Therapy Space Proposal

During my first visit at the organization I mainly observed the visitors; their behaviors,
interactions, talks, needs. People at coffee4craig visit for various different reasons, from seeking
shelter, clothes, advice on bureaucratic housing procedures or simply a cup of hot coffee or a
plate of food; nevertheless they all share in common the fact that they are in search of satisfying
some basic human need, which for the rest of us is more often than not already satisfied to a
degree. One such is the need for mental health, the need to talk and share the load when life
becomes hard to manage. A large recent meta-analytic study which collected data from 39
different studies and 8,000 homeless individuals across 11 high income countries, revealed
important findings regarding mental health and homelessness (Gutwinski et al., 2021). An
impressive 37% of the individuals reported alcohol-related problems; an estimate 10-fold greater
than the general population, with drug abuse being the second prevalent category on 22%. The
relationship between mental health and substance abuse is bidirectional, meaning that the abuse
itself is not only the cause of deterioration in various aspects of life such as housing difficulties
but also the effect or reaction of the abuser to pre-existing mental health problems, serving as a
possible maladaptive coping mechanism. Furthermore, intercorrelation between homelessness
and mental health was shown by significant prevalence of treatable psychotic disorders among
homeless people (12.4%) as well as major depression (12.6%). It is rather evident that mental
health issues are highly prevalent on the homeless population, which further justifies the
necessity of creating a safe space for listening and talking for these people.

One of the things I first noticed during my visits was the casual approach of service
providers to the visitors, in the attempt to ask whether they had an ongoing issue or whether they
would like to talk about anything that bothers them. Since a pre-assigned talking space for the
visitors is absent in order for them to be the initiators of a conversation if they need to, the
providers remaining option is to approach the visitors themselves and initiate talk often by asking
general opening questions such as “How was your day? / How have you been? / How is the
food?”. While such an approach shows a genuine interest and can potentially trigger other types
of talk, it sometimes leaves limited space for a deeper conversation to commence, as often
corresponding responses from visitors can be no more than a few words or sentences leaving the
interaction to a surface level. Unless the visitor themselves feels comfortable enough to open up
in such context, the service provider is then left with the options to either respect the visitor’s
space and not ask more questions or persist, which in turn might feel intrusive.
Relational Dialectics Theory (Baxter & Montgomery, 1996):

This theory highlights the tension between contradictory needs in relationships and
explores the dynamic tensions that exist within interpersonal relationships. Relationships are
characterized by opposing forces or dialectics that create ongoing struggles and contradictions.
These tensions arise from the fundamental human needs for both autonomy (independence) and
connection (interdependence) in relationships.

Actively engaging and passively being available can address the dialectic tension
between autonomy and connection, offering both the opportunity for independent expression and
the presence of support. Up until now, the organization offers a genuine active engagement to
visitors which on one hand has the strength of actively encouraging interdepence to the visitors
by encouraging to share, but potentially risks undermining autonomy in some cases. By creating
a “therapy space”- a safe and confidential space for the visitors to talk- we can offer them the
option to talk when they choose to, the option to let them prioritize their autonomy if this is more
important to some of them. Being there passively means making ourselves available for the
person to approach us if and when they need to talk or seek support. This approach can be
beneficial for individuals who prefer to initiate conversations when they are ready or who may
not want to burden others with their concerns. By being present and accessible, we are letting
them know that we are available if they need someone to talk to, but we are respecting their
autonomy and personal boundaries at the same time. It is important to note that active
engagement of the providers is not discouraged, as there might be cases where visitors benefit
from a repeating and persisting expression of interest towards their mental state in a more active
way. Furthermore, a service provider that approaches visitors actively by having a chat can
always advise them to visit the therapy space if there is a need for a deeper or private
conversation. Ideally, a constant availability of both active and passive engagement should be
present inside the organization at all times.

Proposed Procedure:

It is suggested that that visitors get informed that the service is available for the day
during their sign-in; this way everyone will be informed and get equal chance to use it if they
wish to. At a day when the service is available, the visitors should be told that we provide a 1-1
drop-in talking/ counselling/ brief therapy session in case there is anything that concerns them
and want to vent out. If a visitor wishes to take the chance, they will be guided upstairs to a
private area/ room where the service provider will welcome them and offer them to sit and talk.
Timeframe

The opening times for visitors are 2 hours daily. It is apparent that the time limit is not
sufficient enough to establish proper one-to-one sessions similar to therapeutic sessions that last
45minutes to 1 hour, therefore the talking corner cannot be used as an appointment-based service
with waiting lists and strict time framework. Instead, it is suggested that such a space serves in a
drop-in manner for those who need to talk at the given moment. The time for each individual is
suggested to be given based on the provider’s judgement of the severity of the visitor’s need and
the demand of other visitors, but should not exceed a pre-determined time limit (e.g. 30 minutes).
If the demand becomes high, then shorter fixed time intervals can be decided for justice
purposes.

Privacy and confidentiality

The service can be exclusively private by being served upstairs in a quiet space, on a 1-1
basis. The idea is that a service provider will show availability by passive engagement/ presence.
An important detail however is to make sure that the visitors get informed that this service is
available during their visit, and also encouraged to try it especially for those that seem more
concerned. All information that is shared within the room should be respected and be kept
confidential by the service provider, with the exception of disclosing information when
encountering behaviors that withhold critical risk such as self-harm, or harm towards others.

Mitigating Risk

During the visit hours, the service provider that uses the space upstairs must make sure
that communication with the rest of the team is easily available at any given point, in case of an
emergency. Furthermore, the provider must prioritize their wellbeing and take any breaks
necessary after distressful interactions with the visitors. Personal information should be kept to a
minimum, such that safety is not compromised.
References

Baxter, L. A., & Montgomery, B. M. (1996). Relating: Dialogues and dialectics. Guilford Press.

Manning, R. P. C., Dickson, J. M., Palmier-Claus, J., Cunliffe, A. and Taylor, P. J. (2017) ‘A
Systematic Review of Adult Attachment and Social Anxiety.’ Journal of Affective Disorders,
211, March, pp. 44–59.