ILRC, 70th to 10th Street, San Francisco, CA 94103,
415 – 863 – 0581, 415 – 863 – 1367
Build at 30.06.2001
PEER COUNSELING TRAINING MANUAL
1. RECRUITMENT OF TRAINEES
A. As appropriate, use:
1. Mailing/posting of flyers
2. Notices in community agency newsletters (see Appendix)
3. PSAs
B. Begin recruitment ten weeks prior to start of training
C. Follow-up six weeks prior to start of training
D. Allow three to four weeks to schedule screening interviews
II. SCREENING
A. Prepare a packet to give to prospective trainees before the interview
1.Written criteria for trainees re: disability, education and work background, philosophical approach to disability, any fees charged for training, commitment required, criteria for acceptance or rejection.
2.Written job description specifying characteristic of counselee population, exact nature of job (telephone, group, 1-1; counseling, referral screening, information), location of work, supervision and training provided; any specific policies of agency which apply to peer counseling.
3.Peer Counselor guidelines (see Sample in Appendix)
4.Agency brochure
B. Get basic information about prospective trainee: name, address, telephone number, general background information
C. Specific areas to explore:
1.“Tell me about yourself“- what comes up first – primarily?
What is this telling you about the applicant?
2.“Tell me about your disability“
Look for:
a. Attitude toward disability
b. How well integrated it is in individuals total life situation.
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c. „What would you say you have resolved or come to terms with regarding your disability?“ d. „What are some unresolved areas?“
e. „What has been your experience with counseling?“
3. „Tell me what interests you about our training program /doing peer counseling.“
4.“What do you imagine peer counseling will be like?“
5. Review packet of information: „Are you clear about these items? Any questions?“ Administer Gains Scale pre-test
(Appendix A)
D. When will you let applicant know about your decision?
III. THE TRAINING PROGRAM
Included (in Appendix A) is an outline of a successful program. Generally, the most successful efforts have occurred with one three-hour session per week over a 10-14 week period.
The general procedure for sessions covering listening skills is: a brief introduction by the trainer(s), group discussion, a „hot seat“ roleplay practicing the skill (trainer sets situation), dyads to practice the skill with trainer observation (rotate so each trainee works with several other people, and group summary), as time allows. Each new session begins with 10 minutes for questions about previous sessions. These are guidelines only. Flexibility is a necessity in order to respond to trainees, as their needs and skills become clear.
Trainees are asked to use real-life situations in the dyads. Group sharing is on a process rather than a content level re: specifics of co-counseling dyad practice.
It is Crucial that the trainer establish an atmosphere of clear, straightforward, non-judgmental critical feedback.
Begin in a circle with brief self-introduction (15 minutes)
A.(Session 1) Introduction to Peer Counseling
1. What does the term „peer counseling“ mean to you? (Group Discussion) (15 minutes)
2. Trainer summarizes group’s discussion (1/2 hour)
3. Trainer reviews „peer counselor guidelines“(Appendix) and Underlying Principles
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Shared responsibility for setting and achieving goals.
Peer counselor as role model – sharing own experience.
Providing emotional support
Goal of establishing individual’s support in networks and integration into larger community
The brief specific and renewable contract Differences between peer counseling and psychotherapy
Group discussion of these items
4. Trainer reads poem „Listen“ (Appendix)
5. (Optional) Panel of three to four peer counselors to discuss their experience and issues they have discovered. Questions and comments from trainees. (1 1/2 hours)
6. As you look ahead to this training program and to being a peer counselor, what are you feeling right now? Fears? Strengths you feel / you have? Weaknesses? (l/2 hour)
B. (Session 2) Disability Awareness
1. Introduce Ground Rules for Remainder of Training (5 minutes)
No judgments: right-wrong statements
Encounter content, not each other: talk about how you feel in response to something described by another person, what it calls up in you, what experience you have had
Stay with feelings – no factual case histories
„I“ statements – own your perceptions
Confidentiality – all agree that what is said in group, stays in group
Facilitator’s role (Appendix)
All agree to participate; only degree of sharing differs
Check with group for clarity of a-g
2. Your First Awareness of Disability
(Dyads) Take turns discussing: Do you consider yourself disabled? Is there such a thing as mental illness? Are other people mentally disabled? Are people disabled by the mental health system or psychiatry? (5 minutes each: 10 minutes total)
(Dyads) Take turns describing what you felt when you first became aware of your disability. Stay with feelings. Describe your first reactions. Listen to your partner. No feedback. OR
a. Peer Counseling Training Manual , Page 4
If you believe you have never had a disability, describe your first awareness of your treatment. Stay with your feelings. (5 minutes each: 10 minutes total)
How did you feel hearing your partner’s experience? What does this tell you about peer counseling? (20 minutes)
What were/are other people’s reaction to your disability?
How are these the same as and different from your own initial feelings? (15 Minutes)
Trainer asks group to summarize.
(1) (optional) Make up 20-30 index cards with one word feeling-descriptors (anger, vulnerability, fear, despair, joy, hope, depression, sadness, strength, ability, etc.).
(2)(optional) Each person is given two cards. How do these descriptors fit with where you are now? How is this the same as or different from what you have felt in the past?
(optional) Let’s try to take a closer look at where we are now with a guided meditation.
(optional)
(1) Start with body and mind relaxation
(2) Visualize your first experience with your mental disability or your first experience of b being treated by the Mental Health System. Be aware of the feelings.
(3) Visualize a positive, joyous response to your experience. What does it look/feel like?
(4) Slowly bring group back. Take a few minutes of quiet. Share responses.
3. Two common feelings – Anger and Vulnerability
a. What makes you angry? (Group discussion) (Trainer lists)
b. How do you express your anger? (Trainer lists)
c. How do you feel about expressing anger (wrong, frightening, powerful)? about being with someone who is angry? (15 minutes)
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does this all connect with psychiatric disability? Does it?
What would you like to do differently? (One-two hot seats to
practice. Get suggestions from group). (15 minutes)
What makes you feel vulnerable? What does that word mean to you?
What is the worst that could happen when you are feeling vulnerable? (15 minutes)
What can you do? (one-two hot seats to practice) (10minutes)
Silent scream
C. (Session 3) Self-Awareness
1. Acknowledgment/Integration (this is not an end stage but a point of the circle of awareness and experience.)
Discussion of the definition of Disability
– limitations in life
– disruption in functioning
– do you consider yourself disabled? Have you ever been disabled?
(15 minutes)
(Group Mime) I will call out words that describe our feelings at each stage in the circle of awareness and experience of disability. Face away from each other. When I call out a feeling-word, act it. You may make sounds, but do not interact with another person.
Shock
Sadness
Depression
Vulnerability
Anger
Hope
I am together again. I am whole as a human being.
(Group Discussion) How did you feel doing this?
Where are you now in the circle?
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What does acknowledgement and integration of disability mean to you? What does/will it look like? Are you attempting to be cured or are you trying to get by?
How does this/will this affect your relationships with other people?
(20 minutes)
2. (Optional) Guided Meditation
Start with body and mind relaxation.
Setting: forest, sea, meadow – sensory detail (sights, feel, smell, sounds)
Situation: meeting with wise man/woman who is going to answer the questions: who is the real me? What do I need to realize that me? The wise man/woman gives you a gift to take with you and help you remember
Slowly, bring group back. Take a few minutes of quiet. Share responses.
3. Sensitivity to other Disabled People: The Hierarchy of Disabilities/Diagnoses
What is the „worst“ disability /diagnosis you could have? best?
Why? (OR stage of disability) (10 minutes)
Which disabling condition(s) or behavior(s) make you uncomfortable? Why? Suggestions from others on how to handle this.
ROLE PLAY with a partner to explore ways to handle this – You take the role of „other“ person, then switch. (Hot seat – and dyads 5-10 minutes each (20 minutes)
Social political implications of a hierarchy of disabilities/diagnoses
What are the implications for peer counseling? (15 minutes)
4. Summarize #1-6 and trainer lists counseling issues presented by different stages of awareness/different feelings. (15 minutes)
5. (Optional) Do I know enough to begin counseling?
Trainer participates in two 15-minute hot seats as counselee. (Choose situations re: sexuality, suicide, medication, despair etc.) Counselor and group give feedback – what worked? Tie it all in with a preview of the remainder of the training. (Optional)
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D. (Session 4) Listening Skills – Introduction (Session 4) Listening skills have broad applications. Many of you may find that you use them quite naturally. Good listening is about 50% of counseling and you should find it a useful tool with family, friends, and at work.
Listening is a means of support of helping another person explore where s/he is at, and what s/he is thinking and feeling. Good listening, therefore, may help another person solve a problem or clarify a problem. You may find that being a good listener helps you learn where the other person is „coming from“.
How can we describe what good listening is NOT? Summarize (10 minutes)
It is not doing all the talking; it is not giving advice; it is not manipulating; it is not taking the responsibility for the other person’s problem and its solution. Keep in mind that this workshop does not teach you how to become a therapist. Listening is only part of helping, but it is a crucial part.
E. Attending behavior: Body Language and Basics; Open and Closed Questions (3 hours, including a 15-minute break)
1. Body Language: Components are eye contact, posture, personal space, gestures, and facial expressions. Review meaning of these terms briefly. (Group discussion)
What are some of the cultural variations in body language?
What are some of the disability-related variations in body language?
Taking into account culture and disability, what are some examples of body language we might easily misinterpret?
What does body language tell us as peer counselors? (20-30minutes)
2. Verbal Following: This is different from ordinary conversation, where each person may be pursuing his/her own line of thought. In using verbal following, it is important for you to let the other person determine the course of conversation while you simply respond or ask questions. Keep interruptions to a minimum and avoid topic jumping or changing the subject. Although it may be difficult at first, also avoid giving advice or judging the other person’s motives, thoughts or behavior. At first, avoid sharing your personal experiences or comparing notes. Remember, you are not responsible for solving the problem! (5 minutes)
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3. Hot Seat with trainer as counselee. Feedback from group on body language of both people and verbal following of counselor. (15 minutes)
4. Dyads: Describe yourself: past present future; feelings, thoughts, hot issues for you. (5 minutes. Stop. Counselor-counselee exchange feedback on body language and listening skills for 5 minutes. Reverse roles. Same Procedure. 20 minutes)
(15 minute break)
5. Open Invitation to Talk
a. First aspect is asking questions. We will speak of „open“ and „closed“ questions.
(1) Give examples of „open“ questions.
(2) Who asks these kinds questions?
(3) What purpose do they serve?
(4) Give examples of „closed“ questions.
(5) Who asks these kinds of questions? For what purpose might we ask them? (15 minutes)
b. Positive uses of „open“ questions in counseling?
(1) Flow is controlled by counselee.
(2) Get lots of information.
(3) Chance to see what is most important to counselee.
(4) Can unfreeze a stuck situation.
(5) Lead conversation to more personal, „internal“ place. (5 minu
tes)
c. Negatives?
(1) Too much freedom? No boundaries.
(2) (2) Person may ramble.
d. Positives of „closed“ questions?
(1) Elicit specific information
(2) Act as boundary on rambling. May help bound anxiety.
(3) Check verity of information. (5 minutes)
e. Negatives?
(1) Tend to cut down communication.
(2) Elicit „yes-no“ type answers.
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(3) Tend to create impersonal atmosphere. (5 minutes)
f. What makes „why“ a problem? Other words to use. (5 minutes)
g. Minimal encouragers move the conversation along. They may be both verbal, (such as „Go on“, „Uh-huh“, „I see“, „Yes“, or repeating the last few words the helpee has said, for example, „So little time?“ or non-verbal (such as nodding, smiling). The important part is that they are brief and natural for you. Again, by experimenting, you should be able to find your own best style. Many times this encouragement, or the simple restatement of something already said, has a powerful effect; so do not be afraid to limit yourself to the use of minimal encouragers if you want to keep the flow of conversation going. (5 minutes)
h. Silence as a minimal encourager. How do you respond to silence? What functions might it serve in counseling? (10 minutes)
i. Hot seat for 15 minutes. Group feedback on skills reviewed to date, but particularly use of silence, open and closed questions. (25 minutes)
j. Dyads (7 minutes, 3 minutes for feedback; reverse) 20 minutes)
F. (Session 5) Paraphrasing (Content)
1. Trainer Reads:
Each of you has observed the use of the paraphrase and have probably used paraphrasing, perhaps without noticing it. Newscasters interviewing will often repeat what was said in their own words: a paraphrase. When you have taken notes in a class much of what you did was paraphrase the instructor’s lecture. Likewise, when sending a telegram, you must condense a message into as few words as possible: again, a form of paraphrase. The paraphrase reflects the essence of the verbal content; it expresses briefly the facts of the situation, but pares away details. This skill is a bit more sophisticated, taking more concentration, more practice than the open questions we worked on last week.
The paraphrase has three main functions: (1) it acts as a perception check, to verify that you have understood what the helpee said. This is especially helpful if you are confused, or if you feel you may be.
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identifying too closely with the helpee’s situation. If you have heard correctly, the helpee might respond to your paraphrase by saying, „Yes“, or „that’s it“, or „right“
(2) A paraphrase may clarify what the helpee has said, especially if you pick up trends, set up dichotomies, list priorities. As an active listener with some objectivity, you may see more clearly these trends, priorities, etc. than the helpee, who is „too close to the forest“. (3) A good paraphrase can demonstrate that you have what Carl Rogers calls „accurate empathy“. Accurate empathy is a non-judgmental reflection of the helpee’s world view-, it is „walking a mile in another’s moccasins.“
It is important that a paraphrase be brief, it should almost always be shorter than what the helpee originally said. Make the paraphrase tentative, so that if it is not right, the helpee feels free to correct you; it is crucial that you know when you have not heard correctly. You might end with, „Is that right?“ or something similar. Watch out for endings like „isn’t it?“ or „Aren’t you“ as they turn the paraphrase into a closed question. Standard openings for a paraphrase are: „in other words …“, „So I hear you saying…“ Each of you will discover other openings with which you feel most comfortable.
What is especially tricky about a paraphrase is that on the one hand, if you parrot back exactly what you heard from the helpee, it is not terribly helpful and may even be irritating – but, on the other hand, if you add in too much of your own perceptions, you may be „putting words into the helpee’s mouth.“ The former type of statement is called a „restatement“, the latter is an „interpretation.“
2. Ask three people from the group to paraphrase above material. What are the similarities, differences? (15 minutes)
3. What do we mean by „fair fighting“ technique? How may paraphrasing be used as a „fair fighting“ technique? Examples. (10 minutes)
4. Hot Seat
Practice paraphrasing badly. Group feedback.
Use paraphrasing in an argument. Group feedback.
Comment on use of other skills learned to date. (30 minutes)
5. Dyads (use 25 + 5. 15 minute break, then reverse). (75 minutes)
6. Group discussion: Experience with 25-minute session; experience so far; problem, what you have learned, more hot seat practice? Review of previous sessions. (30 minutes)
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7. Guided meditation to visualize a „great“ counseling session. Share thoughts and feelings. (20 minutes)
G. (Session 6) Reflecting Feeling
1. (Group Discussion) What makes this tricky? (Feelings too private embarrassing or powerful to deal with directly; words and non-verbal expression do not match; culture)
2. Uses of reflection of feeling (says that you see what is happening and it is okay, gives permission to „own“ feelings; validating). (15 minutes)
3. Since talking about feelings is a limited experience, our vocabulary may be equally limited. Talk about your comfort or discomfort, discussing your feelings. (15 minutes)
4. In reflecting feeling, what do we need to be aware of?. (5 minutes)
Notice both verbal and non-verbal communication
Be sensitive to appropriate time to reflect back.
How to ask questions that elicit feeling?
How to reflect without interpreting?
5. Differences between reflecting feeling and paraphrasing? Trainer makes expressive statement. Ask someone to paraphrase; someone to reflect and/or elicit feeling. (5 minutes)
6. Hot Seat (30 minutes)
Badly – Poor timing; interpret
Proper way
7. Dyads (Use 25 + 5 + 15-minute break + reverse = 75 minutes)
8. Group summary and review. (30 minutes)
H. (Session 7) Skills Practice
1. Step-by-step review of listening skills, attending behavior, open invitation to talk, paraphrasing skills, and reflecting feelings: one trainee explains each area; role plays. (140 minutes total)
15 minutes per area (45 minutes)
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Dyads (use 30 + 10 + 15 minute break and reverse = 95 minutes)
2. Group review of handouts: „The Counseling Process“, „Interpersonal Techniques“, „Assessment of Counseling“ See Appendix A (40 minutes)
I. (Sessions 8-9) Special Issues in Counseling
1. Power and one-upmanship: who has the power? what is the power? why is it an issue? Trainer gives examples, then trainees. (15 minutes)
2. Self-Protection: How to take care of yourself and avoid burn-out. Causes of burn-out? See appendix A (10 minutes)
3. Other issues as determined by the class. (as needed)
4. What does our „most difficult person“ look like? How to recognize when you need to refer to other Services. (60 minutes) Dyads (use 30 minutes practice + 5 Minutes feedback and reverse) (70 minutes)
5. If there is time, allow for extra practice.
J. (Session 10) Special Topics
1. Suicide/Depression
a. What feelings does the word conjure? (go quickly – one word or so)
b. Why are we talking about it here? (quickly) –
c. Own feelings – moral, religious (10 minutes)
d. Own experience, suicidal feelings (30 minutes)
e. Look at how much we know. (30 minutes)
f. Lethality Scale – Signs/Clues (20 minutes)
Break
g. Counseling – do’s/don’t’s, skills
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Contract (30 minutes)
h. Hot / seat (20 minutes)
i. Practice in dyads (use 10 + 5 + reverse = 30 minutes)
We often have a presenter from Suicide Prevention during this session. Other presenters might present on medications and crisis intervention.
K (Sessions 11-12) Peer Counseling with Observers
Experienced Peer Counselors are invited to the class to observe and provide feedback to the trainees. The Counseling Assessment form is used as a tool.
Suggested timetable during each of these classes: Check-in, last minute instructions (20 minutes).
Dyads (use 45 minutes + 20 minutes feedback, 20 minutes break and then reverse. = 150 minutes)
L (Session 13) Evaluation of training, Graduation
1. Each person, including trainer(s), evaluates (1) the training and trainer(s) with suggestions for change and (2) his or her own gains from the training, remaining fears and feedback to other trainees who have been partners in dyad practices. (Repeat the Gains Scale – see appendix A)
2. Potluck celebration, awarding certificates and looking ahead to peer counseling assignments.
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Appendix A
Some of the materials included in this section have been used for many years by the Independent Living Resource Center – San Francisco in Peer Counselor trainings. It is unclear where some of the materials came from originally and we apologize for our inability to give credit where it is due.
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PEER COUNSELING TRAINING, APRIL 1990
WHAT’S A PEER COUNSELOR? Peer counselors are people who have experienced emotional difficulties and are interested in helping others with similar difficulties. By listening empathetically, sharing about their experiences and offering suggestions, peer counselors are uniquely able to help others like themselves. If you are someone who is sensitive to others and able to communicate clearly, you may be interested in being trained in peer counseling.
WHEN: Twelve Fridays from 1:30 to 4:30 pm. beginning April 20 and ending July 20.
There is an additional three session mini-series for Peer Counselors who would like to peer counsel at SF General Hospital.
WHERE: Independent Living Resource Center, 70 Tenth St. First Floor, between Mission and Market Sts.
WHO: Participants must be current or former consumers, survivors, clients and/or patients of mental health services. Bi-lingual consumers are especially encouraged to enroll.
WHAT TO DO: Call Carol Patterson at 863-0581 to set up an informal meeting to register for the class. Bring $15 materials fee to first class (or make other arrangements with Carol).
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APRIL 1990 COURSE OUTLINE
#1 April 20 What is Peer Counseling?, The Program at SF General Hospital
#2 “ 27 Stigma, Disability Awareness, IL Philosophy
#3 “ 4 Self-Awareness, Our Limitations, Helping vs. Rescuing, Burnout
#4 “ 11 Listening and Attending Skills
#5 “ 18 Paraphrasing
#6 “ 25 Reflecting Feelings
#7 June 8 Integration and Practice Of Skills
#8 “ 15 Special Issues: Power, Ethics
#9 “ 29 Practice Counseling (with observers)
#10 July 6 Suicide and Depression
#11 “ 13 Practice Counseling (with observers)
#12 “ 20 Evaluation of Training and Graduation
MINI-SERIES FOR, SFGH PEER COUNSELORS
#1 July 27
#2 Aug. 3 Confidentiality, Patients‘ Rights & Working with People with Aids
#3 “ 10
Note: There will NOT be class on June 1 and June 22, 1990.
Please bring your $15.00 materials fee to the first meeting (or make other arrangements with Carol). If you have any questions, please feel free to call Carol Patterson at 863-0581. (Best days to call are Tuesday, Thursdays and Fridays).
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What Is Peer Counseling?
Peer Counseling is the use of active listening and problem-solving skills to counsel people who are our peers. A „peer“ is often defined by context. You may be- a peer in terms of gender or race or age or cultural background. Being a peer is also situational. When you are in school your fellow students are your peers. When you are at a job your colleagues at work are your peers.
In the context of this training program a disabled peer counselor is someone who acknowledges having a disability and does counseling with another disabled person. .Acknowledgement of one’s disability means being more conscious of the range of feelings. and experiences each of us has as a person with a disability.
The basic premise behind peer counseling is that people are capable of solving most of their own problems of daily living if they are given the chance. The role of the peer counselor is NOT to solve another person’s problems -but rather to assist the person in finding his/her own solutions. Peer Counselors don’t tell people what they „should“ do, nor do they give advice. Instead the Peer Counselor helps the person to discover solutions to her/his problems by listening, sharing experiences, exploring options and possible resources and giving support.
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LISTEN
When I ask you to listen to me
and you start giving me advice, you have not done what I asked.
When I ask you to listen to me
and you begin to tell me why I shouldn’t feel that way, you are trampling on my feelings.
When I ask you to listen to me
and you feel you have to do something to solve my problem, you have failed me, strange as that may seem
Listen! All I asked was that you listen, not talk or do – just hear.
Advice is cheap; twenty cents will get you both Dear Abby and Billy Graham in the same
newspaper.
And I can do for myself. I’m not helpless. Maybe discouraged and faltering, but not
helpless.
When you do something for me that I can and need to do for myself you contribute to my
fear and inadequacy.
But when you accept as a simple fact that I do feel what I feel, no matter how irrational,
then I can quit trying to convince you and can get about this business of understanding what’s behind this irrational feeling.
And when that’s clear, the answers are obvious and I don’t need advice. Irrational feelings
make sense when we understand what’s behind them.
Perhaps that’s why prayer works, sometimes, for some people – because God is mute, and
He/She doesn’t give advice or try to fix things.
„They“ just listen and let you work it out for yourself.
So please listen and just hear me.
And if you want to talk, wait a minute for you turn – and I’ll listen to you.
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PEER COUNSELOR GUIIDELINES
1. A Peer Counselor takes in to account his/her own wishes, values and beliefs.
2. A Peer Counselor knows when and how to make referrals.
3. A Peer Counselor’s primary responsibility is listening to the client
4. A Peer Counselor has developed at least certain minimal communication and relationship-building skills.
5. A Peer Counselor respects the wishes, rights, values and beliefs of the client
6. A Peer Counselor maintains confidentiality.
7. A Peer Counselor believes that the least possible intervention is the best intervention.
8. A Peer Counselor respects the policies of the agency with which the Peer Counselor is affiliated.
9. A Peer Counselor works in close collaboration with a supervisor.
10. A Peer Counselor observes the usual, legal, ethical and moral responsibilities and limitations placed upon human service workers.
11. A Peer Counselor understands and accepts the privileges, responsibilities, and limitations of the role in accordance with all of the foregoing guidelines.
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Peer Counseling Training Ground Rules
1. Avoid judgments: right-wrong statements, shoulds
2. Encounter content, not each other: talk about how you feel in response to something described by another person, what it calls up in you, what experience you have had
3. Stay with feelings: avoid focusing upon factual case histories
4. Use „I“ statements, this is a way of owning your perceptions
5. Confidentiality: what is said in the group stays in the group and what is said in pairs, stays in the pairs. When we report back to the group about how the practice sessions went, avoid repeating what the other person said, instead talk about the process, what peer counseling interventions worked, etc.
6. Everyone in the class is a participant, only the degree of sharing differs.
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Independent Living Philosophy
1. Assumes people are capable of solving their own problems, making their own decisions, managing their own lives
2. Freedom of choice – we can delineate/clarify choices
– we can provide information about consequences
– the person has the right to choose what they feel is best
– we have to respect their choice even if we think it is wrong
– freedom to fail – the person is responsible for the outcome of their choice
3. Provide information and assistance to enable the person to do it for themselves
4. Client control of services – the person can terminate at any time and has continual input into the service being provided
5. Confidentiality
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There must be something the matter with him
because he would not be acting as he does
unless there was
therefore he is acting as he is
because there is something the matter with him
He does not think there is anything the matter with him
because
one of the things that is
the matter with him
is that he does not think that there is anything the matter with him
Therefore
we have to help him realize that,
the fact that he does not think there is anything
the matter with him
is one of the things that is
the matter with him
-R.D. Laing Knots Vintage Books, New York 1970
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Following list of dos and don’ts of mutual support work, which we believe to be the basic foundation of all true mutual support groups, that which makes our work with each other distinctly different from the „support“ provided to us by the professional mental health system. These dos and don’ts are the bottom line without which a group cannot call itself truly mutual and supportive. They are:
Do´s
Make all decisions and actions voluntary. Membership has total control.
Create a safe place to be crazy.
Reach across, person to person, back and forth. Be responsive and sensitive. Deal with your own fear first, beforetrying to help another.
Accept and be tolerant of a person.Talk quietly, touch when appropriate,encourage, reassure and comfort.
Ask about sleeping, eating, and basicpersonal and physical health needs. Make contact.
Reflect back ideas and defineconsequences. Provide information and options. Share your own experiences.
Be supportive.
Role model a human approach and a „wecan do“ attitude.
Be open and flexible in your thinking andaction. Be consistent.
Socialize openly.
Mix support and recreation. (Walk and talk) Facilitate. Share power and responsibility. Set limits.
DON´Ts
COMMIT or coerce.
Have professionals present – We are notpart of the mental health system.
Keep records without permission or usediagnoses or other labels.
Separate people into those who give support and those who get it.
Ignore a situation, hoping that it will goaway.
Attempt to handle a situation you areafraid of.
Invalidate or disbelieve a person. Threaten, restrain or corner a person.
Ask about psychiatric „illness“ as such.
Intrude.
Give advice.
Define what a person should do or be.
Make judgments.
Handle things like they do in the hospital by emphasizing the negative in people, dehumanizing them and invalidating them.
Be rigid and unable to treat people asindividuals.
Vacillate erratically.
Whisper in the presence of a person orgossip about a person negatively behind her/his back.
Mix support and business in a formalmanner in the same meeting.
Be directive and hierarchical.
Burn out.
——————————————————————————–
Budd, Su in Reaching Across.- Mental Health Clients Helping Each Other, Chapter 5 Support Groups. produced by the Self-Help Committee of the California Network of Mental Health Clients. 1987.
Peer Counseling Training Manual, Page 24
There have been times people may relate to when their communication or relationships with others just didn’t seem to be going quite right. I came across a list the other day that describes some of the ways an individual may be setting him/herself up for these situations. By the way, there’s a tendency to look at this list as only applying to the other person (see Item 9). Here’s the list; can you recognize yourself? Hank Gambina, SCIC Social Worker.
Fifteen Styles of Distorted Thinking
1. Filtering: You take the negative details and magnify them while filtering out all positive aspects of a situation.
2. Polarized Thinking: Things are black or white, good or bad. You have to be perfect or you’re a failure; there is no middle ground.
3. Over-Generalization: You come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, you expect it to happen over and over again.
4. Mind-Reading: Without their saying so, you know what people are feeling and why they act the way they do. In particular, you are able to divine how people are feeling toward you.
5. Catastrophizing: You expect disaster. You notice or hear about a problem and Start „what ifs“: What if tragedy strikes? What if it happens to you?
6. Personalization: Thinking that everything people do or say is some kind of reaction to you. You also compare yourself to others, trying to determine who’s smarter, better-looking, etc.
7. Control Fallacies: If you feel externally controlled, you see yourself as helpless, a victim of fate. The fallacy of internal control has you responsible for the pain and happiness of everyone around you.
8. Fallacy of Fairness: You feel resentful because you think you know what’s fair but other people won’t agree with you.
9. Blaming: You hold other people responsible for you pain, or take the other tack and blame yourself for every problem or reversal.
10. „Shoulds“: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you and you feel guilty if you violate the rules.
11. Emotional Reasoning: You believe that what you feel must be true-automatically. If you feel stupid and boring, then you must be stupid and boring.
12. Fallacy of Change: You expect that other people will change to suit you if you just pressure or cajole them enough. You need to change people because your hopes for happiness seem to depend entirely on them.
13. Global Labeling: You generalize one or two qualities into a negative global judgment.
14. Being Right: You are continually on trial to prove that your opinions and actions are correct. Being wrong is unthinkable, and you will go to any length to demonstrate you rightness.
15. „Heaven’s Reward“ Fallacy: You expect all your sacrifice and self-denial to pay off, as if there were someone keeping score. You feel bitter when the reward doesn’t come.
Peer Counseling Training Manual, Page 25
Basics for Listening
I. Minimal Encouragers
to let person know you are listening – simple, key word response (Mm Hum) or attentive silence.
CL „There’s so much I need to do. I don’t know where to begin.“
CO „Hm Hm“
CL „About a year ago I sold my home and moved to a condo.“
CO „Go on“
II. Restatement
„You seem to be saying“ another way to show CO is listening and understands
III. Reflection of Feeling
„You seem to be feeling…“
IV. Supportive Responses
„You’re OK .. Based on what you’ve told me that’s a very understandable feeling“
V. Clarification
„Let me see if I’ve got this right“
„I know you believe you understand what you think I said, but I’m not sure you realize that what you heard is not what I meant.“
VI. Non-Verbal Referent
points out or inquires about non-verbal behavior -without interpretation
CL „I don’t know what’s wrong“
CO „You have tears in you eyes right now“
VII. Confrontation
presents listener’s perception of some sort of contradiction or discrepancy in speaker’s communication
VIII. Self Disclosure
reveals CO as real human being use sparingly and only after giving attention to understand counselor’s problem as accurately as possible return focus to counselee’s situation as quickly as possible use „I“ statements
Peer Counseling Training Manual, Page 26
The Art of
Shutting Down
Don’t look
the person in
the eye
Move away from
the person
Lean back and turn
away from the person
Make judgments about the
person and what he is saying
Jump in and say whatever you
think
Don’t listen with anything in mind
Don’t think much about what you are hearing
Don’t notice what the Person is doing
Think about what you’re going to do after work
The Art of Opening Up
Face the person
Move toward the person
Lean toward the person
Maintain eye contact
Initially suspend your judgement
Practice waiting before you respond
Have a reason for listening
Reflect on the content of what you are hearing
Relate what you see the person doing to
what you hear the Person saying.
Peer Counseling Training Manual, Page 27
Attending
1. Put aside what you were doing and give the person your full attention.
2. Maintain a friendly, relaxed manner.
3. Stay as close as possible without making the Person too anxious.
4. Keep your body trunk and major appendages oriented toward the person-
maintaining a slight forward lean most of the time. Avoid assuming a rigid, frozen posture.
5. Maintain eye contact, but avoid staring.
6. Give the Person ample opportunity to respond by communicating a readiness to listen.
7. Develop expressive gestures which encourage the helpee to continue communicating such as: smiling, nodding and hand movements.
8. If the Person doesn’t begin to-or continue to communicate verbally, then respond to him or her.
a. Try to avoid introducing extraneous material such as small talk, questions, etc.
b. Really look at the person and try to imagine what is happening and put this into words.
Example:
I see you’re on the edge of you chair and shuffling your feet, and I imagine you’re feeling nervous and wondering how to get away from here.
Peer Counseling Training Manual, Page 28
What did you say?
Words are important tools for contract. They are used more consciously than any other form of contact. The words we use have an effect on our health. They definitely influence emotional relationships between people and how people can work together.
Words cannot be separated from sights, sounds, movements, and touch of the person using them They are one package.
If you were able to use certain special words carefully it would solve many contact problems created by misunderstanding. Here are two examples: I and They.
Many people avoid the use of the word I because they feel they are trying to bring attention to themselves. They think they are being selfish. Shades of childhood, when you shouldn’t show off, and who wants to be selfish? The most important thing is that using I clearly means that you are taking responsibility for what you say. Many people mix this up by starting off with saying you. I have heard people say „You can’t do that.“ This is often heard as a „putdown“ whereas „I think you can’t do that“, makes a more equal relationship between the two. It gives the same information, without the putdown.
The use of they is often an indirect way of talking about you. It is also often a loose way of spreading gossip. „They say…..“
They can also be some kind of smorgasbord that refers to our negative fantasies. This is especially true in a situation where people are assessing blame. lf we know who they are we can say so.
How many times do we hear „They wont let me“. „They will be upset“. „They don’t like what I’m doing.“ „They say….“
lf someone else uses it, we can ask „Who is your they?“
VIRGINIA SATIR
author and lecturer
Making Contact
1976
Peer Counseling Training Manual, Page 29
1. Which feelings make me uncomfortable when I experience them?
2. Which feelings do I tend to deny because I believe that I shouldn’t be feeling them?
3. Which feelings when expressed by others, make me uncomfortable?
4. Are some of my feelings frightening to me? Which ones?
5. Am I usually aware of when I am feeling angry, anxious, uncomfortable, inadequate or embarrassed?
6. Do I withhold showing my feelings most of the time?
Peer Counseling Training Manual, Page 30
A vocabulary for feelings
abandoned
accepted
affectionate
afraid
alarmed
amazed
angry
annoyed
anxious
appreciative
apprehensive
approval
ashamed
balmy
belittled
belligerent
bitter
bored
bottled up
calm
capable
competent
confident
conflicted
confused
contented
crushed
defeated
depressed
desolate
desperate
despondent
discouraged
disinterested
disparate
dissatisfied
dispassionate
distressed
ecstatic
elated
embarrassed
empty
enthusiastic
envious
euphoric
excited
exhilarated
fearful
friendly
frustrated
furious
futile
grateful
guilty
happy
hateful
helpless
hopeless
horny
humble
humiliated
hurt
identification
inadequate
incompetent
inflamed
insecure
insignificant
jazzed
jealous
joyful
lonely
longing
loved
loving
miserable
misunderstood
needed
negative
neglected
nervous
numb
passionate
pleased
pressured
proud
put down
puzzled
reborn
regretful
rejected
rejecting
rejuvenated
relaxed
relieved
resentful
sad
satisfied
sensual
serene
sexy
shocked
startled
surprised
tearful
tense
terrified
threatened
thrilled
transcendent
trusting
uncertain
uncooperative understood
uneasy
unhappy
unloved upset
uptight
vengeful
vindictive
wanted
warmhearted
worthless
worthy
yearning
Peer Counseling Training Manual, Page 31
INTERPERSONAL TECHNIQUES
Technique / Example
1. Using silence
Gives the person a chance to reflect on what s/he has said.
2. Accepting
Yes, Uh-hmm, Nodding, „I follow what you said.“
3. Giving recognition
Good morning, Mr. _________.You’ve tooled a leather wallet. I notice you have a new dress on.
4. Offering self
I’ll sit with you for a whileI’ll stay here with youI’m interested in your comfort
5. Giving broad openings
Is there something you would like to talk about? What are you thinking about?Where would you like to begin?
6. Offering general leads
Go on. And then? Tell me about it.
7. Making observations
You sound tense.Are you comfortable when you…? I noticed you were biting your lip It makes me uncomfortable when you..
8. Encouraging comparison
Was this something like…? Have you had similar experiences?
9. Restating (type of reflecting)
Speaker
I can’t sleep. I stay awake all night
Listener
You are having difficulty sleeping?
Speaker
Do you think I should tell my husband?
Listener
Your are wondering whether he should know?
Speaker
My brother spends all my money and then has the nerve to ask for more!
Listener
This causes you to get angry.
10. Exploring (probing)
Tell me more about that.How did that make you feel?Would you carry that a little further?
Peer Counseling Training Manual, Page 32
I. BEGINNING COUNSELING A. Rapport
1. Confidentiality
2. Positive regard
3. Listening/understanding
B. Defining the Problem
1. Client’s Statement
2. Revised impressions
3. Referral information
C. Contract
1. Statement of services/goals
2. Limits (time, scope)
II. MIDDLE PHASE A Listening
1. Reassurance/support
2. Ventilation
3. Problem solving/decision making
B. Sharing
1. Information giving/referral
2. Self-disclosure
3. Confrontation
III. ENDING
A. Reassessrnent
1. Refer to original contract
2. Evaluate changes
B. Providing Closure
1. Client’s part in changing
2. Development of other client resources
C. Follow-up
1. Referral
2. Checking up
Peer Counseling Training Manual, Page 33
San Francisco Suicide Prevention, Inc.
SUICIDE — WHAT YOU CAN DO TO HELP
1 Recognize Signs Of Depression And Suicide Risk
– recent loss-through death, divorce, separation, broken relationship, loss of job, money, status, self-confidence, self-esteem
– loss of religious faith
– loss of interest in friends, sex, hobbies, activities previously enjoyed
– worry about money, illness (either real or imaginary)
– change in personality-sad, withdrawn, irritable, anxious, tired, indecisive, apathetic
– change in sleep patterns-insomnia, often with early waking or oversleeping, nightmares
– change in behavior–can’t concentrate on school work, routine tasks
– change in eating habits–loss of appetite and weight, or over eating
– diminished sexual interest, impotence, menstrual abnormalities (often missed periods)
– fear of losing control, going crazy, harming self or others
– feeling helpless, worthless, „nobody cares“, everyone would be better off without me
– feeling of overwhelming guilt, shame, self-hatred
– no hope for the future, „It will never get better, I will always feel this way“
– drug or alcohol abuse
– suicidal impulses, statements, plans; giving away favorite things; previous suicide attempts or gestures
– agitation, hyperactivity, restlessness may indicate masked depression
REMEMBER: The risk of suicide may be greatest as the depression lifts,
2. Do Not Be Afraid To Ask: Do You Sometimes Feel So Bad You Think Of Suicide?
Just about everyone has considered suicide, however fleetingly, at one time or another. There is no danger of „giving someone the idea.“ In fact, it can be a great relief if you bring the question of suicide into the open, and discuss it freely without showing shock or disapproval. Raising the question of suicide shows that you are taking the person seriously and responding to the potential of her/his distress.
3. If The Answer Is „Yes I Do Think Of Suicide“ You Must Take It Seriously And Follow It Through. Have you thought how you’d do it? Do you have the means? Have you decided when you would do it? Have you ever tried suicide before? What happened then? lf the person has a definite plan, if the means are easily available, if the method is a lethal one, and the time is set, the risk of suicide is very high. Your responses will be geared to the urgency of the situation as you see it. Therefore it is vital not to underestimate the danger by not asking for the details.
4. Making A Contract
If you ascertain that the risk of suicide is high (i.e. a strong possibility exists that the caller will commit suicide in the near future) try to make a verbal agreement with the caller to call us back BEFORE he/she follows through with suicidal intentions. The degree of suicide risk can be determined by applying criteria outlined in „Evaluating Potential Suicide Risks“, attached. The decision to make a contract will be based on your best judgment of the callers‘ suicidal risk. As in all cases, consult with staff or other volunteers on your shift if you are uncertain as to the best direction to take with callers.
Peer Counseling Training Manual, Page 34
EVALUATING POTIENTIAL SUICIDAL RISK
Is there a way to tell whether suicide threats are real?
University of Hawaii researchers have devised a questionnaire to guide counselors attempting to assess the seriousness of a suicide threat.
The nine categories in the questionnaire are followed by characteristics that may determine a person’s suicide Potential (the degree of possibility that a person may take his life).
The number three is the value assigned the most serious characteristic, the zero representing the least serious. (If two numbers could apply, the highest value is used for scoring.) A score of one-to-nine indicates a low Potential, 10-18 is moderate, and 19-27 is high.
AGE
1-9
10-34
35-49
50+
PROBLEM
0. No significant stress.
1. Tension related to success, Promotion or increased responsibility.
2. Changes in life or environment, such as illness, surgery or hospitalization, accident, threat of prosecution, criminal involvement, etc.
3. Loss of loved one by death, divorce or separation. Loss of job, money, prestige or status.
SUICIDE PLAN 0. No plans but may have thought about it at some time.
1. Definite plan.
2. Bizarre plan. Method well thought out but means not instantly accessible. Or, has a previous suicide attempt.
3. Has a lethal method, plan with means available (such as a gun or sleeping pills). Has decided on a specific time and has made one or more previous suicide attempts.
SYMPTOMS
0. No specific change in behavior.
1. No medical problems. Recurrent complaints of minor illness.
2. Repeated unsuccessful experiences with doctors. Alcoholism, drug addiction, compulsive gambling.
3. One or more previous suicide attempts of high lethality. Insomnia. Loss of sexual desire. Weight loss. Social withdrawal. Loss of interest in people and activities previously enjoyed.
Peer Counseling Training Manual, Page 35
RESOURCES
0. Employed or has finances.
1. Family or friends willing to help. Physician, clergy, social agencies or other professional help available.
2. Financial problems. Family and friends available but unwilling to help.
3. Has nowhere to turn. No family, friends, employment or agencies for help.
ATTITUDES
0. Expresses good reason for living.
1. Is upset about suicidal thoughts.
2. Reasons for dying are equal or outweigh reasons for living. Ambivalent about suicidal thoughts.
3. Sees no reason for living. Makes no attempt to keep suicidal thoughts under control.
STRENGTHS
0. Has made attempts to work things out for himself.
1. Has sought help or is seeking help of others.
2. Has not sought help because problem is thought to be beyond solution.
REACTION OF OTHERS
0. Sympathetic, concerned and/or supportive.
1. Alternates between feelings of anger and rejection, and feelings of responsibility and desire to help.
2. Denial of person’s need for help.
3. Defensive and/or rejecting. No feelings of concern. Does not understand.
EXPRESSION OF EMOTION
0. Can express rage, anger, hostility and revenge (verbally).
1. Shame, guilt, embarrassment, agitation, tension, anxiety.
2. Disorganized, confused. Has hallucinations or delusions. Loss of control and judgment.
3. Future looks bleak, despondent, hopeless, helpless, worthless. Change in appetite. Decline in job performance (real or imagined).
SF – Suicide Prevention, Inc.
Peer Counseling Training Manual, Page 36
MYTHS AND FACTS ABOUT SUICIDE
1. MYTH: A person commits suicide without warning.
FACT: Although suicide can be an impulsive act, it is often thought out and communicated to others, but people ignore the clues.
2. MYTH: People who talk about suicide never kill themselves.
FACT: Most suicides – 8 out of 10 – have given definite clues and warnings about their suicidal intentions.
3. MYTH: Suicide is a random happening; there are few cases.
FACT: Suicide is the 8th leading cause of death among all adults in the US. There are twice as many suicides as homicides.
4. MYTH: Suicide strikes much more often among the rich – or, conversely, it occurs almost exclusively among the poor.
FACT: Suicide shows little prejudice to economic status. It is represented proportionately among all levels of society.
5. MYTH: More women than men commit suicide.
FACT: Although women attempt suicide twice as often as men, men commit suicide twice as often as women.
6. MYTH: Suicidal persons really want to die so there’s no way to stop them.
FACT: Suicidal persons are often undecided about living or dying right up to the last minute; many gamble that others will stop them before it’s too late.
7. MYTH: A suicidal person can never be saved; s/he’ll do it eventually.
FACT: People who want to kill themselves feel that way only for a limited time; the „crisis-period“ passes.
8. MYTH: If a Person really wants to kill himself no one has the right to stop him
FACT: No suicide case has only one victim; wives, husbands, lovers, children and friends all suffer from the loss of a suicide.
Peer Counseling Training Manual, Page 37
9. MYTH: Most suicides are caused by a single dramatic and traumatic event
FACT: Precipitating factors may trigger a suicidal decision; more typically the deeply troubled person has suffered long periods of unhappiness, is withdrawn, depressed, helpless to cope with life, has little self-respect and no hope for the future.
10. MYTH: Suicide is inherited, it runs in the family.“
FACT: Suicide is a highly individual matter – there is no genetic predisposition to self- destruction.
11. MYTH: Once stopped, the suicidal Person is „cured“.
FACT: Four out of five persons, who kill themselves have tried at least once before.
12 MYTH: It is morbid to talk about suicide to a Person who is unhappy.
FACT: Depressed individuals need attention and emotional support; encouraging them to talk about their suicidal feelings can be therapeutic as a first step.
13. MYTH: People who commit suicide have sought medical help prior to their attempt.
FACT: Suicidal individuals often exhibit physical symptoms as part of their depression and might seek medical treatment for their physical ailments.
SF Suicide Prevention, Inc.
Peer Counseling Training Manual, Page 38
ASSIGNMENT – ON DEPRESSION/SUICIDE
Before next week’s class, take some time and answer the following questions for yourself:
1. Think about a time when you were depressed – was it a mild depression or a severe depression?
2. How did you feel during the depression – for example: hopeless, powerless, etc. Did it feel permanent, endless, timeless?
3. What led up to the depression?
4. What were the „symptoms“ of the depression – for example: no appetite, no sleep, lots of sleep, fatigue, etc.?
5. How did you get out of the depression – did you seek help? Take actions? What helped you feel better?
6. How do you feel when someone around you is very depressed? – Do you feel the need to cheer the person up? Do you feel hopeless, powerless, frustrated, or what?
7. Have you ever contemplated committing suicide?
8. If yes, what was going on in your life at the time that may have led you to consider suicide?
9. How did the situation that led you to consider suicide change for you?
10. Did you seek support and help – for example: from friends, family, Suicide Prevention, a counselor?
11. Did you ever attempt suicide?
12. If yes, what were your feelings after the attempt?
13. Do you feel it is OK or NOT OK for a person to commit suicide? What are your values, belief systems regarding suicide?
SF Suicide Prevention, Inc.
Peer Counseling Training Manual, Page 39
The Chinese character for „crisis“ is, incidentally, one which means „dangerous opportunity“.I think we all perceive the „danger“ in a crisis-time, but I am not always sure we perceive the -opportunity. So, let me belabor this for a moment. Imagine that a friend of yours is in a crisis situation and you want to be helpful to him or her. We are all so hypnotized by the virtue of „being helpful“ that we rarely stop to think about the fact that there are two principal ways of being helpful. One is to render services. The virtue of this is that if you are successful, you will pull your friend out the crisis (like, being without a job), and he or she will be very, very grateful to you. However, the difficulty with (if I may say) merely rendering services is that your friend who received your help actually hasn’t even a clue, when it is all over as to how you did it- And, therefore, no idea as to how to pull it off the next time that that same crisis, or one like it, occurs in his or her life. This kind of help therefore, might as well be an act of magic, for all the comprehension your friend ha\s afterwards as to solve the problem the next time.
Fortunately, there is a second way of being helpful. And that is to take tremendous care as you go through the process of helping your friend with his or her crisis, so that your friend clearly understands you are using this particular crisis to teach him or her how to solve that kind of crisis for himself or herself, even thereafter. In order to do this, of course, you will need to use no exercises or …st-instruments which your friend does not fully understand; to undertake no step in the process without explaining to your friend what is being done, and why; and to offer him or her no additional „helpers“ without explaining why you are offering them, what their virtues and limitations are, and how you found them. I call this latter form of helpfulness Empowerment, not because that word was made popular in the late sixties, but because I don’t know a better way to describe a process in which both the goal and the acknowledged outcome is that your friend becomes stronger and more in control of his or her life, rather than merely grateful or dependent. And this, because of the way in which you get about to help him or her deal with their „dangerous opportunity.“
All of this is equally important, if not more so, when it is your life which has a crisis in it. You can find help – from books or people – which merely renders you services; or you can find help which is only Empowering to you. You must set the goal. An Empowering sort of help will be one which helps you learn a method and/or pick up tools which you can relatively easily master, remember, and .se…l the rest of your life.
-Richard D. Bolles
Peer Counseling Training Manual, Page 40
San Francisco Examiner June 5, 1988
Faces of violence-
E. FULLER Torrey – the „world authority“ on schizophrenia – proclaims much that U, and many others, would dispute regarding the „schizophrenic“ (Style Section, May 29).
One statement that is particularly infuriating was his opinion that if a stranger happens to strike you in the face while you are upon a public sidewalk, „chances are“ the stranger is schizophrenic. Chances are Torrey doesn’t know that he is talking about.
I feel safer and would rather be around „schizophrenics“ than many „normals“ out there. Attending programs on a daily basis for 15 years and rubbing elbows with well over 1.000 people considered mentally ill, I can count the acts of violence on one hand; none of the acts resulted in harm and all were over almost as quickly as they started.
More violence occurs in six months in the friendly neighborhood tavern. You are even more likely to get clobbered by being part of an American family. Just ask a little kid or a woman. Most „mentally ill“ people are arrested for minding their own business and are usually victims of crimes rather than perpetrators.
Doc Torrey talks about rehabilitation and medication as being effective for treatment. People get rehabilitated by being accepted, not by being rehabilitated.
John G. Price
SAN FRANCISCO
Peer Counseling Training Manual, Page 41
San Francisco Bay Guardian
Vol. 19, No. 28
May 1, 1985
Painting a different mental picture
As the result of a severe depression I found myself in Langley Porter’s acute crisis unit – translate locked ward. In the seventeen days that followed (a 72 hr. hold plus 14 days treatment) I got the help I needed to start putting my life back together. I was not forcefully drugged or „dosed with powerful tranquilizers“ as the Guardian article (4/17/85) indicates. My former history of valium dependency was taken into consideration and I was not given any medication until the fourth day of my stay. The anti-depressants and neuroleptics that I am taking are literally saving my life. The other claim, that patients are virtually ignored was also false in my case. I received personal attention within a half hour from physicians and staff.
It is true that all mental patients don’t receive the red carpet treatment. I too have heard horror stories and may have been lucky in my choice of hospitals: I don’t believe, however, that it is poor or indifferent psychiatric treatment that creates the vicious cycle of hospital hopping but rather the prejudice and stigma of being mentally ill once we return to the outside world.
R. La Fontaine
San Francisco
Peer Counseling Training Manual, Page 42
What is Burnout?
Webster defines Burnout as „to cause, to fail, wear-out or become exhausted by making excessive demands on energy, strength, or resources! Burnout can also be defined as to burn until the fuel is exhausted and the fire ceases.
In the social services it is not a result of personal failing but a result of the work situation. Burnout individuals can be affected in three ways, emotionally, mentally, and physically.
Symptoms
—feeling that you don’t care anymore,
—- decline in Performance,
—cynicism,
—– tension,
—negative outlook,
—– irritability,
—poor health,
—– physical exhaustion,
—substance abuse,
—– mental exhaustion
—withdrawal,
All these can be symptoms of Burnout
Helping-Suggestions
Here are some ways to deal with Burnout. Although we are mentioning only a few suggestions or disengaging from stressful work situations you may find other tactics that work for you.
— slow down
—– develop support system among colleagues
— sit in Ihe park
—– vary work activities
— hot tub
—- look for other career opportunities
— exercise and/or other physicial activities
—– spiritual development
— meditation
— take up hobbies
This pamphlet is the result of a research project on the phenomenon of Burnout in the social services. Our team of researchers were all part of the Senior Group Project class in the Human Development Department of California State University, Hayward. We gratefully acknowledge the assistance of:
Dr. Donald Strong
Dr. Dora Dien
Dr. Ayala Pines
Manuel Alcala
Willie Bluford
Unda Heng
Carol Patterson
Jeanne Uhlenbrock
February 1981
Peer Counseling Training Manual, Page 43 ILRC – SF Gains Scale (Peer Counseling Training)
Name:____________________________
Date:______________________
1. Do you know what peer counseling is?
______________________________________
If „yes“, how would you define it?
_
_
_
_
_
_
_
_
_
_
_
_
2. Please rate your level of self-awareness regarding the following:
(1 = poor, 5 = excellent)
a. Anger 5 4 3 2 1
b. Vulnerability 5 4 3 2 1
c. Disability Awareness 5 4 3 2 1
d. Depression & Suicide 5 4 3 2 1
e. Stigma 5 4 3 2 1
f. Power and the Counseling Relationship 5 4 3 2 1
g. Independent Living Philosophy 5 4 3 2 1
3. Please rate your counseling ability in the following areas:
(1 = poor, 5 = excellent)
a. Knowledge of Body Language 5 4 3 2 1
b. Use of open and closed questions 5 4 3 2 1
c. Paraphrasing 5 4 3 2 1
d. Reflection of Feeling 5 4 3 2 1
e. Summarizing 5 4 3 2 1
f. Opening a counseling session 5 4 3 2 1
g. Closing a Counseling session 5 4 3 2 1
h. Empathetic listening 5 4 3 2 1
4. Comments:
_
_
_
_
_
_
Peer Counseling Training Manual, Page 44
ASSESSMENT OF COUNSELING
1. Established Rapport:
Comments:
-promotes comfortable, safe setting
-shows warmth, caring concern
-engenders self-worth, non-judgmental
-reinforces counselee’s concerns as important
2. Appropriate, Open Ended Questions:
-good timing, natural flow
-minimal interruption
-avoids yes-no questions
-uses closed questions appropriately
-avoids unfounded assumptions
-avoids leading questions
3. Feelings/Issues:
-reflects, acknowledges, supports,
gives permission to express, picks up cues
and pursues feelings and sensitive issues
-does not deny or skirt feeling, issues
4. Body Language:
-uses listening behaviors, nodding, leaning
forward, etc.
-avoids distracting body language
-allows silence, allows pauses
-avoids interrupting
-tone of voice
5. Zeroing In/On Targetness:
-assists counselee in getting to problems and
….cuses on them
-develops plan with counselee
-explore alternatives
6. Summarizing/Paraphrasing
-accurate -clarifies
-summarization at end of session
7. Referrals (If Used):
-avoids Problem-solving
-appropriate use of resources
-provides alternatives
8. Other
Counselor’s Name_______________________________________
Counselee’s Name ___________________________________
Observer’s Name_____________________________________
Peer Counseling Training Manual, Page 45
APPENDIX B
The following contracts and documents
have been created to define the Peer
Counseling Program in practice at
S.F. General Hospital.
Peer Counseling Training Manual, Page 46
After completing the Peer Counseling Training, you may be interested and eligible to participate in the BUILD Peer Counseling Program. The main component involves Peer Counseling at SF General Hospital but also includes peer-led groups at Shrader and Cortland Houses. We hope to expand Peer -Counseling to other sites in SF.
PEER COUNSELING AT SFGH
1. In addition to completing the Peer Counseling Training, you must also complete the 3 session mini-series on Patients‘ Rights, the Shanti Project and Confidentiality.
2. You will need to register with the Volunteer office at SFG9 7F8, the phone # is 821-8193. This involves:
– filling out forms at the Volunteer Office
– Health screening (usually takes a minimum of two weeks)
a) Immunity to German Measles (Rubella) – you will be tested to make certain you have antibodies to fight off Rubella. If you don’t have these helpful antibodies, SFGH will give you a vaccination so that you will develop a mild form of German measles and develop the antibodies. This is for your protection!
b) TB testing – You will be given 2 skin tests for-TB, this will require 3 visits to SFGH. If you have been exposed to TB, SFGH will provide you with treatment. Each year, you will be retested. This is for your protection!
IF you have recently received a negative TB test and have the proof in writing, bring this with you because it can shorten the amount of testing you need to have done.
get an ID badge provided by SFGH
3. Paperwork with Carol
-Oath of Confidentiality
-sign contract with BUILD
-W-9 form
-Standard of Conduct
4. Your first time going on the units, Carol will go along with you. The second time (if you’re ready), you’11 go with an experienced Peer Counselor.
5. Peer Counseling happens on Wednesday evenings. We usually meet in the cafeteria on the 2nd floor at 5:00 pm and have dinner/support group. (On some of the units we attend community meeting, so some of the Peer Counselors come earlier than 5 pm.)
At about 6:00 pm we go on the units. Generally we go in pairs or in groups of three. This is an informal type of Peer Counseling: we might just hang out with people, play cards, watch TV with them, etc. At 8:00 pm we’ll meet off the units to share about how it went and to compile statistics.
Peer Counseling Training Manual, Page 47
6. There is a monthly support group that sometimes covers business but also allows time for us to talk about issues, that are arising as we do Peer Counseling.
7. The units we go on are: 7A – Latino and Women’s focus, 7B – AIDS/ARC focus, 7C – Asian focus, and 6B – Black focus. AU are psychiatric units and all treat persons of all ethnicities regardless of WV antibody status. lf you have a preference for a particular unit, we’ll try to accommodate you.
8. In addition to visiting the units on Wednesday evenings, we also lead Transition Groups on 7A and 7B. Right now these groups are meeting on Mondays for 1/2 hour. The purpose is to allow discussion and information exchange about the transition of getting onto the unit and leaving it from a Peer prospective. We also visit PES (Psychiatric Emergency Services) on Monday afternoons.
9. Both these types of Peer Counseling require previous experience Peer Counseling on the units. PES also requires an additional two session training provided jointly by SFGH and BUILD.
10. A limited number of stipends ($) are available for Peer Counseling.
Peer Counseling Training Manual, Page 48
Statement of Agreement about the function of BUILD Peer Counselor at San Francisco General Hospital:
1. A BUILD Peer Counselor is an individual who is a consumer/survivor, client or patient of Mental Health Service who has successfully completed d BUILD Peer Counseling Course.
2. Direct supervision is provided by Carol Patterson in a weekly support group and individually as requested.
3. The Peer Counselor may serve as a community resource specialist, a role model and/or a friend to persons currently hospitalized (and recently hospitalized).
4. Although the Peer Counselor does not function as part of the ward team/staff they are expected to maintain confidentiality and respect the rules of the ward.
5. The basic philosophy under which the Peer Counselor operates is the independent living philosophy: empowerment, self-help and self-advocacy. The Peer Counselor is a resource person, a facilitator who assists the disabled individual to do for him/ herself
6. Initially we would start with 2 Peer Counselors coming together to the ward during visiting hours for 2 hours per week. If this is successful, we could increase the number of hours and/or expand to additional wards.
-A Peer Counselor would come to the daily community meeting to announce that Peer Counselors will be visiting later that evening. Patients could request a visit or could drop In.
-Peer Counselor may be available to accompany patients on their passes to handle personal business. (However, the role of the Peer Counselor is not to police the patient but to act as moral support).
-If agreeable to both parties, the Peer Counselor may visit individuals more frequently than once a week.
-If agreeable to both parties, the Peer Counselor and Counselee may continue to meet after having left the hospital. The Peer Counselor can also introduce BUILD and Spirtmenders services. (Spirtmenders is a MH consumer-run community center located in the Mission.
7. Since there may be much to work out as we begin on a new ward, I suggest a trial period of two months.
8. BUILD will keep the ward informed of specifically who will be visiting the ward as Peer Counselors.
9. BUILD Peer Counselors will function as hospital volunteers which will mean that they are registered through the hospital Volunteer Department, will receive meal passes, wear name badges and sign an Oath of Confidentiality.
Carol Patterson, August 28, 1986
BUILD Project Coordinator
Peer Counseling Training Manual, Page 49
CQNTRACTUALS SERVICES CONTRACT
Between ILRC-SF and
__________________________________________
For______________
to _________________________________________
The Independent Living Resource Center San Francisco agrees to pay $50 per month to
______________________ for the BUILD Project Peer Counseling Program.
Services shall include but are not limited to:
(1) A minimum of 4 hours per week ____________________________through BUILD.
(2) Attendance at Weekly Peer Counselor support group.
(3) Consultation with Carol Patterson as needed.
As a stipend independent contractor, it is understood that:
(1) No health coverage is provided by the agency.
(2) No vacation or sick days are acrued.
(3) The contractor is responsible for filing his/her own taxes as a self-employed individual.
___________________________
Kathy Uhl Executive Director
______________
Peer Counselor
___________________________________
Street Address
______________________
City, State, Zip Code
Peer Counseling Training Manual, Page 50
PEER COUNSELOR STANDARD OF CONDUCT
1. I understand that as a Peer Counselor my purpose is to listen, clarify issues, support and share my experience with fellow consumers, and offer suggestions.
2. I understand that I am not working in a professional capacity and I will accept no fees for peer counseling services.
3. I agree to work with a supervisor on a regular basis, which may include observation (with permission of my client)
4. As a Peer Counselor, my concern is for the well-being of the person I am counseling. For example, it would be ill-advised to have sex with someone I am concurrently counseling. It is often difficult to peer counsel people I have other relationships with and may actually be a conflict of interest.
5. All information given me by a person I am counseling is to be held confidential as well as the fact that I am counseling the Person.
6: I will keep up with necessary but minimal record keeping.
________________________
PEER COUNSELOR / DATE
Peer Counseling Training Manual, Page 51
OATH OF CONFIDENTIALITY
I, the undersigned, hereby agree not to divulge any information or records concerning any client/patient without proper authorization in accordance with California Welfare and Institutions, Code, Section 5328, et seq.
I recognize the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
W & I Code, section 5330: Any person may bring an action against an individual who has willfully and knowingly release confidential information or records concerning the person in violation of the provisions of this chapter, for the greater of the following amounts:
(1) Five hundred dollars ($500)
(2) (2) Three times the amount of actual damages, if any, sustained by the plaintiff
Any person may, in accordance with the provisions of Chapter 3 (commencing with Section 525) of Title 7 of part of the Code of Civil Procedure, bring an action to envision the release of confidential information or records in violation of the provisions of this chapter, and may in the same action seek damages as provided in this section.
It is not a prerequisite to an action under this section that the plaintiff suffer or be threatened with actual damages.
___________________
Name (Please Print)
______________
Position Title
_____________________________
Place of Employment
________________________________
Address
______
Date
_________
Signature