[NYAPRS Enews] Mead: Intentional Peer Support as Social Change

[Harvey Rosenthal]

NYAPRS Note: The following very thoughtful and timely article comes from
the 'intentional peer support' developer Shery Mead. Please go to
http://www.mentalhealthpeers.com/trainings.html for details of online
and in-person training Shery and her team offer. 

 

Intentional Peer Support as Social Change

Shery Mead Oct 2010

 

As peer support in mental health proliferates, we must be mindful of our
intention: social change. It is not about developing more effective
services but rather about creating dialogue that have influence on all
of our understandings, conversations and relationships (Shery Mead,
SAMHSA webcast; 2010)

Intentional Peer support is about conversation. It's about how we know,
how we create new "knowing" through dialogue, and about how we as human
beings interrelate by beginning to practice the art of connection, with
ourselves, the people in our lives and the people on the planet we may
think we have nothing in common with. For me it is a practice that has
no right or wrong. It is always in flux; much like improvisation in
music. It is a process of experimentation and co-creation. It assumes
that we "play" off each other and create ever more interesting and
complex ways of understanding. We see it as a tool for keeping the world
on its toes, becoming more comfortable with less predictability as we
become less reactive to fear. In other words, it is not another practice
that presumes to have the answers but instead, it aims to generate good
questions. This paper will provide a brief overview of the three
principles in which IPS is grounded.

*       Learning versus. Helping

*       Relationship versus the individual

*       Hope and possibility versus Fear

 

Learning versus Helping

How have we become so stuck in assuming that our relationships have to
be about helping and problem-solving? What does it mean to help? What
does our need to help say about our assumptions of the other person?
What happens if either they don't want our help, or our help doesn't
"work"?

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. For example many good hearted people have
gone to third world countries and tried to "modernize" and "help" other
cultures. After all, it doesn't have to be this way...does it? But what
often ends up happening is that we (the outsider) act in ways that
appear presumptuous, misinformed, disrespectful and even self-interested
or dictatorial. We set up programs where people can learn from us
without attempting to listen, to understand, or to acknowledge that
perhaps the other culture has some important learning for us.

In the end maybe one or two people will do something differently for a
while but then things often go right back to the way they were.  Why is
that? Are they just "unmotivated?"(How many times have we been called
unmotivated by supposedly caring others??). We realize that in our haste
to "help," we have neglected to learn, share, get to know people in the
context of their culture, let them get to know us and our
understandings.... Given our failing to do all that, is it really so
surprising when nothing changes?. 

How could we do this differently? Well for one thing, most people don't
like someone coming in and setting up programs for them, telling them
what to do, and making assumptions that what they're already doing is
bad. 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 the status quo, 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. And this takes time. If our task has traditionally been to come in
and do an assessment and create a plan (many organizations do this with
well paid consultants, aid organizations do this in other countries), we
forget that it is not US who should be doing the assessment.  In fact
it's not particularly helpful for anyone to do an assessment of the
situation (which is usually one party's perspective of what's wrong with
the other party) before we know more about each other, build some trust,
and get a chance to collaboratively see the bigger picture. Learning
together takes time, it's about building relationships where new
information and new knowledge can emerge. 

When people are willing to listen to each other's stories without
providing analysis, and at the same time compare and contrast
experiences, possibilities for transfiguring meaning are endless. When
we become part of each other's narratives, we not only offer possibility
for alternate (mutually enriching)  interpretations, our new shared
story becomes a way to negotiate future challenges and crises (see
Crisis and Connection, Mead & Hilton, 2002) while building real
communities.

 

Relationship versus the Individual

What's the difference between focusing our attention on the individual
vs. focusing on the relationship. Let's think back to our discussion of
the "helping" paradigm. What happens when I come in and do an assessment
based on my beliefs and assumptions about your situation? Chances are,
it sets up a dynamic between us that gives me the power and control and
puts you into the role of passive recipient (possibly even seen as the
ungrateful recipient). If my attention is on your changes or outcomes,
chances are I lose sight of what we are doing/learning together, and
most likely so do you.

For me there was a time when most of my relationships were about me and
my "problems." Sure I had friends but it got to the point where every
conversation started with "How are you doing today," which led to me
going off on a thermometer speech about how relatively difficult or easy
a day it was, and ended with suggestions about what I might do or try to
do and the promise that we could check in tomorrow...and these friends
weren't even getting paid. My idea of mutuality at the time was that
when my friends were experiencing some difficult times, our
conversations just switched in terms of our roles. In other words, the
attention was either focused on me and my problems or you and your
problems. While it has been conditioned into us to help people who are
having difficulties, the mental health system has actually created
relationships where we act more like each other's therapists than we do
friends.

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 personto the conversation. This flow of
increased mutual understanding, as well as generation of new meaning, is
the goal of intentional 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.  Following is an illustration:

Mary and Sue have been getting together for several weeks and Mary is
feeling kind of stuck because it seems that Sue talks about her same old
issues over and over again. She has tried to help but all her
suggestions have been ignored. She decides that perhaps she's been much
more focused on solving Sue's problems and much less focused on the
quality of their relationship.

Sue starts again today by saying, "Hi Mary, I wonder if you can help me
with my anxiety. It's still really bad and I don't know what to do."

Mary's typical response has been to say something like, "when my anxiety
gets bad, I usually go for a walk," in the hopes that Sue will start to
take some responsibility for taking action on her own behalf. Today
however she sees that this problem solving response is about her own
need to feel like she's doing something and she begins to wonder if
talking about anxiety is the only way Sue knows how to connect. Mary
wants to maintain the connection but is beginning to see that she's as
stuck in trying to help as Sue is in talking about what's wrong. She
says, "Sue, I wonder if you're also feeling frustrated with our
relationship since I tend to give you all these suggestions that don't
seem to do anything. I have to tell you, there was a time in my life
when all my relationships revolved around getting "help" for my
problems. It was my only topic of conversation but I realized that I was
too scared people would go away if I didn't need them as helpers. I
wonder what our relationship might be like if I stopped just acting like
a helper or as if I had some special wisdom?

Sue owns that most of her relationships are based on getting help,
particularly with regard to her mental health, and she doesn't know how
to do anything differently. Mary talks about how she is still needing
work at not either taking or giving up power in her relationships- it's
such an old habit for her. In her family charity and helping others were
highly valued, so if there appeared to be a problem, it was expected
that it was the role of others in the family to fix it or to sort it
out. She now realized that this encouraged family members to get stuck
in these roles of peacemaker/rescuer/fixer or the one needing to be
fixed.

Sue says "I never thought about it that way. I guess in my family my
mother was a perfectionist, and I was always anxious that I wasn't
getting something right. Then she'd take over and do it for me, so I was
anxious that I couldn't do what I needed to do well enough, and being
anxious was the only way to get things done to my mother's standard,
because she'd end up doing it for me. I guess I never learned to do
anything different".

A whole new conversation is created, and the connection is around
patterns of relating and their impact on relationship rather than solely
on Sue's anxiety. They can start a discussion about what they might do
in the context of the relationship to think about this differently.

This conversation in and of itself now gives both of them more
information about what's been going unspoken and allows for new meaning
and new dynamics to unfold.

 

Hope Vs. Fear (OR: Focusing On Hope To Move Through Our Fear And
Discomfort)

Let's face it, when we feel frightened we do whatever we know how to do
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 (e.g. safety contracts etc) 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.

What does it look like to be hope based rather than fear based?

For years when I had uncomfortable feelings, I would think about
suicide. My own discomfort led to an automatic reaction that seemingly
alleviated the uncomfortable feelings. After all, the back and forth
between "should I or shouldn't I," was better than the feelings. 

When others knew about this thought process, they would do whatever it
took to try to get me to "stay safe." They were afraid I would end up
hurt or dead. Over and over, these responses lead to me simply getting
through my discomfort with the least amount of harm. Nothing changed and
the fear or discomfort drove the same reaction.

Finally someone asked me what the discomfort was about and why I was so
afraid to just be uncomfortable. Why did I think I needed to do
something about it?. I wasn't sure I knew the answer. Through meditation
I focused my attention on sensation. What was going on in my body, what
did it actually feel like? I talked with my friend about shame, my deep
embodiment of feeling intrinsically bad. She asked me why the shame was
important enough to keep coming up over and over and I finally realized
that it kept everything in sync. If I am bad, then my beliefs about what
others think about me are true and I can continue to keep my distance
from people. In other words, the discomfort of shame was more
comfortable in some ways than changing my assumptions, beliefs and ways
of relating. This conversation changed the nature of our relationship.
Instead of reacting out of fear and desperation, we talked about why
shame has such an important hold on us and began to challenge each other
around our comfort with holding on to it.

This kind of conversation rather than a "learning to cope" conversation
has huge implications for the world. If instead of reacting out of our
anxiety around "what if's" (desire for predictability), we welcomed
discomfort as a generator of possibility (unpredictability), whole new
ways of responding would open up.

 

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