Yearly Archive: 2012

A year of writing for Xtra Newspaper and what that was like

 

 

It has been a year since my first column came out.  It is time to talk what has and has not changed  in that year.

Know the risks of HIV transmission got lots of attention, and some professionals in the field of HIV did not like it.  I only quoted Spectrum Health’s website for the data, but people who did not like what I said about risks attacked me but not the 10 doctors at Spectrum who specialize in the field. Interesting I think.

PEP (Post Exposure Prophylaxes) seemed to stir some interest.  Although BC is generally advanced in addressing HIV issues, we are backward in addressing PEP.    Guys can be kept from getting HIV by going to the Hospital emergency room and getting PEP.  But BC is slow to act, now that is about to change.  In the next few weeks PEP will be available to guys who feel they were exposed to HIV. The wheels move slowly and every day more guys are needless infected by HIV, but finally PEP will be available soon!

What happened with the condoms?  Well I was told by the media person at BCCDC that a committee decides on which condoms will be bought,  I was told that I would not be told who is on that committee and I would not be told what goes into making a decision.  But now there are new condoms provided for the public.  I manufacture of these condoms claims that they exceed the US and International standards for condoms.  The only criticism I have seen about the new condoms it that they may be a bit small.  Now the HIM clinic at 1033 Davie gives out larger condoms and non-latex condoms.

Where is the wart vaccine?   I am told that the BC Cancer XXX will be recommending that the wart vaccine become available for males.  I talked to a doctor in the field and he said that if he were again out on the sex market he would get the vaccine because it has few side effects and help a person immune system cope with the wart virus.  A very nice nurse took the time to review my article and point out places in my article that were unclear and could have presented the issue more accurately.

Loneliness feeling disconnected.  Well this one seemed to get the most positive reaction for people.  It seems though that most people could identify with the problem.  But most people in the helping business seemed to miss my point that though there are many activities for gay guys to participate in, there are reasons they don’t.   People are less likely to attend group discussion than a course where because of shyness (or whatever).   I called for courses to help guys address their isolation but people seemed to respond with the same programs that are out there.

I expected a lot of reaction to HIV immunity but it seemed like interesting information at people took in to use as they might.

How often should you get tested?   Well BCCDC is working on a policy about how often gay guys should get tested.  I think that risk based testing as well as routine testing is the best answer.  IF you have a risk then get tested, if you tend to be a bottom who has lots of sex then your routine might be every 2-3 months, if you tend to be a top than every 3-4 months get tested.  We will see what BCCDC has to say eventually.

Now for some personal reflections about this column.  Not everyone likes what I say here.   I was surprised how intensely some people will react to me voicing my opinion.   I think I am a bit naive about this, but I did not expect some of the reactions I got.   Someone lobbied Xtra to have me fired, I felt bullied by someone.  Some professionals started talking about me being mentally ill in an apparent attempt to discredit me.  One person hit me, though it was not an assault it was harder than necessary just to make a point.  And there were many guys who will come up to me and tell me how much they enjoy what I write about.  I hope it is useful and gets discussion going about important topics for our health. My goal is to create a healthier and happier community for us all.

More on gay guys and drug use

 

 

There are many things that gay guys may do to excess.  The excess causing the most problems I see in our community are:  alcohol, Crystal Meth, coke, body image concerns.  The things that we do not do enough of are: self love, support for each other, self acceptance as we are, pursuing things that make us really happy.  Here I will look at the excesses.

Is there anything wrong with occasionally using drugs?  While some gay guys do not use substances there are many who do.  A few of those who use substances sometimes have trouble because of their use.

Some of the main problems around substance use are: unsafe behaviour, using drugs so much that is causes problems for the user i.e., financial concerns, and disrupting relationships, hindering personal growth.

I have tried to experience most drugs during my life, but I have not achieved that yet.

I think that the typical way of approaching problem substance use is to focus on the drug and not on the reasons for using the drug(s).  There are reasons why we may use drugs.  Drugs do something for the user.  The most common benefit we look for in substance use is to feel free/uninhibited.  Crystal Meth is a good example of this.  Crystal Meth often allows guys feel sexually free; to be free to be the sex pig they would like to be but are too inhibited to freely enjoy such sex without the assistance of drugs.  Alcohol also helps guys to feel less inhibited; coke can help guys to feel less vulnerable/more in control.  Marijuana can help us to feel more mellow/relaxed.

So the common theme behind most of this substance use is to compensate for feeling inhibited.  We do not feel free enough to be ourselves.  We learned at an early age to not be the gay kid in school, to not be who we are, to hide who we are … to inhibit our natural feelings.   It is no surprise to see our community use drugs that helps us to feel less inhibited and freer to be ourselves.

Most of us spent years trying to survive childhood and early adulthood by hiding our feelings, because we felt that was the only way to survive and thrive.  We knew that there was a risk in being free to be ourselves, these risks are real and intense, the most common fears of being ourselves centred around: safety risks (gay bashing), risk to our career advancement, risks to being teased or bullied in school, risk of losing love of our family/friends.  This early trauma of threat and survival will have an effect all our lives.  Some of us can use these experiences to make us stronger, confident that we can handle what comes our way.  For others we feel afraid, scared to be; apprehensive about the world that seems unsafe and unfair.   For most of us it is a bit of both.  (For me I think part of the reason for getting a PhD is to prove I was ok I was acceptable.)

It is not surprising that some of us use substances.  I believe that drugs are not the problem.   Drug use is the symptom. Usually the symptom is our trying to cope with fears and inhibitions in our lives.

Some guys find the traditional drug abstinence programs work for them, but many do not.

So what is another way to approach drug use in our community?  There is no one answer for everyone but I believe that for most guys it is important to explore what we get out of our drug use.  How can we get that same result without problematic substance use?  An example of this might be, how do we be free enough to be the sex pig we enjoy being without Crystal Meth?  Again in this case Crystal Meth may not be the problem but the enabler to allow us to be free.  Crystal often provides the sense of being free/spontaneous/inhibited, but most guys find the actual sexual stimulation/organism is less important than the feeling of being free to be a sex pig.

We all use substances to help us feel better it may be coffee, alcohol, chocolate, etc.  Do these substances we use bring us closer to being the person we feel good about, and do they make us a happier better person?  If these substances do not contribute to our ultimate happiness then we may want to make some changes.   We must understand our fears and inhibitions as well as work on ways to change our habits.  I think drug use is not a bad thing but if we feel it is not helping us to be the best we can be, then we may want to make some changes.  Some things that we can do is use less of the drug, try a different drug that does not cause us problems.  But addressing the underlying issues is important to grow to be who we want to be.  This may involve counselling, or self-examination, or just pushing ourselves to take some risks to be more our ultimate ourselves.

The failure of medical community in delivering HIV messages

 

 

It has been more than 25 years that gay guys have been told to use condoms for sex.  Yet many of us still sometime do not do what we are told.  Almost no sexually active gay guys will say “I did not know I should use condoms”.  So why do we still get the same message, for 25 years, that clearly is not working?

Sex is complex and there are a lot of emotions that are part of our sex lives.  But the emotional part of who we are and the importance that sex plays in our lives, is not addressed.  Our originations around the world still shout at us to “USE CONDOMS”.  This message gets old and tiresome, yes we know that.   Where are the messages that help us to understand why we are not using condoms?

HIV has for over 25 years been dominated by the medical profession.  Medicine has done wonders at helping those of us who may be infected to have a healthier and better life.   But medicine tends to take a scientific and logical approach to problems.  Hence the simple message of “use condoms”.  Medicine is not as good at dealing with complex emotional aspects of human behaviour.

I think it is time for medicine to step aside in addressing HIV prevention and give way to the social scientists to explore more effective messaging.  It is also time for our organizations to focus more on messages other than “use condoms”.

If you ask gay guys why they sometimes do not use condoms they often have no more understanding than “I do not like condoms.”  There was an effort to tell us that condoms were fun and sexy but that message did not go very far.  So we may know that sex is better, more fun, easier, and more intimate without condoms.  But we are not assisted much in understanding how we sometimes allow ourselves to not use condoms.

It seems that there has been an underling message of: “be afraid of HIV”, and then by extension that leads to  fear  HIV poz guys.  Many gay guys have become so scared of HIV that they reject HIV poz guys.  Messages of fear are not effective.   Messages of fear have had the effect of marginalizing members of our community, not building a stronger community.  We know too much about stigma in our community; we do not need any messages that promote stigma amongst members of our own community.  We need messages of understanding, acceptance and support.  Where are the messages that a poz guys with undetectable viral load is not going to transmit HIV?  Where are the messages of support and understanding?

I have spent almost 20 years talking to guys about their sex lives and HIV.  I have noticed a few trends in HIV infections.   For over 10 years I would say “Guys are most vulnerable to get infected when a relationship ends.”  In the last few years I have seen that perhaps this message is too narrow.  It seems to me that guys are most vulnerable to get HIV when they are feeling their life is falling apart.  That can be death of a parent or a loved one, job loss, depression,  loss of home and loss of relationship, etc.

I do not pretend to have “the answer” to why we do not always use condoms but I feel I have some understanding of how bare sex happens.  But let’s focus more on why we take risks, when we will take risks and how to support all of us to take better care of ourselves.

Help for gay guys to decide when to have bareback sex

 

 

Sex between guys can be very complex.  Often when guys begin a sexual encounter they do not know how it will unfold, will it include: sucking, ropes, handcuffs, fucking, rimming, piss, electricity, alcohol, drugs, lots of alcohol, sounds, scat, tit play, other guys, fisting and many others.  The creative play between two guys exploring where their sex will go it part of the fun.

 

Reducing safe sex messaging to a simple prescription of “use condoms” is not very helpful, because we already know that message but who helps us to make the decisions in a complex playful experience of having sex.  The medicalization of safe sex messaging has not served us well.  Almost all new HIV infections now have emotional and psychological reasons as a main cause for lack of condom use.  The medical professional is not trained to integrate the emotional and psychological causes of problems, they are trained to look for medical causes.  Where is the messaging that helps us make the decisions we are comfortable with?

 

Let me give an example of how a psychosocial messaging may be more helpful for guys

 

A while ago a guy asked me, if he as poz bottom with long standing undetectable viral load could be fucked without condoms by his boyfriend who was negative.

 

I, as a person trained in psychology, made a few suggestions as follows:

 

1.         Consider how upset would your boyfriend be if he became poz.

 

2.         Also consider how upset you would be if your boyfriend became poz.

 

3.         Some people think that if either you or he have an STI that HIV transmission is more likely, so you could decide to not have unprotected sex outside the relationship.

 

4.         Some people think that if he cums and/or pees after fucking it will clean out the urethra and reduce the chances of getting HIV.

 

5.         If you (the poz guy) get a cold or some other infection your viral load MAY go up; you may wish to be more careful at these times.

 

6.         The spectrum Health website (the largest group of doctors treating gay men and HIV poz guys in BC, suggests that without an undetectable viral load there is 1 in 1,666 chance of getting infected as a top for each fuck.  (6.5/10,000) We can assume that with an undetectable viral load these odds are much less.  The exact chance of getting infected is not known but it may be 1 in 10,000 or maybe 1 in 100,000.  (BC is spending $50 million to reduce HIV poz guys viral load in an effort to reduce transmission; so they must believe that this will have a big effect in reducing the number of new infections.)  (The cynic in me thinks that it is not $50 million being spent because they care about the welfare of poz gay guys, or other poz persons.)

 

So by using the complex information above they can make decisions about the kind of sex they choose to have.

 

Notice that none of the above are “shoulds” but only things to consider when making decisions.  Medicine is good at “shoulds” and “musts” – at prescribing – a behaviour.  He did not want a prescription, but he really wanted to know was “what do I need to consider if we proceed with not using condoms” (if that is our choice).  He knows the normal message of use a condom, that is not what he is looking for and if no one helps him to know what to consider and give him an understanding of what are the risks and  how to reduce those risks of transmission he/they will be “fucking in the dark” – so to speak

 

What is interesting about this question is why he did not go to a medically trained person to ask this question.  I believe that he would have gotten a medical response that is prescriptive and not really useful for their decision making.  The medical profession has done wonders at supporting, treating and educating all of us on HIV.   But, the medicalization of HIV safe sex messaging has run it course.

 

It is time for medicine to step aside with the less than useful messages.  We need a psychosocial approach that will help us makes decisions that fit in our complex lived sexual experiences. What is needed is to understand that only pushing condoms is not effective.  What we need instead is messages to help guys to make informed decisions around their complex sexual decisions.

 

If there was more space I would add the following:

 

We need help to understand when and how we find ourselves vulnerable to take risks that are outside our comfort level.  For some it may be when drinking, for others it may be when depressed, for others it may be when horny, or lonely, or he is hot, or any number of things that we all need to understand more about how we put ourselves in situations where we are not comfortable afterwards.  In my experience the general pattern is when a person feels their life is falling apart, (job loss, boyfriend break up, money problems etc.) then they may do things that later they wish they had not done.

Risks and HIV Transmission for Gay Men

 

 

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

 

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV.  S/he feels we need new messaging because s/he see people every day coping with viral load questions.  My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.)  S/he confirmed s/he likes the all or nothing short simple messages.  Short and simple seems to be more important than how accurate the message is.

 

 

 

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99.  You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain.  But likely this would not be practical or fun – but safer.  Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful.  After all you did it for two years and had no problems so just tell yourself to be careful.  Well it is a lot like fucking.  There are things you can do to make it safer but they may not all be fun or practical.

 

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%.  One article said “Having an undetectable viral was as effective as condoms.

 

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00.  That is a huge difference.

 

So lets look and what this means for fucking without condoms.  If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000.  If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

 

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%.  So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

 

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load.  They call it “Treatment as Prevention”, but that is just the marketing to the government.  It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

 

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!.  What do us as gay guys do?  Do we take more risks?  Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

 

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

 

You may ask a negative partner if he get tested on a regular basis.  If he does it likely is because he is concerned he is maybe positive.  So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

 

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV?  We know 2.5% of those guys who think they are negative are really positive.  If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative.   An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

 

Where do all these numbers leave us.   Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load.   Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

 

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

 

So where does the leave us?  Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others?  The science may say there is a good case for this.  But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science!  Our prejudges against poz guys as sex partners will not change easily.

 

What we do not need is the institutional marginalization of poz guys.  Many organizations will tell us we are at higher risk if we have sex with a poz guy.  Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

 

Well this is my last regular column in Xtra,   I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider.  I may be back with the occasional writing on gay men’s health.

Manual for peer counsellor training

 

Peer Training Manual: The NANNIE Approach
(a draft, currently under construction)

Bill Coleman PhD
CIHR funded Research on: Early Recognition and Rapid Response to HIV Status

 

Introduction

A brief introduction to the NANNIE Method will be outlined here.  Each of the six core characteristics in the NANNIE Method will be described later in the manual with the rational and purpose of each of these basic principles.

The NANNIE approach incorporates basic counselling skills generally taken from the non-directive approach of counselling.   Below are the basic tenants of the Model.

 

 

The NANNIE approach

 

No Judgment

Acceptance

No Fixing/No advice

No Questions

It is not about you

Empathy

 

Who is a peer?

A peer is someone who is similar to the person they are working with in some significant ways. The peer counsellor and the person being helped may have important characteristics in common. These may be such things as women working together, unemployed, gay people, or HIV+ persons.   What makes the peer important to the process is that the peer will have experiences similar to the people they are talking with.  These shared experiences will allow greater understanding (enhanced empathy) of the problems faced by the client.  These shared experiences can allow better empathy and enhance trust between the counsellor and client.

History of peer counselling

Peer support and peer counselling has a long history. Though formal counselling was not a concept in medieval times, some would argue that the Knights of the Round Table and the Three Musketeers were peer support groups.   The most well-known modern peer-based program in North America is the Alcoholics Anonymous (AA) model, which dates back to the 1930s.   In the AA model, people share the problem of alcohol negatively affecting their lives.  Many schools and universities also have active peer programs for students helping other students.

Why peer counselling

Peers offer unique perspectives to counselling and support that professionals do not have.   Very few professional therapists can truly understand the life of living on the street the way a peer is able to understand.  Only a peer who is living on the street can truly understand the problems and feelings experienced while living on the street.   Similarly, peers in many situations may have greater understandings of the particular circumstances that a professional may lack. Not only can the peer perhaps empathise more with the client, they may be less judgemental about the circumstance.  Understanding and acceptance without judgment are some of the basic tenets in counselling.  This enables the peer to begin their work with enhanced basic counselling qualities.

The nature of being a peer counsellor is that payment for service is not part of the context.  This makes for cost effective programming.  Because the peer is not paid, they begin on a more equal footing to explore the issues at hand.   When a therapist is paid, there may be much inequality in the relationship.  The power in the relationship is much more that of equality, with no judgment, and no fixing, cobbled with acceptance makes the basis for an open supportive relationship.

 

What do peers bring?

Peers bring an understanding of some basic experiences.   These experiences are what make them a peer.   The peer has unique experiences shared by the client.  The peers share experiences that are unique to the group of people being identified for counselling. It might be cancer survivor, rape victim, or gay teen; these experiences are very different from the average person.   The peer can more easily empathize and understand some of the problems faced by the shared experiences.

The peers also bring a human experience, rather than a professional role.  The peer is there to help, out of caring for others; they are not being paid to listen to others.  The peer has an understanding of what it is like to … for example live with a cancer diagnosis, or the emotional impact of being raped, or living as a gay teen.  These shared experiences are an important aspect of being a peer counsellor.  Trust and understanding are more readily built between the peer and the client because of shared experiences.

What can peers do?

Peers generally offer support and understanding to persons with problems of living.  However, there can even be a place for peers to work with mentally ill persons in supporting them in problems of living with mental illness.

Peers help others to explore their problems and concerns and allow the client to find their own solutions.   By allowing the client to find his or her own solution, the peer does not get involved in “fixing” or advice giving.  The peer takes the position that if the individual explores and understands their problem or situation then the individual/client can find workable solutions for themselves.

When “helpers” take the approach of giving advice, the subtle message is that the client is not able to solve their own problems.  When a peer listens, supports, and assists the client to fully explore their issues, and find their own solution, then the client learns that they can solve their own problems with support.

Limitations of peers

Peers may not be the best at addressing severe mental illness (unless it is as a peer who has had similar experiences), or very complex issues like sexual abuse, suicide (unless it is peer support for this purpose). Peers also should not be put in position where they have to address violent and dangerous situations.

It is also important that peers always have supervision to go to for help and assistance in dealing with any situation that they may not feel comfortable or equipped to handle.  By providing supervision for peers, any difficulties that arise are addressed.   It is important for the client and the peer counsellor to meet soon after each peer counselling session, this allows for prompt response and support to important issues that arise.

 

Strengths of a peer model

The use of peers to provide services expands the service of any non-profit organization.   Peers also gain tremendous satisfaction out of offering their skills to others.

The model of peer counselling in this manual does not involve the peers in giving advice or telling the client what to do.   By not giving advice, peers avoid situations where there may be problematic results.  Peers provide a sounding board and make space for the client to find their own solutions.   This model supports the client in understand their own resourcefulness, and abilities to resolve problems of living.   This can also have long-term consequences for the client to become more confident and independent.

An additional strength for this model is that it is very inexpensive to implement.  Offering peer counselling services to an organization’s members both assists the membership and enhances the organization’s reputation.

 

The non-directive approach to counselling

It is important to explore the underpinnings of the peer training model described in this manual.   These principles primarily come from the non-directive approach to counselling that Carl Rogers is generally credited with founding.

This approach is based on focusing on the human being as a person and putting the person in the centre of psychotherapy, it is seen as an art of personal encounter. (Schmid, 2002)

The training helps the peers to learn a few basic aspects of non-directive counselling.

These include:

  • Focus on the experiencing of self
  • Moment by moment empathy
  • High level of personal presence
  • Egalitarian stance
  • Self-determination and free choice as human possibilities
  • Pro-social nature of human beings
  • The client is the expert
  • The peer accepts the clients knowledge
  • The client is the expert for both the content and process of discussion
  • The peer is a facilitator for the client
  • The peer is wholly present
  • The client comes first (client centred)
  • Counselling is the art of “not knowing” not fixing not having answers….
  • The non-directive approach sees resources instead of problems
  • Non directive approach sees the ability to grow instead of disorder
  • The peer listens and is facilitative instead of guiding/steering or giving advice
  • The peer may provide education but not teach

 

The non-directive approach the peers will strive for the concepts of “What does the client show, or reveal? What are the aspects that the client wants to be understood?”

The client is the expert in that he is the one who has knowledge of his life and circumstances, and the capability to solve the problems facing him, even though he may not have as yet come to believe that himself.

Non-directive approach to counselling is not truly nondirective, but it is less directive than some other approaches.   Any response to a client is directive in some way.

The non-directive approach is a type of psychotherapy in which the patient is in the dominant position and is given complete freedom to express himself.

Making counselling affordable and accessible to everyone

Peers need to be recruited from the population being served.   It is important that the peers are part of the population that is being served.  Peer counselling should be done in a relaxed non-clinical atmosphere.  The peer also needs to look like his peers he is working with.  He should dress like them and sound like them as much as possible

The peer counsellors must be supported with supervision, and whatever institutional support that is available to make the volunteer experience stress free and enjoyable.  An agency may pay for transportation to the office for volunteering; they may give the occasional gift cards, or gifts of appreciation.  It is important that peers not be seen as employees but are recognized for the great service that they are volunteering to the agency.

Generally, peers should not volunteer more than four hours at one time.   Shorter volunteering experiences are likely to cause less stress.  It is important to provide supervision as soon as possible after the volunteer practice.

Peer counselling practice – how do peers provide counselling

The role of the peer is to provide support.  They have learned to listen without judgment and assist the client to explore their concerns and find their own solutions.   The peer is non-judgmental, and carefully listening to the client.  With the peer’s empathic understand the client is able to explore fully their concerns and arrive at their own solutions.   The peers initially may wish to “help” and often find it difficult not to offer advice, but they also have learned that by “fixing”, they limit exploration of the problem and the client is less likely to act on the offered solution.   By not “fixing” and offering advice the peers are free to focus on the client’s feelings, emotions and concerns.  Through this process, the client feels heard, accepted, and safe to explore fully the issue at hand.

It is important for agencies that provide services to a community ensure that there will not be harm done by the peers providing counselling.  The NANNIE process as outlined in this manual strives to reduce harm, this is done by not offering advice or “fixes” for problems.

Peers are not to be “professionalized”. Peers are to remain peers.

The important role that the peer plays is that they share some important similar important characteristics.   The value of the peer is that they can empathize in a way a professional may not.   The peer must remain a peer and not be encumbered with extensive theory.   The peer needs to be free to attend fully to the client and bring only his human understanding and acceptance to provide the comfort and safety to explore fully the client’s issues.

Do peers make better counsellors than professionals?  Some studies have shown that peers can do as well or even better than professionals.   Peers are a valuable resource!  Berman and Norton found that paraprofessionals and professionals were equal in effectiveness.  (1985)  Hattie Sharpley and Rogers found that paraprofessionals were more effective than professionals (1984)  There are many other studies showing the effectiveness of peers vs. paraprofessionals.  Many studies indicate that peers are equal or better than professionals. (Christensen and Jacobson 1994, Durlak 1979,Harris, Larsen 2007, Dennis 2003)  In fact most of these studies indicate that peer or paraprofessionals are more effective than professional therapists.

What peers have to offer clients.

Many people feel more comfortable discussing their situation with someone who has experience in confronting a similar problem that the client is having.  The peer also may be able to empathise better with someone if they have shared some of the same problems.

A peer is also not likely to be as threatening to talk with as a professional might be, just by the nature of the professional being a therapist can make him threatening.  Also the profession therapist may not have had some of the same experiences so may be only intellectually relate to the problems being brought forward.

Selecting peers for training

In selecting people for the training to be a peer counsellor, there are a few important characteristics.  You will want someone who is flexible and can adapt to a “new approach” to listening to and helping others.  They must also be interested in people and able to empathise with others.   What is sought is people who can truly listen, respect others and their differences, and be able to keep a confidence.

The training its self will also act as a screening method in selecting peers for training.  The use of criteria in evaluating when a peer is ready to begin counselling for an agency is an excellent approach.   Once a person has shown they can integrate the training into something workable session with others they are ready to work as a peer under supervision.

People person

The peer must be the type of person who genuinely enjoys people.  Someone who is curious about people, someone who tries to understand what a person is going through.  It is important to recruit people who naturally like people.

Strong sense of self

A strong sense of self is important because the peer must be able to set aside who he is and his needs, and be there for the client.   When a person has a strong sense of who they are and are more or less comfortable within themselves, they are then more able to focus on others much more easily.

Believe in respect, non-judgment, accepting of differing views

This may sound simple but we find that respect and acceptance is very difficult for people.  As long as people have similar views they are easy to accept and respect them but when people have differing views it can become more difficult for the peer to respect and accept.  The peer must be able to accept others who are different have different values and work with them in a positive way.

An example of this might be an intelligent successful individual may decide to leave his wife and kids and just tour the world on his own, or decide to begin experimenting with heroin, or expand their use of pornography and prostitutes.   The peer must be able to accept the person in front of them without judgment, with acceptance, and respect.   Through training, many people can learn to become less judgmental, and more accepting.  Therefore, this is a place where flexibility is also important for the peer.  In selecting peers, they need not be without judgment but open to letting go of their judgment of others.

Honest – having integrity

It is important that the peer is honest with others.   He then has creditability.  If the peer is honest with others, they will have credibility.  If the peer is not able to be genuine with the client then it undermines trust and the process of support.

The ideal peer would find it difficult to “protect” a client from hurtful or difficult responses.  He would value the honest relationship he has developed with the client and respect him by being honest even if the client would be hurt by the information.

Some examples of this might be:

“It sounds like you can be quite vicious at times.”

“It seem as though you really want to hurt him.”

“Hurting him as much as you can seems to be very important to you.”

“You talk about being honest, but it sounds like you will easily lie to get what you want.”

By being honest with the client, they realize that there is not only acceptance but also honesty allows the client to feel safe and open up more about his concerns.

Personally secure – tolerance of ambiguity

When a person is personally secure, they are freer to make mistakes, and take risks.   Peer counselling is not an exact science, most of the time it may not be clear of what is the precise response to make, and therefore it requires flexibility as well as risk-taking.  Persons who like a predictable safe way of working can find peer counselling difficult, because it is vague, without a rigid set of rules of what to do.  Peer counselling is not an exact science.

They share important qualities of client population

The peer must be part of the group they are working with.   Therefore, if the peer target group is for gay youth, then the peers MUST be young AND gay.  Just being young or just being gay is not enough to be a peer in this case; they must be identified as “gay youth”.

It is important that the peer share the same characteristics that are identified for the peer.  A bisexual person may not relate as well as a gay person to the issues faced by gay youth.  Many organizations “bend” the criteria to recruit peer volunteers.  No matter how skilled the “peer” may be it is deceptive for a client to believe they are meeting with a peer only to find out that they are not really peers at all.

An example may be peers working with other mentally ill persons.  Someone who once has a short course of antidepressants is not a peer to someone with an entrenched mental illness and diagnosis.

Persons who do not try to control or direct others

Some people who are drawn to the profession of counselling like to control and influence others.   It is important to make sure that the peers are not looking to increase their own sense of importance by directing or telling others how to live their lives.  The person who is interested in controlling others can build dependence and create many problems for the client.   It is important that during the training that the trainer be able to identify persons who have such control issues.

Comfortable to be around – likeable

The peer counsellor needs to be someone who is likeable, and someone that is comfortable to be with.  They need to be non-threatening, easy to talk to.  They need to show a bit of confidence without arrogance.   

The Training

 

The training is mostly a time for the peers to practice and get used to intensely listening to someone.   This is the opportunity for them to try to apply the basic principles learned.

A demonstration of proper use of the NANNIE method is extremely important.  The opportunity for a class to see the application of the NANNIE method provides a practical realistic use of the method.   The abstraction of a described method can be difficult to understand.

The other important aspect of the training is the practice by the peers.   They only learn how to use this method and become comfortable with it after many hours of practice.   This involved working together on their own issues to learn how they can use the method.

One additional difference in this training is the role-playing is not done in groups of two. Many persons find the role-playing difficult and very stressful.   In this role-playing, the peers break into groups of three.   One-person plays the “client”, and one is the “peer counsellor” and the third is an assistant to the “counsellor”.

The peer counsellor will discuss what he heard from the client with his assistant (in front of the silent client).  (The client listens to the discussion and learns how differently things can be interpreted and perceived)   The counsellor and his assistant will also discuss the theme of the response to give the “client”.   This enables a complete discussion and greater understanding of what was said to the peer counsellor.  They are working together to understand the client so it feels safer and easier.  {After the peers gain sufficient skills they do the role-plays in groups of two.}

This three-some method allows for a safer more comfortable experience.   In addition, the exercise is much more than “choosing the right phrase or sentence to respond” to respond to the client.  It becomes an exercise in understanding what was important in what was said to the peer.   This three person training provides a rich experience for the peers to learn much more about the depth of content that can be presented in a simple sentence.

How much training is needed?

Experience shows that about 30- 40 hours of training are required.

Participating in peer counsellor training can be an exciting process.  The concepts are difficult to implement at first for most people.  It is generally a struggle for the peers to relearn new ways of being with someone.   This relearning process can be a significant challenge.  Usually between halfway and 2/3 of the way through the training, the peers gain skills and confidence, and become excited about what they can accomplish through applying the NANNIE model.

The peers often find it difficult to let go of their own ego, their sense of self, and who they are. It is not easy for peers to initially understand that “who they are, that is, their beliefs, values, and morals” is not part of the helping process.  Peer counselling involves trusting people to find their own answers to their life problems. The helping peer also understands that the peer provides an environment where the client can explore the dynamics of the problems and talk about them openly and freely until they find something that works for them.   The peer’s job is only to create an accepting open space to explore problems.  Most peers wish initially to give lots of advice and tell others what to do.   When the peer learns that listening and accepting others is how the peer can be the most helpful he begins his growth as a peer.  It can take a while for the peers to be able to understand the concept and the value of it.  Once the peers see the NANNIE concept at work and understand the value they can more easily integrate it into the counselling.

Learning counselling skills

Individuals will come with differing experiences and skill levelsIt can sometimes be more difficult for people who have some counsellor training or experience to relearn a new approach.   This is where observation of the NANNIE method can be most effective in helping peers to understand the value of, and how to use the model.

Introduction of basic counselling principles

The basic peer counselling principles in the NANNIE method embrace the widely accepted basic principles of counselling.  These basic principles are empathy, acceptance, and nonjudgmental acceptance of the client.  These basic “core conditions” are the basis of many current counselling theories.

Each of the six core characteristics in the NANNIE method will be described below with the rational and purpose of each of these basic principles.

 

 

The NANNIE approach

 

No Judgment

Acceptance

No Fixing/No advice

No Questions

It is not about you

Empathy

 

NO JUDGMENT

This basic “core condition” that is widely accepted in counselling approaches is important because only when the person feels accepted are they free to explore more risky or treating issues.  When a person feels that there will be no judgment of their feelings and beliefs then they can experience the acceptance that is also demonstrated by the peer counsellor.

The lack of judgment is a basic (elemental) part of effective peer counselling because most of the other “core conditions” of the NANNIE method are based on establishing a atmosphere of true acceptance of the other.

An additional aspect of there being no judgment allows the client to be more accepting of the peer without judgment.   Peers can feel vulnerable because they lack extensive formal training in counselling theory.   If they also feel that there will be no judgment of them by the client they can be more relaxed, naturally responsive in the peer counselling/support process.

Suspending judgment is more difficult than many believe.   Most people think that they are not judgmental, but we all have our “hot button” issues where we find if hard not to judge.   Some typical examples are rape, sexual assault, spousal assault etc.   If we rationally think about the effects of our judgment of these issues, we generally will know that our judgement will not be helpful in the process of discussion of these issues, but we often still find it hard to accept without judgment. Part of the training is to help the peers to understand how difficult it is to be free of judgment.  Also the training will help the peers to become more sensitive to their “Hot button” issues and work on reducing judgment in the counselling process.

ACCEPTANCE

Acceptance is when one is able to accept the person or situation without a desire to change or fix the situation.  This is very similar toRogers “unconditional positive regard”.  Acceptance goes beyond non-judgmental approach.  Acceptance also includes the concept of having no agenda of change.   A peer may be able to be without judgment of a situation that the client brought to them but they must also have no agenda for that person to change in some way the peer believes to be in the client’s own best interest.

 

Thomas Gordon said back in 1970 that:

“When a person feels that he is truly accepted by another, as he is, then he is freed to move from there to begin to think about how he wants to change, how he wants to grow, how he can become different, how he might become more of what he is capable of being.”  Gordon 1970, 1975, 2000 page 38)

It is very common for a person to harbour a desire for a person to change or move in some specific direction that the peer may feel is in the best interest of the other.   An example of this might be a person who has pre-cancerous condition and is told to stop smoking for they will have severe health complications.  It is easy for a well-meaning peer to have the agenda for this person to stop smoking.   The effective peer counsellor recognizes that it is not his place to try to run someone else’s life, and pressure him to change in any particular way.   The role of the peer is to support the client in his life’s struggles and explore the issues before him.  Acceptance of another without trying to change/control/influence his life and decisions frees that client to fully explore himself and his options.

Acceptance is a difficult concept to get across to perspective peer counsellors.  Most people’s interaction involves trying to influence and change those around them.   This attempt to influence others can be about them changing their opinion, actions or words.  The irony in peer counselling is that only by not trying to change/control/influence another person is that person fully free to broadly explore and take action that he feels right for him.

Peer counsellors often need to be reminded that they are not to try to influence change but they are to support the person in exploration of their options and support their choices.  It is seductive for peer counsellors to see themselves as directing people into building better lives for themselves.  Whereas, the successful peer counsellor will support the client in finding their own direction without pressure or direction from the peers.

NO FIXING/NO ADVICE

This concept of no fixing is a difficult concept to implement for most new peer counsellors.  Most persons volunteering to be peer counsellors tend to see themselves as person who are dispensing advice and directing people’s lives.  Because of this it is often difficult for peers to refraining from fixing and telling others how to live their life.  With integration of the concepts of ACCEPTANCE and NO JUDGMENT, the concept of no fixing becomes clearer for the peer.

It is important that the peer understands that their solutions may not be the best for everyone.   The peer does not live the others life and cannot really know what is best for them to do.   Fixing and advice giving usually ends exploration of the problem and other options to cope with the problem are left unexplored.

A good example of the advice giving and fixing would be a situation where a person is repeatedly engaging in very risking sex.  One may be tempted to “fix” by telling the other that this is extremely dangerous and they need to use condoms when they are having anal sex.  Such advice giving often results in ending discussion.   The person never explores why they are putting themselves at risk; what such sex means for them, how and where these situations take place etc., the exploration never takes place.   So there is near a complete understanding of the whole issue and hence the client cannot find his own solution. A physician once told me he really likes counselling his patients, but he felt that he was not very good at it.   He said he often gives them advice on what they can do to improve their health.  I tried to ask how often they took that advice and before I finished the question he held up his hands forming a “0” with his fingers.  We seldom take other peoples advice, and more often follow the solution we find within ourselves.   Our best solutions/actions come when we fully explore the problem/situation and understand fully the consequences of our planned solutions/actions.   When the peer understands that though their best intentions in helping (fixing) is not very useful. When the peer understands that to be helpful is to offer is acceptance without judgment, then it is easier for the peer to refrain from “fixing”

The concept of no fixing/no advice also protects the agency from peers directing clients into situations that can be problematic.   By not directing the client into action the agency can feel comfortable that the peers volunteering for them will not be directing people into situations that may cause the clients problems..

There is always the place for education.   If the peer has information that the client needs then of course the peer will provide factual information for the client.

For example, there is a person who asks the helpful peer counsellor “Where are the toilets?”

The helpful peer reflects back ‘You’re anxious to find a toilet.’

The person seeking a toilet responds with a quick retort of “Yes, now where is it?”

The helpful peer responds about: ‘You feel frustration at not being told where the toilet is.’

This can go on and on and the helpful peer may be very good at listening and understanding the needs of the person looking for the toilet.   In this case, it is obvious that by having factual information the client does not have, but needs, he can help him immensely and his NANNIE approach to the situation is not the only helpful reply.   Here helpful peer tells the person directly where the toilet is; but as in all situations, the helpful peer does not tell him what to do with the information.   In other words, the helpful peer provides the information and leaves the client the option to act as he wishes as to how to use the facts.  An example is the toilet is down the hall on the left, NOT you go down this hallway, and look on the left and go in the second door on the right!

The effective peer also will make sure that the subject being discussed is fully explored before he offers factual information.  It can be easy for a peer to do more educating than listening.  There is a place for education but it must not be entered into to quickly and only when necessary.  Usually it is better to provide factual information at the end of a session.

NO QUESTIONS

The idea of the peers not asking questions is the most difficult aspect of the NANNIE approach for the peers to integrate into their practice.   There can be many different aspects to the desire to ask questions.

The most common reasons for peers wanting to ask questions are:

  • Desire to fix
  • Desire to influence others
  • Curiosity
  • To more fully understand a situation
  • Voyeurism
  • To take control of the interview

 

The next concept we will discuss is “it is not about you”. But before that, let’s explore the “No Questions aspect.  Looking at the list above, all of these relate to the peer counsellor and not to the client.  To be effective the peer needs to keep their focus on the client and not on their own needs.   The questions are usually come from needs of the peer.

Asking questions also sets up the client to explore what the peer counsellor thinks is important.  This takes away from the client exploring his own issues his way.  Asking questions disrupts the client’s natural process of exploration and moves the discussion to what the peer counsellor wants to discuss.   Asking questions tends to put the peer counsellor in control and not the client.

It is a new and different concept for the peer counsellors to find ways to assist the client to explore a situation without questions, rather than leading the client to some place the peer wants him to go.  The effective peer will find a way to introduce a concept without asking a question.  The peer of course wishes to assist exploration of issues in the broadest way possible.

 

 

An example of changing a question to a reflective statement would be:

Why don’t you …..?

Have you tried …..?

Have you considered ……?

The effective peer might say:

You are not sure how to move forward.

You cannot find a way to solve this.

You have considered many options and you are not sure what is best for you.

It sounds like it is hard for you to make a decision when you are not sure what is best.

You know what you think you should do but it is hard for you always to do that.

Another example might be:

How did you feel about ……?

Did you feel ……?

The effective peer might say:

It seems like you had some strong feelings about that.

It was hard for you not to react to that situation.

The responses of the effective peer give very broad areas to respond.   The client can explore any aspect that they feel is important for them.   The questions tend to narrow and shut down exploration of the situation.  The goal is for full exploration of the issue(s) and possible action the client wishes to consider.

Sometimes the peer counsellor is just curious about the situation that is being described.  The peer may want to know what happened next, or how someone responded to a situation.

A client may talk about his vacation at great length and the peer may ask:  “Where did you go?  Have you been there before?  How was the weather?   Did you enjoy the sun? These types of questions do not enhance the client’s understand of the issue but are for the peer.  Of course, the peer is not there to have his curiosity needs met.  He is there for the client.

By staying away from asking questions, the peer counsellor keeps his focus on the client.  The questions do not get in the way of the expression of the situation and feelings of the client.  By not asking questions, the peer also clearly demonstrates a focus on the content of what he is being told.  The focus remains on the client and his needs not the peer’s needs.

Because the peer is not “fixing” the client, he does not need to understand details, (like where he went on his vacation.)   In one teaching situation, I did a counselling demonstration for over half an hour and I had no idea of what the problem was that the client was talking about.  I did not need to know because I was not fixing or giving advice but my role was to help him to explore the situation, explore his options and consider the effects of what action he may take.   He reported that this was very helpful to sort out the problem and more clearly understand the complexity of his situation.   Yes, as a counsellor, I was curious about what the problem/situation was about but I never did learn what the concern was about.  And I never needed to know. — It was not about me.

IT IS NOT ABOUT YOU

The concept of it is not about you brings together all the above concepts.   It is not about what the peer thinks or feels about a situation.   It is not about the peer telling someone what to do.  It is not about the peers judgments.  It is not about the peers own reaction to what they are being told.  It is about the client!

The “it is not about you” aspect of the NANNIE method helps the peer to stay out of the way of the client telling his of situation.  This concept helps the peer to remain accepting, non-judgmental, focused on the client.

It is not about you – focuses on no ego involvement, and the letting go of the peers own ego.   Not being part of the process, but just facilitating the movement.

The peers are asked to not have their ego involved in the counselling process.  It is important to be focused on the client, and detached from their own needs and desires.  This can be difficult for some peers.  Letting go of self and putting the focus on the client is the important aspect of the peer’s efforts.

 

Empathy

Empathy is a basic part of counselling.  The counsellor needs to understand what the client is going through.  By truly understanding who the client is and how he got to where he is allows the counsellor to empathize with the client more fully.  To truly empathize with a client the counsellor must give up some of their own identity. The counsellor can more fully appreciate the client’s experiences when they can let go of their own way of being in the world.

 

Empathy is a basic part of helping and truly understanding another.  Though it is last on our list, empathy is a basic aspect of building a helping relationship. In helping peers to understand the concept of empathy it is useful to frame it as:

“Know what it feels like to be in the client’s position.”

Imagine what it would be like to experience what the client is going through.”

“Fully understanding the experience of the client from his perspective not the peers own life experiences.”  The peer much also think about how it might feel for that person and their situation.   This takes practice.  Real empathy does not come easy for most people.

 

 

PUTTING “NANNIE” ALL TOGETHER

What peers find hard to do.

Consistently, peers that participate in the training report that the hardest part for them is accepting (and understanding) that:

  • It is not about you
  • No Questions
  • No Fixing

 

It is important to spend extra time on these three aspects of the NANNIE method.  These three aspects all relate to the peers intervening, controlling, directing.   Once the peers understand that not only is this not helpful but also that people will find their own solutions, without the aid of advice or fixes.

The desire to ask questions often comes from wanting to feel in control.   The effective peer is not in control of the discussion.  He allows the client to talk about what he needs to talk about.  If the peer is in control of the discussion than it most certainly then it is all about the client’s needs and it is not about him (the peer)!  He must leave his ego and curiosity behind and only focus on fully understanding the experience of the client, clearly without judgment.

The message about not fixing and no questions needs to be continuously reinforced and modeled by the trainer. There is often such a strong desire to ask questions that the peers while learning the method will not even be aware that they are asking questions.  Often the peers are lost when it comes to how to proceed without questions in the early stages of training. Extra help and support often needs to be provided to assist the peers to understand how to proceed without asking questions.  The questions often can be re-worded to be a reflective statement for the client.   The trainer needs to demonstrate how to reframe questions into reflections is the best way of supporting the peers in learning a very new way of communicating.

 

IF a peer wants to ask a question, then the peer needs to examine what do they want to communicate?  NOT “Was that hard for you?”  But instead the skilled peer will understand that a statement conveying empathy and understanding is most helpful.  Something like:  “That sounds like it was hard for you.”  This shows empathy, understanding, and acceptance.   It allows the client to go wherever he wants to go in response.

 

THE ROLE-PLAY PRACTICE OF THE NANNIE METHODS

Role-play is the best way for people to learn the skills of peer counselling.  The idea of role-playing can be very difficult for people and cause a lot of anxiety.   It often seems like the goal is to find the best words to put together to make a counselling response.   The understanding of how to do this and what the concepts are behind it are difficult to grasp.

The initial role-playing is designed to explore the concepts of the NANNIE method and understand how to apply them.  The role-plays are important to be realistic therefore; people should use something real in their life to talk about.  It does not have to be a big problem but something to talk about that has real meaning for the person talking about their problem.

The peer counsellor has an assistant helping him to explore what was said and help him to explore how he might respond.   Each time before the peer responds to the person with the problem the peer will discuss what was heard with the assistant and they also discuss what is the content as well as the concept that needs to be addressed.   The peer develops his own wording for the response.  The person with the problem listens to the discussion with absolutely no comment.  The client learns more about the many different ways one can interpret something that is said.  As he listens to the discussion, he also learns what was heard and how someone might respond to what was heard.  The peer counsellor learns how to phrase a response in his own words.  He may check this out with his assistant before he replies.  The assistant makes sure that he is always consulted before there is any response from the counsellor, and the assistant helps the peer counsellor to work out a response.

Practicing using counselling skills

Practice in using counselling skills is the most important part of the learning.  The goal of the training is to provide ample time to practice using the skills presented, in an easy non-threatening situation.  It is very important for the peers to see the NANNIE Method used in front of the class.  Observing the NANNIE Method and using the skills in the NANNIE Method will demonstrate how to be a good peer counsellor.  This will be the beginning of the learning process.  When the role play  begins the peers will learn how hard they may find it is for them to apply the NANNIE Method.  Support and practice will help them achieve the skills in the end.  Having the assistant to help the peer to work through a response is a vital part of the learning experience.

The peers can practice the skills with their family and friends.  There is ample time to practice these skills outside the training situation.  It is also important that the trainer(s) demonstrate the use of these skills in all aspects of the training.

Observing counselling skills in action

It is important for the trainer to assist the trainees with difficulties they may be having in the role-play.  The trainer will walk around observing role-plays and noting issues and difficulties that come up.   The role plays are the time when real learning and integration happens so it is important that the trainer make the role play a maximal learning experience.   Reinforcement of good use of the method is very important.   When the trainer sees trainees doing an effective use of the NANNIE Method it is important to recognize this with support.

Becoming proficient in using the skills

After the trainees become more comfortable with the NANNIE Method, they then move to a one-on-one role play situation.   This can be challenging at first but often the trainees feel good to be able to respond spontaneously without checking with another person first.  There tends to be much more enthusiasm in the room when one on one role-plays begin.  Once the trainees begin to feel comfortable with using the Method they tend to seek opportunities for additional role-plays.  This stage of proficiency is often half to two thirds through the training schedule.  Remember in the training the same skills are used by the trainer(s), that is: support, no judgment, no questions, and understanding!

Identifying areas of difficulty

It is important that each peer explore what they are having difficulty with during the training process.   The peers need to freely discuss the areas that they are having problems and special attention should be given to learn how to overcome the problems that peers are having in applying the Model.   During the role-play the instructor will observe many different situations and they can bring into whole group discussion discussions about problems and difficulties observed in the role plays.

Most common challenges for peers are:

No questions

No fixing/advice

It is not about you

 

Help with “No Questions”

The peers often need help understanding why asking questions are not helpful.

When a peer asks a questions they are directing the discussion to the concerns that the peer wants to explore.   This takes the focus away from what the client wants to talk about.

Asking questions is also a way of the peer taking control of the counselling process where the control should always remain with the client.

Asking questions by the peer also sets up the peer as the expert.  “Just answer my questions … and I will fix you.”

Asking questions is not communicating acceptance, empathy, and respect for the client.

The questioning is done for the peers benefit and not for the clients benefit.

Often the desire to ask questions is for the benefit of the peer understanding more about a particular situation.  The peer does not need: facts, context, and explanations, to be helpful.  The peer is reflecting the feelings connected to a situation but the peer does not need to know and understand the situation to show acceptance and empathic understanding of the feelings.

The peers soon learn when they want to ask questions and refrain from doing so that at the end of the session they will most of the time understand that the information that they “desperately needed to know” really is not important and listening and communicating empathically with the client is all that is necessary.

 

The questions are for the peers not the clients.  Some common reasons peers ask questions:

  • Peers can feel in control of the counselling
  • Understand a context better (which is not necessary to be helpful)
  • Sometimes it is just voyeurism and curiosity

 

Peers can be helped to understand why they want to ask questions and can find some reflective ways to address the issue at hand.

Below are some examples of how questions can become reflective statement:

Why did you do that?

Sounds like you are: (not sure/or do not feel good about/or feel pleased/ or …) that you did that.

This response allows the client lots of room to respond in any way that is comfortable for him.

Is your father still alive?

Does the peer really need to know this, likely not.  If a peer wishes to ask such a question; then he sees that the client is concerned about their relationship with their father.  Therefore, a reflective statement about the relationship with the father seems appropriate here.   “Your relationship with your father (is/ important/or difficult) to/for you.”

The client can explore many aspects of his relationship with his father even if the father is dead, not around, or close by.

 

How do you feel about that?

Here empathy comes in.  Can the peer understand the feelings of the client?  If they are confused about the feelings the client has then they may feel that a reflective statement like:  “It sounds like you have lots of different feeling about that.”  This invites exploration of these feelings.

Peers need to understand that the questions are not helpful for the client, they distract from counselling, from understanding, from acceptance, and from exploration.  The peers often need to find other ways to communicate understanding without asking questions.  Lots of practice in large groups of looking at ways to avoid questions by exploring alternatives is very helpful.

No Fixing/No Advice

Peers find giving advice to be the easiest thing for them to do.  By peers not giving advice not fixing, they sometimes feel not useful.  One person explained that they felt the clients got a lot out of this type of counselling but felt that “their cat could do it”.   They were not fixing, telling others what to do, and they felt worthless.   This can be especially true of persons who are trained in a job where their value is to give advice and tell others how to behave.  Doctors and nurses find this approach very difficult when they cannot give solutions and fix other peoples situations.

One of the unspoken messages given to the client when they are given advice is that the clients are not capable to finding their own solutions to their problems.   The clients are in effect told that they cannot run their life but need someone else to tell them what to do.  While most people feel that it is helpful to give advice, the reality is that it is seldom taken or implemented.  The advice is not usually useful and is given more for the benefit of the helper.  When the peers learn that clients can find their own solution to their problems then it becomes easier for the peers to avoid fixing.

It Is Not About You – It IS About Him (the client)

This one is a broad statement about the peers understanding that their own opinions and experiences are not part of the counselling process.  The peers may have some feelings about what is being talked about but they need to work hard to avoid this affecting the counselling. The peers must understand that their feelings are not part of the process of counselling.  “It is not about you” is to keep the focus on the client and not on the peer.   So often, the peer will want to tell stories about their own experiences as a way of showing empathy, and offering solutions.  “It is not about you,” conveys that it is about the client!  The peer support process involves the peer not having ego involvement in the process, and focuses on the client’s feelings, experiences and needs.

 

Berman, J., and Norton ,N. (1985), Does professional training make a therapist more effective?, Psychological Bulletin, 98, 401-406.

Christensen, A.F., and Jacobson, N., (1994) Who (or what) can do psychotherapy: The status and challenge of nonprofessional therapist.  Psychological Science, 5, 8-14.

Dennis, Cindy-Lee, Peer support within a health care context: a concept analysis, International Journal of Nursing Studies, 321-332.

Durlak, J., (1979) Comparative effectiveness of paraprofessional and professional helpers.  Psychological Bulletin, 86, 80-92.

Gordon, Thomas, PET, Parent Effective Training, A proven program for raising Responsible Children,  Random House of Canada, 2000.

Harris, Gregory, Larsen, Denise, HIV peer Counselling and Development of Hope: Perspectives from Peer Counsellors and Peer Counselling Recipients. AIDS Patient Care and STDs, 2007, 21,843-859.

Hattie,J., Sharpley, C., and Rogers, H., (1984) Comparative effectiveness of professional and paraprofessional helpers.  Psychological Bulletin, 95, 534-541.

Schmidt, Peter, The Person in the Center of Therapy: The Ongoing Challenge of Carl Rogers for Psychotherapy 3ed World Congress for Psychology,ViennaAustria, July 2002.

Peer counsellor training videos – The NANNIE Method

Trained in psychology, Bill has devoted a major portion of his career to treatment, training and program development in the field of sexually transmitted disease with a particular focus on HIV. Working in North America, Europe, Africa and Asia he has cultivated his craft in many different cultural settings.

 

In practice and in life, he combines frank realism with unflinching humanism.  He believes in people, whatever their particular circumstance, and their capacity to find their way.  Bill has developed keen sensitivities for authenticity and fairness.  He is alert to ways in which organizations and systems may exert power over individuals, or for that matter, how one individual may exercise power over another.  Fittingly, his model for peer counselling specifically address these issues.  His basic working premise is that when people feel safe, understood and supported, the will naturally enter into honest self-exploration and change.

 

He currently operates a private practice and lives in Vancouver providing counselling to clients as well as consultation and training to agencies and organizations.

 

Below are links to the four 15 min segments of the NANNIE Method peer counsellor training video:

The NANNIE Method – Part 1

The NANNIE Method – Part 2

The NANNIE Method – Part 3

The NANNIE Method – Part 4