IPS Learning & Practice groups

Following is a draft format that some of us are trying out for leaderless International Peer Support groups that can be held on line or in the community.

Opening

Welcome to the IPS Learning and Practice Group.  We’re glad you’re here.

Brief Overview of IPS (ask someone to read)

Intentional peer support (IPS) is a way of thinking about and being in purposeful relationships. In IPS, we use our relationships to look at things from new angles. We develop a better awareness of personal and relational patterns. We support and challenge each other as we try new things. IPS is different from traditional service relationships because it doesn’t start with the assumption of “a problem.” Instead, we learn to listen for how each of us has made sense of our experiences. Together, we create new ways of seeing, thinking, and doing.  At the end of the day, it is really about building stronger, healthier communities.

 Check In 

How are people doing this week? If you’re new here, what drew you to this group?  What are you looking for?

Topic of the week 

(Topics are pulled from the key learning points in in Intentional Peer Support: An Alternative Approach)

Read a topic from the topic list (attached below, maybe just go in order through the list)

Ask questions about the topic that help the group to develop what it means.  The idea is to figure out how I want to practice the concept when I'm relating to others.  Also, to let others in the group know how I want them to practice this concept when they are relating to me. 

Sample questions:

·       “What does [the topic] mean to you…?

·       “How is it different from…”

·       “How does it make you feel when someone approaches you this way (or doesn’t)?

·       “How would you like us to practice this skill here with you if you are sharing?”

Practice Time

This is a time where we can practice what we’ve been discussing with each other.  Does anyone have an example from real life they want to share?  Then the rest of us can practice 2 ways.  

• First, by playing around and doing the opposite of what this skill means to us.  
• Then by doing a redo and really trying to practice the skill to the best of our ability. 

Sample script for practice session

Ask: "Is anyone willing to go first?  Ok go ahead and share your situation.  Be prepared though.  Because first everyone else, give the worst responses they can think of."

[Group practices examples of getting the concept totally wrong, often using examples of how others have messed up with us]

After 5 minutes, ask the sharer: What did you notice.  How did that feel?

Next the redo.  

Ask the shared:  Can you continue your sharing from here.  Except this time, everyone try to really practice the skill we are working on. 

After 5-10 minutes, ask the sharer: What did you notice.  Did that feel the same or different?  How so?

Give as many people turns as time allows.

Closing 

About 10 minutes before the end of the group, announce:  We’ve got about 10 minutes left.  

Then reflect together as a group, about how the group felt to people.  

Sample questions: 

Is there anything on anyone’s mind that feels unfinished or important that you want us to get to before the group ends?

How did the group go for you?  

Anything you want to should remember for next time – either that worked really well for you, or that you might want to change?

Summing up:

Next time we’ll talk about (next topic on list)

Thanks for being here!  Have a great week.

Topics

1.      Helping versus Learning & Growing

2.      Needs of Individuals versus Needs of Relationships

3.      Fear & Discomfort versus Hope & Possibility

4.      Connection vs. Disconnection

5.      Worldview: How we come to know what we know

6.      Mutuality / Mutually Responsible Relationships

7.      Moving Toward (what we want) vs. Moving Away From (what we don’t want)

8.      Sitting with Discomfort

9.      Holding Multiple Truth

10.  Embracing Uncertainty

11.  Listening from a Position of Not Knowing

12.  Listening for the Untold Story

13.  Providing Validation (Rather than Jumping Straight to Problem-Solving)

14.  Reflecting Feelings (That must make you feel really…)

15.  Asking Powerful Questions (What do you want? Do your beliefs support it? How do you want to feel? If you believed and felt that way, what might change?  How could you get there?)

16.  Deep presence - authenticity, commitment, honesty, willingness to be affected and changed

17.  Listening with an Ear for Role (good patient/ bad patient; good mother/ bad mother, etc.)

18.  Direct Honest Respectful Conversation (See-feel-need)

19.  Negotiating Reality

20.  Sitting comfortably with silence

21.  Conversations about diagnosis (human vs diagnostic language)

22.  Staying peer (what am I feeling right now,whose need am I trying to meet,what' s making me uncomfortable, am I owning my part, am I listening for the larger story?)

Intentional Peer Support Weekly Co-Learning Group

Free Online Weekly: 

Saturdays 5:15*-6:30 pm Eastern

(*please note time change)

An online learning and practice group for Intentional Peer Support

** Beginners Welcome **

~Join by computer: https://zoom.us/j/119362879

~Join by phone: +1 669 900 6833 or +1 646 558 8656
Enter Meeting ID: 119 362 879

~International callers: https://zoom.us/u/jkwt3wHh

*New Topic Every Week

*Learn and Practice

*Offer and Receive

*Peer Support in Action

About Intentional Peer Support:

IPS is a way of thinking about and being in purposeful relationships. In IPS, we use our relationships to look at things from new angles. We develop a better awareness of personal and relational patterns. We support and challenge each other as we try new things. IPS is different from traditional service relationships because it doesn’t ,start with the assumption of “a problem.” Instead, we learn to listen for how each of us has made sense of our experiences. Together, we create new ways of seeing, thinking, and doing. At the end of the day, it is really about building stronger, healthier communities.
(More information, trainings, workbook and resources available at www.intentionalpeersupport.org.)

What to expect

Each week we focus on a different topic from the IPS Workbook: Intentional Peer Support: An Alternative Approach by Shery Mead.  (No purchase is necessary - the relevant text is made available at each meeting.) We use the reading to focus our attention and spark discussion about important concepts in peer support.  We learn together from the reading and the experiences we share.  We explore how we might apply what we are learning to the real issues in our lives and also to support each other to navigate our challenges meaningfully and well.  Our aim is to  build a supportive, mutually responsible peer community capable of negotiating different needs, values and views of reality with dignity, rights and personhood fully in tact for all concerned.

Group "Discomfort" Agreement

IPS encourages the use of 'Discomfort' Agreements, moreso that 'Comfort' Agreements.  This is because learning new things is often uncomfortable.  New learning usually requires sincere effort and a willingness to stretch beyond the known into the unknown.  The IPS Discomfort Agreement acknowledges this challenge, as well as the temptation to quit when the going gets rough.  the Discomfort Agreement thus supports us to stay with the process by helping us to think, intentionally, ahead of time, about the kind of environment we want to create in order to support and facilitate new learning.

Here's our working Discomfort Agreement for the Saturday Group on Zoom:

DISCOMFORT AGREEMENT 

1. One person talk at a time. 
2. Offer respect and dignity. 
3. Listen to understand and relate rather than to help or convert others. 
4. Participate to the level of your comfort (self-care). 
5. Keep the focus on learning and practicing Intentional Peer Support. 
6. Maintain a non-judgmental atmosphere. 
7. Don’t make assumptions or put words in people's mouths. Instead: ask, reality check, validate. 
8. There is no right or wrong here in the sense that sincere discussion and questions are welcomed. However, apparent power imbalances, unfairness or nonconsensual treatment of others can and should be respectfully questioned. 
9. When controversy arises, explore differing viewpoints with curiosity about the personal experiences that led others to see things the way they currently do. 
10. Work to transcend disagreement by learning about the realities of others and finding points of connection. 
11. Being respectful of modalities that others find useful and refrain from promoting or denigrating specific approaches. 
12. Stay away from debates about pharmaceuticals, healthcare or politics. 
13. At a minimum: agree to disagree 
14. “Stretch”: Step up if you tend to stay in the background, step back if you tend to take up a lot of space. 
15. “Ouch”: If it hurts say so. 
16. Be conscious of how you use power or privilege, as well as open to hearing from others about how they may experience you using it. 
17. Use power to support and grow relationships rather than to gain personal advantage or prestige. 
18. Don’t scapegoat or marginalize anyone. 
19. Promote equality, fairness and understanding. 
20. Reach out to include others who may have less power or privilege than you have. 
21. Some here may prefer to type in the chat box instead of speak out loud. You can access the chat box from the control panel at the top or bottom of your screen. If you don’t want your comments read out loud, please let us know. Otherwise, we try to read them in real time so they can be part of the conversation. Everyone is encouraged to pay attention to typed comments and read them. 
22. A major purpose of this group is to encourage conversation, create space for diverse viewpoints, and make sure everyone has a chance to speak.  If you have something to say and someone else is speaking, please raise your hand. Other members are encouraged to notice to when someone has their hand raised and call attention to that in a sensitive way if the speaker doesn’t seem to notice.  Group members are encouraged to bring bells or musical instruments and use them for this purpose if the someone has gone on for several minutes.  
23. We recognize that there are times if life where any one of us might feel the need to speak at length about matters that concern us.  If that appears to be the case, anyone may request or suggest a breakout room where two or more members can have a private conversation.  Alternatively, anyone may request or suggest that a particular issue be discussed further after the formal group meeting.  
24. Moderation of the group is shared by group members.  At the end of each group we ask for a volunteer to moderate for the upcoming session. If that person is able to make it, we ask for volunteer to moderate when the next session starts.  Those new to moderation are encouraged to try their hand at moderating once they become familiar with the group process.  All group members are encouraged to use the peer support skills we are learning to support the moderator or to respectfully share needs or concerns that seem important to them. 

But wait!  There's more!

A Discomfort Agreement is not just something we make together as a group.  It is also an agreement we make with ourselves.  Intentional Peer Support is about embarking on a journey deep into the realm of human relationships.  This journey entails a commitment to learning and growth - not just for others, but also for ourselves.  From the very outset, therefore, each of us is encouraged to ask ourselves:

1. What my 'defaults' when the going gets rough in my relationships with others?
2. What do I tend to do when I feel scared, uncertain or overwhelmed?
3. How does this usually work out for me?
4. What usually happens in the relationship?
5. What would I like to do differently in the future..?

If I carefully consider these questions, I may well come away with a specific, personal learning and practice objective for myself for the group.

But wait! There's even more!

Another thing the Discomfort Agreement does is to give us an opportunity to explore and deepen the relational potential of our peer support practice.  A foundational tenet of IPS is that peer relationships have the potential to make outcomes possible that few of us could accomplish alone.  Accordingly, the Discomfort Agreement invites us to consider how others might support us to achieve the learning and practice objectives we set for ourselves.  For example, can they help us to:

1. Stay with the learning/ practice process, remaining both true to our experience and respectful of others, when we feel uncomfortable. 
2. Keep our commitment to ourselves to try to do something different if/ when we fall back into old patterns.
3. Step up when find something hard or feel like running away.  
4. Step back when we want to dominate or think we have all the answers.

If I carefully consider these issues, I may well come away with some specific requests I make can to other group members that will help them - and me - to notice when I'm stuck in old patterns and navigate them differently.

Hope to see you there!   😉😏

Talking Openly About Suicide: FREE ONLINE Sat. 8/11/18

IPS Practice Series

Intentional Peer Support Practice Series  

Weekly on Saturdays 5-6:30 EDT 

• Join by computer: https://zoom.us/j/119362879

• Join by phone: +1 669 900 6833 or +1 646 558 8656 (Meeting ID: 119 362 879)

• International callers: https://zoom.us/u/jkwt3wHh

Study Guide for Talking Openly About Suicide

(Saturday 8/11/2018 from 5-6:30 EDT)

Note on the study guide: 

The following study guide has been personalized and adapted with permission from Intentional Peer Support: An Alternative Approach by Shery Mead.  To purchase the full manual (book, kindle, audiobook), see http://www.intentionalpeersupport.org/store/.  To learn more about Intentional Peer Support and available trainings, see http://www.intentionalpeersupport.org/

The kind of peer support we are learning about in this series assumes that all of us - helpers, helpees, family, friends, community members, professionals as well as those of us with identified social concerns like suicide - have things to share and things to learn.  It assumes that risk is a part of living and that we all take risks as well as create them -- both for ourselves and for others.  It assumes we all have power -- as well as a mixed record when it comes to the choice of taking power for ourselves, giving it up to someone else, or negotiating and sharing it with others.

Consequently, one of the most important things we can learn to do with each other is put our cards on the table and talk honestly about our needs and concerns.  A huge challenge for me in doing this is  when I think your needs, views or reality conflicts with mine.  This creates (in my mind) a zero sum game where one of us is going to win and get our needs met and the other is going to lose and go wanting.  (Stressssssfulllllllll!!!!)

So what to do....?

Enter See-Feel-Need.

See-Feel-Need

See-feel-need is a variation on nonviolent communication that's been adapted to the mental health context.  The reason for the adaptation is that, in mental health situations, it's fairly common that we're both not in the same reality.  Often, I'm seeing, hearing, believing, feeling or sensing something that you don't.

For example, with regard to suicide I might experience impending doom, see myself as totally worthless, believe that others have decided to intentionally target and torture me, know that my life is over and that nothing I do will ever make a difference.  You might see me as a bright, capable 30 something who hit a streak of bad luck and is taking the ordinary hard knocks of life a bit too personally.  If your experience around this is anything like mine, we can argue about our different viewpoints forever,  get nowhere and end up with both of us in more pain than we started despite our best efforts and deep longing for connection.

See-feel-need is a way for me to voice my own reality without defining yours or taking away your power.  The process is fairly straightforward:

Say what I see 

This is simply owning up to the thoughts going on in my head about a situation.  It includes my beliefs about what is happening between us.  It also includes anything concrete that I've observed (read, seen, heard, felt, touched, smelled, tasted, etc.) that I'm focusing on to support my thinking.

My beliefs and observations may ring true for you too, or they may not.  The point is that they are real for me, and they impact how I'm experiencing our relationship.  So I own them as my thoughts.

Then I take the risk of saying something like this:

I'm having a really hard time with they way I'm experiencing the energy between you and me.  The story I'm telling myself is that you think I'm going to kill myself so you're watching me like a hawk.

😕😟

Say what I feel

Here is where I own up to the effect that my way of seeing is having on me.

I'm finding myself shutting down and hiding from you.  I'm also spending all kinds of time in my head telling you off and arguing with you about why I think you should act differently.  This isn't how I want to be.  It's bothering me a lot.

😐😐

Say what I need

Here is where I say what I'd like to be different.

 I'd like to get out of my head.  I'd like to see you as an ally and on my side.  I'd like to be able to believe that you trust and respect me.  Or at least I'd like to figure out how we can relate in a way that feels more equal.   

Does any of this make any sense to you? Do you have some time to talk about it?  Would you be willing to tell me how you see things? Do you see it the same as I do or differently...?

😏😏

IMPORTANT NOTE 

Did you notice that I left you and your reality out of what I said to you?

• I stuck with my own reality and my own needs.   
• I said only what I was seeing, feeling and needing.  
• I owned my beliefs as my own and didn't assume that you believe the same things I do.
• I didn't assume that my observations, feelings or needs hold true for you too. 
• I didn't assert that my observations, feelings, beliefs or needs mean that you are doing something wrong or that there is anything you have to change.  
• I simply shared with you:
• what I was observing and experiencing as a result of us being together;
• the conclusions I was drawing as a result of what I was experiencing; and
• how this was leading me to want to respond to you as a human being.
• Then I asked you about you:
• if what I was saying made sense to you; 
• what you were experiencing;
• how what you were experiencing was similar or different from what I was experiencing.

These are the kinds of conversations that allow both people to take risks and grow. These are the kinds of conversations that can lead to fundamentally different ways of thinking about help.

Practice Exercise

Practice having a see-feel-need conversation.  Two people can role play a conversation or everyone can take turns jumping in with new lines.  Notice the responses that make you feel more or less safe. Discuss this as a group at the end.     

Building the airplane while you're flying it

Ideally, we would know each other and have some time under our belt before either of us ends up in crisis.  That allows us to iron out at least some of these practices in advance.  That's usually a good thing because it can be a heck of a lot easier to practice your first see-feel-need conversation over the groceries instead of in dire matters of life and death.  But sometimes that's a luxury that just isn't afforded us.  Or suddenly, we find ourselves in the thick of it anyway.  During these times we’ll need to negotiate on the fly.  A couple of the skills here include:

• Talking honestly: What does it feel like for each of us? Are we scared, frustrated, confused, angry, etc? 
• Self-reflection:  Where is my reaction coming from?  Life and death danger? Break with routine protocol? Difference of opinion?  Unfamiliar territory?  Added workload? Not my preferred was of operating?  Past experiences?  Gut feeling...? 
• Relational WRAP:  Helpful hint.  Create a relational ‘crisis’ plan ahead of time.  This is essentially something along the lines of a Wellness Recovery Action Plan that two or more of us can create together for our relationship.  Once we have one, we can refer back to it in difficult times and just follow what we agreed to until we are out of hot water and have some space to think things through.

Debriefing After the Fact

After we’ve come through a difficult situation and we’re on the other side, practicing open honest communication is still important. We both probably have some feelings about what happened.  We maybe even created a little mistrust and now need to re-establish what’s going to work for both of us.

Some suggestions for doing this when either of us has been struggling with wanting to die include:

• Talk about how it felt for both of us and what’s happened with our feelings since.
• Figure out what’s going to help both of us regain trust.
• Examine our own reactivity to these kinds of situations, and then mutually negotiate a new response.
• Each of us own our own hot buttons (triggers, sore spots, pet peeves) and plan for how we’ll deal with them differently next time.
• Explore (re-explore) what risk and safety mean to each of us and how we will share responsibility for addressing these needs in ways that work for all concerned.
• Revisit / create a relational WRAP…

Summing up

1. Have you noticed some ways that this kind of peer support different from other kinds of ‘help’ you might be familiar with?
2. What differences do you see?   

PAST TOPICS

Sat. 6/30/18:  Suicide and 'Safety'

• Is 'safety' about legalities or relationships?  
• Do risk assessments and safety contracts make us less likely to attempt suicide - or can they actually backfire and increase the risk...?
• What can we do instead...?

Sat. 7/7/18:  Supporting others who want to die

• How do our own needs affect how we support others?
• What assumptions might we make about supporting others based on our own needs or experience?
• What are the gifts and limitations of such assumptions?

Sat. 7/14/18:  Practicing relational safety

• What makes a relationship feel safe (trusting/ trustworthy) to me?
• What kinds of things seem to come up that can get in the way of for me (stuck points, patterns, bad luck streak, etc.)?
• How have I tried to cope or manage that?
• What (if anything) would I like to hold myself accountable try differently for next time?
• What (if anything) have I been able to do to make a relationship better rather than worse when things started taking a turn for the worse...?

Sat. 7/21/18:  Suicide and Power

1. What is the relationship between suicide and power?
2. How, if at all, does power (having it, not having it, losing it, feeling used, abused, put down or ignored by others who have it) affect my feelings about living or my will to live?  
3. How is power different depending on whether I am a 'helper' or a 'helpee'?
4. Is power different when I 'feel suicidal' compared to when I don't?
5. What implications might that have for our relationship if one of us starts talking about wanting to die...?

Sat. 7/28/18:  Suicide and Responsible Relationships

1. Think about mainstream mental health relationships (therapy, psychiatry, case management, formal or informal caregivers): 
• Who defines 'risk'/ 'safety'? 
• Who or what is considered 'risky'/ 'safe'? 
• Who decides what risks are acceptable?  Required?  For whom?  
2. What happens in a relationship when you feel like someone is always assessing your safety?
3. What assumptions do you make about who holds the power or control?

What It's Like to Be a Mother Watching Your Son Destroyed by Psychiatry

Editor's note:  Thanks everyone. Those concerned are now conscious, aware and free to speak for themselves. They've asked for some privacy, which has included modifying this post in significant ways.  There may be more changes in the future as concerns are further clarified and expressed.  This is how advocacy should work.  In the mean time, this is what unfolded near the end of July 2018: 


This is an all hands on deck call for advocacy. The trauma is unfolding as we speak. I received the following texts over the past 24 hours from the mother of the young man pictured on the left. This is reprinted with permission. The circumstances are dire. They are desperate for any advocacy expertise or assistance you might offer.

UPDATE: Important strategy change:  Please do not call the hospital.  The healthcare providers are now responding and being helpful.  The mother has requested that advocates contact her directly with suggestions to minimize the possibility of retribution or wagon circling responses by healthcare providers. Those offering ideas or support can friend Martha at https://www.facebook.com/martha.marti.7 or call her at 813-468-9022.

Dino and Martha's Story

Friday 4:50 pm

Sorry. I think I hung up on you yesterday. I was driving and trying to figure out where I was going. Trying to find where they had taken my son. It’s not good. They ran out of his Clozapine and he is gone. I don’t know where he is. A person cannot just abruptly stop Clozapine. He was Baker Acted yesterday. He was violent, like a trapped animal, and scared. He can’t even talk. Has lost his memory. I’m exhausted. Just got home from hospital and need rest.

Why so much suffering? The residential treatment facility was supposed to be monitoring and dispensing his Clozapine. They messed up but now he is suffering. He’s been on medical observation but now being transferred to psych. I’m sorry. I’ve had no time to callback. Another trauma for him. It’s draining for me. I’m sorry. God help him. He’s suffering.

Saturday 1:25 pm

I’ve been lied to by the facility that was supposed to be managing, monitoring and dispensing his meds. Three people told my husband and I the same story and blamed my son for them running out of medication. When I found holes in their story, I asked questions. So, yesterday, a different story was told to me.

But my son is suffering severe severe rebound psychosis and more. Extreme paranoia! Now he’s almost in a catatonic state I was told. Last night he was trying to choke himself by producing saliva and choking himself with it. He was spitting on people and was violent. This morning he was staring up at the ceiling with his jaw open.

Thursday night at ER they gave him an injection of Geodon and Ativan. Friday, while on medical observation because his blood work is all messed up. He started punching the window so they gave him haldol injection. Now he is in psych ward. And they have destroyed him again.

Saturday 6:15 pm

Just saw him for a few minutes
It is a complete NIGHTMARE!
He’s dying
They MADE us leave
They called to have an ICU nurse evaluate him and MADE us leave
He cannot swallow. He’s struggling to breath. He’s aspirating his saliva and liquids that they were trying to give him.
He’s trying so hard to breathe
I hear all the liquids rattling around in his throat
He cannot swallow and is choking. He cannot breathe
His eye started bleeding. The same eye started turning black and blue around his eye
Wish I had had my phone and could have taken a picture!
This is pure EVIL

Maybe the liquid was rattling in his lungs! Rattling. Every time he tried to breathe. Struggling for air.

White foam coming out of his mouth and filling his mouth.

They moved him to medical. I know nothing else. I think ICU

Saturday 6:51 pm

On a bi-pap machine. Heavily sedated. Critical care doctor is still assessing him.

Saturday 10:14 pm

Can you talk?

A nurse friend of mine just said that she’s sure he was having a seizure

And they were going to just leave him in isolation in the psych ward! The nurse was talking to us, saying he’s in isolation and we can’t see him. Then she said, “do you hear him screaming?” I said”no I only hear someone groaning “. She said that was him. I begged to see him. They finally put him in a private room for us to see him. I insisted on medical care. I could tell he was having a medical crisis and I’m not the professional!! The nurse even admitted that she wasn’t sure what was wrong with my son!

I guess they thought he was just having psychiatric issues. Can’t they tell if he’s having medical issues? I don’t get it. Why leave him in isolation like that? This is so scary that no one seems to care. I’m not a professional and I could tell he was having a medical crisis!

I heard him groaning in isolation and begged to see him. They did nothing for him until I expressed my concerns.

When I saw him he was trying to speak, moving his mouth, but only sounds like groaning came out and not words. His eyes were all the way up looking at ceiling.
And white foam pouring out of his mouth

His entire body beet red. Veins popping out of his neck. He grabbed my hand and tried so hard to tell me something but he couldn’t speak.

I’m so upset!

We’re on our way to the hospital because they refuse to give us information.
They said we can’t come. But I’m his proxy. They need to tell me everything. They didn’t even know he was having a seizure?

He is at St. Anthony’s Hospital in St. Petersburg, FL.

Begging for help

Yesterday, Martha posted this plea in MAD in America:

Please help—the residential treatment facility abruptly stopped my son’s Clozapine 500mg daily medication because they forgot to get his bloodwork for the pharmacy. They forced him to stop abruptly and did not receive them for many days. They manage his medication and he has been very stable on Clozapine. He went into full blown rebound psychosis with forced hospitalization. Thursday night in ER they gave him an injection of Geodon and Ativan. Friday he was on medical observation since his blood numbers were all messed up. But he punched a window trying to get out so they gave him an injection of haldol and Ativan. Later they moved him to the psychiatric floor. A nurse called me today to make me his proxy. She said his eyes were rolled back in his head and his mouth was wide open. She said - maybe Catatonia or allergic reaction so they gave him an injection of Benadryl. When we arrived for visitation a nurse came to us and said our son was in isolation and we couldn’t see him. She said, “do you hear someone screaming?” I said, “no, but I hear someone groaning “. She said that was our son. I begged to see him for just a minute. They put him in a private room for us to briefly see him. The nurse even admitted that she wasn’t sure what was wrong with him. When we saw him his eyes were rolled back in his head. White foam was coming out of his mouth. He was choking on this liquid foam. He grabbed my hand and tried to say something. He moved his mouth but only groans came out. He was stiff and beet red. Veins popping out of his neck. Profusely sweating. I said, “he needs medical attention.” So they called an ICU nurse to come assess him. They made us leave. He is now in ICU with a bi-pap machine breathing for him and he is heavily sedated. They will tell me nothing else. This is so wrong that he was forced to cold turkey his Clozapine and now is suffering horribly. And the psychiatric ward was just going to keep him in isolation and let him die if I had never insisted I see him? So wrong. My son needs representation. Advocating. Help. Anyone. The front desk at the hospital said we cannot come now but I’m coming because no one will give me information over the phone. This is injustice. Please. How can I get justice for my son. He’s suffering horribly. Help please. If you can.

The 'Good Ole Days'

June 10th 8:08 pm

I was visiting my son because he is court ordered to a residential treatment facility and court ordered drugged.  Just now driving home with my husband.  My heart hurts every time I leave him.  I will try to get it together myself to call tomorrow.  I am drained.  Will probably go to sleep after we get home.  Have about an hour’s drive.  Just now left the residential treatment facility. 

Dino's Song

May 30th 10:27 pm

My son’s song.  Stormy Paradise.  He says a stormy paradise is what he sees in the refrain.  It may not make a lot of sense to you, but this was s big step for him.   He's been through a lot.

"My first song"  

Suicide and 'Safety': This week in Intentional Peer Support

FREE ONLINE -- Beginners Welcome!

• Join by computer: https://zoom.us/j/119362879

• Join by phone: +1 669 900 6833 or +1 646 558 8656 (Meeting ID: 119 362 879)

• International callers: https://zoom.us/u/jkwt3wHh

Intentional Peer Support Practice Series

Weekly on Saturdays 5-6:30 EDT 

• Join by computer: https://zoom.us/j/119362879

• Join by phone: +1 669 900 6833 or +1 646 558 8656 (Meeting ID: 119 362 879)
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Full Study Guide

The following study guide has been personalized and adapted with permission from Intentional Peer Support: An Alternative Approach by Shery Mead.  To purchase the full manual (book, kindle, audiobook), see http://www.intentionalpeersupport.org/store/.  To learn more about Intentional Peer Support and available trainings see http://www.intentionalpeersupport.org/

A Deeper Look at 'Safety'

When I was a patient in the mental health system, I heard the language of safety a lot! Was I safe, was I going to be safe, would I contract for safety, etc. etc...?  Through these questions, safety came to mean that I was simply agreeing not to do anything to hurt myself or someone else.

But what did that leave me with?

Reflection questions

• What has it meant to you when others have asked if you’re 'safe'? 
• When you’ve asked others if they’re safe?

Frankly, the more safety questions I got, the less I felt reliant on my own abilities to take care of myself. So instead of feeling safe in the world, I felt like a time bomb that could go off at any time.

It also left my clinical relationships with a huge power discrepancy:  If I told the truth -- "I feel like hurting myself" -- the practitioner would feel obliged to take precautions.  Perhaps they were legitimately concerned I would follow through.  Or, maybe they acted more from a need to protect their job, their license or their organization.  Either way, once the magic words got spoken, they mostly had the power and I mostly didn't.

Option two was to lie.  If I denied my true experience, I could keep my power.  But denying my reality - and keeping secrets in important relationships - also have their costs.

This was abundantly true for me.  I felt miserably alone at the most vulnerable times of my life.  I came away feeling like there was no one on the planet who I could really trust.  I was out of my league and I knew it. I desperately wanted human support and counsel.  I desperately wanted to get to the root of my true feelings and to be able to uncover any options I had.  Yet, here I was trying to make a good decision - perhaps the most important decision of my life - without knowing a single soul I could trust to be truly honest with.

In retrospect, I don't think there is much that is LESS SAFE for me as a human being in that frame of mind.  In fact, I can only think of one thing that's less safe from my perspective: 

EVEN MORE UNSAFE = to feel coerced or pressured by others who don't understand my unbearable suffering into making a bad decision makes it even worse.  

Unfortunately, that was often where I found myself in times like these, given the mainstream practice of reporting, detaining and drugging those of us who acknowledge the depth of our distress and despair.   

Re-Thinking Safety

The painful contradictions noted above have led to a lot of reflecting on what safety actually means to me.  Here are two bottom lines I've come to:

1. Real safety doesn’t mean talking to someone with a reporting obligation.
2. Real safety doesn't mean making a safety contracts or promises to stay out of harms way.

Reflection questions

• What does real safety mean to you?
• What makes you feel safe (or safer)? 

Real safety - for me - is about creating culturally respectful, mutually responsible, trusting, trustworthy relationships. It happens in relationships where we don’t judge or make assumptions about each other.  It happens when someone trusts and believes in me even when they’re uncomfortable.  It happens when I'm free to share my deepest truth and you take time to reflect on what I've said. You make the effort and sincerely try to get to the heart and soul of what I'm attempting to get across to you.

When you make that kind of effort and actually 'get' me, everything starts to change.  You've proven to me that you can put your needs aside long enough to hear me out when it really matters.  So I begin to feel ok about letting you into my world and loosening my grip on the urgency of now.

You've also proven to me that you understand the territory.  You've treated me like I have value and like my experiences do too.  So I begin to get interested in what you think and might possibly know.  I get curious about what I might find out if I stick with you.  I feel bouyed up enough to risk the uncertain and the unknown.  After all, you're a pleasant companion and the spent time with you feels bearable. That alone gives me hope that there might be something on the other side to make the journey worth hanging in for.

This buys us time.  The time we need to take risks, learn from them, explore new possibilities, and learn some more.  All the while behind the scenes, subtly, incrementally, without me knowing it, a revolutionary change in my assumptions is taking place.  The way I think about how this world and how it all operates (me, others, the planet) will never be the same.

Reflection questions

• What happens when you are with someone you trust and feel safe with? 
• How does actually feeling safe change things?  (Can you do things when you feel safe that you can't do when you don't?)
• How does being with someone you feel safe with change things? (Have you ever noticed yourself being able to do something with a person you trust that you couldn't do without them...?)

This is what we call building relational safety.  As you can see, it is very different from the liability management practices that are oriented toward legal safety.   It requires both of us to take risks and be vulnerable, instead of just one of us unilaterally protecting our interests. This is what we call shared risk.

How safe the relationship is for both of us depends on...  both of us.  It only works if both of us are willing to learn to share our power and take responsibility to do our part.  This is what we call mutual responsibility.

Relational safety, shared risk and mutual responsibility are foundation principles in creating relationships that work for both people.  You will learn a lot about them - and practice them a lot - in this kind of peer support.

Reflection questions

• What happens to 'safety' for you if... 
• I am continually assessing you for 'risk'...?
• I can unilaterally decide to 'keep you safe'...?
• I expect you to do all the risking...?
• I am the authority on what risks you can take...?

Practicing Relational Safety

It's time to put the rubber to the road and practice creating this new kind of safety in our relationships with each other.  Here are some strategies to get us started:

1. Initiate proactive conversations

Whenever possible, it's best to practice these principles proactively (by thinking ahead) rather than reactively (oops...). The idea of proactive conversations is to get our concerns on the table early on, before either of us is in discomfort or crisis.  That gives us the space to look at ourselves from a comfortable distance.  Then we can reflect honestly together about:

1. The kinds of stuff that often comes up for us (in relationships or in our lives); and 
2. What we'd like to do differently this time.  

For example, if wanting to die is a common issue for either of us, we can talk about it ahead of time.

• We can explore what will help the relationship feel safe for both of us if those kinds of feelings come up again.  
• We can both acknowledge (honestly, out loud) the extent of our “bottom lines.”  
• We talk about how we each are likely to react when we feel untrusting or disconnected. 
• We can figure out together what we will do, should we get to that edge. 

By proactively exploring potentially sensitive issues like these, we pave the way for negotiating our relationship when future challenges arise.

2. Talk (and talk and talk) about power

Power and safety are totally intertwined.  I, for one, feel safe and optimistic when I have power.  I also feel vulnerable (and worried, angry, confused, sad or overwhelmed) when I don't.  I suspect it works that way for lots of us, though I don't hear this talked about very much.

Being aware of the impact of power is critical for this kind of peer support.  Relationships are a virtual land mine of power dynamics.  There's a zillion ways to feel more or less powerful than someone else.  Taking risks, sharing responsibility, being vulnerable, creating safety - these things are all about power.

As you can see, the fact of power is inescapable in peer support.  But power itself is not a problem.  What matters is how we choose to use it.

Reflection Questions

• Do I use the power I have to build respect, equality and participation in relationships?
• When am I tempted to use power to advance my own self-interest?
• What does that do to my relationships?

Can you begin to see how our use of power affects the quality of our relationships...?  That's why, in this kind of peer support, we talk about power a lot:  What it’s like to have it, use it, lose it, abuse it and try to share or balance it.

We tend to talk about power imbalances again and again because, well... we're human.  So these issues come up again and again.

3. Practicing mutual responsibility

Most of us who have seriously considered giving up on life have experienced the kinds of assessments, safety contracts, and evaluations that I talked about above.  This affects our 'mental health relationships' and how many of us learn to think about them.  

Reflection questions

• Think about mainstream mental health relationships (therapy, psychiatry, case management): 
• Who defines 'risk'/ 'safety'? 
• Who or what is considered 'risky'/ 'safe'? 
• Who decides what risks are acceptable?  Required?  For whom?  
• What happens in a relationship when you feel like someone is always assessing your safety?
• What assumptions do you make about who holds the power or control?

As a mental health client, it went unsaid that the clinical professionals were the one's who defined the realm of risk.  They told me the risks I was supposed to take - e.g., share honestly even if I don't trust them; do what they tell me to even when it doesn't make sense to me.  They also were the ones to decide whether my thoughts or actions were 'risky', how 'risky' they were, and when additional management (treatment) or surveillance (prevention) was required.

As noted above, the peer support we are learning here makes very different assumptions.  It assumes both us of have things to share and things to learn.  It assumes that risk is a part of living and that we will both take risks and create them.  It assumes we both have power -- as well as a mixed record when it comes to the choice of taking it for ourselves, giving it up to someone else, or negotiating and sharing it with others.

Consequently, the most important thing we learn to do with each other is put our cards on the table and talk honestly about our needs and concerns.  Some suggestions for doing when either of us struggles with wanting to die include:

• Talking about our own reactivity to these kinds of situations, and then mutually negotiating a new response.
• Building a relational ‘crisis’ plan (e.g., a WRAP plan that we create together for our relationship).
• Talk about hot buttons for both of us and how we’ll deal with them.

4. Reflective Feedback

A huge challenge for me in building relational safety is when I think your needs, views or reality conflicts with mine.  Reflective feedback is a way for me to voice my own reality without defining yours or taking away your power.  The process is fairly straightforward:

Say what I see 

This is just simply owning up to the thoughts going on in my head about a situation.  They may be true for you too, or they may not be.  The point is that they are real for me, so I own them as my thoughts.  Then I take the risk of saying something like this:

I'm having a really hard time with they way I'm experiencing the energy between you and me.  The story I'm telling myself is that you think I'm going to kill myself so you're watching me like a hawk.

😕😟

Say what I feel

Here is where I own up to the effect that my way of seeing is having on me.

I'm finding myself shutting down and hiding from you.  I'm also spending all kinds of time in my head telling you off and arguing with you about why I think you should act differently.  This isn't how I want to be.  It's bothering me a lot.

😐😐

Say what I need

Here is where I say what I'd like to be different.

 I'd like to get out of my head.  I'd like to see you as an ally and on my side.  I'd like to be able to believe that you trust and respect me.  Or at least I'd like to figure out how we can relate in a way that feels more equal.   

Do you have some time to talk about it?  Would you be willing to tell me how you see things? Do you see it the same as I do or differently...?

😏😏

These are the kinds of conversations that allow both people to take risks and grow. These are the kinds of conversations that can lead to fundamentally different ways of thinking about help.

Practice Exercise

Practice having a relational safety conversation.  Two people can role play a conversation or everyone can take turns jumping in with new lines.  Notice the responses that make you feel more or less safe. Discuss this as a group at the end.     

Relational safety in real time

Sometimes, we don’t have these conversations in advance.  Or suddenly, we find ourselves in the thick of it anyway.  During these times we’ll need to negotiate on the fly.  A couple of the skills here include:

• Talking honestly: What does it feel like for each of us? Are we scared, frustrated, confused, angry, etc? 
• Self-reflection:  Where is my reaction coming from?  Life and death danger? Break with routine protocol? Difference of opinion?  Unfamiliar territory?  Added workload? Not my preferred was of operating?  Past experiences?  Gut feeling...? 
• Go back to the relational WRAP and follow what was agreed to.

Debriefing After the Fact

After we’ve come through a difficult situation and we’re on the other side, redefining safety is still important. We both probably have some feelings about what happened.  We maybe even created a little mistrust and now need to re-establish what’s going to work for both of us.

Some useful skills here might be:

• Re-define together what safety and shared-responsibility means for us.
• Talk about how it felt for both of us and what’s happened with our feelings since.
• Figure out what’s going to help both of us regain trust.
• Revisit / create a relational WRAP…

Summing up

1. Have you noticed some ways that this kind of peer support different from other kinds of ‘help’ you might be familiar with?
2. What differences do you see?   

PAST TOPIC

Sat. 6/30/18:  Suicide and 'Safety'

• Is 'safety' about legalities or relationships?  
• Do risk assessments and safety contracts make us less likely to attempt suicide - or can they actually backfire and increase the risk...?
• What can we do instead...?

Sat. 7/7/18:  Supporting others who want to die

• How do our own needs affect how we support others?
• What assumptions might we make about supporting others based on our own needs or experience?
• What are the gifts and limitations of such assumptions?

Sat. 7/14/18:  Practicing relational safety

• What makes a relationship feel safe (trusting/ trustworthy) to me?
• What kinds of things seem to come up that can get in the way of for me (stuck points, patterns, bad luck streak, etc.)?
• How have I tried to cope or manage that?
• What (if anything) would I like to hold myself accountable try differently for next time?
• What (if anything) have I been able to do to make a relationship better rather than worse when things started taking a turn for the worse...?

Sat. 7/21/18:  Suicide and Power

1. What is the relationship between suicide and power?
2. How, if at all, does power (having it, not having it, losing it, feeling used, abused, put down or ignored by others who have it) affect my feelings about living or my will to live?  
3. How is power different depending on whether I am a 'helper' or a 'helpee'?
4. Is power different when I 'feel suicidal' compared to when I don't?
5. What implications might that have for our relationship if one of us starts talking about wanting to die...?

Sat. 7/28/18:  Suicide and Responsible Relationships

Most of us who have seriously considered giving up on life have experienced a variety of assessments, safety contracts, plans, checks and evaluations intended to 'help' us act 'responsibly.'  This affects our relationships with important others in our lives.  That includes professional helpers, as well as friends, family and community members who would sincerely like to be helpful.  It also affects how many of us - both helpers and helpees - have come to understand what 'help' means when human needs feel high and options low.  

Reflection questions

• Think about mainstream mental health relationships (therapy, psychiatry, case management, formal or informal caregivers): 
• Who defines 'risk'/ 'safety'? 
• Who or what is considered 'risky'/ 'safe'? 
• Who decides what risks are acceptable?  Required?  For whom?  
• What happens in a relationship when you feel like someone is always assessing your safety?
• What assumptions do you make about who holds the power or control?

As a mental health client, it went unsaid that the clinical professionals and 'responsible caregivers' were the one's who defined the realm of risk.  They told me the risks I was supposed to take - e.g., share honestly even if I don't trust them and follow their advice or instructions even when this doesn't make sense to me or fit with the needs, values or dreams I experience for myself.  They also were the ones to decide whether my thoughts or actions were 'risky', how 'risky' they were, and when additional management (treatment) or surveillance (prevention) was required.

The peer support we are learning about here, however, makes very different assumptions.  It assumes both us of have things to share and things to learn.  It assumes that risk is a part of living and that we will both take risks and create them.  It assumes we both have power -- as well as a mixed record when it comes to the choice of taking it for ourselves, giving it up to someone else, or negotiating and sharing it with others.

Consequently, one of the most important things we can learn to do with each other is put our cards on the table and talk honestly about our needs and concerns.  Some suggestions for doing this when either of us struggles with wanting to die include:

• Talking about our own reactivity to these kinds of situations, and then mutually negotiating a new response.
• Building a relational ‘crisis’ plan (e.g., a WRAP plan that we create together for our relationship).
• Talk about hot buttons for both of us and how we’ll deal with them.