Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful … It is about under-standing another’s situation empathically through the shared experience of emotional and psychological pain (Mead, Hilton, & Curtis, 2001, pp. 6-7).[6]
Experiential knowledge underpins “the expertise of lived experience” that is the basis for “the gift of hope and companionship” delivered to the bereaved by people “who have walked a similar path” (Perkins, 2010, p. 3). This powerful knowledge, while it gives peer helpers “greater credi-bility as ‘experts’ in dealing with the problems and challenges faced by the person seeking support” (Money, et al., 2011, p. 15), is not the same kind of expertise, for instance, that a mechanic brings to the task of fixing a stalled car (namely, the expertise to identify the problem, name it, and implement a solution that fixes it). It is, rather, expertise that enables the helper to discern whether the client is moving closer to or further away from his or her own understanding of (or relationship with) the so-called problem. With the client’s perspective as the starting place—along with the support of the helper, which is rooted in empathy and commitment to partnership—the client can work toward formulation of his or her own solution and implementation of self-efficacious action to accomplish the outcome he or she desires. The helper’s personal story of loss and recovery and the content of specific lessons learned from the helper’s own grief journey may or may not have practical applications in the client’s case (and making recommendations, giving advice, or “educa-ting” the client are not necessarily considered helpful approaches in PGC). The essence of the helper’s expertise lies in the fact that he or she has “been there” and, therefore, is capable of especially empathic under-standing of and uniquely meaningful engagement with the client’s situa-tion, regardless of the details.[7]
Trust is, of course, a fundamental component of all healthy inter-personal interactions and is not uniquely an ingredient for effective Peer Support. Even though it is a rather complicated and subjective matter, trust is unquestionably a tangible force in helping relationships. Money and colleagues’ conclusion (2011, p. 15) about Rotter’s classic theory on trust (1971) is that it involves “generalized expectancies that a person is (1) honest, (2) unselfish, not going to take advantage of me, and (3) reliable, or ‘knows his stuff.'” Professor Madan Pillutla of the London Business School chooses different terms but points to the same three attributes of trust (2007), which he identifies as integrity (telling the truth, keeping commitments), benevolence (caring about the other per-son), and competence (being capable of meeting the other person’s expec-tations, of doing what is supposed to be done). These qualities are encap-sulated in the intention a person might declare—the intention “to say what I mean and mean what I say”—in establishing the guiding prin-ciples for his or her role in an interaction.[8] This is a way of affirming that a person intends for his or her decisions, words, and actions to accur-ately reflect the reality at hand (honesty, integrity); to constructively advance the best interests of all concerned (unselfishness, benevolence); and to dependably lead to a desirable and constructive outcome (reliability, competence). It is only through the cumulative effects of successfully delivering on such intentions—and of accounting for lapses in keeping commitments in this regard, not only through means such as admitting error and apologizing but also through “making things right” with restitution and changed behavior—that trust is established and maintained in helping relationships.
Confidentiality is integral to peer-to-peer assistance, just as it is to all coaching and counseling practice, for confidential communication is a self-evident requirement in establishing a safe environment where people can share their private and intimate experiences, thoughts, feelings, and beliefs. The death of a loved one is perhaps one of the most intimate and private of occurrences in a person’s life, and people generally feel a strong sense of vulnerability over their reactions to substantial loss. This feeling of vulnerability stems from the mental turmoil and emotional pain people commonly experience after the death of someone central to their lives—and from the fact that they may be taken aback or knocked off course by the intensity and persistence of their grief. Attempting to grasp and cope with grief, therefore, often requires people to delve into the most sheltered or challenging elements of their own personal make-up and the most profound and poignant aspects of their relationship with the deceased—and for many, into the dynamics of a drastic, unwanted, and unanticipated change in the trajectory of their lives.[9] Confidentiality is essential to creating and maintaining a space where a person can explore such sensitive and vital territory without fear of being exposed, analyzed, or judged.
Individual connectedness—perhaps more than any other quality of Peer Support—is strengthened specifically because the caregiver has had an experience of loss similar to that of the bereaved client. One of the common reactions to a traumatic death by those left behind is the dramatic and quite disorienting feeling that something altogether extra-ordinary and utterly unbelievable has occurred—which is often accom-panied by an overwhelming feeling that they are alone facing a tragedy that is singular and unique.[10] Encountering someone who has faced a similar tragedy can have an automatic palliative effect on a bereaved person, and if that “someone” turns out to be genuinely understanding, helpful, and skilled at acting in partnership with the person, then a deep sense of connectedness can develop. This connectedness is to coaching and to peer-to-peer helping relationships what the therapeutic relation-ship between therapist and client is to psychotherapy; and one of the key research-based conclusions about psychotherapy is that “the therapy relationship accounts for why clients improve (or fail to improve) as much as the particular treatment method” (Norcross, 2011). His or her similar experience of loss enables the peer helper to effectively use techniques such as “positive self-disclosure … role modeling … exploring new ways of using experiential knowledge … [and the] ability to ‘read’ a client based on having been in the same shoes he or she is in now,” which are all approaches identified in a recent literature review as “especially well-suited for peer [helpers]” (Davidson, et al., 2012, p. 124).
Empowerment has become such a buzz word or a cliché in circles where helping others is at issue that it is important to define it very care-fully and completely in the context of Peer Support and PGC:
Empowerment connotes a process of gaining control over one’s life and influencing the organizational and societal structures in which one lives … However, empowerment in any context cannot be bestowed by those with greater power upon those with less. Peer programs empower people because their practice facilitates a grassroots process … of self-efficacy, self-esteem, and the belief that positive personal change can come about through one’s own efforts (Campbell & Leaver, 2003, p. 14).
In PGC, the coach’s emphasis is on helping the client with “influencing … organizational and societal structures” only if that is an expressed goal of the client, but PGC can be universally described as a method for helping the client with “a process of gaining control over … [his or her] life.” This defines empowerment very well as long as personal control over one’s life is understood to be a dynamic interplay between internal and external experiences. In other words, a fully empowered person controls his or her outer circumstances up to the limits where that is maximally possible and, at the same time, seeks to ultimately control his or her inner reac-tions to circumstances regardless of the limitations encountered.[11]
The idea that empowerment “cannot be bestowed by those with greater power upon those with less” is an extension of the notions expressed above regarding the Life Coaching relationship being a partnership, in contrast with the relationship in the medical model being between an expert and a patient. Most importantly, empowerment is based on making operational in a person’s life “the belief that positive personal change can come about through one’s own efforts.” In PGC, empowerment is not considered a belief at all (other than in its formative stages), for empowerment can only become a reality through actions (decisions and behavior) created and executed by the person being “helped.” The words with the root help in the usages here are surrounded by quotation marks because the very concepts of “helper” and “helpee” are dismantled by forces such as empowerment, which is undoubtedly the great equalizer in “helping” relationships. Empowerment is, in fact, the force that causes people working together to operate as peers, making it both a tool and an outcome for the two people involved in a PGC relationship.
In conclusion, this essay barely touches upon the mounting body of evidence verifying the overall effectiveness of Peer Support in mental health services. That evidence is extensively summarized by Harrington-LaMorie (2011), who also concludes that for at least one category of the traumatically bereaved (suicide loss survivors) peer-to-peer assistance is uniquely capable of promoting the following:
It is hoped that such connections—between the value of Peer Support in general and its value specifically for helping people who have lost a loved one to a traumatic death—can be strengthened by practices such as Personal Grief Coaching.
[6] The original source of this quotation is identified by Mead and colleagues as “Stiver & Miller, 1998,” but in Mead’s references, the only similar item listed is: Miller, J.B. & Stiver, I. (1997). The healing connection. Boston, MA: Beacon Press (and a search of related topics in that book’s index did not lead to the quoted material).
[7] Although it is couched in humorous language, a statement from one program’s train-ing material captures another vital aspect of the expertise involved in being a peer helper: “‘Peer support is about being an expert at not being an expert, and that takes a lot of expertise’” (Repper & Carter, 2010, p. 5).
[8] This is a declaration the author often uses to establish his intentions when he works as a dialogue facilitator in instances where he is a participant-observer, such as the one documented at bit.ly/survivorsummit.
[9] It is important to distinguish between exploration of a person’s make-up, relation-ships, and life trajectory by a helper with a treatment goal in mind, as in psycho-therapy, and the practice of PGC, which involves the caregiver supporting and bearing witness to a person’s own exploration of these matters. (The concept of bearing witness to a bereaved person’s story is further discussed in a forthcoming essay on PGC and Compassion).
[10] Such reactions occur along a continuum, from, at one extreme, the shocking but fairly straightforward and monolithic realization that a traumatic death has occurred to, at the other extreme, the very severe and disturbing reaction described here.
[11] A classical expression of this view of personal control is given by Frankl: “When we are no longer able to change a situation … we are challenged to change ourselves” (1992 [1946], p. 116).