Tuesday, July 5, 2011

Peer support: what is it and what makes it different?

An article posted July 4th on the Scottish Recovery Network (SRN) website:
In a specially commissioned article for SRN, international author, trainer and peer support expert Shery Mead [pictured] talks about some of the distinct features of the peer relationship and considers implications for practice. Shery is the keynote speaker at the forthcoming Experts by Experience conference being held in Perth on 21st September 2011.

Peer support is becoming an established practice in mental health. It is being used in informal settings as well as in hospitals and other services. But what is it about peer relationships that make them different to just having a good friend or for that matter another service worker? I will talk in this article about some of the distinct features of the role of peer support and implications for practice.

Peer Support is not new. As long as there have been people on earth, they have come together around shared experience to learn from each other. In mental health we have added a more formal layer to peer support by making it a specific role that is often paid. This is where it may get confusing. In paid peer support you and I come together to learn from each other (like some friendships) but you (the paid peer support worker) actually need to practice a few things.

After many years’ experience working and writing in the field of peer support, I’ve produced the following guide for prospective and active peer workers to some of the core principles of peer support practice:

1. Learning vs Help

In the best of all worlds we are altruistic, 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. When we go into a relationship with the intention of helping or even assisting or supporting we go in with some kind of agenda about you and your “problems.” Perhaps I know a little bit about you from some of my colleagues and before I’ve even met you I decide who you are and what you need. Even if I don’t know anything about you, when my attention is focused on helping we may well end up in a power struggle.

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 their reality, 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. Learning together takes time; it’s about building relationships where new information and new knowledge can emerge.

2. Focusing on the relationship vs. focusing on the individual

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 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 pre-determined 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 what seems most important to us to contribute.

3. Responding out of hope vs. reacting out of fear

Let’s face it, when we feel frightened we do whatever we know how 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 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.

While these principles are just a basic outline of what peer support might encompass, they give us a chance to reflect on what factors contribute to making it unique. As we build these skills across a paid workforce of peers we actually increase our ability to self reflect on all our relationships and what makes them work. In doing this we’re working towards social change. Maybe, at the end of that day, that is a role for peer support.

Find out more about the Experts by Experience conference, including how to register.

Find out more about SRN's work on peer support.
Also see:

Defining Peer Support

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