Motivational Interviewing in peer support: Handle with care!

4-minute read

Over the past few weeks, I’ve had a handful of conversations about the training that is offered to Peer Supporters. These discussions have been with peers, their managers, and Directors of Services. Interestingly, the approach of Motivational Interviewing (MI) seems to keep coming up. MI has its benefits and can be a valuable tool in certain therapeutic settings. But, when it comes to peer support, we need to tread carefully and be aware that using it can inadvertently lead to coercive practices in the world of peer support.

Here’s why:

It’s all about the training

Motivational Interviewing requires some serious training and practice to get it right. Although there are simple techniques that can be learned quickly, it takes time and practice to master Motivational Interviewing, so that it can be used most effectively. Many therapists go through intense training in MI techniques, whereas Peer Supporters (and many other support professionals) don’t come with the same level of expertise. Without the proper know-how, there's a risk of misusing MI, and so miss the mark on its intended impact, or worse still potentially causing unintended harm.

When sharing changes into guiding and telling

Peer support is all about shared experiences and building connections. But here's the thing, MI often emphasises guiding and directing people towards change. That clashes with the core principles of peer support, such as empowerment and respecting personal autonomy. We want to avoid becoming motivational dictators and instead focus on empowering people to make their own choices and not undermine people’s autonomy. Peer support should never, under any circumstances, become a platform for coercive practices. It erodes trust, damages relationships, and can cause harm to the very people we aim to support.

The emotional connection

Peer support has often been described like a big emotional support hug. It's about creating a safe space where folks can freely express themselves without judgment. MI is great for encouraging behaviour change, though it might not always prioritise the emotional well-being and validation that people seek in peer support. There needs to be a balance struck between using MI techniques and the emotional support aspect. We need to remember to hold space for those feelings!

Mind the goals

Peer support is a wonderful blend of empathy, understanding, and trust-building. On the flip side, MI primarily aims to tackle ambivalence towards behaviour change. Sometimes, these goals might not align perfectly. Peer Supporters, need to be mindful of this potential mismatch and adapt approaches accordingly. The main focus should always be on meeting the unique needs and preferences of those people who peers walk beside.

Proceed with caution

So, let's proceed with caution. Whilst Peer Support training is lengthier than MI training (an often-cited reason for organisations to adopt the training), it actually provides the skills needed to be a Peer Supporter. It embeds the core principles that makes peer support different to other roles, ones of empowerment, hope, autonomy, and mutuality.

While MI can be helpful, if it’s to be offered to Peer Supporters, it should be done in a tailored way. Ensure that it aligns with the peer model and doesn’t remove the unique qualities that make peer working impactful. Peer Supporters are effective precisely because they act differently to other types of providers. They disclose personal details to inspire trust, dispel stigma, and instil hope. But Peer Supporters rarely self-disclose in a manner that is consistent with MI.

The problem that exists is that there aren’t any guidelines yet on how and when to use MI as a Peer Supporter. For those Peer Supporters already using MI, they should be thoughtful and cautious when using it. Skills of MI training erode quickly without ongoing training for anyone using the approach. Particularly because Peer Supporters rarely receive supervision in MI, organisations should ensure regular training specifically modified to ensure that peers continue to use MI techniques appropriately and continue to preserve the essential ingredients of peer support.

If MI is to be used by Peer Supporters, they will need to know how and when to use MI. However, no guidelines are currently available.

Next time you think about providing MI training to Peer Supporters as a professional development opportunity, or more worryingly as a replacement for peer training altogether, perhaps revaluate, ensuring you weigh up the decision carefully. It's not that you shouldn't use Motivational Interviewing in Peer Support training, but rather that its use should be approached cautiously. Its use needs to be with full awareness of its potential impact on the principles and goals of peer support. If MI is introduced, it should be done with proper training, a deep understanding of the values of peer support, and a commitment to maintaining the integrity of the peer support relationship.

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