The concept of peer support is not new. It is not revolutionary. In fact the earliest recordings of peer support for people with mental health difficulties can be traced back to 1793, at Bicêtre Psychiatric Hospital, Paris, where patients who had recovered from a mental illness were used as hospital staff by the psychiatrist Jean Baptiste Pussin. The chief physician commended the peer staff for being ‘disposed to kindness’ and ‘gentle, honest and humane.’1
In the 1930s Bill Wilson and Bob Smith founded Alcoholics Anonymous, as they believed – and their experience showed them – that recovery from alcoholism could only happen through being around people in a similar situation and on a similar journey. In the 1970s the concept of using paraprofessionals and peers to deliver services to those with mental health difficulties burgeoned. However it was in 1969 that Barbara Varenhorst first developed a peer counselling training manual, and it was from this point that the concept of using formally trained peer supporters became widely acknowledged.2 Currently there are many ways in which the term peer supporter is used, ranging from patients supporting patients with mental health difficulties to formalised programmes in which peer supporters have training and ongoing supervision. Regardless of what peer support looks like in practice, the premise is the same: support helps us to bear the weight of our experiences, providing a secure base from which we can more confidently venture through life. Our wellbeing depends on our support networks and our ability to use them.
We humans are wired to connect to others and have the need to be accepted and loved. When we come into the world our need for connection is driven by our need to survive. Infants rely on the world around them to respond to their needs in order to develop the ability to attach to and develop a sense of belonging and being valued. In infancy babies need others – primary caretaker(s), family members and the community – to help regulate their emotions by responding to their physical needs. In order for secure attachment to take place, the interactions must be sensitive, regularly available, warm, responsive and consistent. Recent neuroscience has backed what the early attachment theorists posited. There has been much research into the effects of early bonding on babies’ brains and the shifts in the neural pathways when an infant is or isn’t regularly and consistently responded to. Levels of the stress hormone cortisol increase when an infant isn’t physically and psychologically tended to, which influences how she or he typically reacts to high stress situations later in life.3 Conversely, levels of oxytocin and serotonin – the so-called feel-good hormones – increase when babies experience ‘attuned’ parenting.4
As we continue to develop and grow, our need for connection and belonging shifts from basic survival to developing and nurturing our emotional, physical, intellectual and social wellbeing. In university students this is especially apparent when they face the transition from home to university and the developmental tasks that come with this. Peer relationships become extremely important in ensuring that students feel secure in and attached to their groups and institution. It is a time when students are becoming more independent, and at the same time are developing more intensely interdependent relationships with their peers. Research into belonging at university shows a direct correlation between feeling connected and social and academic satisfaction.5–7 However achieving a true sense of belonging is easier said than done.
Brené Brown has been researching the concept of belonging for the past 12 years.8 Interestingly, when she first began her research she would ask participants to recall instances in which they felt connected and a sense of belonging. What she heard over and over again were stories about disconnection and feeling alone with problems, feelings or experiences. She highlights this sense of alienation by focusing on the difference between fitting in and belonging, something especially relevant to students attending university: ‘Belonging is not fitting in. In fact, fitting in is the greatest barrier to belonging. Fitting in is assessing situations and groups of people, then twisting yourself into a human pretzel in order to get them to let you hang out with them. Belonging is something else entirely – its showing up and letting yourself be seen and known as you really are.’8
So, how do the concepts of attachment and belonging relate to peer support?
Peer support training
At Oxford University 30 hours of experiential peer support training is facilitated by trained peer support trainers through the University Counselling Service. Topics covered in training include confidentiality, getting to know a stranger, welcoming and unwelcoming behaviours, effective questioning, active listening versus advice giving, assertive communication, families, cultural awareness, working with people in crisis, suicide prevention, referrals and limit-setting.9 The content of training increases the emotional intelligence (EI) of the peer supporters and, subsequently, that of the students they are supporting. As in many universities, we find that students at Oxford are highly developed intellectually but need ‘permission’ to develop their EI so they understand themselves better and are better able to support non-judgmentally and with compassion those around them. As a peer support practitioner, it is wonderful to witness the ‘light bulb’ moment when the peer supporter in training understands what it really means to receive and give peer support. This transformation takes place when the peer supporters in training allow themselves to open up and be vulnerable in a safe and contained space. They thereby gain a deeper understanding of the courage it takes to reveal oneself to another.
The skills developed in training – empathy, an understanding of body language (including mirroring), the technique of reflecting back what is said when listening, being alongside someone despite the chaos they might bring – all emulate positive early bonding experiences. This way of being with someone – showing compassion, empathy and a non-judgmental attitude – offers space for students to experience what it is like when their feelings are heard, accepted and taken seriously. Sue Gerhardt suggests that therapeutic work helps clients to regulate their emotions, which in turn may change neural pathways in the brain. This in turn gives people a different way of experiencing overwhelming and stressful emotions.3 Research into mirror neurons also shows that there is ‘evidence of the human capacity to form powerful connections between people, allowing one person to understand another from the inside in a bodily as well as mental way’.4 Brené Brown suggests that empathy is the antidote to feelings of shame and the fear of being disconnected, due to a feeling of lack of worth. She states that if we can bear our feelings and those of others, we can help to reduce shame and increase feelings of belonging.10 Although peer support training is not therapy and peer supporters are not therapists, training and what peer supporters provide to others is therapeutic and, therefore, offers the potential for deep connection and the possibility for change. It is an adaptation of therapy that takes place on the ground, in the community.
A trainer’s perspective
In the first instance, our job as trainers is to create a safe space in which trust in the group of peer support trainees can grow. This will enable them to gain insight into their emotions and behaviours and those of others. It is also a space in which they can test out their new skills in a non-critical environment. The experiential training is challenging and intensive, and the importance of having a positive learning environment is crucial. Creating a secure environment, one in which the peer supporters receive constructive feedback, enables and motivates students to continue learning and cultivates resilience.5 Potential barriers to learning include cultural differences, past experiences, high anxiety, embarrassment, fear of being seen as weak/showing vulnerability, and language difficulties. It is important for the training atmosphere and content of training to mitigate the myriad barriers students might bring with them, consciously or unconsciously.
Colwyn Trevarthen states: ‘The proper environment for children to develop relationships, and their sense of belonging, and knowing, and understanding, and their preparation for learning about the world is in a community. The human brain is looking for relationships, companionship and playfulness. The ideal practitioner is a familiar person who really treats the baby with playful human respect.’11
Like caregivers for young children, we peer support practitioners need to offer a clear framework and safe setting for the training so that students can show vulnerability – a place where they can play and be creative in their learning in the presence of a warm, consistent and responsive trainer. Graham Music postulates: ‘Generally, the better loved and cared for one feels, and the more one feels part of a community, then the better one tends to feel about both oneself and others, and the more likely one is to be kind and generous.’4 It is therefore imperative that we help peer supporters to feel a sense of belonging and being valued within the training group. This in turn helps them to attach to the training, supervision and the Peer Support Programme as a whole, and to show kindness and generosity to their peers.
As one peer supporter said: ‘I will miss our weekly sessions. Training has been a sanctuary from a busy term. The biggest surprise is how much I learnt about myself, how personal it got and how much better I am at communication with my friends, family and those I am supporting. I am looking forward to putting the skills into practice more formally around college.’
Peer support on the ground
In the community, peer supporters create and increase opportunities for connection between individuals and with the institution. This can be seen in their informal interactions with students in their colleges, departments, societies and friendship groups. Peer supporters run events in which students can meet and get to know them, especially during transition points such as Freshers’ week, exam periods etc. The students don’t necessarily come to the events for support; rather, the events provide opportunities for students to connect with other students in a friendly, welcoming atmosphere. The peer supporters aim to run a range of events to include students who might not otherwise become involved in college life. It is important that there is a variety of routes and opportunities for students to engage with university life; peer support plays a crucial role in developing and enacting ways to help students to increase their sense of belonging – an important aspect of how they experience university as a whole.
Much has been written about the positive impact of peer support on new students’ experiences of engaging in university and the relationship of this to retention in higher education. This is true for both the supporter and the person being supported.12 Attachment needs are activated at times of perceived stress,13 such as during times of transition, discomfort, fatigue and illness. We aim to provide trained peer supporters who are aware of the issues new students face, as well as the potential trigger points related to aspects of university life. (These might include exams, cultural differences, coming to university as a mature student, taking a year out from university and students taking a year abroad.) Peer supporters can help provide a contained, positive and compassionate experience to those going through these changes.
At Oxford the focus of peer support is primarily on the emotional and psychosocial experience of students. The fact that emotions are recognised and spoken about and the acknowledgement that we all need support at some point underpin the role of peer support in reducing the stigma of seeking help.
T’s story – being seen
One of our peer supporters spoke at the annual student peer support conference about his experience of ‘being seen’ and the impact it had on him. He had been feeling low for a while but had not acknowledged to himself or his friends how badly he was feeling. Although he was not ready to talk, his friend (also a peer supporter), who had noticed significant behavioural changes, looked him in the eye and told him that if and when he wanted to talk he was ready to listen. T’s message to peer supporters was this: ‘You will never know the impact you have had on someone. The fact that the peer supporter saw me, really saw me, made all the difference. I had felt invisible until then.’ T sought support after this interaction and said that the motivation for seeking help was that the peer supporter had shown an interest in him and had acknowledged verbally, non-verbally, compassionately and non-judgmentally that he could see something was amiss.
The Peer Support Programme is designed to complement, not compete with, the University Counselling Service and other support services within and outside the university. In fact the programme is preventive, as peer supporters are often the ‘first stop’ for those who may need professional help, and trained peer supporters can help a person before a problem becomes too severe. If necessary, they signpost students to professionals. They work within the clear framework of our code of confidentiality, which explicitly states when to extend confidentiality, ensuring the safety of the peer supporter, the person seeking support and the institution.
While the Oxford University Peer Support Programme has an identifiable and positive impact on the wellbeing of students, peer support training and the experience of being a peer supporter offers a unique development experience for students involved in the programme. Students often say, ‘This is the most valuable thing I have been involved in at Oxford.’ Those who engage with and attach to the training and supervision often refer to the group as a family – one in which they appreciate the close bonds and the feelings of safety they experience, knowing that they will be supported and cared for.
Peer support programmes promote connectivity, emotional intelligence and wellbeing in students, beginning with the peer supporters themselves. Within a clear and strong framework of training, supervision and a code of confidentiality, peer support is fluid and adaptable; there is no one way to promote and enact it. At its most basic and important level, peer support offers increased opportunities for connection, thereby reducing isolation and promoting a sense of belonging. Finally, over the years it has become clear that the power of peer support is that it transcends culture and language barriers in a deeply profound way. This is because it is based on human connection and the need to feel attached to others and one’s institution.
Anne Ford has worked at the Oxford University Counselling Service since 1988, both as a counsellor and as co-ordinator of the Oxford University Peer Support Programme. In addition, she trains peer supporters at the London School of Economics and has also co-run training for trainers in Estonia and Oxford. She is passionate about peer support as a means of helping young adults develop themselves emotionally, socially and psychologically, and now spends all her working time in this area. Anne is the author of Peer Support in Colleges and Universities: a training manual.9
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