“I need to learn to walk at their pace and not mine. It can only be done at their pace.”

Edwina Gately

The model which has evolved over the last twelve years, has always been and continues to be client led. The women who have come to Street Talk have defined the therapeutic work according to their own rhythm and at their own pace.

It has taken thirteen years to write up the clinical model because it was necessary to look back over the work, to identify the patterns of engagement which have emerged. Whilst each woman’s experience has been individual, it is possible to map out a distinct pattern of engagement for those women who have made significant progress. It is this pattern of engagement that has formed the basis of the four stage model which Street Talk practices.  

The name “Therapy of presence” has arisen from the importance of the presence of the therapist throughout the process, including those times when the client is not present. 

Accompaniment and bearing witness is central to the therapy and connects all four stages, including those periods when women are absent or attending intermittently.  Sarah Anderson’s paper The Value of ‘Bearing Witness’ to Desistence examines the importance of accompaniment in the work of Street Talk. 

“Drawing on Object Relations Theory in work with women who had, for the most part, experienced significant trauma, ‘bearing witness’ – and related ideas from psychoanalytic psychotherapy such as holding, containing, and accompaniment – were presented as both an activity and outcome of the service’s work………… The women’s accounts emphasised that one of the most beneficial aspects of the service for them was presence, in Cody’s three senses; temporal and emotional ‘accompaniment’ on their journey, reiterated through physical accompaniment at significant life events, such as family court proceedings.”

Anderson, S. et al (2014)

Therapy in Four Stages

Stage 1, the beginnings of the therapeutic alliance: “How can I know that I can trust you?”

Women usually ask to see the Street Talk therapist at a time of a crisis, when something traumatic such as a serious attack or rape, an overdose or other event which makes them feel particularly vulnerable has happened.  It is frequently an experience which involves survival, either their own or that of someone else who is significant to them. Women typically attend about five sessions at this stage which may be anything in length between twenty to fifty minutes, according to how long they can manage. The focus of the sessions at this stage is mainly on the recent event which brought them to the therapist and their immediate relationships with hostel residents and staff. 

During this phase the client tests the therapist, discovering whether the therapist is a person who can be trusted, the client feeling their way with some caution. At the same time the client is getting accustomed to the nature of the relationship and there are the tentative beginnings of a therapeutic alliance. The client will often ask questions such as, “How can I know that I can trust you?”  or “How can someone like you help someone like me when you know nothing of my life?” Reasonable questions which should be asked, although not necessarily easily answered.  

This phase is usually too brief for the therapist to begin to work with the transference, or to come anywhere close to making any interpretations. The therapist offers some containment which may be a woman’s first experience  of containment within a relationship. During this phase, the therapist looks past the client’s immediate trauma and their defences, the acting out, to catch a glimpse of their humanity. This forms the basis of the counter-transference which is fundamental to the next phase.  Although this phase is short and the client may not manage for fifty minute sessions, something significant takes place during this phase. Almost all the women come back to the therapist to do some serious, committed work at a later stage, when they are ready. This period of initial engagement seems to lay the foundations for the therapeutic alliance which will develop at a later stage. The women hold on to that experience and carry it with them, putting it to one side until needed.

Stage 2, passive creative work: “You didn’t give up on me.”

This is the phase of the work which most distinguishes the Street Talk model from other models. This is a difficult phase for women as well as for the therapists. 

“…{therapy} is not an easy option. It requires demons to be confronted: many women find it harder than prison.”

Corston, J (2007)

During this phase, the client more or less withdraws from the therapy, only making intermittent and informal contact with the therapist over a period which may last up to four years. The client makes occasional contacts, sometimes just a few words in passing or a message sent with another woman, that seem to serve to reassure the client that the therapist is still there and still willing to work with them. The therapeutic alliance is supported by those occasional contacts made by the client,  who seems to be communicating that they have not forgotten the therapist, they have not ended this process; it is a gentle tap from time to time on the therapist’s door. Occasionally the client may ask to see the therapist during this phase, but usually for an isolated one-off session. 

Throughout the period the therapist continues to be available to the client. The counter-transference which began to form in the first stage sustains the therapeutic alliance through this phase. It is important to the client that the therapist remains engaged and is willing to pick up the work at any point over this period. When the client is ready to engage in a more regular way, to go on to the next phase they look back on this period, as one where the therapist has maintained their belief in their capacity to recover which forms the foundation of the therapeutic alliance over the next critical stages. Looking back over this period women have frequently said, “You didn’t give up on me.” It is evident that the experience of the therapist waiting patiently, without putting a time limit on the wait, provides a significant, positive experience for the woman. It is crucial that the therapist keeps the woman in mind throughout this period, remembering her experiences. 

 “They did not overwhelm us with their optimistic plans for our future but they remained hopeful despite the odds. Their love for us was like a constant invitation, calling us forth to be something more

Deegan (1988: p.3)

Looking back over the last thirteen years, the women who have worked with Street Talk, with only one or two exceptions out of hundreds of women, have needed to step back from the therapy for a period.  It seems that a period of latency is integral to the process which within Street Talk we have come to refer to as passive creative, the antithesis of passive aggression. There are periods in this work when the client is absent, during which the therapist holds the therapeutic space and holds the client in the countertransference. As with passive aggression, whilst there may be no activity, there is intention.  

“most journeys of recovery involve shifts in motivation, action, and circumstances”

Farrall and Calverley (2006)

Although the client is not engaged in the conventional way throughout this phase, there is nevertheless some small tenuous engagement, possibly relying on no more than the memory of an earlier session, but it is this phase which eventually leads the client to the third and most creative phase of the work.   

The challenge for the therapists during this second phase is to feel confident with the rhythm of the work which allows for a long period when the client is mostly absent. The women who have come to Street Talk have their own pace and their own rhythm which it is the responsibility of the therapist to adapt to without judgement and without negative interpretation. The conventions of therapy, the fifty minute session, evenly paced, a week apart, works well for people who have a minimum of stability in their lives, who are not living in chaos. The women who have come to Street Talk over the years have demonstrated that one can engage with a therapist in an entirely different way and ultimately achieve the same outcome.  

“Continuous and flexible support, that is not time-limited, is important”.  

Maruna (2001)

The continuity, referred to by Maruna in this case is created by the continuous presence of the therapist.

Stage 3, turning point: “I know why I am here.”

This is the stage when women make an active choice to engage with Street Talk. Looking back over the cases it was striking that those women who made significant progress all encountered their turning point four years after they first presented to the service. This was sometimes precipitated by a significant life event, such as a pregnancy or a bereavement which made them reflect on their own life, or sometimes it was an experience which made them fear that they wouldn’t survive unless something were to change. Whilst these are the most common events which bring women back to the therapy there is a range of circumstances.  It is evident that women have to find their own motivation before they will engage with commitment.  

Once they are motivated, women return to the Street Talk therapist and organise to have weekly sessions which last for the full fifty minutes, even when to do so involves travelling across London or further. Attendance during this phase is very high, the momentum picks up, the therapeutic alliance strengthens, and it is during this phase that the therapist is able to work actively with the transference. This stage lasts for eighteen months on average. In some cases, women were offered the opportunity to take up counselling with a different agency at this point, perhaps as part of family proceedings, but without exception, the women have insisted that they continue the work with Street Talk. Where the court has ordered counselling as part of a sentence or in the case of family court, where counselling is as part of a care plan, in every case women requested that their lawyer insist that the counselling be provided by Street Talk. 

Women tend to come to this phase of the therapy with a goal, which may be to get their child back from foster care, or to get well enough to make contact with family from whom they have been estranged, or to live a little longer. The goals will reflect the motivating factors and come from the women. Women frequently come back to the therapist at the start of this stage with the words, “Will you help me to….?” 

Whilst women come to this phase with a specific goal, object relations therapy works closely with the client’s experience of relating, the observance of the client’s shifts between the depressive and the paranoid schizoid position, and the work with both the projective identification and the transference. Those women who come back to the work at this stage have the capacity and commitment to work with these concepts. 

At some point in this stage women have sometimes said, performatively, “I know why I am here”, or words to that effect, at a point of insight, when they have made the connection between childhood events and their current situation. Peta said those words when she was in rehab after her baby had been born and Rachel said those words at one of her sessions which took place in prison.  The women’s lives are extremely complex, traumatic experiences in their day to day lives, obfuscate the facts of their earlier lives and for many, growing up moving from one foster carer to the next they don’t have the shared narrative of their lives which people who grow up in loving families have. This makes it hard to unravel events, to put the facts together in a way which creates a coherent narrative. Sally did not know her age, her name, her ethnicity or anything about her birth family, including whether she was removed from her birth mother or voluntarily given up to the state care system.  

That moment when women begin to make sense of the connection between the events and relationships of childhood and those of adult life represents a therapeutic turning point, where women begin to free themselves from the deep rooted, unconscious shame which comes with sexual and other abuses in childhood. They begin to distinguish between the self and the abusive actions of others, over which they had no control and for which they had no responsibility. This third stage is a period of discovery and release for the client, an untangling of suffering. It is a rich and deeply rewarding time for both client and therapist. It is worth the wait, even when that wait lasts four years. The important thing is that women have to find their own motivation which is always unique; our work is to be there when they do.  

“Nothing inherent in a situation makes it a turning point”

Maruna (2001: p.24)

Stage 4, working from a more peaceful place.

“I am starting out now. This is the first time I have been able to look back to understand  what has happened, how I got here and to look forward to see where I want to go. I never thought about those things before. I was on the run. This is my beginning.”


Across the sector there is a general understanding that recovery occurs when a woman becomes abstinent, exits prostitution, moves into independent accommodation and in some cases, has parental responsibility for her children. When women achieve these goals, professionals tend to withdraw, not least because services are stretched and can’t justify continued involvement. What we have learned from the women is they are vulnerable to relapse at this time. Having achieved goals they have strived for over years they can feel an anti-climax, as well as a loss of direction which can be disorientating. The dream of an ordinary life is just that, ordinary. The drama they have become accustomed to is replaced by mundanity. Instead of appearing in court on Tuesday, women have to remember to put the bin out on Tuesday. They are frequently accommodated in an area where they feel isolated, because the tendency is to accommodate women out of borough where there will be less chance of encountering people who might  trigger cravings. Women frequently experience a profound sense of loss at this point. They have lost their old familiar community of drug dealers and working women and suddenly they find they have also lost their support network of professionals. For women who have lived communally all their lives, the adaptation to living alone or alone with a child is challenging. After being used to having company at all hours of the night and day, solitude is extremely difficult and this is what the women we work with struggle with the most.  

Street Talk continues the therapy with women over this period, but it is at this point that there will be a contract between the client and the therapist to decide when the work will end, which may be six months or a year, according to the circumstances of the woman. Women experience something of a shift in perspective at this point; the establishment of a stable routine, free from trauma and free from the pressure to achieve specific outcomes enables a rich, insightful period in the therapy. Women have the freedom to consider what they want for themselves in their future without having to jump through hoops imposed by other professionals, and this is often a time when women go back to revisit deep hurts from their earlier life. It is a creative but deeply reflective period when the past and the future come together. 

Recovery seems to depend on making sense of how one came to hurt all the people one ever loved and how one made selfdestructive choices.  When Laura, referred to above, was awarded full parental responsibility, there was an atmosphere of celebration in court, professionals were congratulating her as well as each other. The judge wept with joy.  Laura ruptured this mood when she stood up and reminded the room full of jubilant professionals that she still grieved for her four other children, who had been removed and who had grown up without their mother. What she was telling us was that whilst we  professionals were celebrating, the experience was much a much more complex one for her. 

This period post so called recovery, is one where women can examine that complexity and make sense of their recent triumphs alongside their previous losses.  Rather than measuring success by outcomes, it might better be measured by the sense that women make of their lives once they have achieved their goals. Women feel not only that deeply embedded instinctual shame experienced universally by anyone who has been sexually abused, but alongside that women feel self-loathing and a different kind of shame for the people they have hurt along the way, family, their children, the people they have loved. This is the stage when women confront grief and some of that grief is for the loss of the life they might have led and for the person they might have been if they had lived a different life. It is a period of  grief, of knowing that other people, sometimes children, have also suffered. To enable women to reconcile with the self might be our primary goal with the women and it is at this stage when that work mostly takes place. 

Once women have reached the agreed end of their work with Street Talk they know that if a crisis should happen in the future, they can return to the therapy and there have been women who have ended at the point when that felt right, but who have come back when something has happened to make them vulnerable again. 

It is very common for women who have reached this stage to want to use their own experiences to help other people who might be struggling with similar issues. When women have ended their own work with Street Talk, some take up the opportunity to volunteer with us as mentors. Almost all of the women who reach this stage want to work with vulnerable women. None has expressed material goals; their goals are always altruistic.