CHAPTER PEER SUPPORT FUNDAMENTALS 3 Peer support does not adhere to any one “program model.” Rather, it is a dynamic and flexible approach A NATURAL HUMAN RESPONSE to connection and mutual understanding based on a set TO SHARED ADVERSITY of core values and principles. This chapter will present Most people who’ve been through hard information on the fundamentals of peer support that times empathize with and have an urge have been developed over the years by people who to reach out to others who struggle with have worked in peer support roles, conducted research problems that feel similar to their own. For on the topic, and have reflected upon and written about example, an older woman with children it.1,2,3,4 These ideas can be applied to any setting or shares her experiences with an over- activity. Understanding the fundamentals will help whelmed new mother. A widow offers tea you use the strategies presented in later chapters to and words of comfort to a woman whose apply these principles to peer support relationships husband has recently died. The desire for with women who are trauma survivors. The chapter peer support relationships can be seen also suggests books, articles, and websites that provide as a natural human response to shared additional information. struggles. What is Peer Support? Peer support is a way for people from diverse A “peer” is an equal, someone who has faced similar backgrounds who share experiences in common to circumstances, such as people who have survived come together to build relationships in which they cancer, widows, or women who parent adolescents. In share their strengths and support each other’s healing peer support, the people involved have had some sort and growth. It does not focus on diagnoses or deficits, of similar experience, such as being given a psychiatric but is rooted in compassion for oneself and others. diagnosis and receiving behavioral health services. Through peer support, we can challenge ourselves and That is one of the key differences between peer support each other to grow beyond our current circumstances and professional services and treatment. “Support” is and build the lives we want and deserve. Peer support another way of expressing the kind of understanding promotes healing through taking action and by building and encouragement toward growth that people who relationships among a community of equals. It is not struggle with similar issues can offer one another. about “helping” others in a hierarchical way, but about learning from one another and building connections. Peer support can take many forms. In the 1930s, the twelve-step model emerged to provide mutual emotional, social, and informational support for people struggling with alcohol dependency. Today, twelve- SECTION I. FUNDAMENTALS step programs are the most widely available mutual support groups for people in addiction and substance 1 Campbell, J. & Leaver, J. (2003). Emerging New Practices in Organized abuse recovery, although other models for peer support Peer Support. Report to the National Technical Assistance Center for have emerged, including Women for Sobriety (WFS), State Mental Health Planning (NTAC), National Association of State Mental Health Program Directors (NASMHPD). Alexandria, VA. SMART Recovery (Self-Management and Recovery 2 Campbell, J. (2005). Historical and Philosophical Development of Peer Training), and Secular Organizations for Sobriety/Save Run Programs. In Clay, S. (Ed.), On Our Own Together: Peer Programs Our Selves (SOS).5 for People with Mental Illness (17-64). Nashville, TN: Vanderbilt University Press. 3 Solomon, P. (2004). Peer support/peer provided services: Underlying process, benefits and critical ingredients. Psychiatric Rehabilitation Journal 27, 392-401. 5 Substance Abuse Fact Sheet in Brief, Spring 2008, 5:1. “An 4 Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical Introduction to Mutual Support Groups for Alcohol and Drug Abuse” perspective. Psychiatric Rehabilitation Journal 25, 134-141. http://kap.samhsa.gov/products/brochures/pdfs/saib_spring08_v5i1.pdf CHAPTER 3 . PEER SUPPORT FUNDAMENTALS / PAGE 13 ROOTS OF PEER SUPPORT: THE FEMINIST PRACTICE OF CONSCIOUSNESS-RAISING Consciousness-raising is a group process rooted in feminism in which people with a common problem share and explore their experiences in order to draw connections between the personal and the political . In the 1970s, former mental patients used consciousness-raising as a tool to understand their experiences in a social and political context . This helped people realize that many of their issues were not individual problems related to their diagnoses, but the result of patterns of discrimination and oppression . Ex-patients learned that their feelings of isolation, inadequacy, and powerlessness were the result of real practices within the mental health system and real discrimination in the community, not by-products of their “illnesses .” Consciousness-raising also helped people to recognize their own internalized stigma—their unconscious agreement with society’s negative stereotypes of “mental patients”—and to develop new, more empowering beliefs about their ability to regain control of their lives . In mental health, peer support in its modern form to the hierarchical roles of other behavioral health began in the early 1970s among former mental patients professions. But in this guide, we define peer support who were angry about the involuntary treatment they as an activity based on mutual relationships that had received in state hospitals and other institutions. incorporate the principles described below. Some of these people found each other and came together in groups to share their outrage, support each Principles of Peer Support6 other’s healing, and demand changes in the system. While peer support can be practiced in different In those days, peer support—more commonly called settings and through a variety of activities, there are “self-help” at the time—was a communal activity. No some important underlying values that make peer one was paid, and people supported each other as they support unique and valuable. As we discussed earlier, became activists and advocates for positive change. these principles have been developed by consensus In the decades since, peer support has developed in a over the years by people who have been directly number of different ways, many of which bear little involved in peer support as participants, researchers, resemblance to the peer support groups of the 1970s. and writers. Today, as a peer supporter, you may work in a paid Peer support is voluntary. The most basic value of or volunteer job in mainstream behavioral health peer support is that people freely choose to participate. programs such as outpatient clinics, inpatient units, It is for people who want to be involved, not people or emergency rooms. You might work in other service who have been told they need it or who are pressured systems, such as a homeless service program, the to attend. The voluntary nature of peer support makes justice system, or a domestic violence shelter. Maybe it easier for us to build trust and connections with one you are involved as a staff or volunteer in a peer-run another. program. Or perhaps you are a member of a free- standing, independent support group that maintains Peer support is non-judgmental. In peer support, we many of the qualities of peer support from the early meet people who have experiences, beliefs, or ways days of the ex-patients’ movement. You may have of living their lives that may be different from our had formal training by a peer-run organization or a own, despite the things we have in common. Being state-certified program, or maybe you learned about non-judgmental means approaching each person with peer support through reading articles and websites or openness, curiosity, and genuine interest. through participating in a peer support group. Some organizations—mainly programs that hire 6 Many of the ideas in this section are adapted from an unpublished Medicaid-reimbursable peer specialists—define manuscript by Shery Mead, Darby Penney, and Laura Prescott and are peer support as a “helping relationship,” similar heavily influenced by Shery Mead’s work on intentional peer support (see Resource section at the end of this chapter). PAGE 14 / CHAPTER 3 . PEER SUPPORT FUNDAMENTALS Peer support is empathetic. Sometimes people call Peer support requires honest this “putting yourself in the other person’s shoes.” It and direct communication. means that we each make a genuine effort to imagine Each of us says what is on our how the other person feels, what might have led to mind in a respectful way. Learning those feelings, and how we would want someone to how to speak honestly but with respond to us in that situation. compassion about difficult issues can be the most challenging part of developing relationships with our Peer support is respectful. Everyone is seen as having peers. Combining directness with caring requires that something important and unique to contribute. We we move beyond our fear of hurting other people or value everyone who wants to be a part of the group and making them angry and have honest conversations with treat each other with kindness, warmth, and dignity. the people we need to address. We accept each other and are open to sharing with people from many ethnicities and cultures, educational Peer support involves mutual responsibility. We levels, and religions. We honor and make room for each take responsibility for voicing our own needs and everyone’s opinions and see each other as equally feelings. Each of us needs to understand that we are not capable of contributing to the group. there to take care of the other, but that each participant is responsible for making sure that everyone is heard. Peer support is about sharing power. No one is in RESEARCH SHOWS PEER charge and everyone is equally responsible.