On homelessness, marginalisation and addiction – some observations
by Marika Mikulak
Decades of Irish neoliberal housing policies that have ignored people’s housing needs and have treated housing as a financial asset rather than a home, have resulted in a debilitating housing crisis in the last number of years (Hearne, 2018). I spent five years (2013 – 2018) working in an emergency shelter for homeless men in Cork. During that time I saw first-hand how the demand for beds drastically changed, how suddenly we were creating long waiting lists and how people who should have resided in the hostel for three months before they secured stable accommodation lost some or most of their ability to live independently and became institutionalised after living in there for years with no light at the end of the tunnel. My current role as an addiction counsellor for the Polish-speaking population with the priority given to the homeless has further deepened my understanding of homelessness. The fact that I am Polish adds another dimension to my work, and to this article, as I draw on my experience as a bilingual therapist. I discuss some of the issues that need to be considered when engaging in therapy with this and other marginalised minority groups and argue that we need to pay more attention to the intersectional nature of their experiences.
For some migrants, including me, the idea of home is not a black-and-white concept. In the movie Brooklyn (Crowley, 2015), Eilis, played by Saoirse Ronan, has similar wonderings and questions to ones I often have, such as, ‘Where is my home?’ Being torn between my home country and the country I have resided in for over a decade becomes an ever-familiar feeling, at times an accepted companion and at others an unwanted guest full of longing, doubt, and unsettled feelings. Heidegger (1966, as cited in Dovey, 1985: 42) considered what he called autochthony or rootedness in a place as a basic condition for the development of authentic human existence. Dovey (1985: 9) further sees home as connectedness (Fig. 1): “Home orients us and connects us with the past, the future, the physical environment, and our social world.” Home can be seen as strengthening or forming part of our secure base (Bowlby, 1988) and in the book Home coming: Reclaiming & championing your inner child, Bradshaw (1990) compares the experience of finding your inner child to finding home for the first time. Hence, being without/losing a home (home-less not house-less) or not having that experience of having a home carries multi-layered impacts which reach to the depths of our existence. Too often the approach to addressing homelessness is, to use Seager’s term, “mind-blind” (Seager, 2011: 184), focusing on providing a roof over a person’s head, food, medicine and money but failing to meet the deeper psychological and spiritual needs of being loved, of belonging, of having meaning and hope.
One of the difficulties that a homeless person faces is discrimination on the basis of their homeless status, which negatively affects their well-being. Johnstone et al. (2015) highlight that not having a home is perceived as something within one’s control and responsibility and so carries so called controllable stigma as opposed to uncontrollable stigma, such as race or gender. Thus, discrimination against people with controllable stigma, in this case the homeless population, is perceived to be more legitimate. Furthermore, homeless people belong to the out-group which tends to be dehumanised, excluded from full humanity and perceived as the lowest of the low within the society (Harris and Fiske, 2006). Finally, this group experiences discrimination based not only on the fact that they are homeless but also for other reasons such as addictions and/or mental health issues.
Figure 1. Home as connectedness (Dovey, 1985: 44)
It is clear that both the discrimination and the prejudice placed on homeless people carry a lot of weight and are multidimensional. Another intrinsic part of addiction and homelessness is the loss of control over one’s life. The regaining of that control should, in my opinion, start in the therapy room. The first thing we as practitioners must do is to recognise our clients’ humanity, look at them and not look away, and treat them as equals. In practice, this can be as simple as giving them some control or power over what time we meet or for how long, trying to facilitate them, if possible, around their other appointments.
The clients I have been working with over the last two years in my capacity as an addiction counsellor, homeless Polish men in their majority, face an added level of being a migrant in this country. Therefore, not only are they socially disadvantaged, homeless and on a low income, but they are also migrants and struggling with addiction. This could be more appropriately described as experience that is intersectional. Intersectionality, when originally coined, applied mostly to Black women and the overlapping discrimination based on gender and race (Crenshaw, 1989). However, with time, it has expanded to other marginalised groups and identities, and has become a metaphor for multiple and intersecting categories of discrimination: “intersectional approaches look to forms of inequality that are routed through one another, and which cannot be untangled to reveal a single cause” (Grabham et al., 2009: 1). Focusing on how different levels of inequality interact with each other further offers a broader and more detailed picture of the oppression and discrimination experienced by various groups (Weldon, 2008 as cited in Kantola and Nousiainen, 2009).
Freire (1970/2017) wrote extensively about oppression: “the situation of oppression is a dehumanised and dehumanising totality affecting both the oppressors and those whom they oppress” (21). He highlights that dehumanisation is “a distortion of the vocation of becoming more fully human” (Freire 1970/2017: 18) and, although it is a fact, it is not a destiny and it results from an unjust order that “engenders violence in the oppressors, which in turn dehumanises the oppressed” (18). Violence does not necessarily equal physical violence, it can be looking down upon or ignoring someone’s existence altogether, it can be depriving someone of their voice or misusing/abusing a position of power that we hold over someone. This brings us to the broader issue of ethics in the helping professions, which unfortunately I cannot delve into here, that “the primary purpose of a code of ethics is to safeguard the welfare of clients by providing what is in their best interest”(Corey et al., 2007: 8). It is important to remember that where there is vulnerability, there is the potential for abuse.
Freire (1970/2017) further speaks about how the oppressed identify with the oppressor, with the former having “no consciousness of themselves as persons or as members of an oppressed class” (20). Hence, therapy with the oppressed needs to start with recognising them as full human beings and helping them restore and strengthen the internal sense of themselves while also facilitating them to fully see their position within the unjust order, not to make them into victims but rather into agents who can potentially transform it. Psychotherapy has often been criticised for placing the emphasis on individual and personal pathology while isolating it from social and political concerns (Lago, 1996). Lago warns that lack of a structural awareness of society (how society works regarding race, socioeconomic status, gender; how power is exercised; how stereotypes and ideologies affect our actions and policies, etc.) will prevent therapists from understanding their clients’ worlds fully. In addition, therapists need to develop their personal awareness of where they stand in relation to these issues. There are various philosophical and psychotherapeutic approaches which can aid therapists in that regard, such as phenomenology (Merleau-Ponty, 1962), Gadamer’s hermeneutic attitude (Dostal, 2002) or the Gestalt field theory (Yontef, 2005). They highlight the importance of seeing an individual as embedded in the whole context of forces that constitute the background of their daily lives, including political, social, and cultural contexts.
In The role of culture and cultural techniques in psychotherapy: A critique and reformulation, Sue and Zane (2009) discuss factors that make therapy more efficient with ethnic-minority groups. While they focus mainly on the U.S., I think their conclusions are also applicable in other geographical contexts. They emphasise the strong evidence from literature and research showing that the provision of mental health services to these groups has been inadequate and these groups are either underserved or inappropriately served. There seems to be a consensus about the reasons for these inadequacies; lack of bilingual therapists, stereotypes therapists hold about various ethnic groups, and discrimination. However, the most important reason they cite is the lack of therapists’ ability to offer culturally responsive therapy. In this regard, my role is quite unique and responds to that need of ethnic minority clients, as my clients do have access to treatment with a bilingual therapist that comes from the same cultural background. Lago (1996: 47) writes that “Culture profoundly affects people’s ways of being, their behaviour, their interpersonal relationships, their notions of meaning and so on” and adds:
when people share cultural origins and understandings, they share, often without any awareness, sufficient ‘recipes’ for understanding each other’s present behaviour and predicting their future behaviour.
In my private practice I work both in English and Polish, and I have noticed that while working in Polish, therapy often goes deeper faster; undoubtedly, those subconscious recipes, which Lago speaks about, play a significant role in deepening the work nearly from its onset.
Prior to taking on this role, a colleague of mine, who is also an addiction counsellor/ psychotherapist, told me that when working with the homeless, it will be a success if they attend the first appointment and an even greater success if they return for the second. Another colleague of mine posed a very relevant question, ‘What is success?’ To me it is someone coming for the second session. Keeping this in mind made me particularly cautious during first meetings as I wondered what kind of environment and meeting my clients needed in order to return. It turned out to be quite simple, but simple is often the most difficult not only to grasp, but more importantly to embody. They needed to feel welcome, seen, understood, and respected. To me, in many ways, my clients are heroes who inspire me as they have been through so much and yet, once they sit in front of me, they are willing to try again and start from scratch, in situations where giving up would have been a much easier option. This work has taught me to be grateful for what I have, for how privileged I am and as a result, to approach my work with humility and gentleness.
While cognitive-behavioural therapy and its different variations seem to be the predominant approach to addiction counselling, I always start with Maté’s wise words, “The question is not why the addiction, but why the pain” (2017: 1). The whole person comes into the room with thoughts, feelings, different forms of trauma, past, present and future, not just their addiction. My style of working is very relational and I pay a lot of attention to building the therapeutic relationship. My friend who has worked many years in this field often says, ‘Just hang out with them’. This is probably the best advice I heard in relation to this kind of work. I have clients who have absolutely nobody in this world and others whose relationships (familial and others) have broken down. As humans we are wired for human contact. The Covid-19 crisis is highlighting this need even more acutely. Human contact means being with someone, laughing and crying together, talking about good and bad times, listening to the pain but also to the joy that possibly has been buried. It is about establishing a connection. I do not minimise the challenges and dangers of addiction and the importance of stabilisation and different steps of the recovery pathway, but I know it starts with connecting and really meeting the other person.
Another aspect of the difficult situation of some of my clients is the language barrier. Imagine for a moment receiving important correspondence and not understanding it; receiving phone calls and not being able to communicate with the person ringing you; going to court and relying on interpreters, if they are present (not always the case), and if they are not, trying to guess what decisions have been made which can significantly impact on your life; always needing someone with you who can speak English every time you go to the doctor, bank, social welfare office, and so forth. We all have experienced those awkward moments in foreign countries when we are spoken to in a language we do not understand and one we cannot respond to or be understood in; it can generate discomfort, anxiety, uncertainty, frustration, helplessness, excitement, among other feelings which can create a mix of all of them depending on an individual. However, the consequences of a language barrier for migrants’ lives are far more serious than the fleeting moments of emotional discomfort for a tourist. For instance, Timmins (2010) looked at the impact of a language barrier on the health care of Latinos in the U.S. and found that it puts this group at risk for experiencing both decreased access to care and decreased quality of care. Ding and Hargraves (2009) concluded that immigrants with language barriers generally experience more stress which leads to poorer health. Bacik (2007) examined the issue of access to justice across language barriers. Whilst Ireland is not always thought of as a multicultural hub, its population is diverse and also multilingual. This is clearly a vital issue considering the fact that approximately 200 languages and dialects are used in Irish courts. While in Ireland, at common law, granting access to an interpreter is at the discretion of the court, at an international level ensuring access to justice in a language one understands has increasingly become seen as a human right.
In conclusion, offering therapy to marginalised groups requires therapists to be aware of the world they and their clients inhabit, the discrimination their clients are experiencing and the difficulties they are facing in their daily lives. Each marginalised group will have their own unique struggles which need to be seen as embedded in the wider context, context that we, as therapists, are also part of. In a thought-provoking obituary for E. Margaret Burbidge – an astrophysicist who made huge contributions to our understanding of the cosmos but who in her professional life experienced debilitating discrimination because of her gender – the author speaks about a ground-breaking article Burbidge co-authored which in essence states that we are all made from stars (Fox, 2020). If we acknowledge that we are all made from the same material, that is not merely earthly but stellar, we might be better placed to recognise how equally deserving of respect we are. As practitioners, we all have a role to play in working towards full equality, improving access to services and de-stigmatisation of the marginalised groups in our society. Our work as therapists does not happen in a vacuum, and to acknowledge and own one’s privileges and others’ disadvantages should be a departure point and not an afterthought of any therapeutic intervention. Paying attention to additional barriers our clients face, be it on the basis of their ethnicity, homeless status, gender, disability, or other, is a good place to start.
Marika Mikulak trained as a psychotherapist with the Flatstone Institute and completed her postgraduate psychotherapy studies in the Metanoia Institute, London. She is an accredited member of IAHIP. She has a private practice in Cork and she works as an addiction counsellor, primarily in homeless services. She is a co-facilitator on a personal development course, Steps: A Journey of Growth. Her research interests include diversity, equality, and discrimination. She can be contacted on firstname.lastname@example.org
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