Narrative insight into risk, vulnerability and resilience among older homeless African American women

The Arts in Psychotherapy 39 (2012) 471–478

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The Arts in Psychotherapy

Narrative insight into risk, vulnerability and resilience among older homeless African American women David P. Moxley (PhD) a,∗ , Olivia G.M. Washington (PhD) b , Holly Feen Calligan (PhD) c a b c

Anne and Henry Zarrow School of Social Work, University of Oklahoma, United States College of Nursing, Wayne State University, United States College of Education, Wayne State University, United States

a r t i c l e

i n f o

Keywords: Risk and vulnerability Homelessness Homeless women Narrative method

a b s t r a c t This paper highlights narrative method as a tool for gaining insight into the risk, vulnerability and resilience of older homeless African American women. The authors incorporated narrative method into the Telling My Story (TMS) Project, a subproject of a parent research effort designed to identify ways older homeless African American women can leave – and stay out of – homelessness. TMS sought to explore the usefulness of narrative for structuring meaningful assessment of the issues eight older African American women experienced in their struggle to leave homelessness. The authors identify sources of risk and resilience the women discuss within their narratives, and they consider how advocacy can incorporate narrative assessment for helping older African American women resolve the issues that sustain their homelessness. © 2012 Published by Elsevier Inc.

Introduction Increasingly older African American women are finding themselves among the homeless, a problem that is growing, and that will likely accelerate, as the current economic situation takes its toll on those whose resources are limited. There are a number of factors producing the vulnerability of older African American women, many of whom are at risk of negative life outcomes. These include marital change or disruption due to either the death of a spouse, or divorce late in life, limited employment options earlier in life that did not produce sufficient assets to support secure retirement, the onset of serious illness, limited income, the absence of benefits that typically accompany workforce participation, or lack of eligibility for income maintenance programs. Poverty or marginalized economic status serve as the real drivers of homelessness and even small changes in the resource status of an older African American woman with limited means can create a crisis resulting in homelessness. Limited stocks of affordable housing exacerbate this problem, giving those women who plunge into homelessness few if any options (Minnery & Greenhalgh, 2007; Springer, 2000; Toro, 2007). The ones that exist, taking refuge on the streets, living uncertain lives in shelters, or doubling up with family members, are not viable solutions since all of them can trigger further problems such as abuse and exploitation, exposure to violence, the exacerbation of

∗ Corresponding author. Tel.: +1 405 325 0365. E-mail address: [email protected] (D.P. Moxley). 0197-4556/$ – see front matter © 2012 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.aip.2012.08.002

chronic health issues, and the emergence of new health challenges (Washington, 2005). Those situations can rapidly deplete a person’s adaptive functioning. Reduction in supportive resources, particularly social and legal services, health care, and income supports for stable housing, added to the existing shortfall in the quality and amount of affordable housing stock, form the context in which homelessness is rooted (Toro, 2007). Surveillance systems that specifically focus on older African American women may be simply absent from many local systems of care. Thus, service systems may be unprepared both to identify and reach older African American women who nonetheless are becoming more prevalent among homeless populations. The complexity in forms of homelessness creates challenges for service systems as they grapple with multiple forms and different definitions of homelessness, and variation in ways of counting homeless individuals (Tipple & Speak, 2005). Such systems must increasingly deal with gender, race, and age as influential factors in causing and sustaining homelessness. Older African American women present service systems with considerable challenge since, from the authors’ long term research work, homelessness is likely a product of interacting social structural factors. Other factors, like serious mental illness, or substance use, will be less prominent in explaining how African American women enter homelessness later in life, although such factors can emerge as consequences of their coping with long term exposure to such stress producing situations. From the authors’ research, narrative method is a useful and meaningful way to assist older African American women and their helpers better understand sources of resilience, and factors that can limit if not erode resilience given how homelessness

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undermines adaptive responses by women already coping with serious risk factors, like poor health. While it is important in this paper to focus on resilience at the individual-level of functioning, the authors’ research points to the importance of developing supportive resources that can foster resilience in contexts in which risk and vulnerability are prevalent. The purpose of this paper is to highlight the important role narrative serves in understanding how older homeless African American women plunge into and cope with homelessness. Narrative is a portal through which helpers can truly come to better understand the dynamic forces of homelessness in each woman’s life, and come to understand how resilience factors into a woman’s efforts to extricate herself from homelessness altogether. Background Overview of LHIRP In the late 1990s the authors observed among the homeless in Midwestern city an increase in the number of older African American women entering shelters, using mental health and medical services for the homeless, or living on the streets of the city. The second author’s community assessment revealed the serious nature of this issue and a review of literature showed that there was little attention paid to the needs of this group (Washington, 2005). The authors’ subsequent qualitative research revealed the operation of multiple factors pushing older African American women into the ranks of the homeless. This basic research inspired the founding of the Leaving Homelessness Intervention Research Project (LHIRP), a collaborative effort of the authors with support from an urban university’s Humanities Center, College of Nursing, School of Social Work, and Institute of Gerontology. LHIRP, a portfolio of subprojects, is interdisciplinary in its research and practice, and combines the best practices of social work, counseling, the arts, and nursing, forming a synergy of several professions whose heritage emphasizes outreach to vulnerable populations. In 2005, LHIRP strengthened its focus on developmental intervention research and incorporated participatory action research practices so homeless women were increasingly involved in the governance of the project (Moxley & Washington, 2012). For the researchers moving from basic to developmental research recognized the participants’ and investigators’ desire to formulate and test new concepts of helping. From its inception in 2000–2010 over 530 women participated in some subproject of LHIRP including development of assessment tools involving narrative methods (Washington & Moxley, 2008), self-efficacy group work (Washington, Moxley, & Taylor, 2009), the use of the arts as a recovery tool (Feen-Calligan, Washington, & Moxley, 2008), quilting to stimulate reflection on the homeless experience (Moxley, Washington, Feen-Calligan, & Garriott, 2011), education to expand community awareness (Moxley, Washington, & Feen-Calligan, 2008), and an advocacy intervention prototype designed to help women leave homelessness (Moxley & Washington, 2009). Centrality of narrative method within LHIRP The narrative method is central to LHIRP’s research and development aims since a woman’s story places a human face on her struggle, builds relationship and trust between helpers and recipients, and facilitates deep insight into the lived experience of homelessness. Narrative method is a form of humanistic and creative inquiry in which an abstract social issue is better understood by observing it through a person’s actual lived experience, thereby humanizing the problem in all its complexity (White & Epston, 1990). A bold assertion of humanistic method is that a single story can embody a broad range of social forces thereby helping to demystify how a

particular problem “works” in the lives of those people who experience it. Early in LHIRP research participants reported that few helpers actually took time to listen closely and empathically to their stories. The authors’ engagement of participants came at a time when their considerable frustration, worry, anger, and loss of morale literally dampened their motivation to escape homelessness, and eroded their optimism about future possibilities. “Being heard,” as one participant referred to her narrative experience, and “being understood,” as another participant reported, are very real assets for any person who moves about a community largely ignored. Thus, personalization of the participant and her situation as well as unburdening are yet other benefits narrative method can produce. The method honors the person as a rational actor coping with an intractable situation. In the ensuing catharsis of narrative engagement the unburdening a woman experiences from telling her story in depth can foster well being however temporary. All of these benefits strengthen the helping relationship, particularly when the participant is convinced that the potential helper “knows” the toll homelessness has taken in actual terms. When participants come to see their strengths and sources of resilience inherent in their stories they can find more respect for themselves as resilient problem solvers. Within narrative practice, such benefits can produce therapeutic ends (Monk, Winslade, Crocket, & Epston, 1997; White & Epston, 1990). Narrative also serves as a different strategy for undertaking assessment (Hardt & Angus, 2004). By helping a woman narrate her own story, the participant authors a map of her own experience charting those situational factors she sees as conspiring to make her vulnerable (that is, those forces increasing her risk of homelessness), triggering homelessness, and tipping her into such a negative situation. An alternative map can introduce resilience and strengths as factors useful to a woman in freeing herself from homelessness. Within LHIRP narratives that focus on problem factors describe the woman’s plight, while those narratives that incorporate resilience and strengths form narratives of efficacy (Washington & Moxley, 2009b). For White (2007) the metaphor of narrative maps is appropriate since a participant is literally charting her own world (and course of experience) so that it is fully explicit to a helper who seeks to better understand the problem through the eyes of a person who has experienced it directly. For helpers individual narrative can communicate a rich and evocative sense of the social problem of homelessness thereby revealing hardiness, motivation, and coping of those who experience it firsthand. Narrative can also shape the helpers’ understanding of how people relate to those circumstances that tip her into homelessness including situational challenges and unmet needs. Here either narrative, the representation of plight or efficacy, can invoke strong emotional reactions in which a participant expresses guilt, shame, or regret. It can also stimulate optimism, motivation, and goal setting. The cathartic quality of narrative can set the stage for change: the person’s appreciation of her own circumstances can shape a solution focused approach to addressing the immediate situation freed from debilitating emotions that can circumvent progress. For helpers, engaging in and processing narrative can have profound implications for how they come to understand people living in homelessness. The narrative approach highlights the vulnerability of researchers in the qualitative process (Dickson-Swift et al., 2008; Fincham et al., 2008). Certainly helpers can come to experience powerful emotional consequences from the considerable pain people will likely share. LHIRP staff members conducting interviews were greatly moved by learning about the lived experience of participants, and those staff members transcribing content were aroused considerably by this experience, and by how each woman portrayed her situation in terms of loss, recovery, and transcendence. One staff member noted how she was simply overwhelmed

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emotionally by those stories as she transcribed the digital recordings. After each interview session, the authors themselves needed time with one another for the purposes of processing their own emotional experience and gaining insight into each life story as it unfolded within a given session. Debriefing and the ensuing reflexivity were integral parts of the qualitative research process (Creswell, 2007). For the authors, through post session debriefings they undertook to better understand the social factors influencing each woman’s experience, they came to further admire a woman’s resiliencies in the face of the often times overwhelming struggle she described. The use of narrative not only has implications for the storyteller, it can have profound emotional and cognitive implications for those seeking to help. For the helper such implications could be considered a source of reflexivity for those who conduct inquiry through narrative method. Reflexivity means that through successive sessions the investigator constructs a deeper understanding of the dynamics of homelessness and the role of human adaptation in such difficult situations. Narrative can shape the way helpers come to understand someone’s situation, adaptation, and coping. The narrative method of the Telling My Story subproject The authors launched the Telling My Story (TMS) subproject so they could partner with eight participants whose personal stories involved different pathways into homelessness. The purpose of TMS was to capture the compelling narratives of participants who were previously involved in an experimental shelter-based group intervention designed to protect the self-efficacy of women who were homeless (Washington, Moxley, & Taylor, 2009). At this time they were well known to the second author. In addition to their involvement in the experimental group intervention the eight TMS participants received basic services from the shelter involving some housing assistance and limited case management. TMS was undertaken by the authors in anticipation of the development of an intervention of broader scope and so another purpose of the narrative project was to augment the authors’ knowledge of how older African American women became homeless, the strategies these women used to extricate themselves from this situation, and the recovery process they experienced in moving their lives forward. The authors considered narrative as a promising method for achieving these aims given the in-depth and rich content it can produce. In this sense, TMS followed illuminative aims. The authors identified eight pathways into homelessness with substance use, criminal activity, and serious mental health concerns being less salient than other paths, which emerged as more powerful in influencing homelessness for African American women entering late life. These other paths involved marital dissolution, escape from domestic violence, housing accidents, limited employment options or job loss, and poor physical health that prevented gainful employment. While substance use and mental health concerns can figure into homelessness in critical ways, for this population, older African American women, structural factors as determinants of homelessness appear more central. It is such factors that reveal the tenuous status these women hold in American society and the limited resources they have accumulated over the life course cannot prevent a dramatic change in life circumstances in mid- to late life. All participants held in common gender, age (all were nearly or over fifty years of age), race and length of homelessness. Consistent with qualitative research, the authors selected a limited number of illuminative critical cases so they could come to understand the trajectory of homelessness in each woman’s life, produce in-depth evocative portraits of homelessness, and assess whether the narrative method was useful in helping participants identify the risk and resilience factors operating in their situations.

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The authors implemented narrative method in a rich context of conversation, reflection, documentation and representation of the homeless experience. The authors met with each woman over multiple sessions and, using a simple paradigm guiding the dialog, the authors and participant moved through six phases of illumination starting with (1) considering a woman’s early history, (2) proceeding through how vulnerability to homelessness formed, (3) examining triggers (or the tipping process), (4) considering the woman’s actual experience of homelessness (including functioning, adaptation, and survival strategies), (5) examining the emergence process, and (6) finally looking at the ways each woman navigated recovery from the harsh experience of homelessness. Attaching a positive lens to each of these periods, the authors assumed that the women were vital, engaged, purposeful and strategic in their coping with homelessness. Such a positive lens ensured that the authors respected each woman as an active agent who did not simply capitulate to homelessness, but rather sought to resist and oppose it. Also justifying the use of such a lens was how the participants experienced treatment professionals in the past. They found little responsiveness to their needs, and limited valorization of their strengths and fortitude often times interacting with treatment professionals who were more interested in their deficits than their obvious strengths. This positive lens amplified the importance of Saleebey’s (2006) strengths perspective helping participants and researchers better understand how women approach the overwhelming stress and challenges of homelessness with considerable resilience. While the authors maintained a positive lens, they also sought to understand when resilience could fail given how the substantial situational stress homelessness produces can weaken the host physically, cognitively, emotionally, and interpersonally. Arts-based methods were used to supplement the narrative approach (Carlson, 1997). These methods included photography, scrapbooks, poetry and diaries, and quilting as a group exercise to unify themes about risk, vulnerability, and resilience. Armed with disposable black and white cameras, each of the women took photographs of those places in the community from which they obtained help and assistance, as well as those places where they found rejection, disdain, or degradation. They then sat with the interviewers to explain their choices and to elaborate on how the images captured by the photographs fostered either risk or resilience. For example, photographs taken by two participants reveal that homelessness exposes people to considerable degradation, environments that produce little in the way of esthetic engagement, complexity, and beauty. Alternatively, the participants offered numerous photographs showing places where participants found refuge, care, and assistance. Such photographs amplify amplify the importance of the sacred as helping resources that strengthen resilience. The photographs of a Franciscan organization and another of an urban church underscore the important role these places served in helping two women survive homelessness. One participant was confident that the priest of the Franciscan organization was always willing to lend a hand in helping her navigate the many challenges she faced daily while the urban church offered events, activities, and meals integrated with the mainstream congregation. Photographs extend people’s narratives and through image reveal what the participants see as the places that compromise or fortify resilience. The eight participants individually interpreted scrapbooks they constructed in earlier phases of the project, clarifying for the investigators their vision of what their post-homeless worlds could be like in the realms of housing, relationships, career, and health (Washington & Moxley, 2004). Several women introduced other sources of narrative including the poetry they authored while they were homeless and diaries in which they recorded their key

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experiences and the intimate feelings specific events produced. Communicating her sense of hope and fortitude through a poem she entitled “Every Day,” one participant used verse to cope emotionally with homelessness: Every today has a billion yesterdays, and a million hopes for tomorrow. Every today has a billion smiles, and a million tears from sorrow. Every day someone laughs while another one is crying. Every day someone gives birth while someone else is dying. Every day the sun shines somewhere in another place it’s raining. Every day someone gives thanks while someone else is complaining. Every day is fresh and new, one never seen before, and once that day is spent, will be seen no more. Today was yesterday’ tomorrow. Today will be tomorrow’s yesterday. The author’s interpretation of this poem emphasizes themes of hope, fortitude, and persistence. What resonates here is the confidence this participant had in her own recovery from the ravages homelessness induced. About her motivation to write this poem, she says: I never gave up believing I was going to get my life back. God had not brought me that far to leave me. There is a song that says ‘When the praises go up, the blessings come down.’ God had watched over me and protected me while I was sleeping in my car on the streets and in the alleys of (the city). Even though I was homeless, and in a shelter, I was thankful to be alive. I had food, clothes, a job, and a reasonable portion of health and strength and oh yes, my sanity. Whatever situation you find yourself in, it could be worse. Being thankful is one of the main ingredients of ‘The Secret.’ I knew ‘The Secret’ but I didn’t know it was a secret. Quilting was used as a capstone event. After the completion of the TMS interviews, the authors and the eight women convened for additional sessions. With the assistance of a group work facilitator, each woman created an individual panel capturing her principal theme in which she interpreted her resilience in the face of vulnerability (Washington, Moxley, & Garriott, 2009). In the spirit of Faith Ringgold’s (Farrington, 2004) story quilts, the panels assembled together tell a story of leaving homelessness. So within the TMS subproject, narrative was broadly defined, and was conducted individually and in group sessions, mindful that each level of narration brought forth new insight into risk, vulnerability, and resilience. The inclusion of multiple forms of representation inherent in the use of a broad framework of narrative facilitated the identification of meaning clusters across the eight lives. The meaning clusters moved the authors from thinking about resilience as solely an internal quality of a person to viewing it as possessing transactional qualities, as a fund available to individuals who pull from the wellspring of relatedness to others in strengthening themselves against the harsh and demanding realities homelessness entails. Interpreting resilience within the context of the Telling My Story inquiry Resilience as co-creation The meaning clusters the authors derived from the eight narratives demonstrate how resilience possesses transactional qualities—connecting an older African American homeless woman

to others, whether these are fellow travelers seeking to cope with and escape homelessness, trained human service professionals, church leaders, or other professionals like attorneys or a teacher, guidance counselor, or school principal, such as in the case of one participant who had school contact because she parented a dependent child. What was missing from these meaning clusters was the option of approaching the biological family for immediate concrete assistance, particularly the family of origin, or the family of procreation. One reason for this reticence stood out for one participant who emphasized: “My family is in as bad a shape as I am so I’d only add to their burden.” Each of the eight women considered what for them constituted resilience. One participant indicated that resilience was “survival in the face of overwhelming odds, which required grace, and the presence of god.” Another participant indicated that resilience was for her a way of “keeping going even when things brought me down.” Still for another participant resilience meant creativity—of creating new options when others had closed down, of creating new ways of thinking and discovering “who I am as an artist.” For this latter woman, resilience stood as a creative process, one that brought her into new commerce with individuals who were fellow sufferers, and with those who could help in novel and profoundly important ways. She spoke of resilience as something formed among two or more people undertaking the hard work of coping, struggling, surmounting, and eventually transcending. By temperament and life experience, this woman was a creative artist who committed herself to the practice of poetry, something she rekindled from traditions handed down to her on her mother’s family line. But when the authors consider the countenance of resilience among all of the women, each is an artist in her own way: only one created in isolation, the other seven co-created solutions with other people using resources they could secure through community agencies, shelters, past relationships, caring people, sacred places, and devoted health care providers. For one participant attempts to co-create failed when those from whom she sought help exploited her. Co-creation also came from psychological stores garnered from past relationships. For one woman, the voice of her deceased grandmother came to her during a difficult time, stimulating memories of her grandmother as a powerful role model who showed fortitude in the face of adversity: “My grandmother was my guide,” according to this participant. Still another source were the shared memories of African American cultural survival and triumph: at least four of the eight women remarked that they hung onto memories of relatives from the past that helped them think of themselves in historical terms. These relatives faced injustice and discrimination with great courage, and they moved forward, and sustained themselves in the face of adversities. Sources of co-creation Bolstering resilience in partnership with other people is a powerful framework of intervention for helpers reaching out to those who are homeless. What are these sources of co-creation, from the perspective of the eight women who participated in the Telling My Story inquiry? The following thematic categories stood out in the women’s narratives: 1. Forming a proto-family. Six of the participants shared time in the same shelter and came to know one another in meaningful ways. One of the participants assumed the role of the elder or “mother,” who was seen by the others as possessing a wealth of coping resources she could share with the members of the proto-family: wisdom, fortitude, clear thinking even under stress, depression management, and a strong sense of humor. “Mother” was a clear source of support to the other women who sustained their

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morale in partnership with one another as siblings of sort, and by touching base with the family leader when things felt overwhelming. 2. Observing or invoking memories of powerful role models. Earlier the authors discussed this source of resilience in the face of vulnerability. It is particularly relevant since it is one of the principal sources of the self-efficacy Bandura (1986, 1997) identifies as critical to adaptation. For five of the women, they could speak to how people they knew handled adversity, and maintained their morale in the face of great challenges. Role models could be drawn from the immediate situation by looking around and finding individuals who stood out as people who were resilient underscoring the importance of observation and vicarious processes in effective coping (Bandura, 1997). As mentioned previously, participants could draw from the memories of family members long deceased whose conduct, character, and world view could inform a woman’s active coping with the exigencies of homelessness. While most of the women were reluctant to request help from their immediate biological families, the storehouse of coping passed on to them from previous generations of family members proved important. Still attention to role models in the immediate situation enabled the participants to engage in social learning—in observing vicariously what they thought were productive strategies undertaken by others who were homeless. Discussing these strategies among themselves shows how resilience can be transactional: being with others, particularly those with whom we identify, fortifies us—it can reduce anxiety and structure cognition in goal directed ways (Csikszentmihalyi, 1994). The women’s dialog about their homeless situations often took place within informal group settings, which underscores the importance of group work, whether this activity is undertaken informally or formally. Work in group augments information processing and can foster among members a consideration of productive ways of thinking and doing. Meshing group work with the proto-family can integrate instrumental and emotional support within a context of peer self help thereby offering ways of further preserving and developing participants’ self-efficacy during periods of considerable adversity. 3. Aural reception of adaptive knowledge. Standing out from much of the content of the TMS interviews was just how much participants talked about the importance of sharing with others the knowledge of what works in surviving and overcoming homelessness. Hearing ideas from others was of great importance to four of the women when they underscored the benefits of hearing others talk about good social services, places where housing could be secured, accessible health care, and places where one could secure food. “Listen and learn,” one TMS woman asserted. Being receptive to these ideas required a person to pay attention within contexts in which they could learn peripherally. If you are not a member of a certain group (or proto-family) hang out in a convenient location so you can hear what is being said and shared. Such aural reception of knowledge is a further selfefficacy asset contributing to social learning. The knowledge comes in the form of “know how,” inherent in hearing something that sounds productive and useful within the immediate context in which one must prepare each day to survive homelessness. A decision to try out what was heard was a salient part of strategy for leaving homelessness. 4. Using folk wisdom. This concept indicates that there is a fund of knowledge within the African American community useful in surviving bad situations and in transcending adversity (Bridges, 2001). For the TMS participants, folk wisdom came from mothers, fathers, aunts, uncles, grandparents, and other family members who selflessly handed down knowledge from previous generations in the form of action strategies for “making do,” as one TMS participant suggested. Folk wisdom was of broad

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scope and included care of the body and hair, making nutritious meals, caring for wounds and injuries, keeping the spirit intact through prayer, and keeping hands and minds productive by mending and making through the application of practical arts involving sewing and stitching. Also, important here, is a heritage of song and verse, since spiritually oriented singing proved to be an important way the women sustained hope within group life. 5. Maintaining the practice of faith and spirituality. This source of resilience emerged as a consistent theme. The women saw their faith and spirituality as a bulwark against adversity. The theme of prayer emerged time and again across all of the eight narratives imbuing this practice as one of the most salient and frequently identified. One participant saw her entire resilience built on a foundation of the spirituality she enacted both in her church and in the chapel of the shelter in which she sought comfort. When asked how she faced homelessness with so much resolve, this participant said “I prayed a lot.” When asked how she maintained her momentum, she reported “I prayed deeply.” For her, prayer was not only a way of soothing the pain from serious health challenges she experienced regularly, but as a way of handling cognitively and emotionally the challenges of homelessness. Moving on In their roles as governors of the project, the eight TMS participants convened in December, 2009 to review the project and set its direction for the period of 2010–2011. No longer are the participants homeless and all function well despite serious health challenges that may involve diabetes, gait problems, lung disease, arthritis, or auto-immune disorders. The participants came together to honor the second author’s retirement and had opportunities to discuss what was working for them. All of the following references to personal names are pseudonyms. For Mary, recovery meant working as a peer support specialist employed by a major urban mental health provider. She is active statewide in the peer support recovery movement and serves as a speaker and trainer for the state program. Her expertise extends to helping her peers access mental health services, housing options, and social security benefits. With their housing secure, two other participants have made plans for further education involving matriculation in community college. Lisa, although displeased with her current employment situation, follows her strong work ethic, and holds two part-time jobs. She is adamant about obtaining full time employment with good benefits. Still, Harriet is following her dream of entering a mentoring role that enables her to help inner city minority youth develop skills in the use of computers. Through peer support from other TMS participants, she is overcoming a serious depressive episode that has fortunately resulted in her access to responsive mental health services. Molly is enjoying retirement secure in her housing situation with the assistance of Section 8 benefits. She continues her avocation as a collector of memorabilia. Margaret is working at an entry level job, which she does not find satisfying, but is proud of her productive involvement in the world of work. She is anticipating heading back to school soon as she accumulates more savings. Very importantly, however, is her role as an educator. In partnership with the second author, recently Margaret conducted a workshop educating graduate students in the health professions about their role in preventing homelessness, and in helping homeless women achieve successful transitions. And finally Sally nurtures an adolescent son who has grown to be an intelligent, motivated and engaged student. He was actively involved in the meeting offering insight into the next steps of the project he witnessed unfold over seven years as his mother brought him to numerous project events beginning when he was nine.

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The participants found housing options with the support of the project and through local programs that offered Section 8 benefits. Employment has remained a vexing issue since all of the women do not qualify for priority status under vocational rehabilitation. Finding dignified work in the face of serious health challenges, and with good benefits, is a major challenge each woman can still face. Paradoxically, the more participants employed their strengths in overcoming homelessness and the more success they achieved through their own efforts, their eligibility status foundered because, as one participant pointed out, “I function too well for benefits.” For several women their strong work ethics can be a source of stress if they are unable to fulfill them through what they consider productive and good employment. And, access to high quality health care, particularly dental care, remains a challenge several of the women face. But these outcomes do indicate that each woman is out of harm’s way for now; yet no one is completely satisfied with her current circumstances. The women’s involvement in the TMS project spearheaded their further involvement in peer and mutual support (the group has stayed together for some seven years), advocacy work on behalf of other women who are homeless, education of health and human service professionals, self development through art and hobbies, and search for productive activity typically through better paid work. For seven of the women, good jobs remain an important but elusive goal, and even though they are on the threshold of late life, they still yearn for productive engagement in the world of work. For six of the women, career development stands out as an important personal focus of further investment. While not specifically designed as an intervention, the narrative approach for each of these women had powerful implications for their life planning. As one of them emphasized, reviewing the life course is a “good way for appreciating what you have overcome.” For another woman, the narrative process helped her “think about my direction and my strength as a person.” All of the participants agree that a principal product of the narratives, an exhibit they organized in partnership with the LHIRP curator and principal investigators, in which they acted as docents of their own conceptual portraits (composed of artifacts and photographs), served as a powerful developmental experience. The exhibit was initially piloted with over 100 visitors in 2006 and subsequently moved to other locations during 2007 and 2008. The TMS participants learned that their own stories held significance for the community as a whole as they saw directly how their own stories aroused considerable emotion in exhibit visitors. Educating these visitors about risk, vulnerability and resilience empowered their perspectives and amplified their fortitude. While some may criticize such conclusions, they are nonetheless integral to an empowerment frame of practice. Such empowerment is a product of the self-efficacy process LHIRP incorporates. If anything the use of narrative is heuristic: the method suggests useful hypotheses about the influence of narrative on participant motivation, persistence, and outcome in group and interpersonal helping. Souls in extremis: pervasive risk and vulnerability While the authors suggest that these sources of resilience serve as virtues, the context in which TMS participants enacted them were not virtuous. Homelessness is not intentional poverty, but a form of violence in which risk and vulnerability are pervasive. The TMS women serve as models of what Blatt (1973), the advocate for people with developmental disabilities who were inmates of large congregate care institutions, called “souls in extremis.” Risk and vulnerability are constitutional, particularly in the case of homeless minority women who are coping with serious health problems prior to entering a context that can only undermine well being and adaptability.

Diminished supplies, like good nutrition, can weaken host resistance to viral and bacterial infections, particularly in congregate care situations, like shelters. And the depression of the immune system through constant exposure to considerable stress can further reduce adaptation and thus erode the women’s functioning. The social dynamics of discrimination and racism factor into this situation also. For Sally, getting past what she called “brick walls,” impediments to realizing a desired practical outcome, like housing, was one of the biggest challenges in making a successful transition out of homelessness. But she was very mindful of her own race and anticipated facing discrimination as one of those brick walls: Interviewer: Were there any fears that you started to feel or experience when you started moving out of being homeless? Sally: Yeah, many Interviewer: What was one that you’re the most mindful of? Sally: Whether or not I was gonna run into the same brick walls again. Interviewer: And the principal brick wall for you was, the feeling of racism, the feeling of . . . Sally: Discrimination, you know I hate to use the word racism, you know because, I don’t know, that’s been around for so long it seems like it’s obsolete. I prefer to say like, discriminate. Isn’t there a difference between racism and discrimination? Interviewer: For other purposes there probably is a difference, but for our purposes it’s the way you view the world that’s the most important. Sally: Ok Interviewer: So if discrimination captures that better than another word then let’s stick with that. So you were concerned about hitting that brick wall. Were there other brick walls? Sally: Um Interviewer: That you feared Sally: That I feared? Not really, I think that was about the only one, you know. Interviewer: And you were thinking that . . . Sally: I would have to fight and struggle and present my case more forcefully, and it would be more determined, you know, to get them, the person to understand, you know, where I’ve been and where I’m trying to get to, and please don’t let it be the same, you know, the same answers all the time. Seems like it be the same answers all the time but yet I’m asking different questions, you know. So, that’s the biggest fear. Interviewer: Were there resources that you felt you needed, not ones you had, but were there resources that you felt you needed to begin recovery from your homeless situation? We identified financial ones, employment, spiritual ones, governmental services, we can go through each one. Did you feel you needed to do anything specific to get your financial situation in shape? Sally: Um, financially I knew that I needed an income but there was no way of getting it. Risk and vulnerability are locational: Locating oneself within a shelter can put one at risk of potential violence and victimization, and regimented cultures do little to personalize those who need genuine attention the most. Thus, constant anxiety is a part of homelessness as well as learned helplessness that depersonalization can induce. For one participant the shelter was a place in which she had little opportunity to personalize her living situation for herself and her son: The actual shelter; we had one room where we were living in, it was a big room with three sets of bunk beds. There was really no privacy. You just; you were only able to bring in a bag of clothes per person, so I had a bag of clothes and Christian had a bag of clothes.

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Living on the streets is no better as a woman must be constantly vigilant—being constantly wary of strangers, resisting offers of assistance because of trust that easily evaporates in the face of uncertainty, and warding off potential danger through hostility. Constant vigilance coming from a need to protect oneself may account for the hostility people who are homeless may demonstrate toward others. Learning how to instill fear in others is an asset one TMS participant modeled quite well in explaining her own strategy of self protection. For Margaret (a pseudonym) the purposeful expression of hostility was a way to manage her vulnerability. Physical, paraverbal, and verbal manifestations of menacing threats served her well and, from Margaret’s perspective, ensured her survival on the streets by warding off strangers. Souls in extremis, people living in health and safety compromising situations, may adapt in ways that accentuate the negative self. Her own “make do” efforts to take care of herself could lead to misinterpretation in public settings and considerable frustration could well up in Margaret, which she counteracted psychologically by hoping for a better future: Margaret . . ...it was hard. It was very hard. And ah . . . sometimes if I’m on the bus, I would go to sleep on the bus, and the people thought I was drunk. But, you know . . . once I got on the warm bus . . . goin to where I was goin, I’d go to sleep before I’d get there. Interviewer-You must have been exhausted. Margaret-I was. Interviewer-For 6 months. So, when you think about that 6 month period that you’re probably thinking . . . I was just exhausted. Margaret-Yes . . . Interviewer-How did you survive? Margaret-I just kept telling myself things gonna get better. Interviewer-Is that right. Margaret-and I had to keep the faith. I had to start . . . ah . . . Interviewer-that’s okay . . . if you need to cry . . . Margaret . . . if you need to cry, cry . . . even if it slows us down. Okay. Margaret-(Crying) I had to tell myself that things gonna get better, and ah . . .. I refused to let it get to me real, real bad. The vulnerability here is demonstrated in practical ways through the Getting Out of Homelessness Interview (GOOHI) the authors developed in another subproject of LHIRP. GOOHI facilitates a structured dialog process with a helper in which the participant identifies the serious issues she faces in her efforts to extricate herself from homelessness. Practical issues emerge from the interview such as damaged credit, debt as a product of predatory lending, the need for expensive, specialized health management equipment or medications, income inadequacies, and the absence of affordable housing. The issues themselves form a proxy indicator of vulnerability since when they are seen as intractable (i.e. not lending themselves to resolution), pile up because they resist resolution, create considerable stress for the person, and cause high levels of frustration, a person exists in very problematic circumstances. Such vulnerability can manifest itself in depression, loss of morale, pessimism, and helplessness, all psychological qualities souls in extremis experience, but qualities that likely did not cause homelessness in the first place. The GOOHI profile is the operational indicator of extremis, the extreme situation, and reflects the extent to which a person can be considered vulnerable to diminished functioning, poor health, and low morale. In the helping professions assessing extremis may be one of the most important steps in understanding a person’s vulnerability. For those who experience extreme negative situations, the vulnerability multiple, serious, and intractable issues produce can overwhelm resilience.

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Conclusion The homeless experience involves considerable hardship and threat, and squanders human potential. When considering this kind of situation, one into which a woman falls because of vulnerability, and one that amplifies vulnerability, the issues a woman reveals both in her narrative and GOOHI interview are likely practical handles for appreciating her profile of risk. In other words, the illumination of specific issues, elaborated in the actual words of the woman, continues narrative development. The eight narratives themselves influenced the development of the LHIRP assessment framework and the practices project personnel have applied to helping subsequent participants elaborate their situations, identify their strengths and needs, and formulate promising strategies useful in removing themselves from homelessness (Washington & Moxley, 2009a). The assessment approach itself does serve as a form of intervention. A different LHIRP study of the assessment benefits participants have identified involve information, unburdening, cognitive focus, and clarification of direction as some of the positive outcomes participants gain through their involvement in the LHIRP assessment process (Washington & Moxley, 2009a). A woman’s full participation in elaborating those issues she sees as important, and prioritizes for resolution, imbuing each one with criteria that will operationalize what she finds satisfying in a resolution, make the entire process person-centered in the best sense of the word (Moxley & Freddolino, 1990, 1994). Helping each participant mobilize those strengths that make her resilient can also bolster cognitive focus and enhance motivation. It is this action undertaken in concert with the helping professional that fosters the participant’s development of a new narrative. And, it is this new narrative that can serve as the well spring of change. References Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman. Blatt, B. (1973). Souls in extremis: An anthology on victims and victimizers. New York City: Allyn & Bacon. Bridges, F. (2001). Resurrection song: African-American spirituality. Maryknoll, NY: Orbis. Carlson, T. D. (1997). Using art in narrative therapy: Enhancing therapeutic possibilities. American Journal of Family Therapy, 25, 271–283. Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage. Csikszentmihalyi, M. (1994). The evolving self. New York: Harper Perennial. Dickson-Swift, V., James, E., Kippen, S., & Liamputtong, P. (2008). Risk to researchers in qualitative research on sensitive topics: Issues and strategies. Qualitative Health Research, 18, 133–144. Farrington, L. E. (2004). Faith Ringgold. Petaluma, CA: Pomegranate Communications. Feen-Calligan, H., Washington, O., & Moxley, D. (2008, September). Use of artwork as a visual processing modality in group treatment of chemically dependent minority women. Arts in Psychotherapy Journal, 35(4), 287–295. Fincham, D., Scourfield, J., & Langer, S. (2008). The impact of working with disturbing secondary data: Reading suicide files in a coroner’s office. Qualitative Health Research, 18, 853–862. Hardt, K., & Angus, L. (2004). The narrative assessment interview: Assessing selfchange in psychotherapy. In L. E. Angus, & J. McLeod (Eds.), The handbook of narrative and psychotherapy (pp. 247–262). Thousand Oaks, CA: Sage. Minnery, J., & Greenhalgh, E. (2007). Approaches to homelessness policy in Europe, the United States and Australia. Journal of Social Issues, 63, 641–655. Monk, G., Winslade, J., Corcket, K., & Epston, D. (1997). Narrative therapy in practice. San Francisco: Jossey-Bass. Moxley, D., & Freddolino, P. (1990). A model of advocacy for promoting client selfdetermination in psychosocial rehabilitation. Psychosocial Rehabilitation Journal, 14, 69–82. Moxley, D., & Freddolino, P. (1994). Client-driven advocacy and psychiatric disability: A model for social work practice. Journal of Sociology and Social Welfare, 21, 98–108. Moxley, D., & Washington, O. (2009). The role of advocacy assessment and action in resolving health compromising stress in the lives of older African American homeless women. In P. Bywaters, E. McLeod, & L. Napier (Eds.), Social work

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