Pause

Peer Leader Training Notes

Notes from Session 1:

  • Not a certified peer “counselor” training
  • Many available resources to come and consult, ask questions and get feedback
    • Providing support for others should be a collaborative effort
  • What’s the student’s role?
    • Front line—much more aware what other students are going through
      • First to recognize problems in our peers
      • Not expected to provide counseling
      • Want to let students know what they CAN do to help
      • Only about 17% of students are actually seen for counseling
        • Much more likely to reach out to a peer
  • What is a crisis?
    • Subjective—crises are not the same from person to person
      • Things matter differently from person to person
    • Emergency—anytime you feel someone may pose a threat to themselves or others
      • REQUIRES IMMEDIATE ACTION
  • What are emergencies?
    • Suicide attempt, gesture, threat
    • Homicidal attempt, gesture, threat
    • Behavior posing threat to self or others
    • Loss of contact with reality
    • Inability to care for oneself
  • Indicators of distress:
    • Decreased productivity/functioning
    • Poor personal interactions
    • Impaired cognition
    • Amplified emotion
    • Diminished self-care
  • Look for clusters, frequency, duration, and severity—not just isolated symptoms
  • What can I do?
    • Lots of options—some passive, some direct
    • Passive:
      • Observe
      • Listen
      • Consult
    • Direct:
      • Initiate contact
      • Communicate concerns directly
      • Show your interest and concern
      • Empathize
      • Refer
  • Empathizing and sharing experiences is a powerful way to normalize a student’s situation
    • Share that they are not alone
    • Can normalize without naming names
      • Keep your peers privacies
      • Especially if the story is not necessarily yours
  • Non-Judgmental Support
    • Try to understand what the person is saying/feeling
      • Show your effort and make that person feel valued
    • Put that into your own words and feed it back to the person
      • Makes it clear that you’re hearing what they’re going through
      • Allows them to clarify if you’re missing the mark
      • Lets them know that you’re listening
    • Avoid evaluation or absolutes
      • You’re not here to provide diagnoses
        • “You sound like you’re feeling overwhelmed” vs. “You sound like you’re depressed”
      • Let someone decide how to experience/deal with their own problems
  • Active Listening
    • Refer to handout
  • Many younger students looking for advice.. how can we offer some without sounding condescending or overly confident?
    • “If I was in your situation I would consider”
    • “In my situation, I found this helpful, but your situation might be different because of…”
    • Not telling them the only thing to do, just offering self reflection and general knowledge obtained
    • Keep checking in
      • is this making sense?
    • Let them direct/lead you to whether you’re simply telling them what to do
  • How often should we be communicating?
    • Completely depends on the person/situation
    • Following up is very important
      • Use your best judgment
    • Good to be specific about when you plan on following up
    • Great way to let a person know that you’re still engaged and you still care
  • What about when people are just looking for what they want to hear?
    • “It seems like you know what you want” or “It seems like you’ve made up your mind”
    • let’s them know that you’re picking up on what they want
    • allowed to disagree and say “I don’t know that that’s how I would approach the problem but if that’s what you want to do..”
    • “how about we check in after this and see how it went”
      • make them feel as though they can still talk to you even if there are negative consequences to their actions
  • How do you respond?
    • Five point formula
      • Not necessary but helpful for more difficult situations and trying to respond to people
    • I care
      • I’m interested in your well being, I want you to solve this problem
    • I see
      • Review and respond to the problem. Summarize what they’ve told you and what you’ve noticed about what they’ve shared
      • “you seem upset”—talk about observable behaviors, not interpretations
      • talk about objective truths of the situation and their response
    • I feel
      • Based on what you’re seeing, what concerns you have
      • What could be beneficial for them
      • Doesn’t have to be deep, just let them know how you respond
    • I want
      • What your hope is for them next
      • What options can you offer to that person
      • Give outside resources
    • I will
      • When will you follow up?
      • What will your next actions be?
  • Dealing with High Emotion
    • 3 things to do:
      • ensure your safety
      • try to dissipate the emotion
      • consider the other person’s perspective
    • 3 things to NOT DO:
      • don’t get caught up in the moment
      • don’t one-up the person
        • don’t try to minimize their situation or feelings
      • don’t patronize
  • What about suicide concerns?
    • Consult decision tree handout
    • Trust your instincts
    • DO ask the person directly:
      • “Have you considered suicide?”
      • “Have you every thought about killing yourself?”
    • DO NOT ask in a negative way:
      • Indicates judgment and makes someone not be honest and open
      • “You wouldn’t hurt yourself, would you?”
      • “You’re not thinking of doing something crazy are you?”
    • Asking directly can feel relieving if they are feeling that way
      • Makes them feel not alone
      • Won’t put the idea in someone’s head who is not suicidal
        • Potentially could be offending, but better option than ignoring the issue
  • How do I bring up counseling?
    • Counseling is a RESOURCE that can give you tools and options
    • It is free and confidential at student health
    • They work with your schedule and there’s no commitment
      • They won’t try to diagnose you
    • It can be about problem-solving, relationships, etc.
    • Helpful to normalize counseling with your own counseling experiences if you feel comfortable
  • What if someone has tried counseling in the past and wasn’t satisfied?
    • Not everyone clicks with the counselors that they meet with
    • You can let them know that they can request specific counselors
      • They can request to not have a previous counselor
    • Counselors expect to not keep every client
      • Not everyone matches up with every patient’s needs
    • Student health can give you outside resources if don’t want to pursue options at student health
  • Know your limits:
    • Problem is more serious than you feel comfortable handling
    • You are worried about someone’s safety
    • Your attempts to be kind or helpful fail
    • The student has evoked strong emotions or feelings in you
      • Don’t need to self-sacrifice to help other people

Notes from session 2:

  • What is peer support?
    • Intentional relationship between people between people who appreciate how they are “like” each other
      • Not casual, step above a casual lunch conversation
      • Different than going to a mental health counselor
    • Supports transformation and growth for people with shared life experiences
      • Grad students helping other grad students
    • Demonstrates hope, optimism and self-responsibility in a relationship between equals
      • Eliminates the power differential and removes a potential barrier for support
    • Provides opportunities for mutual empowerment
      • The leader gets something out of the relationship just as much as the person being supported
  • Self Disclosure/Advice & solidarity
    • Peer support has a lot of similarities and differences with conventional “therapy” relationships
      • Some overlap with a role of a counselor
        • No professional, legal obligation to maintain boundaries
        • You are playing a certain role, need to consider your boundaries
      • Expected to share experience, perspective, and advice
      • In a position to have a more direct effect than a counselor
    • Relies on mutuality and reciprocity
      • There’s a give and take for peer support
      • Bi-directional sharing
  • Boundaries
    • Set limits
      • Can be explicit or simply kept in your own mind
      • Make them clear and stick to them
      • Be honest about your own abilities and constraints
        • Balance peer support with your own responsibilities and obligations
    • Be aware of your own needs
      • Pay attention to your reactions/feelings
        • Peer support should not drain energy or raise strong emotions
        • Shouldn’t overwhelm you
      • Can be boundaries on both time and what you can deal with from an emotional standpoint
    • Know when to say “No” and do it
      • Delegate, defer, be honest
    • Your role is not to “fix” people or their problems
      • Help facilitate and problem solve, not fix
      • You are not RESPONSIBLE for them or their problems
    • The peer support center is a community
      • Don’t need to feel that have to help every other student on campus
      • You can be both a peer leader and seek support from other peers
  • Boundary Bill of Rights:
    • See slide
  • Multiple Role Relationships
    • Professional relationship with a person but you also share another relationship with that person
      • can also apply to present or future relationships with people close to that person
  • Compassion fatigue
    • Reduced capacity or interest in being empathic
    • Almost all helping professions run into this problem
    • Combination of secondary trauma and burnout
      • Secondary trauma are emotional impacts from individuals working with trauma survivors
        • Can be associated with anything difficult
      • Symptoms can parallel PTSD (not always)
      • Symptoms located on slides
    • “vicarious trauma”
  • Burnout
    • Exhaustion
      • Feeling disengaged
      • Poor work ethic and efficacy
    • Cynicism
      • Depersonalization, disconnection from others
    • Inefficacy
      • Lower productivity
      • Feelings of incompetence
    • Causes
      • Workplace conditions
      • Workload
      • Inadequate support
      • Conflicts with personal values
    • Not related to personal strength and abilities
      • Not a reflection of you as a person
  • Self-care
    • The antidote to burnout
    • Often easier said than done
      • Rest from work
      • Develop a circle of supportive people
        • Can just be 1-2
      • Identify sources of joy and playfulness
      • Learning to recognize signals of distress in yourself
      • Know when to seek professional consultation
    • Okay to take a step back from SPSC responsibilities to “save yourself”
  • Self-Care Plan
    • Fun
    • Sleep
    • Relationships
      • Can include pets
    • Healthy diet and exercise
    • Vacations
      • Ranges from mini-meditations and short walks to actual destination vacations
    • Regular checking in with others
      • Colleagues, peers, family, trusted advisor, mentor, counselor

 

QPR: Suicide prevention training

  • NOT intended to be a form of counseling or treatment
    • Intended to offer hope through positive action
  • In US, one person dies from suicide every 14-18 minutes leaving an average of 6 loved ones each
  • QPR is modeled after CPR
    • Any average person can do and it is easily learned
  • Question a person about suicide
  • Persuade a person to get help
  • Refer the person to the appropriate resource
  • Language of suicide can stigmatize
    • Death by suicide vs “committing suicide”
    • Don’t make suicide appear to be a criminal or sinful act
    • Non-fatal rather than “successful or unsuccessful”
      • Not something to be achieved
  • Around the world (2010): self harm took more lives that war, murder, nature combined
    • Only three diseases do more harm than suicide in developed countries
    • In developed world it is the leading cause of death age 15-49
    • Incidence rates are still extremely low in terms of percentage of population
      • Still significant in world/country
    • 90% of Americans who commit suicide were suffering from a diagnosable mental illness
  • Second leading cause of death in graduate/professional students
    • Males more likely to die by suicide
    • Females more likely to attempt suicide
    • Up to 31% of students have felt so depressed it was difficult to function (in the past year)
      • 6.4% had seriously contemplated suicide
      • 1.1% had made an attempt
    • 45% attribute problems with school as a reason for wanting to commit suicide
  • Myths about suicide
    • MYTH: No one can stop suicide, it’s inevitable
      • If people in crisis get the help they need, they’re likely to never be suicidal again
    • MYTH: Confronting a person about suicide will only make them angry and increase the risk of suicide
      • Asking someone directly tends to lower anxiety and opens up communication to lower the risk of an impulsive act
    • MYTH: only experts can prevent suicide
      • Suicide prevention is everyone’s business and anyone can help
    • MYTH: Suicidal people keep their plans to themselves
      • Most suicidal people communicate their attempt the week preceding their attempt
    • MYTH: Those who talk about suicide don’t do it
      • Those who talk about suicide may attempt it or kill themselves as an act of self-destruction
    • MYTH: Once a person decides to die, there is nothing anyone can do to stop them
      • Suicide is one of the most preventable forms of death
  • Cues and Warning Signs
    • The more you observe, the greater the risk
    • Take all signs seriously!
    • Joiners suicide theory:
      • Thwarted belongingness
        • “I am alone”
      • Perceived burdensomeness
        • “I am a burden”
      • Capability for suicide
        • “I am not afraid to die”
    • It’s a selfless act in their mind—they are harming other people with their existence
    • Direct verbal cues
      • “I wish I were dead”
      • “I’m going to end it all”
      • People will say these things on social media and in person
    • Indirect verbal cues
      • “Who cares if I’m dead anyway”
      • “Pretty soon you won’t have to worry about me”
      • “I’m tired of life, I just can’t go on”
    • Behavioral cues
      • Previous suicide attempts
      • Acquiring guns or stockpiling pills
      • Depression, moodiness, hopelessness
      • Putting personal affairs in order
      • Giving away prized possessions
      • Sudden interest or disinterest in religion
      • Drug or alcohol abuse or relapse
      • Unexplained anger, aggression and irritability
    • Situational cues
      • Being fired or expelled from school
      • Recent unwanted move
      • Loss of a major relationship
      • Death of a spouse child or best friend
      • Diagnosis of serious or deadly illness
      • Sudden unexpected loss of freedom/fear of punishment
      • Anticipated loss of financial security
      • Loss of a cherished therapist, counselor or teacher
      • Fear of becoming a burden to others
    • Situational cues are not necessarily an indication themselves, it’s the interaction between these and other cues
    • Suicide crisis episodes are fast
      • Trigger can begin a couple of day crisis that peaks in a matter of hours
  • Q:Question
    • If in doubt, don’t wait. Ask
    • Be persistent
    • Talk to the person in a private setting
    • Allow the person to talk freely
    • Less direct approach:
      • “Have you been unhappy lately?
      • Have you been very unhappy? So unhappy that you’re thinking of ending your life?
    • More direct approach:
      • “You look pretty miserable, are you thinking about suicide?”
      • “People going through what you’re going through sometimes wish they were dead, I’m wondering if you’re thinking about that too?”
    • How to not approach it:
      • “You’re not thinking about suicide, are you?”
        • adds a negative connotation that shuts off honest communication
  • P: persuade
    • Listen to the problem and give them your full attention
    • Suicide is not the problem, only the solution to a perceived insolvable problem
    • Do not rush to judgment
      • Be supportive, understanding
    • Offer hope in any form
      • Why you care about them, why life is worth living
    • Ask: “Will you go with me to get help?”
      • “Will you let me help get you help?”
      • Let them know that you are interested in helping them through this and being there for them
    • NEVER PROMISE CONFIDENTIALITY
  • R: Refer
    • Suicidal people often believe that they can’t be helped, may have to do more
    • Best referral often involves taking the person directly to those who can help
    • Next best is getting a commitment from them to accept help
    • Can give information and try to get a good faith commitment that they will not commit suicide in the meantime
  • Suicide prevention lifeline (1-800-273-TALK)
    • Helpful to call for feedback in helping others as well
    • Don’t have to be in crisis mode
  • UCSF Resources can be found on the back of packet
  • Immediate threats to themselves or others should be referred to 911
  • How do I bring up counseling?
    • Counseling is confidential
    • Counseling is a resource, not a fix all
    • Counseling is free
    • They can work with your schedule
  • REMEMBER: almost all efforts to persuade someone to live will be met with relief
    • “I want you to live” or “I’m on your side”
  • Follow up is very important to make sure that they’re doing okay
    • Not personally responsible, work with a team