Dr Nikoletta Theodorou discusses some of the findings from her PhD, recently completed within I-SPHERE, and here focusses on frontline support worker responses to the attachment styles of people experiencing Multiple Exclusion Homelessness (MEH).

A growing body of research has highlighted the prevalence of unresolved losses, trauma and childhood adversity affecting individuals with experience of Multiple Exclusion Homelessness(MEH). The ascendence of Psychologically Informed Environments (PIE) and Trauma Informed Care (TIC) within the homelessness sector in recent years is testament to increased recognition of the impact of these experiences on the way that people affected relate to support services. 

Against this backdrop, my PhD explored the attachment styles exhibited by people with experience of MEH and the way that frontline workers respond to the behaviours associated with these.

The study was informed by attachment theory, which provides a way of understanding how individuals relate to other people and the strategies they employ to adapt and cope with adversity since early life stages. The original architect of the theory, Bowlby, argues that an individual’s capacity to benefit from caring relationships is based on their ability to develop a secure attachment and foster positive and nurturing relationships. People with highly insecure attachments may fear intimacy and dependency on others, rely excessively on others or exhibit high self-reliance for managing their distress, have serious difficulty in eliciting care and so on. They can sometimes see themselves as unworthy of care or perceive others as rejecting or unavailable.

This was true of all the individuals with experience of MEH who participated in my study, each of whom exhibited insecure attachment styles of different types. Specifically, some had a marked withdrawn attachment style, which is characterised by social distancing, defensive avoidance of others and high self-reliance.  Others exhibited an angry-dismissive style which is characterised by angry avoidance of others or, a marked enmeshed style which is characterised by over-dependence on others, excessive attempts to elicit support, intensified emotions and so on. Finally, others had a marked fearful style of relating which is characterised by high levels of mistrust, constraints of closeness to others and a strong fear of rejection. Most participants exhibited a dual style of relating where elements of more than one style were present.

Conversations with frontline workers supporting people with experience of MEH indicated that:

• Different attachment styles tended to elicit distinct responses from staff members, and these, in turn, affected their capacity to connect with service users, the nature of support and level of care offered, and which groups of service users were perceived as the most challenging to work with.
• Working with individuals experiencing high rates of powerlessness, emotional turmoil and hopelessness produced considerable work-related stress and anxiety, often leading to emotional exhaustion, frustration, and diminished feelings of self-efficacy amongst frontline staff.
• Dismissive and avoidant service users may benefit from interactions that encourage them to verbalise their needs through a stance of ongoing support, exploration, and curiosity.
• Service users with highly enmeshed attachment styles can benefit from being encouraged to exercise their autonomy and enhancing their ability to cope with anxiety and uncertainty.
• Service providers must understand, indeed expect, that frontline staff members will have their own triggers, hotspots and stressors which can be activated, re-surfaced and re-enacted within their work with this population.
• Greater awareness of trauma and related behaviours through training, regular supervision and reflective practice can partly mitigate such difficulties.

The study concluded that an “attachment-informed” approach to service delivery may offer substantial potential, such that prior to any form of psychological intervention practitioners would aim to establish a secure base that is characterised by psychological contact, empathic responses, regular and flexible meetings, and an acceptance of service users’ psychological state of readiness.

Explicit reference to attachment is rare within the homelessness sector, which is perhaps surprising given that there is a substantial literature advocating attachment theory-based models in mental health and forensic settings.  This study suggests that understanding a service user’s attachment style allows for prediction of likely patterns of interaction in homelessness service settings and might be used to help staff tailor support plans to suit service users’ relational styles.

For further detail regarding these and other findings from the study, read the full article which was co-authored with supervisors Professor Sarah Johnsen, Dr Beth Watts and Dr Adam Burley: Improving multiple exclusion homelessness (MEH) services: frontlineworker responses to insecure attachment styles.