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The
Community
Psychologist

Volume 49 Number 1 
Winter 2016

Self Help and Mutual Support

Edited by Greg Townley and Alicia Lucksted

ERRATUM

In the Summer 2015 issue, a co-author name, Kari Nilsen, was missing from the Self Help and Mutual Support column article. The correct citation is as follows: Robberson, R., & Nilsen, K. (2015). An Evaluation of the Living Room: Members’ Experiences of Hopefulness. The Community Psychologist, 48(3).

Who Decides? Self-Direction is Key to Self-Help: Preliminary Musings

Elizabeth R. Stone, Pacifica Graduate Institute
(Elizabeth.Stone@my.pacifica.edu)

Mental patients are stigmatized not by language, but by the fact that it is legally acceptable to treat them differently… People who are labeled mentally ill become part of a system that deprives them of control over their own life as part of their treatment. (Chamberlin, 1979)

Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. (SAMHSA, 2012)

Power is inherent in making a decision; for a decision is a determination of some sort—a determination of what is happening, what has happened, what to do or not do about it, what something means.

By appending “Self” to a word, one indicates that any actions undertaken will be initiated by the identified individual: The recipient (object, acted upon) transforms into the actor (subject).

What, then, does this look like from the perspective of an individual who experiences mental or affective states that cause discomfort or that lead to a decreased ability to achieve meaningful roles in one’s community? When such an individual seeks to get support/guidance/help, how can others offer that in a way that maintains the integrity of the individual’s desire to be seen and heard not as broken or sick, not needing to be fixed, but as a person with agency who has desires and dreams and needs—which may be momentarily thwarted by seemingly overwhelming mental or emotional states, who may be feeling temporarily adrift—and to explore and define his or her experiences in such a manner that he or she can still feel whole, with possibilities to choose from to again move toward living a more fulfilling life?

Although nomenclature varies (peer-directed, consumer-operated, person-driven, client-led, etc.), Self-Help has been offered as one option. In practice, what Self-Help looks like within the vast continuum of behavioral health sciences can be significantly different. I will argue that it is most effective when imbued with the values upon which the c/s/x (consumer/survivor/ex-patient) movement was founded (Morrison, 2005). In particular, claiming the authority to define one’s needs and realities based on one’s own experiential knowledge, leading to the human right to be an equal partner in determining and participating in treatment/services. Specifically, I will apply this lens in three cases: 1) the guiding values in peer-directed services and the concomitant potential dangers of peer staff being tasked to be enforcers or unreflectively replicating power dynamics traditionally found in the medical model; 2) the values guiding Intentional Peer Support; and 3) the possibly empowering effects of collaborative decision-making among co-coordinators in an independent peer organization.

Clay’s (2005) review of peer programs noted several values at their core, especially “a strong sense of personal ethics and an unconditional respect for each person as an individual with the right to make decisions for himself or herself” (p. 11-12). They are grounded in choice—all activities are voluntary, elective and non-coercive since peers are “experts in defining their own experience” (p. 12); empowerment—“a sense of personal strength and efficacy, with self-direction and control over one’s life”; and the peer principle—“relationships are based on shared experiences and values and are characterized by reciprocity and mutuality” (p. 11).

It is a testament to the potential power of a peer perspective that many service locations now include some sort of peer support, whether that be due to admonishments/encouragements from funding or licensing sources or to a commitment from internal administrators. Frequently, however, peers have reported finding themselves asked to use the ‘special’ relationship they are able to build with individuals who use those services to do clinical bidding, such as ensuring medication compliance and adherence to institutional norms for behavior and expression. In some other cases, where peer staff are the majority of decision-makers, peer staff may perceive themselves as knowing what is best for those who use the services, taking on a stance of expert, authority or even protector, without actually engaging in dialogue with those affected or helping them to develop the tools and skills to articulate for themselves what it is they desire. Sometimes, people who attend peer-run programs expect peer staff to adopt those roles, and then complain when others attempt to rupture hierarchal relations. I would suggest that this is not Self-Help, but rather a continuation of business as usual, albeit with differently-labeled players.

An alternative is to ground relationships in the values espoused in Intentional Peer Support (IPS), an approach developed by Sheri Mead (2015). After establishing connection with another peer, IPS asks the peer supporter to take a stance of not-knowing, to view interactions as chances to learn together and to grow, moving towards what is defined as valuable by the person utilizing services. Key to this is, “Helping each other understand how we’ve come to know what we know (which) means stepping back from our ‘knowledge’ and thinking about how we’ve acquired that knowledge” (p. 12). This includes looking at how we’ve defined roles of helping and how we make sense of our experiences, specifically around our “illness story.” This is important for everyone, but especially for peer providers because we might think we can automatically understand someone if we have the same diagnosis, when, in fact, everyone’s experience of and explanation for the feelings/thoughts/behaviors that accompany that diagnosis may have different meanings and understandings. It is crucial, then, to listen “with genuine curiosity and interest, to what is being said, how it’s being said, what’s not being said… how this person has learned to think/see/understand things in this way” (p. 33).

A third expression of self-directed or non-hierarchal relationships can be found in a collaborative decision-making process. In the case that follows, a group of peers came together to co-coordinate a series of projects in their community, the core of which was a speakers’ bureau (Stone, 2014). The administrative group consisted of four individuals who met regularly to decide on projects, direction and tasks. In a recent review of the project, participants emphasized the importance of working collaboratively, even though it was a novel experience that also initially caused some confusion and discomfort. In particular, one participant explained:

Witnessing how L. was trying to get us together…. I realized I was following a mode of participating that I had learned from a long time ago and that I had to either accept it or deny it and I didn’t want to accept it when I had the opportunity to learn something now… I needed to slip myself out of it, to be part of (TPL)… and I decided to put myself forward more… knowing that I could voice my ideas better—I hardly ever did it, but I knew I could do it (Stone, 2014).

All of this is taking place within a greater societal/cultural context where people are increasingly aware of varied identities and positionalities that inform deciding those aspects of a situation/experience/condition delineated in the first paragraph: what is happening, what has happened, what to do or not do about it, and what it means or how to explain it. No one can any longer presume to know for another individual. It is imperative, therefore, that we ASK, that we are curious, that we listen, that we heed the responses, no matter how tentatively given, that we cede our role as expert no matter how tortuously earned, and fulfill the promise of Self-Help as an opportunity for the “Self” in question—the individual seeking—to be the director, the determiner, the decider.

References

Chamberlin, J. (1978). On our own: Patient-controlled alternatives to the mental health system. New York, NY: McGraw-Hill.

Clay, S. (Ed.). (2005). On our own, together: Peer programs for people with mental illness. Nashville, TN: Vanderbilt University Press.

Mead, S. (2005). Intentional peer support: An alternative approach. Plainfield, NH: Fishery Mead Consulting.

Morrison, L. J. (2005). Talking back to psychiatry: The psychiatric consumer/survivor/ex-patient movement. New York, NY: Routledge.

Substance Abuse and Mental Health Services Administration. (SAMHSA; 2012). SAMHSA’s working definition of recovery: 10 guiding principles of recovery. Retrieved from http://content.samhsa.gov/ext/item?uri=/samhsa/content/item/10007447/10007447.pdf

Stone, E. (2014). Articulating a vision of peer community: Transforming Peers’ Lives in Sonoma County. Unpublished paper.

Stone, E. (2015). An analysis of cooperative leadership in an independent peer-led organization. Unpublished paper. 

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