READINGS
in Independent Living

Peer Counseling: Roles, Functions, Boundaries

by Thomas D. Carter, Jr., Ed.D.

Background

One of the basic core services of centers for independent living has been peer counseling.  Personal counseling and support services from persons who are disabled has been one of the cornerstones of the independent living movement.  The concept of peer support had its beginnings in 1939 with the establishment of Alcoholics Anonymous, which believed that persons who had experienced the problem of alcoholism and overcome it would be more effective in assisting others who were trying to do the same.  The peer concept has grown over the years to numerous settings and issues.

The independent living movement is based on the belief that some rehabilitation services are best provided by people who have experienced disability themselves.  Another reason the peer approach appeals to independent living advocates is that peer counseling is performed by nonprofessionals. Independent living advocates believe that people with disabilities do not always need psychotherapy.  However, peer counseling in centers for independent living is rather loosely defined as to who qualifies as a peer and what are the boundaries of the counseling function.  This paper will address the definition, risks and limitations of peer counseling.

Traditional  Counseling

The title “counselor” is used by many individuals to describe what they do.  Because the title is so widely used there is confusion over what functions a “counselor” performs.   Most agree that counseling involves some type of helping relationship between a counselor and client.  Most definitions accept the following ideas: 

(1) the counselor’s function is to provide conditions which make it easy for a client to change;

(2) the values and approach of the counselor, as well as the choices of the client, serve to define the goals of the relationship and impose limitations on it; 

(3) most counseling theories stress the importance of understanding and listening in the relationship; and, 

(4) the counseling relationship is always conducted in an atmosphere of mutual respect and privacy.  Without privacy and confidentiality, the client may not trust the counselor or be open about problems.

Professional practitioners continue to argue over whether there is a difference between counseling and psychotherapy.  It is said that counseling deals with normal clients having adjustment and problem-solving difficulties, while psychotherapy deals with individuals having more serious emotional problems.  This position leads to the view that counseling is a form of psychotherapy for “normal” clients.

On the other hand, “counseling” has been used to denote a wide range of functions, including encouragement, information giving, advising, testing and psychotherapy. 

Psychological Aspects of Disability

Disability may involve physical, sensory, or mental losses; or environmental, economic, and social/attitudinal barriers. These conditions can lead to serious psychological stress.  In professional counseling approaches, it is assumed that these conditions have the same common psychological effect on all people with disabilities, regardless of the type of disability. These psychological effects come from two places. Some effects come from “inside” the person and are functions of  how the person thinks or feels about his/her disability. Other effects come from “outside” the person and are functions of how other people think or feel about the person’s disability. Another “outside” source of emotional stress is the number of physical barriers the person must deal with. Both the “inside” and the “outside” psychological effects can interact to make matters better or worse. For example, a person with a disability who is accepted by others may better accept him-/herself.  A person with a disability who is facing a lot of physical barriers may believe something is wrong with him/her and experience self-hatred; or a person with a disability may reside in a barrier-free environment causing him/her to minimize the disability. 

Interventions

Professional interventions involve many types of practitioners, i.e., psychiatrists, psychologists, social workers, rehabilitation counselors, speech therapists, occupational therapists, physical therapists, nurses and physicians.  The focus of these professional interventions has been primarily on ways to help individuals with disabilities improve their quality of life by addressing issues coming from the “inside” or from the individual’s specific disability.  Traditionally, their strategies have included medical treatment/cures, individual/group counseling, vocational counseling, educational counseling, social casework and family counseling. However, in recent times interventions have shifted from the specific disability and the “inside” effect to the “outside” effects created by environmental and attitudinal barriers.  This has led to interventions aimed at eliminating these barriers.

Peer Counseling As An Intervention

Peer counseling, one of the services most commonly provided by centers for independent living, is a uniquely different type of intervention.  The difference lies in the fact that peer counseling is provided by nonprofessional persons who have a disability. This approach assumes that individuals who have experienced a disability can better understand and relate to individuals trying to deal with their disability.  Additionally, it promotes a wellness model which considers the clients to be normal, as opposed to a medical model which considers clients to be sick.  Clients are referred to as “consumers,” reinforcing the wellness model.

Peer counseling can be conducted in either a group or an individual setting and has as its primary goal the promotion of the independent living philosophy and encouraging consumers  to embrace it.  This philosophy is considered to be the “magical therapeutic pathway” to healthy psychological adjustment. The message is very simple: the problem is not you or your disability; the problem is dependency on professionals and  environmental/attitudinal barriers.  Consumers are urged to become self-advocates and to demand their rights as citizens.  They are also urged to try to change the system by becoming involved in the legislative process and litigation if necessary.

People with disabilities experience nondisability related emotional stress at about the same frequency as the population at large.  As with the rest of the population, the psychological consequences may range from minimal to severe.  Also, severe psychological consequences could result from disability related emotional stress.  The peer counseling approach can be a problem in these situations. The problem results from a distrust of professionals by the consumer and the peer counselor. Therefore, they may not seek the help of a  professional. Also, the nonprofessional aspect of peer counseling means that it lacks the consumer safeguards of the professional approach, which prescribe minimum standards of education, training, experience, and supervision for certification and/or licensing. Traditional counseling as a “profession” is regulated by ethical and legal rules. These rules are enforced by professional associations, educational institutions, governmental licensing authorities and legislation.

Because peer counseling is not a professional service and is offered to the public on a non-fee basis, it is difficult to establish accountability in the case of negative outcomes.  Another major concern is that peer counselors may mix their personal problems with their own disability with those of the consumer. This can result in the peer counselor creating a problem in the mind of a consumer that really does not exist for the consumer. Other ethical concerns are dual relationships (being a counselor and having a business or romantic relationship at the same time), autonomy (allowing independent actions contrary to the thoughts of the counselor), privacy (setting where counseling takes place), and confidentiality.

Given these concerns, which are due in part to the nonprofessional status of peer counseling, there appears to be a need to define peer counseling more explicitly.  This could begin by dropping the term counseling and using a term with less of a mental health connotation.  Terms such as supporter, adviser, or consultant would be appropriate.  This change in terminology would eliminate any suggestion or expectation that the relationship involves more than information giving, coaching, listening, referring, teaching and modeling.

The peer supporter/adviser/consultant would still require training in communication skills (especially active listening), assertiveness, the independent living philosophy and the ethics of a helping relationship.  Individuals who are to function as peer supporters/advisers/consultants should possess certain personal qualities such as emotional stability, self-reliance and a sense of security. They should also understand the limits of their responsibilities and have the ability to allow consumers to own their problems regardless of the source. Knowing when to refer is a must.  Issues such as substance abuse, threats of violence, threats of suicide, and the consumer residing in an abusive environment must be referred without hesitation.

The following are some suggestions for CILs that will help to minimize the negative potentials of peer counseling: 

  1. Training of peer counselors should include which issues must be referred  and what the signs are for potential referable problems.
  2. Establish a relationship with the local mental health center and state rehabilitation agency on referral procedures and for training assistance on the signs of mental health problems.
  3. Conduct regular staffings with peer counselors to review consumer progress and to determine if referable issues are evident.
  4. When referral is made, continuous follow-up and contact with consumer must be maintained in order not to lose the consumer.
  5. One-on-one peer counseling relationships should be time-limited (10 to 12 weeks maximum). Reassign consumers to other peer counselors if necessary. Favor “group” sessions over  “individual” sessions. This reduces the chances of dual and/or dependent relationships forming.

Peer counseling has been an important service provided by centers for independent living. However, as happens in many agencies that provide services over a long period of time, this service is at risk of exceeding its original intent.

You can contact Thomas Carter at Stym@aol.com

©2000 ILRU 
2323 S. Shepherd, Suite 1000
Houston, Texas 77019
713.520.0232 (v); 520.5136 (TTY); 520.5785 (fax)
ilru@ilru.org

 

This document may be reproduced for noncommercial use without prior permission if the author and ILRU are cited.

The mission of the IL-NET is to provide training and technical assistance on a variety of issues central to independent living today--understanding the Rehab Act, what the statewide independent living council is and how it can operate most effectively, management issues for centers for independent living, systems advocacy, computer networking, and others. Training activities are conducted conference-style, via long-distance communication, webcasts, through widely disseminated print and audio materials, and through the promotion of a strong national network of centers and individuals in the independent living field.

ILRU is a program of TIRR Memorial Hermann, a nationally recognized, free-standing medical rehabilitation facility for persons with physical and cognitive disabilities.

Substantial support for development of this publication was provided by the Rehabilitation Services Administration, U.S. Department of Education. The content is the responsibility of ILRU and no official endorsement of the Department of Education should be inferred.

©2005-2014 ILRU Program, All rights reserved
Contact Us: IL-NET or ILRU
713.520.0232 (Voice/TTY) 713.520.5785 (Fax)