The concept of empathy — as a tool used in mental health care and a forte of psychiatrists — is nothing new.1 Empathy has long been considered a pillar of effective psychiatric and psychotherapeutic intervention.2
But, as many front-line providers can appreciate, empathy is easily challenged by any of the myriad demands on providers in acute-care psychiatry. Empathy is demanding. It requires close attention, sublimation of our own thoughts and reactions, and an ability to put aside the quotidian demands of clinical practice.
Peer professionals provide a critical vector to re-instill and support empathy, recovery and hope in our most challenging treatment settings and provide a needed reminder to keep the person at the center of our care.3
We work with peers across a variety of settings at our institution including outpatient and Assertive Community Treatment, a crisis center and a psychiatric emergency department, and short and long-term inpatient units. In our programs, peers are people who have progressed in their own recovery and are willing to self-identify as one to assist others with a chemical dependency or mental disorder.
They use their own life experience as a foundation for empathy-driven development of rapport and trust. Peers provide an added bridge between patients and other members of the treatment team and use their expertise not only to support patients, but to guide clinicians as well.
Peers are open about their own life experiences, and at the same time they are full members of the treatment team, building credibility with both patients and clinicians.
Peer professionals are a visible, living reminder to staff and patients alike of what recovery looks like. Patients need not see themselves wholly defined by their diagnoses or anchored to their symptoms at their most severe. They can look to the peers on their team to regain hope for what a meaningful life can look like, fighting past the burden and distortion of acute illness.
Clinicians, especially those in emergency and inpatient settings, have a vivid reminder of what people look like when illnesses are subsumed and a meaningful life is achieved, beyond merely when a few symptoms are brought under better control.
Peers provide visible — and often vocal — feedback against the encroachment of stigma that so easily seeps behind the closed doors of a clinic, away from the patients, and into the staff lounges and report rooms.
In addition to their role as champions and exemplars of recovery, peers have a number of other valuable roles. Their ability to provide undistracted empathy can be especially valuable in defusing tension in a milieu or with an individual patient.
Long before an event reaches the threshold for physical intervention, a peer can work with an upset person and engage them in a shared process of conflict resolution.4 Patients are often willing to receive and use feedback from a peer about their behavior — provocative language, illness-related behaviors, denial and other defenses — that they may never accept from a clinician.
Peers are able to help clinicians fine tune their diagnostic and clinical understanding of the people they are trying to help. Clinicians may see a lack of improvement as a treatment failure due to medication or therapy. Peers can also look at the broader spectrum of issues that may create a barrier to recovery, such as stigma and triggers.
With their help, clinicians can be guided to different clinical approaches or explorations and may be able to elicit behaviors and symptoms that would never be comfortably reported to a clinician. Peers can interact from a perspective of shared experiences, peeling away the layers of shame and self-stigma that people may not recognize exist.
Optimally, the strength of peers is not just when they use their empathy with patients, but when patients begin to empathize with them. The meaningful instillation of hope is stronger for many patients when it comes from a peer than when it comes from a provider. When the peer relationship is working at its best, a peer can be a role model for many domains of wellness that traditional treatment may not address.
Peers use a palette of skills — personal medicine, a Wellness Recovery Action Plan, wellness coaching and nonjudgmental listening — to work with patients. Equally important is the role of peers working within the clinical team, as a resource to other healthcare providers.
John S. Rozel, MD, MSL is medical director of the re:solve Crisis Network, Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, where Keirston Parham, CPS, CWF, is a recovery and peer services coordinator.
- Khajavi F and Hekmat H. “A Comparative Study of Empathy: The Effects of Psychiatric Training.” Arch Gen Psychiatry. 1971; 25(6): 490–93.
- Lambert MJ and Barley DE. “Research Summary on the Therapeutic Relationship and Psychotherapy Outcome.” Psychotherapy (Chic). 2001; 38: 357–61.
- Lazare A, Eisenthal S, and Wasserman L. “The Customer Approach to Patienthood: Attending to Patient Requests in a Walk-in Clinic.” Arch Gen Psychiatry. 1975; 32(5): 553–58.
- Richmond JS, et al. “Verbal De-Escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-Escalation Workgroup.” West J of Emerg Med. 2012; 13(1): 17–25.
- Ramaswamy V and Gouillart F. “Building the Co-Creative Enterprise.” Harv Bus Rev. 2010; 93(10): 100–109.