Trauma-Informed Peer Support

1. Trauma-Informed Peer Support Darby Penney National Center on Trauma-Informed Care RSVP Conference workshop September 26, 2012

2. The Power of Labels Before We Dare to Vision, We Must be Willing to See - Patricia E. Deegan, PhD

3. PEER SUPPORT FUNDAMENTALS

4. Peer Support Fundamentals Peer Support is a dynamic, flexible approach to connection & mutual understanding among equals, based on a core set of values and principles.

5. Peer Support Fundamentals Some organizations define peer support as a “helping relationship” similar to the hierarchical roles of professionals. In this guide, it is defined as the development of mutual relationships built upon peer support principles.

6. Peer Support is NOT A “program model” Focused on diagnoses or deficits About “helping” others in a hierarchical way Being a “counselor” Pressuring people to comply with treatment Monitoring people’s behavior

7. Peer Support Fundamentals Peer Support is rooted in: A natural human response to shared adversity The desire for healing & growth Compassion for self and others Consciousness-raising

8. Peer Support Principles Voluntary Non-judgmental Respectful Reciprocal Empathetic Peer Support is:

9. Peer Support Principles Peer support requires: Mutual responsibility for relationships Sharing Power

10. Peer Support Fundamentals Peer support promotes growth and healing through: Building reciprocal relationships among a community of equals Learning from each other Taking action

11. Culturally Responsive Support Develop understanding of groups commonly discriminated against and targeted for violence. (e.g. people of color, LGBT, young people, elders, immigrants) There are many cultural considerations and people have multiple membership. Assume nothing and create space in your conversations for each person to explore and define her own cultural identity and connections.

12. BRINGING TRAUMA-INFORMED PRACTICES TO PEER SUPPORT Section 5

13. Trauma-Informed Peer Support Moves away from the system’s question: “What’s Wrong with You?” to relationships based on the question: “What Happened to You?” 13

14. Trauma-Informed Peer Support Uses everyday “human experience” language, not “symptom-speak” Relates directly to survivors’ experiences and the meanings they make of their lives, not to labels of “mental illness” or addiction 14

15. Trauma-Informed Peer Support Sees coping strategies, not “symptoms” Helps survivors examine the totality of their life situation to make sense of how they are coping and surviving Creates a safe space to consider new coping strategies

16. The Difference • TRAUMA -INFORMED • my experiences • what’s happened to me? • people I work with • I’m here to learn with you • risking new thinking or activities • change patterns NON-TRAUMA INFORMED • my illness • what’s wrong with me? • my consumers • I’m here to help you • Further along in recovery (“high and low functioning”) • coping

17. Avoid “Helping” that Hurts • “Helping” in a top-down manner may: • reinforce feelings of helplessness • imply that one person is more “recovered” than the other • convey the message that the survivor is incapable of directing her own life 17

18. Reconnection Violence and abuse lead to disconnection. Systems’ use of power and control intensifies the sense of powerlessness. “Helper’s” behavior often mimics past abuses. Safety and control come from mutual, reciprocal relationships where power is shared.

19. Authentic Mutual Relationships What do we mean by “authentic mutual relationships?” Is it possible to form “authentic mutual relationships” within programs where one person is paid and others are not?

20. What is “common experience” in peer support?

21. Being with Trauma Survivors DON’T • Assume all survivors need professional help • Focus only on extreme forms of violence • Rely on DSM definitions and symptoms • Ignore the political context of violence DO • Assume resilience and create opportunities • Allow person to define what’s most traumatic • Be open to different ways of making meaning about trauma

22. Self-Awareness Know the topics that create a sense of powerlessness in you. Own the biases you have. Survivors can have sensitive radar for detecting dishonesty and good reason to be sensitive to issues of power and authority. Failure to recognize when you are acting from a place of power instead of mutuality can damage peer relationships.

23. STORY-TELLING AS A HEALING PRACTICE

24. Survivors Telling Their Stories Personal narratives organize our experience and help us make sense of what has taken place. Stories lay the groundwork for survivors to develop hope about the future. Stories can be told through spoken word, music, dance or movement, drumming, art, and writing.

25. Supporting Story Telling Listen for event, meaning, and impact. Prepare for common challenges: Stories that are difficult to listen to. Competing trauma stories. Telling the same story over again. Stories told through the language of behavior (e.g. Self Inflicted Violence) Talking about the taboo.

26. Survivors NOT Telling Their Stories Not everyone can or wants to tell their story. There may be cultural constraints on self disclosure. It may be too painful. It may be unsafe. People need support when they choose not to share their story.

27. What’s Going on For Karen?

28. SELF-INJURY

29. Understanding Self-Inflicted Violence • Self-injury evolves as a way to cope with trauma • A response to distress, past and/or present • Self-injury has meaning for each survivor: • Regaining control • Asserting autonomy • Relief of emotional pain 29

30. What Self-Injury is Not: • Attention-seeking • Manipulative • Confined to people labeled as “borderline” • Self-sabotage • “Para- suicidality” 30

31. Support to Heal • Examine your own feelings/beliefs about self-injury • Treat those who self-injure the same as those who do not • Create a safe space for people to talk about the meaning of self-injury in their lives • It’s not your job to “fix" anyone! 31

32. Reclaiming Power Through Social Action All violence focuses on the unfair distribution of power and the abuse of this power by the powerful against the helpless. The solutions to these problems are not individual solutions; they require political solutions. - Sandra Bloom

33. Reclaiming Power Through Social Action Trauma often leaves survivors feeling both powerless and full of rage Taking social action can be: a positive act of healing a productive way to channel anger a way for survivors to reclaim a sense of purpose and personal power

34. Reclaiming Power Through Social Action Social action can include: Organizing around a common goal Giving witness testimony Working to change harmful policies & practices Challenging injustice Creating supportive alternatives

35. Organizational issues

36. Organizational Considerations Peer supporters working in mainstream programs can face extraordinary challenges Primary role: to bring a different type of conversation to treatment and service settings

37. How do peer support staff… Establish non-clinical, equitable, transparent relationships within a hierarchical medical model organization? Relate as peers when they have keys, a paycheck, and are expected to enforce rules? Effectively raise issues about ways in which the system harms people when they work inside the system?

38. Discussion: Organizational Issues How does peer support change the conversation in a traditional treatment program? What barriers do you see to implementation of this approach?