Peer Support

“It is one of the most beautiful compensations in life that no person can sincerely try to help another without helping themselves." Ralph Waldo Emerson 


We who have the lived experience of a mental illness have "always" used peer support. Peer support is that natural helpfulness when we see a friend struggling with an issue that we ourselves once had - we help out.  We lived through it and now we can guide another person to have a better time of it. 

   Inpatient in the hospital, often times the most helpful information came from the other patients - if only to say things like, "stay away from nurse Betty as she's always in a bad mood" or "the meatloaf on Tuesday is good" or even "try to get Dr. Bob as he is the best doctor." These kinds of statements helped us to navigate our hospital environment.

   When living in the community our peers offered helpful information about living with mental health problems and finding resources in our community. " The soup kitchen is on Vine street." or " You can get bus-tickets from Sweet Time Charities." or ever " don't go to the AA at the Baptist Church, they're faking it."  are great examples.  People who got these kinds of help from peers did better than those who didn't. They became noticed by the medical establishment who saw value and the accelerated progress of the people who were connected to support  from peers .

   Peer support has become a best practice model for supporting people who have been diagnosed with mental health problems, peer support can be one of the most significant tools a person can use on the journey of recovery. This model relies on individuals who live with mental illness to provide peer-to-peer support to others, drawing on their own experiences to promote wellness and recovery. Peer support is about getting help from someone who's been there. Based on mutual respect and personal responsibility, peer support focuses on wellness and recovery rather than illness and disability. Peers share with one another their experiences, their strengths, and their hope - a powerful combination for recovery.

   Peer Specialists are mental health consumers who have completed a specific training that enables them to enhance a person's wellness and recovery  

Intentional Peer Support as Social Change

                                                                                                          by Shery Mead

As peer support in mental health proliferates, we must be mindful of our intention: social change. It is not about developing more effective services but rather about creating dialogue that have influence on all of our understandings, conversations and relationships                                                                                                                   (Shery Mead, SAMHSA Webcast 2010).  

Intentional Peer Support is about conversation. It’s about how we know, how we create new “knowing” through dialogue, and about how we as human beings interrelate by beginning to practice the art of connection – with ourselves, the people in our lives, and the people on the planet we may think we have nothing in common with. For me, it is a practice that has no right or wrong. It is always in flux; much like improvisation in music. It is a process of experimentation and co-creation. It assumes that we “play” off each other and create ever more interesting and complex ways of understanding. We see it as a tool for keeping the world on its toes, becoming more comfortable with less predictability as we become less reactive to fear. In other words, it is not another practice that presumes to have the answers but instead, it aims to generate good questions. This paper will provide a brief overview of the three principles in which IPS is grounded: Learning versus Helping, Relationship versus the Individual, Hope and Possibility versus Fear. 

Learning versus Helping 

How have we become so stuck in assuming that our relationships have to be about helping and problem-solving? What does it mean to help? What does our need to help say about our assumptions of the other person? What happens if either they don’t want our help, or our help doesn’t “work”?

In the best of all worlds, we are altruistic and compassionate beings. We don’t like to see others suffering or in pain, and we want to make a difference. All too often, however, these beliefs and desires get in the way of building deeper understanding between people and can actually thwart learning and growth. For example, many good hearted people have gone to third world countries and tried to “modernize” and “help” their cultures. After all, it doesn’t have to be this way…does it? But what often ends up happening is that we (the outsider) act in ways that appear presumptuous, misinformed, disrespectful and even self-interested or dictatorial. We setup programs where people can learn from us without attempting to listen, understand, or acknowledge that perhaps the other culture has some important learning for us.

In the end, maybe one or two people will do something differently for a while, but then things often go right back to the way they were. Why is that? Are they just “unmotivated?” (How many times have we been called unmotivated by supposedly caring others?). We realize that in our haste to “help,” we have neglected to learn, share, get to know people in the context of their culture, let them get to know us and our understandings. Given our failing to do all that, is it really so surprising when nothing changes?

How could we do this differently? Well for one thing, most people don’t like someone coming in and setting up programs for them, telling them what to do, and making assumptions that what they’re already doing is bad. Instead, most people hope that we’ll learn more about them and how they’ve learned to make sense of their experience, learn about the cultural conditions that maintain the status quo, and most importantly, what their ideas are about what might make a difference. Then and only then are they willing to understand or listen to where we’re coming from. And this takes time. If our task has traditionally been to come in and do an assessment and create a plan (many organizations do this with well-paid consultants and aid organizations do this in other countries), we forget that it is not US who should be doing the assessment. In fact, it’s not particularly helpful for anyone to do an assessment of the situation (which is usually one party’s perspective of what’s wrong with the other party) before we know more about each other, build some trust, and get a chance to collaboratively see the bigger picture. Learning together takes time. It’s about building relationships where new information and new knowledge can emerge.

When people are willing to listen to each other’s stories without providing analysis, and at the same time compare and contrast experiences, possibilities for transfiguring meaning are endless. When we become part of each other’s narratives, we not only offer possibility for alternate (mutually enriching) interpretations, our new shared story becomes a way to negotiate future challenges and crises (see Crisis and Connection, Mead & Hilton, 2002) while building real communities

Relationship versus the Individual

What’s the difference between focusing our attention on the individual versus focusing on the relationship? Let’s think back to our discussion of the “helping” paradigm. What happens when I come in and do an assessment based on my beliefs and assumptions about your situation? Chances are, it sets up a dynamic between us that gives me the power and control and puts you into the role of passive recipient (possibly even seen as the ungrateful recipient). If my attention is on your changes or outcomes, chances are I lose sight of what we are doing/learning together, and most likely so do you.

For me there was a time when most of my relationships were about me and my “problems.” Sure I had friends, but it got to the point where every conversation started with “How are you doing today?” which led to me going off on a thermometer speech about how relatively difficult or easy a day it was, and ended with suggestions about what I might do or try to do and the promise that we could check in tomorrow…and these friends weren’t even getting paid. My idea of mutuality at the time was that when my friends were experiencing some difficult times, our conversations just switched in terms of our roles. In other words, the attention was either focused on me and my problems or you and your problems. While it has been conditioned into us to help people who are having difficulties, the mental health system has actually created relationships where we act more like each other’s therapists than we do friends.

Paying attention to the relationship is an altogether different phenomenon. It’s a bit like a dance or a jazz band where the sum of the parts is greater than all the individuals added together. It is not about playing the right notes (saying the right thing), it’s actually being fully present to the other (listening for the story, the context of the story, what’s unspoken in terms of feelings and meaning) and then responding not with the answers but intuitively, creatively bringing something that is both authentically you AND that is also from the place where you connect with the other person to the conversation. This flow of increased mutual understanding, as well as generation of new meaning, is the goal of Intentional Peer Support. And so we seek to discover what goes into building this type of conversation.

One of the keys is giving up the idea of predetermined outcomes (such as goals or symptom-reduction) and instead, learning to think laterally about the quality of our relationship. For example, instead of trying to persuade – seeking to understand, reflecting on our responses, and then speaking authentically from the heart is what seems most important to contribute. Following is an illustration:

Mary and Sue have been getting together for several weeks. Mary is feeling kind of stuck because it seems that Sue talks about her same old issues over and over again. She has tried to help but all her suggestions have been ignored. She decides that perhaps she’s been much more focused on solving Sue’s problems and much less focused on the quality of their relationship.

Sue starts again today by saying, “Hi Mary, I wonder if you can help me with my anxiety? It’s still really bad and I don’t know what to do.”

Mary’s typical response has been to say something like, “When my anxiety gets bad, I usually go for a walk,” in the hopes that Sue will start to take some responsibility for taking action on her own behalf. Today, however, she sees that this problem solving response is about her own need to feel like she’s doing something and she begins to wonder if talking about anxiety is the only way Sue knows how to connect. Mary wants to maintain the connection but is beginning to see that she’s as stuck in trying to help as Sue is in talking about what’s wrong. She says, “Sue, I wonder if you’re also feeling frustrated with our relationship since I tend to give you all these suggestions that don’t seem to do anything. I have to tell you, there was a time in my life when all my relationships revolved around getting “help” for my problems. It was my only topic of conversation but I realized that I was too scared people would go away if I didn’t need them as helpers. I wonder what our relationship might be like if I stopped just acting like a helper or as if I had some special wisdom?”

Sue owns that most of her relationships are based on getting help, particularly with regard to her mental health, and she doesn’t know how to do anything differently. Mary talks about how she is still needing work at not either taking or giving up power in her relationships – it’s such an old habit for her. In her family, charity and helping others were highly valued, so if there appeared to be a problem, it was expected that it was the role of others in the family to fix it or sort it out. She now realized that this encouraged family members to get stuck in these roles of peacemaker/rescuer/fixer or the one needing to be fixed.

Sue says, “I never thought about it that way. I guess in my family, my mother was a perfectionist, and I was always anxious that I wasn’t getting something right. Then she’d take over and do it for me, so I was anxious that I couldn’t do what I needed to do well enough. And being anxious was the only way to get things done to my mother’s standard, because she’d end up doing it for me. I guess I never learned to do anything different.”

A whole new conversation is created, and the connection is around patterns of relating and their impact on relationship rather than solely on Sue’s anxiety. They can start a discussion about what they might do in the context of the relationship to think about this differently.

This conversation in and of itself now gives both of them more information about what’s been going unspoken, and ultimately allows for new meaning and new dynamics to unfold.

Hope versus Fear (OR, Focusing on hope to move through our fear and discomfort)

Let’s face it: when we feel frightened, we do whatever we know how to do to alleviate the fear or the discomfort. We even go so far as to try to prevent situations that might potentially be uncomfortable. In peer support, as in the rest of community, this translates into coercion – subtle or otherwise.

Fear reactions come in all forms – from avoiding, persuading, and knowing “what’s best,” to controlling, assessing, and force. These reactions are hardwired by our animal instincts as well as from cultural norms that reinforce difference as dangerous (e.g. people from cultures different from our own). Fear has even influenced how we think about safety (e.g. safety contracts) and has left us anxious about what’s not safe rather than comfortable with creating our own sense of safety.

This is where the idea of hope comes in. In order to sit with the discomfort of a difficult situation, we must have some hope that something interesting or even positive will come out of going right through the middle of it. We may not know what that is (trying to control the outcome would be a fear-based response) but gradually begin to trust that there is learning in our discomfort. This learning then creates possibilities that give us options – options that didn’t exist when our goal was just to get through this frightening time.

What does it look like to be hope-based rather than fear-based?

For years when I had uncomfortable feelings, I would think about suicide. My own discomfort led to an automatic reaction that seemingly alleviated the uncomfortable feelings. After all, the back and forth between “Should I or shouldn't I?” was better than the feelings.

When others knew about this thought process, they would do whatever it took to try to get me to “stay safe.” They were afraid I would end up hurt or dead. Over and over, these responses lead to me simply getting through my discomfort with the least amount of harm. Nothing changed, and the fear or discomfort drove the same reaction.

Finally, someone asked me what the discomfort was about and why I was so afraid to just be uncomfortable. Why did I think I needed to do something about it? I wasn’t sure I knew the answer. Through meditation, I focused my attention on sensation. What was going on in my body; what did it actually feel like? I talked with my friend about shame, my deep embodiment of feeling intrinsically bad. She asked me why the shame was important enough to keep coming up over and over, and I finally realized that it kept everything in-sync. If I am bad, then my beliefs about what others think about me are true and I can continue to keep my distance from people. In other words, the discomfort of shame was more comfortable in some ways than changing my assumptions, beliefs, and ways of relating. This conversation changed the nature of our relationship. Instead of reacting out of fear and desperation, we talked about why shame has such an important hold on us, and we began to challenge each other around our comfort with holding on to it.

This kind of conversation rather than a “learning to cope” conversation has huge implications for the world. If instead of reacting out of our anxiety around “what if’s” (desire for predictability), we welcomed discomfort as a generator of possibility (unpredictability), whole new ways of responding would open up.