Making a Connection: How Do You Accomplish That?

I recently listened to Melinda Gate’s audiobook, The Moment of Lift: How Empowering Women Changes the World, and found it quite thought provoking.  Near the end she infers that when we are unable (or unwilling) to ‘be’ with another person’s pain, we are in fact marginalizing them and contributing to their feeling of being alone in their struggle. That might not be the intent, but in her opinion, it is the result.

Personally, I had never thought of it that way before, but it makes a lot of sense.  She tells the story of a person who needed to leave the room while a woman spoke of her painful and disturbing life story. Melinda could see that the demeanour of the woman sharing her story changed when the other person left. It was as if the woman became more alone in her pain as she sensed that the other person could not be with her as she shared it. 

As a peer supporter we intrinsically understand how helpful it can be to listen and ‘be’ with another.  That is one of the reasons that peer support works.  Feeling alone in our struggle is an often-stated symptom of mental health illness– peer supporters offer empathy and support as a person travels their path of recovery. Peer supporters help another person to not feel alone in their pain.

 So, what does it mean to offer empathetic support or to ‘be’ with another person?

One of the best expressions of this, in my opinion, is by Karen Liberman, former speaker, advisor, and
Executive Director of Mood Disorders Association of Ontario, and dear friend of the Canadian peer support movement.

 “To support a person is more than to listen and to talk. It’s more than effective questioning.
Those are mechanics. To be truly present is to communicate in a whole new way. It's as if,
each time, with each conversation, you're hearing the story for the first time . . .
and it's the most important story you've ever heard.”

Brene Brown’s Sympathy vs Empathy video is another excellent resource.  This short and light-hearted video demonstrates how empathetically listening to a person who is in struggle can be validating and help a person to feel less alone and more hopeful.  Stepping into a situation with the intent of fixing the problem or artificially making the person feel better is not as helpful as connecting with the emotion that you believe the other person is feeling, (which is the meaning of empathy).  If you have not yet seen this video, google “Brene Brown sympathy vs empathy”.

Peer support is about being willing to accept another person’s story of struggle (without doubt or judgement), acknowledge and validate their emotions, and have the courage to listen attentively to whatever it is they wish to share.  All of this can be done without words.

Brene’s statement at the end of her video summarizes how valuable our presence is: “Rarely does a response make something better.  What makes something better is connection.”  Many may be afraid that they won’t know what to say, which might lead them to avoid others who are craving acknowledgement and support.  Our simple willingness to listen and authentically care is more important that having the right words or response.

This also reminds me of my theory on body language

We can all agree that if a listener sits tensely in their chair, with their arms tightly crossed across their chest and a steely, disbelieving look on their face, they are not emitting a sense of open minded, non-judgmental validation of what the other person is saying.  This would be an example of negative body language and it would not likely encourage openness or build a trusting connection.

But for me, I do not believe that the lesson is to learn how to position our body or adjust our face, but rather the work that each of us needs to do is examine our own internal beliefs and become more self-aware of our emotional reactions and our tendency to judge.  I believe that the more open minded each of us becomes, our body language will naturally adjust.  Changing our body language so that we appear to be more supportive is not authentic and will not work as the other person will eventually see through it.

Hmmm, time for another important consideration - protecting your own mental wellness

I have been stating the value and necessity of listening and accompanying others on their journeys of struggle and recovery, but now its time for the flip side.  Human interactions are never simple and straight-forward, so we must look at this from another angle.

 As a peer supporter, it is equally important that you honour your own wellness and needs.  Nothing is gained if you push yourself to be there for another when it may be traumatizing or a harmful trigger for you.

 Whenever I do peer support training, I include an exercise near the end of our time together where I ask each person to consider what conversations or situations they know are not wise for them to be a part of.  As we go around the room there are a range of responses.  Some folks say there isn’t anything that they feel would risk their own mental wellness, while others state specific topics or situations that would hit too close to home for them. 

 The range of items that risk a person’s ability to listen safely and non-judgmentally is wide and might include things like domestic abuse, pet abuse, or grief due to loss by suicide.  The reason we do this exercise is to encourage prospective peer supporters to consider what might be a trigger or traumatizing in order to protect their own mental wellness. 

 While it may be a great goal for each of us to be open to any and all conversations, it is equally important for each of us to be self-aware enough to know what we need to do to keep ourselves healthy. It is not a failing to have some things that you cannot discuss but rather its an accomplishment that you have gained the self awareness of knowing that its not wise. 

 Another reason for this exercise is for each supporter to become more aware of what might risk their ability to be non-judgmental and to empathetically hold the other person in high regard no matter what their prior activities or experience might be.  If we find that we are negatively judging a person or thinking less of them because of something that they say, then we are not the right peer supporter for them.

 Hopefully you are a part of peer support team rather than working in isolation.  If so, I can assure you that someone else on your team will be able to step in if you find yourself in a situation that is not healthy for you.  One of the goals of doing this exercise in our training is to demonstrate that there are others on the team who are not negatively impacted by that topic that concerns you.  I also suggest that you take the time to look in your community for additional backup resources, especially if you are not part of a team.  It can give you a level of reassurance to know that you can refer a person to another resource especially if you discover that you are not a good fit for a relationship.

 The magic of peer support comes from a supporter’s ability to listen fully, without judgement, and to offer empathy and validation no matter what the person may choose to speak about.  That is a lofty goal, yet it happens all the time when peer supporters go forward into relationships with a desire to support a person and ‘be’ there for them no matter what happens, as they strive forward on their recovery journeys.  Developing your self-awareness to know when you might be personally impacted and to have a plan for how to maintain support while caring for your needs, will help you to do this important work on into the future.

I will give the final word on Melinda’s theory to Kate Hart, a person I met in a peer support training session:

Pain Shared is Pain Halved

 

The Art of Honouring Self-Determination

“She really needs to go to a nursing home, but she won’t go willingly, and my father is not taking a stand on this with her.  I’m worried about the strain this will have on him.”

 I vividly remember this phone conversation with Dianne[1] years ago as she was talking about her father and stepmother who lived across the country.  Dianne was with them for her semi-annual visit and was telling me how she was attempting to convince her stepmother that staying in her home was too difficult for her father to handle.

 A tinkling bell sounded in my thoughts.  At that time, Dianne was a guiding oversight to my efforts to finalize the writing of the MHCC Peer Support Guidelines.  These guidelines represent the wisdom of over 20 peer support leaders who came together from across Canada to inform the content.  Dianne and I often had in-depth discussions when she got her ‘niggling feeling’ that a phrase or word wasn’t quite right.  We dissected the source of these niggling feelings as we worked together to ensure that the language we used fully and accurately represented the nuance and meaning of each peer support principle.  To say the least, Dianne was a respected authority on the nuances of peer support principles.

 The tinkling bell in my mind that day was my own niggling feeling that something was a bit ‘off’ when Dianne shared her concern about her father and his ailing wife not listening to her well-meaning advice.  My delicate reply to her was, “Self-determination can sometimes be a hard concept to honour.”  This brought a moment of silence and contemplation to Dianne as she realized she had potentially fallen into that ‘I know what’s right for you’ trap.

Self-determination is the term peer supporters use to describe the right each of us humans have to determine our own path forward in life.  This is one of the cornerstones of Peer Support – the movement borne during the 70’s as psychiatric survivors fought the clinical and inhumane treatment of psych patients at that time and turned instead towards supporting and helping each other. Thankfully, mental health systems have advanced since then, but self-determination has firmly held its place as a key requirement of peer support services – for good reason.

As a Peer Support Training Facilitator, I have seen how the concept can be challenging to understand and honour.  Sometimes its just the term that prospective peer supporters are unfamiliar with, but other times, it is the concept itself that can be hard to accept.  In a word, I define it as choice.  The choice as to what steps to take – or if steps will even be taken.

For example, peer supporters honour each person’s choice to see a doctor, or not;  to speak to a therapist, or not;  to take steps towards overcoming addictions, or not; to take their medications, or not; to speak to a peer supporter, or not.  In fact, the only time peer supporters are expected to break confidentiality and take action is if a person is in imminent risk of harm to oneself, another person, or there is suspicion of child abuse or neglect. [2] 

This sounds straight-forward but it can get tricky.

One of my favourite examples is a story shared by a peer supporter at a workshop in Nova Scotia.  (I’m going to call her Candice for the purpose of this story.)  Candice told us about meeting with a person who, among other concerns, was in constant pain and frustrated that she could not find a way to get sustainable relief.  This in part was due to a lack of financial means, living on a limited disability pension, and the social determinants of health that accompany that challenge.

On this one day, the conversation between Candice and her peer touched on a variety of topics as it normally would.  But as they neared the end and were ready to go their separate ways, the peer cheerfully told Candice that she had found a $10 bill earlier that day and her next stop was going to be the liquor store since she had some extra cash!  This provided our training room of peer supporters an excellent real-life example.  If you were the peer supporter in this situation, how might you respond, and why?  What do you say or not say? 

In addition to this being a self-determination question, this touches on the topic of ‘no judgement’. 

It was obvious that Candice knew that Advil or some other form of pain relief would be the smarter choice for getting longer lasting relief from the pain, but she also knew the person she was supporting and that person’s willingness (or readiness) to hear an alternate viewpoint.  She shared with us that she chose to not share her opinion, and simply wished the woman a good week until they met again. 

So why is there wisdom in Candice’s decision to not speak up? To answer this question, I propose we look at the pros and cons of a situation like this:

- If Candice had suggested that an over-the-counter pain medication might provide a longer lasting relief from the pain:

  • Possibly the peer would have paused for a moment, considered this option, and decided to go to the drug store instead of the liquor store.  Many of us would consider that a good outcome (based on our opinion).

  • Or, alternately the peer might have felt like she was being negatively judged by her peer supporter.  If she felt judged, a number of things might happen such as not returning to peer support, or hiding (not sharing) some aspects of her life, and/or feeling alone in her struggle as no one else seemed to understand.  This outcome would result in a setback in the development of a trusting (and helpful) relationship between supporter and peer.

- To be fair, there is a downside to saying nothing and not attempting to propose a different option for the new-found money.

  • Possibly the person is bringing this topic forward because they subconsciously want their peer supporter to help them make different choices.  I have heard stories where a person hints at having an issue that is too embarrassing to state outright, but they hope that their peer supporter will read between the lines so that they can begin to work on the it together.  Knowing this, was there a chance that the person was hinting at something that she wanted Candice to pick up on?  I knew Candice well enough to trust her instincts.

Hopefully, you are not throwing your hands into the air and thinking, “I give up.  How will I ever know what to do?”  It’s true.  There is no cut and dried answer – no flow chart to follow where you can track, “if they say this, then I do that.” 

Supporting a person through some of their toughest times is complex.  Which is why peer support is all about empathy and drawing on the wisdom gained through your own lived experience.  You also have been through some challenging times with challenging day-to-day decisions.  When supporting another, the most important goal that you have is to connect with them empathetically and to strive to develop a relationship that is based on trust.  Each person is unique which means that your responses to each person you support will also be unique.

In this situation, as stated above, if Candice had mentioned that Advil might be more effective than alcohol over the long term, she would have been exposing her judgement.  Judgements happen – we all have them now and then even though we try not to.  Its what you do with your judgement that is important.  By keeping her opinion (judgement) to herself Candice was placing more value on continuing to build trust in the relationship. 

I do not remember the specifics that Candice shared but possibly she could relate to her own past where she might have ‘needed’ to have that alcohol to get a couple of hours of relief – even though it was temporary.  Possibly she remembered what it was like for her in some of her more difficult days and how much she wished there was someone who could relate to that need and continue to hold her in high regard.

I turn to one of my favourite quotes to help summarize the value of building non-judging trust in a relationship:

“When a person feels that they are truly accepted by another, as they are,
then they are free to move …. to begin to think about how they want to change,
how they want to grow, how they can become different, how they might
become more of what they are capable of being.”

-Gordon 1970, 1975, 2000

With this sincere attitude of non-judgemental acceptance of the person’s choices in how to cope, we are meeting the person where they are at, and demonstrating that no judgements will happen if and when they wish to discuss other difficult topics.    

There is also no guaranteed prediction of how this is going to play out, but here are a few possibilities:

  • The person being supported might speak at a later date about the on-going physical pain and wished they had used that extra cash differently.  That would be an opportunity to listen and chat with them as they think through their options making them more prepared for the next time some extra money arrives.

  • Or, some time later, the person might have another similar opportunity to make a different decision.  Possibly Candice feels that the relationship has evolved enough that she can say something like, “Are you in the mood to brainstorm some other ways to spend that money?”.  Notice that this approach is still striving to honour self-determination.  Candice has floated another option that does not specifically contradict the peer’s original intention, but rather it offers an opportunity to discuss options.  If the peer supporter’s instinct is correct that the person has an interest in considering options, then a conversation might happen.  If the peer prefers to go forward with the original plan, that is okay too, but hopefully the message was heard that the peer supporter is willing to talk through options if/when it comes forward again.

Let me return to Dianne’s story and her concern for her parents.   It is never straight-forward.  Dianne was the concerned daughter in this story, not a supporter, and possibly it was becoming unsafe for both her Stepmom and her Dad.  If I were in her shoes, I might have done the same thing.   But a calm reminder about this very important principle helped her to consider options from a more open-minded point of view.  And, it was a demonstration to me that honouring self-determination can be difficult to do in some situations, even for those of us who are respected leaders in the peer support field.

When situations like these come forward for you, talk it over with another trusted peer supporter, and compare your responses with the guidance of the Peer Support Canada Standards of Practice and the MHCC Peer Support Guidelines

I give the closing words to Theresa Claxton, a contributor to the MHCC Peer Support Guidelines (page 20):

“For me a key principle of peer support means working from a position of choice and therefore respecting the choices each individual makes. It is a principle of peer support to encourage self–determination and respect the fact that people will make their own choices, whether or not I, as their peer support worker, agree or would choose the same for myself. I hold respect for every human being; for their capabilities, their possibilities, their hopes and dreams, for the humanity that connects everyone, so I can respect a field or an intervention because there are people behind it, and a peer has identified it as their choice.”

 

[1] The name has been changed.

[2]Note that a peer supporter has the responsibility to break confidentiality and call for help from others (such as 911) if a person is in imminent risk of life-risking harm to oneself, another person, or suspicion of child abuse or neglect.  In this example, imminent harm to oneself or another was not a concern, but if there is ever a situation where your instinct tells you otherwise then you must ask more questions to assess the risk.