Social Contexts of Peer Support Copy

Developing relationship concept: Construction machines building up with letters the word relationship, isolated on white background.

Peer support is all about relationships. When we look at how and why it works, we have to think about it in the light of this fact. As we look at the social context of peer support, it is important to consider three principles:

Learning vs. Helping – in this principle, the emphasis is placed on developing the client’s skills and capabilities to manage life, rather than merely helping them through a crisis. The assumption is that if we help in the same old ways, we will keep getting the same results. If we focus on learning, it assumes a different process and, therefore, a different outcome.

Focus on the Relationship – In this principle, we understand that it is important to place an emphasis on sharing power and responsibility within the relationship. In the peer support relationship, we recognize that the client has the primary power, and the peer specialist has the primary responsibility for maintaining the relationship. In addition, the peer relationship is grounded in dialogue – two-way communication between the peer specialist and the client – rather than on a monologue where an expert dispenses advice. The skills that the client develops within the peer relationship carry over into other relationships and life contexts.

Fear vs. Hope –The peer relationship is based on hope, rather than on fear. Treatment and intervention services may sometimes be fear-based – that is, they focus on what is wrong and what we are afraid is going to happen. Hope-based relationships, on the other hand, are based on what is possible, where someone is going and how they can create something new.

Peer support has gained more widespread acceptance thanks to the consumer movement in the mental health arena. This movement strives for social justice for individuals with behavioral health conditions who have been marginalized and stigmatized by society’s views of addiction and mental health disorders. The consumer movement describes wellness and personal liberation as occurring within the context of recovery based environments. .

Peer support helps to create a culture of health, wellness and ability for persons with behavioral health conditions, as opposed to a culture of “illness” and disability. The successful recovery demonstrated by a peer specialist challenges negative assumptions about persons with mental health and substance use disorders.

It is also important to recognize that the peer support specialist may struggle with a sense of dual identities – as a person in recovery themselves and as a formal “helper” to others in recovery. During the course of their behavioral health difficulties, some people developed a sense of themselves that focuses around their problems. They have developed an identity of “client” or “patient” and created affiliations with others who share that identity. This creates a “client culture” where members assume that “normal” people who have not experienced behavioral health conditions can’t understand their world and results in an “us/them” split with others that looks like the flip side of stigma. Recovery lies in undoing the cultural process of creating divisions and focusing instead on the similarities and strengths that can empower us to lead healthy lives as individuals and in communities.

Addressing Multiple Issues

The consumer movement has helped to redirect the medical model of behavioral health treatment from its focus on “problems” defined as diseases to be “treated” by professionals. The medical model ignores other contributing stressors such as poverty, loss, trauma and lack of resources that hinder recovery. The client brings all of these factors into the peer relationship to be addressed. Peer support specialist must be prepared to meet their clients in the context of their whole lives, not just in the context of their behavioral health condition.