) ‘behaviours’. A person’s behaviours are essentially an outward manifestation of their inner thoughts, needs and feelings, driven by their past experiences.
In last week’s blog I wrote about the importance of ensuring that Centrepoint’s Psychologically Informed Environment (PIE) is ‘trauma-informed’ in line with good practice in both the voluntary and statutory sectors. This includes of course considering of trauma informed evidence based approaches to working with homeless Young People, and ensuring that they are in our skills and knowledge based PIE Training being offered to all staff in early 2020. Our PIE also consists of monthly reflective practice sessions for all staff, wherein there will be another opportunity to embed trauma informed thinking across the organisation. This is particularly important, as we know that many of our homeless young people have experienced previous trauma and we know that this past trauma can then manifest in challenging behaviours (e.g. aggression, substance use, self-harm, lack of compliance).
Specifically, the European Federation of National Organisations Working with the Homeless (FEANTSA) report on homelessness and trauma (c.f. https://www.feantsa.org/download/feantsa_traumaandhomelessness03073471219052946810738.pdf) has reviewed evidence from across Europe to argue that research consistently shows high prevalence rates (e.g. 85%; Lankelly Chase Foundation, 2015) of childhood trauma in adult homeless populations. Moreover, traumatic events often occur during periods of homelessness (e.g. violent or sexual attacks), and homelessness in and of itself can be arguably a traumatic experience, due to the associated physical and mental health stresses, breakdowns in relationships, lack of control and wider consequent social exclusion. Centrepoint’s own recent data in July 2019 (c.f.
file:///S:\Key%20Messages%20And%20Facts\Centrepoint%20Key%20facts%201920.pdf) also shows that the homeless young people we support often have complicated and traumatic histories. For example, 64% of young people left their last home due to relationship breakdown, 29% have slept rough, 40% are care leavers, and 21% are refugees. Homeless young people also often report high rates of childhood abuse, physical assault and being victims of crime.
Another question I often get asked is ‘What’s the difference between a Psychiatrist and a Psychologist?’ and is best demonstrated in how we understand and approach an individual’s ‘distress’. A Psychiatrist is a medical doctor whose role is to understand distress as an ‘illness’ and then identify and treat this utilising medical treatments (e.g. medication). A Psychologist on the other hand, is trained to consider the impact of past experiences, trauma, attachments, and wider social influences on that individuals’ ‘distress’ and how this impacts on their thoughts, feelings and behaviours. In essence the question a psychologist would ask is ‘What has happened to you?’, not ‘What is wrong with you?’ (c.f. Power Threat Meaning Framework; https://www.bps.org.uk/sites/bps.org.uk/files/Policy/Policy%20-%20Files/PTM%20Summary.pdf.
This subtle difference in approach is important, as it leads to a further exploration of an individual’s behaviour in a psychologically informed manner (i.e. PIE). When thinking about what has happened to an individual (i.e. a past trauma), we can think about how it may have affected them (i.e. ‘Did it threaten them?’ / ‘What meaning or sense have they made of it?’). Most importantly, it leads to the questions; ‘What have you had to do to survive?’ and ‘What are your strengths / resources?’ Sometimes what an individual has had to do to survive may have been adaptive in the short term (i.e. the use of drugs or alcohol to block out painful emotions) but turn out to be maladaptive in the longer term (i.e. the impact of alcohol and drug use on physical health, mental health, housing, relationships or opportunities to engage in education, training or employment).
Given that many homeless young people have experienced past traumatic events, either leading to or consequences of homelessness, it can be expected that they will have learnt to ‘survive’ with a range of behaviours that are possibly adaptive initially but can become maladaptive in the longer term. Drug and alcohol use is just one obvious example, but sometimes ‘survival strategies’ can be subtler. For example, if a young person has been let down by past adults who were meant to care and support them (e.g. family, care system) then they may display rejecting or hostile behaviours towards future adults who try to help (e.g. keyworkers), as the young person tries to prevent themselves from ‘relying on’ or forming relationships with others, to save themselves from being hurt or rejected again. Therefore, it is often the case that when we meet with another person, and interact within that relationship with them, that their behaviour towards us reflects their history or past experiences and consequently their future expectations about us. And if that past has been traumatic, then we can expect their interactions with us to reflect this in some way. Thus, understanding their past ‘story’ can help us to understand their current presentation or behaviours better, and generate positive solutions. It is being ‘psychologically informed’ in our approach.
For example, in a staff reflective practice session this week, I heard an example of where a young person was falling behind with their rent so was starting to avoid staff. This individual was very anxious about becoming homeless again, due to their past experiences of rough sleeping, but struggled at times to remember to pay their bills and budget appropriately. One option to deal with this was to issue a ‘warning letter’, with standard wording threatening eviction for non-payment of rent. However, this would have likely triggered a negative reaction from the young person, driven by their anxiety of being evited, which could have escalated the situation further. Instead, staff were aware of the young person’s specific ‘psychological needs’ and ‘past experiences’ and spoke to them directly about ‘solutions’ (rather than just focusing on the problem). This led to the setting up a reminder processes for rent payments (e.g. phone alarm, verbal prompts) and doing some key work sessions on budgeting skills. The young person settled their account with a jointly agreed payment plan, and experienced positive relationship building with staff in the service, who he felt understood his anxiety / avoidance and wanted to build his strengths to manage his finances.
Therefore, in a PIE, staff’s awareness of what might be underlying a young person’s seemingly challenging behaviour is critical; it is important to try and understand it in terms of the psychological ‘needs’ of the individual. It doesn’t require any ‘mind reading’ thank goodness(!), just an awareness of that young person’s ‘story’ and then using that knowledge to consider how they can best work with them to address the ‘need’ that underlies a behaviour. This is being ‘psychologically or trauma informed’, and addresses the ‘cause’ of an issue not just the ‘symptom’, thereby increasing the likelihood of a positive outcome of a ‘home and a job’ for that young person as well as staff’s own satisfaction and sense of efficacy.