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Participant views

Hope and enthusiasm brought by counsellor caring for homeless

Contribution by Dr Cliona Ni Cheallaigh* on John Connolly’s  presentation at UK Faculty for Inclusion Health study day on the 18th of September 2015.

You are sitting across from a patient who is clearly in great distress. It feels like you can’t get through their anger and aggression, you can’t help them. Your psychiatry colleague sees them, but all the help they can offer is the diagnosis of a personality disorder. Are you feeling  hopeless now? Frustrated? Angry yourself? At a loss for what to do?


Up to 70-80% of homeless people have trauma-related personality disorder. Terrible events experienced in childhood in the absence of a safe adult to help manage them leave people with a disorder similar to PTSD seen in war veterans. These individuals can become overwhelmed with fear and anger which can be triggered by seemingly innocuous stimuli. Their aggressive, “difficult” behavior is often interpreted as coming out of wilfulness rather than vulnerability, and results in further exclusion. Simply understanding the source of their anger can help staff manage these situations.


At a UK Faculty for Inclusion Health study day on the 18th of September, John Connolly, a counsellor working with homeless people in Great Chapel Street in London, brought hope and enthusiasm to helping these individuals. Counselling can work, but normal levels of support will not – homeless people and others with trauma personality disorder (TPD) need enhanced care, where the carers will go the extra mile to provide them with support. Tailoring the length of sessions to the clients attention span, accepting that the care provider needs to negotiate and be clear about their expectations of the client. Plenty of positive reinforcement, help with dealing with other services, and the knowledge that changes can take 3-5 years to become apparent are also part of the mix.


People working with clients with TPD also need to be aware that their own emotional reactions may be triggered by the clients behaviour, and to learn how to manage their own emotions!


The future? Psychologically informed environments (PIEs), where everyone from the receptionist to the CEO is aware of why clients may behave in challenging ways, and how to create a positive psychological atmosphere. Counsellors equipped to help homeless patients and others with TPD make real changes in their behaviours. Are you feeling more hopeful now? Want to read more? and are a good place to start.


* Dr Cliona Ni Cheallaigh  is a SPR in Infectious Diseases/GIM on the National SPR Academic Fellowship Programme. Email:





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