Innovative Therapeutic Care for Homeless, Mentally Ill Clients: Intrapsychic Humanism in a Residential Setting

Abstract

IN THE MOST RECENT STEP in the trend towards deinstitutionalization of severely mentally ill clients, the Supreme Court's landmark decision on June 22, 1999, ruled that "isolating people with disabilities in big state institutions when there is no medical reason for their confinement is a form of discrimination that violates Federal disabilities law" (New York Times, 1999). The occasion for the decision was a lawsuit brought by two Atlanta women against the state of Georgia, claiming that they were being held in an inpatient setting when they could benefit from residential care, and that their rights under the 1990 Americans with Disabilities Act (ADA) were being violated by the excessive confinement. In addition, as the Times reported, a determined, vocal grassroots movement on behalf of the rights of persons with disabilities has arisen nationwide to support the rights of clients with severe mental illness to live in the community in the least restrictive environments possible (Chamberlin, 1990;Harp, 1990;Tower, 1994). These groups are also active in demanding funding from states to develop residential care. Although there are cutbacks in resources for other forms of mental health care, increased funding is available through The U.S. Department of Housing and Urban Development and other federal and state sources for residential programs for homeless mentally ill clients. For these and a number of other reasons, residential care is seen as critical to the future of mental health services. Social workers are especially suited to direct residential care programs, because the programs use psychosocial rather than medical means of healing (Sullivan, 1992).This paper applies the unique, original psychology, intrapsychic humanism, to offer guidelines that social workers can use for residential program planning and management. The conceptual framework used as the base for the research presented here is the postpositivist heuristic paradigm, with an emphasis on the value of research for advancing human rights (Heineman (Pieper), 1981,

Design and validation of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI)

“…As a countermeasure to prevailing negative attitudes and widespread stigmatization toward marginalized persons, recent medical literature has drawn on a well-known practice in the social sciences [10,11] and has begun calling for greater emphasis on the dimensions of compassion and humanism in medical education [12-14]. Humanism in psychology became popular in the 1950s when Rogers [15] began practicing client-centered therapy, which allows the relationship between therapist and client to develop so that the client can be guided within the framework of the therapeutic encounter.…”

Therapeutic management of violence in residential care for severely mentally ill clients: An application of intrapsychic humanism∗

“…Developed using postpositivist scientific principles, intrapsychic humanism yields a culturally-sensitive, non-misogynist, individualized treatment approach that incorporates advocacy, resource provision, and a 542 CARROLL AND TYSON focus on client strengths. The effectiveness of intrapsychic humanism's treatment principles is increasingly corroborated by research (Pieper & Pieper, 1995;Pieper, M.H., 1999;Tyson, 1995Tyson, , 2000Tyson & Carroll, 2001).…”

“…Since self-destructive motives often feel right, real, and even pleasurable to clients, without therapeutic help they cannot distinguish their constructive and self-destructive motives -they do not know their own ability and potential, nor can they control the motives that sabotage genuine happiness. In a residential setting, as clients experience that they can turn to the relationships with staff 544 CARROLL AND TYSON for help rather than erupting in violence, their constructive motives gain strength, and gradually clients can choose the better pleasure afforded by foregoing self-destructive motives and pursuing constructive motives (Pieper & Pieper, 1995;Tyson & Carroll, 2001).…”

“…A shortage of outpatient and community services (Allen & Goldfinger, 1986;Davis, 1991) means that clients often know that what awaits them is grossly inadequate for their needs, and they are even more distressed by impending discharge. The currently widespread revolving door system of care for severely mentally ill clients is profoundly iatrogenic, and should be prohibited from treatment systems (Tyson & Carroll, 2001).…”

Doing Good Science without Sacrificing Good Values: Why the Heuristic Paradigm is the Best Choice for Social Work

“…Social workers can realize this opportunity only by definitively turning away from the unsound and detrimental set of beliefs derived from logical positivism (or logical empiricism, see below) and embracing the beliefs currently espoused in the philosophy of science and the "hard" sciences, and imported into social work by Martha Heineman Pieper (1981Tyson, 1995) as the heuristic paradigm. Already, many social workers have chosen the heuristic paradigm for developing and evaluating social work research and knowledge: The heuristic paradigm is now taught in many masters and doctoral social work programs; research based on the heuristic paradigm has been published in several social work publications (D'Haene, 1995;Murdach, 1995;Heineman Pieper & Pieper, 1992;Tyson, 1999Tyson, , 2000Tyson & Carroll, 2001); there is increasing acceptance of methodological pluralism or "many ways of knowing" (Davidson, 1988;Dean & Fenby, 1989;Goldstein, 2000;Hartman, 1990;Laird, 1993;Saleebey, 1994;Weick, 1991;Witkin, 1995); and, in general, uncritical acceptance of the flawed logical empiricist paradigm has been replaced with a lively debate over which foundations we will choose for our field.…”