Does Peer Counseling Compete with Psychotherapy?

This is a tricky question to answer.  If we frame the question in terms of the interest of the client, the current research indicates that peer counseling and psychotherapy complement each other – they do not compete.  For example, if we look at the studies that evaluate services that include psychotherapy and peer support, it is clear that, on average, people who use clinical care show substantial improvement.  People who used 12-step and other peer support also show substantial improvement (Kaskutas, 2009; Houlston et al., 2011; Kennedy et al., 2007).  The people who use both at the same time improve more than those who used either treatment alone or peer support alone (Pagano et al., 2013; Kelly et al., 2010).

 Adding Peer Counseling to Psychotherapy provides clients with several key advantages:

Information About the Experience of Illness, Care, Recovery. Your personal experience, as a Peer Support Specialist, provides you with a lived knowledge of both illness and recovery from that illness.  Most clinicians do not have that personal experience.  They may have studied these topics in books, and have personal experience with some form of illness and with helping people with those disorders, but their limited personal experience is still an important disadvantage.  Even those clinicians who do have the personal experience will not usually talk about it openly with their clients.  Training for psychotherapy usually emphasizes that psychotherapists do not talk about their personal experiences except in very specific situations.  In contrast, Peer Support Specialists must talk about their experience if they are to actually be a “peer”.

 Added Credibility.  Because of your shared experience with your clients, you have a type of credibility that is different from the type clinicians typically have.  This is particularly important early in the relationship when clients are trying to determine if a helper is trustworthy and credible.  Peer counselors have a shared experience that often leads to early trust. 

 Enhanced Connectability.  Establishing a sense of connection between the client and the helper is typically a critical element in both peer counseling and psychotherapy.  Because the client sees you as a Peer Support Specialist as more like them due to your personal experience, most clients will find you easier to relate to and so that connection will develop more quickly.

 A Different Voice. The peer counselors I work with have helped me to see that peer counselors tend to say different things to their clients and say them in a different way.   This is due in part because they have a different perspective on recovery.  It is also due to the fact that clients trust peers in a different way.  Whatever the reason, the input from peer counselors is different – it may push the client to take personal responsibility, it may bring in topics like spirituality that most psychotherapists are hesitant to talk about, and it may focus on more practical or immediate aspects of recovery.  Peer counselors should be proud of their different voice and perspective and protect and nurture it. 

 Additional Personal and Community Connections. Peer counselors typically have an array of relationships with other people in recovery that can be of great help to the client.  Again, this complements the types of connections that psychotherapists have – which usually involve other formal healthcare providers and services.  In contrast, peer counselors are often more able to connect clients with other peers, other peer support groups and other resources in the community.

Good peer counseling helps clients make more progress in their psychotherapy.  They are more hopeful, and more active in thinking about their problems and recovery.  They feel more supported and so are more willing to take the risk of looking openly at challenging topics.  Psychotherapists will find that clients who also engaged in good peer counseling will talk more openly, move more quickly to solve problems, and be more optimistic about their own recovery.

 Good psychotherapy helps clients make more progress in their peer counseling.  Many people have problems and experiences that make it difficult to connect to others, including peers.  Progress in psychotherapy can improve clients’ ability to connect to others and so to benefit from peer counseling.  I see many clients moving from psychotherapy to peer counseling and peer support groups, as they are better able to trust others and talk openly about their recovery.

 Close collaboration between peer counselors and psychotherapists is already growing and is a future area of specialization for Peer Support Specialists.  That doesn’t mean that some psychotherapists do not feel intimidated by peer counseling or feel the need to act like their work is more important than yours.  There are many people who are competitive by nature and feel the need to communicate their conviction that they are more important than others.  That is a waste of time, and does not typically merit a response.  Over time, I’ve seen many clinicians change their views of the value of peer support and peer counseling as they get more experience in working with Peer Support Specialists, and more opportunities to see their clients improve because of good peer counseling.  I would encourage you to avoid thinking and talking about your work in ways that imply competition and help clinicians see the value of collaboration.

 REFERENCES

Kelly, J. F., R. L. Stout, M. Magill, J. S. Tonigan and M. E. Pagano (2010). "Mechanisms of behavior change in Alcoholics Anonymous: Does AA improve alcohol outcomes by reducing depression symptoms?" Addiction 105: 626-636

 Pagano, M. E., W. L. White, J. F. Kelly, R. L. Stout, R. R. Carter and J. S. Tonigan (2013). "The 10-year course of AA participation and long-term outcomes: A follow-up study of outpatient subjects in Project MATCH." Substance Abuse 34(1): 51-59

KEY WORDS: Peer Support Specialist, Peer Support Training, Peer Support Counseling, Psychotherapy