Introduction
One of the main tasks of peer support is building a relationship with the other person by relating to them. This is not always the easiest task: both the supporter and the one receiving support have had different experiences in life and we cannot assume to fully know what someone has been through. The way we understand our surroundings, relationships and events that take place in our life is influenced by our values, cultural upbringing, education and many other things that make us who we are. For this reason we need to be mindful of how we approach others and open to their feedback. It may be difficult to approach someone that is suffering and they may be very sensitive to both verbal and non-verbal cues you may be unknowingly giving – for example seeing slight discomfort as rejection and dislike. In order to make navigating these situations a little easier, we have put together some principles for peer support in this part of the online course.
2.1. Boundaries
If you have a passion for supporting others, you have probably noticed that while our problems and preferred ways of being comforted may differ, there are certain elements of support that are important to many. Safety is one of them. In this context, a lack of safety does not mean being in danger of receiving physical harm, but rather feelings of anxiety, discomfort and fear that make it hard for the person to open up. Creating a safe environment will be further discussed in chapter 4 – Safe space.
The feeling of safety is not only tied to our surroundings but also the way others interact with us. It is impossible to write down everything that we wish for the other person to do and say, and for that reason we talk, instead, about the limits peers can set in order to communicate more efficiently. These limits are commonly called personal boundaries.
What are personal boundaries?
Personal boundaries or the act of setting boundaries is a life skill that has been popularised by self help authors and support groups since the mid 1980s. It is the practice of openly communicating and asserting personal values as a way to preserve and protect against having them compromised or violated.
In peer support, boundaries are set in order to keep both parties safe and comfortable. As people with lived experiences, the peer supporters and the people they support may have topics that are painful to them or that they’re not ready to discuss, they might want to avoid physical contact or even interacting when others are present. It is impossible to guess what someone might be sensitive to, so “going in blind” and asking questions without considering whether your conversation partner is okay with those questions may lead to a misunderstanding, or worse, a loss of trust, and thus the end of the peer relationship.
Boundaries protect the peer supporters as well: if they do not give clear information on how they can be contacted, at what times or how often they might be available, they might find themselves in a situation where they receive calls at the most inconvenient times, are approached more often than they can handle, and they might burn out. You can find more information on how to care for yourself as a peer supporter in chapter 8 – Self care.
Important things to keep in mind
Boundaries are set as an agreement between the peer supporter and the person they support. It is essential to discuss them at the very beginning of your peer support relationship so that you are aware of what the other expects and what they might be apprehensive about. For some people, their personal boundaries may change after getting to know their peers, as their mental health improves or simply based on how they feel that day, so it’s best to check with them every once in a while in order to provide the most fitting support possible.
Examples of boundaries
There are many ways to classify boundaries: there are legal and societal boundaries that guide as citizens in a community, cultural boundaries that define how to behave in different settings and, of course, personal boundaries that we communicate verbally or nonverbally that give us cues on how to act with a particular person.
Some people do not like to be touched or do not tolerate people in close proximity, others have certain topics that bring up painful memories or frustration that they would like to avoid. There are people that can only communicate through emails and those that are only comfortable talking one on one or find hour-long meetings too intense. What is important is that all of these are valid and should be respected and followed as much as possible in order for the peer support relationship to flourish.
Exercise
In this table you see some different acts and situations that might come up in your peer support relationship. Your task is to decide where your hard limits (e.g. something that should never happen) and soft limits (things that may be okay depending on the circumstances) lay, taking into consideration the potential consequences of each for both you and your peers. Reflect on your own boundaries and keep them in mind when you are peer supporting.
Your boundaries are your choice, but while choosing, it’s important to consider whether a boundary aligns with principles of offering ethical support. The following table is represents the perspective of the peer supporter and it’s context is offering peer support.
2.2. Distance and closeness dynamics
When you first meet the peer you will be supporting, it is natural to recognize yourself in them and feel an instant connection due to your shared experiences. This is what makes peer support so effective: it is much easier to establish trust when you have a common ground and speak as an equal. This may also cause problems, however, since it might create confusion about the nature of the relationship and lead to a counterproductive dependency on the supporter. In this chapter we discuss ways to keep a healthy peer relationship without it becoming too close or too distant.
What are distance and closeness dynamics?
People that have mental health challenges, have suffered from abuse or addictions, may struggle to find someone that would understand what they’ve been through and relate to their experiences. Finding that person, a peer that has been through similar hardships, can be a powerful feeling and it can create an intimate connection, as they bond over thoughts and memories they might have not shared before. It is natural then, to seek closeness with the person they found this precious kinship with.
Another aspect of peer support that makes it very attractive to people that lack an effective support system is the fact that the peer supporter uses their own experiences as an example, or to encourage the person requiring support. And while it’s somewhat of a one-sided relationship (one party often listens more, the other talks more), the supported person may come to feel as if it is actually a two-sided relationship, or even a friendship. Having someone that listens to you without sharing their own everyday concerns, is sympathetic towards you, is curious about your life and only inserts parts of their own experiences into the conversation when it’s beneficial to you may seem like the perfect relationship to someone that is still struggling and is for that reason, less interested in what others are going through.
A peer supporter is not a friend, romantic partner or family member. While they can take on different roles in relation to the person they supported after the peer support relationship has ended, then during the process of peer support, it is important that their roles are clear and understood by both the supporter and the peer. This means setting boundaries like: agreeing to meet a certain number of times, restricting communication by keeping your social media accounts and phone number private, rejecting gifts and offers to meet in a different setting. It may seem cruel to set these conditions on your peer support relationship, but in actuality, these are necessary to protect both the peer supporter and the peer.
Peer supporters often support more than one person at a time and tend to do it outside their work and social life, so their time is already limited. In order to avoid burnout, it is important for the peer supporter to be honest with themselves about how much energy and time they have to offer others. If they let themselves be swayed by the pleas of the person they’re supporting and dedicate too much of their time to peer support, they might become stressed, overwhelmed, and at one point decide to quit. This may negatively impact the wellbeing of the peer supporter and the person in recovery. For example, people that have severe mental health issues have probably been let down in the past by people that have entered their lives with good intentions but wound up deserting them when it’s become too much to handle. The peer supporter should not become another name on that list.
In conclusion – a peer support relationship should be reliable and transparent. Some distance is helpful to allow both the peer supporter and peer to rest, form other relationships and reflect on the process.
2.3. Empowerment
While none of us have superpowers to pass on, what we do have is the capability to make choices, learn, experiment and through all this, grow as people. Mental health issues can take away a person’s drive and decision-making skills, causing them to become passive, pessimistic and powerless when it comes to helping themselves. In this chapter we will discuss ways that peer support can empower those that need it most.
What is empowerment?
Empowerment has been defined as an intentional ongoing process centred in the local community, involving mutual respect, critical reflection, caring, and group participation, through which people lacking an equal share of valued resources gain greater access to and control over those resources; or a process by which people gain control over their lives, democratic participation in the life of their community, and a critical understanding of their environment (Perkins & Zimmerman, Empowerment Theory, Research and Application, 1995). In the mental health field, empowerment can also mean a belief in the possibility of recovery and that the person themselves can make decisions and changes that improve their wellbeing.
What does empowerment feel like?
Empowerment has everything to do with experiencing your own power. It is a feeling of strength and belief that things can change in your life and you have power to change them, that you are in control of your own life (again). This feeling of power gives you hope and functions as fuel for recovery.
How do you empower?
Empowerment is, in a sense, similar to recovery: you cannot recover for someone else, nor can you actually empower another person. What you can do as a peer supporter, is to guide and facilitate the process, drawing on your own experiences and the resources you have at hand.
The belief that there is nothing one can do to help themselves is hard to combat since hope, self-confidence and trust in others are not easy to regain once lost. There are no shortcuts or blueprints for achieving self-empowerment but as someone with similar experiences, you can use yourself as an example to prove that it is possible.
How can peer support help someone empower themselves?
Peer supporters can offer information, thought exercises and help the person work through any doubts and insecurities that may arise so that they would not hinder the progress. They can also create a positive and accepting space with opportunities to vent, participate in fun activities, connect with others on their recovery journey and learn self-help skills. When people feel that they are appreciated and welcomed just as they are, flaws and disorders included, it opens up space for introspection and courage to embrace and even seek change.
One method of using peer support in empowerment is called the Wellness Recovery Action Plan (Copeland, WRAP & Peer Support Handbook, 2016). WRAP offers some basic principles for creating an environment of hope and empowerment.
- Believe that recovery is endless;
- Believe that your peer is an expert about his/her/their own life and that there are multiple paths to wellness and recovery;
- Accept people as they are;
- Give a sense of hope;
- Focus on your peer’s strengths and express confidence in them;
- Validate the individual’s experiences;
- Provide people with choices and options in the recovery process;
- Be an example of hope and recovery yourself.
Exercise
- Think about your life and recovery process.
- Seek a moment when you experienced a feeling of power and hope in a difficult situation or period in your life.
- Reflect on what created that moment of (em)power(ment). What did you feel? Who were or weren’t involved? What did they do or say?
- How did this moment of empowerment change your life?
2.4. Recovery
What is mental health recovery?
When it comes to mental illness, recovery can mean different things. For some people, it means no longer having symptoms of their mental health condition. For others, it means managing their symptoms, regaining control of their life and learning new ways to live the life they want.
The process of recovery is highly personal and can happen in many different ways. It may include clinical treatment, peer support, family support, self-care, and other approaches. An effective recovery is built on the person’s own strengths, talents, coping abilities, resources, and values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members.
Recovery is rarely a straightforward process, but rather a journey with many ups and downs, with periods of growth and improvement, followed by temporary setbacks, or periods of stability. In this sense, recovery is pretty much like life, not following a straight line, but quite a messy path through the complex experience of being a human. That is why recovery needs a lot of patience and self-compassion, and the constant reminder that there is hope for the better after hard times.
There are different things that may help and no right or wrong way to recover. The commonly used four-dimensional recovery model (SAMHSA, Working Definition of Recovery, 2012) suggests that there are four key factors on the road to recovery:
Health – making informed, healthy choices that support physical and emotional well-being;
Home – having a stable and safe place to live;
Purpose – conducting meaningful daily activities, such as a job, volunteering, family caretaking, or creative activities and the independence, income and resources to participate in society;
Community – having relationships and social networks that provide support, friendship, love, and hope.
Peer support and recovery
In the realm of mental health, a peer supporter’s work should be guided by the belief that recovery is possible for every single person.
Here are some of the many ways in which you can support the recovery of a peer:
- Encourage reflection about what recovery or a meaningful life means to them.
- Offer support with setting personal goals towards living that meaningful life.
- Facilitate reflection on what are the peer´s strengths, values, resources and how they can be used for recovery.
- Express hope and encouragement every step of the way, through all the uphills and downhills of recovery.
- Acknowledge and celebrate the achievements, however big or small, and the steps forward that the peer is taking.
Goals for recovery
When setting goals with the peer, it may help to consider making them SMART (Doran, There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives, 1981), which in this online course has been adapted to better suit goals oriented towards wellbeing:
Specific – the goal should be clear and specific so they will be able to focus their efforts and feel truly motivated to achieve it
Meaningful – if the goal is truly important to them, they are more likely to stick with it
Achievable – they should have the resources, abilities and help necessary to achieve the goal
Realistic – the goal should be appropriate and within reach
Time-limited – the goal should have a start and finish date to give it some urgency
Recovery and relationships
Recovery may feel like a lonely place to be from time to time, because of all the emotional pain involved, but it’s important to know that no one should be expected to take this road alone. Relationships play an essential role in recovery, because connections are generally strengthening mental health and can provide the safety net needed to bounce back from difficult times.
Ideally, one should have a social network with various types of relationships, differing in depth. Good relationships of any kind can be helpful in various ways for recovery, if we look at them as sources of emotional, practical and informational support.
We all need a community or a group to belong to, so when recovering from mental health challenges, could be the right time to find your tribe people with similar interests, aspirations, passions or lived experiences. Joining a peer group can be a nurturing experience that allows you to feel that other people are struggling too, and learn from each other about ways to overcome the difficult times and build yourself up.
However, relationships can also be part of the problem that landed us in bad mental health in the first place, so as part of recovery it might be necessary to clean out some of the current relationships if they hinder personal wellbeing, let go of people, reorganise, set boundaries.
2.5. Trauma informed peer support
We all have our difficulties in life: disappointments, accidents, conflicts, fights. Growing up without any bad memories or painful lessons seems impossible. Some of these incidents, however, are more severe than others, changing the way the brain operates and leaving a mark that may never heal. In this chapter we talk about how peer supporters can help the people that have been through such life-altering events.
What is trauma?
“Trauma is a psychic wound that hardens you psychologically that then interferes with your ability to grow and develop. It pains you and now you’re acting out of pain. It induces fear and now you’re acting out of fear. Trauma is not what happens to you, it’s what happens inside you as a result of what happened to you” (Gabor Maté, 2020).
Common events that produce trauma can include: natural disaster (like fire or flood), physical attack or sexual assault, witnessing somebody being badly hurt or killed, domestic/family violence or abuse, physical or emotional abuse as a child, being threatened with a weapon, being held captive, experiencing war (as a civilian or in the military), serious accident (like a car accident).
Different circumstances like familiar places, memories, persons, sounds or smells can trigger the memories of trauma and can cause emotions like anxiety, anger, grief, or even a fight-or-flight response. While they may seem extreme, these feelings are actually normal reactions to abnormal circumstances or the memories of abnormal circumstances.
As a peer supporter you may meet many people that have experienced different traumas, and for that reason it is important that you know how to create a trauma-informed space.
How to create a trauma-informed space?
There are Five Guiding Principles that serve as a framework for how service providers and systems of care can create safe spaces to reduce the likelihood of re-traumatization and promote recovery:
- Safety – ensuring the physical and emotional safety of the peer is the first important step in trauma-informed care. That may mean choosing a particular location but also finding a peer supporter that the person is not intimidated by;
- Trustworthiness – the individual needs to know that the peer supporter is trustworthy. This can be proven by respecting their boundaries and having a consistent structure for their meetings;
- Choice – the more choice and control the person has over the meetings, the more comfortable they are, which in turn makes them more likely to open up;
- Collaboration – collaboration is another way to give the peer back the power. Making compromises, sharing materials and really giving them a chance to be an active participant in the process are important facets of trauma-informed peer support;
- Empowerment – focusing on an individual’s strengths and empowering them to build on those strengths while developing stronger coping skills provides a healthy foundation for them to fall back on in case they relapse.
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