What Happens Between Sessions: The Value of Peer Support in Counselling

For decades, therapists have worked alone with their clients, with the occasional input provided by a watchful clinical supervisor. While peer support has existed informally for years, it is only in recent years that peer work has become formally recognised in mental health settings through government endorsement, inclusion in national frameworks, and the integration of peer worker roles within services. This introduction of peer support has begun to reshape the landscape and now offers the client with an extra point of support. While this may not seem like much to some, those who regularly work with peer support workers know how much of a relief this may be to many clients.

Nowhere is this effect more visible than in the regional parts of this country. Loneliness looms large in rural areas and meeting a peer support worker may be the only person the client may have met the whole week outside the sessions. Services use peer support in different ways. Some may choose to have them strictly for client engagement and encouraging clients who might be hesitant or distrustful of services. Others may provide more autonomy and may involve them in supporting clients in the early stages of therapy, running peer led workshops or groups for psychoeducation, or supporting clients in navigating through complicated government systems etc.

One interesting pattern I have observed was the clients who were connected with a peer support worker were more likely to have higher attendance rates in sessions. Most therapy sessions occur fortnightly, with a peer support session arranged for the client in the week in between. This not only ensures that the client has an extra source of support during that period but also can serve as a reminder about the upcoming session next week, as well as any exercises assigned to them. In many instances, I have also noticed that a client uses polite yet more formal language with, yet will speak more warmly and informally with their peer support worker. This is, in part, due to the differences in our roles.

While we therapists usually have to see clients in our clinical rooms, peer workers are not bound by these constraints and are able to see clients at a variety of locations. Depending on the client’s preference, this may include their home, a park, a café, or a walk by the lake. This flexibility can shift the dynamic by reducing the formality of the interaction, fostering a greater sense of equality, and helping clients feel more comfortable and open in a familiar environment. Additionally, while therapists may be able to use self-disclosure sparingly during their sessions to build trust, a peer worker’s approach is often more personal and in fact, sometimes reliant on self-disclosure on their past lived experience in order to relate to the client’s situation.

However, their role in therapy is not limited to helping clients through complicated bureaucratic processes or relating to the clients with their lived experience. Peer workers actively contribute to the therapeutic outcome and in addition to helping attendance levels, can help the therapist actively implement some of their interventions. For instance, if the therapist may have designed a behavioural activation plan along with the client, a peer support worker can help the client feel the plan is doable in real life rather than abstract instructions. They might share their own lived experience of what strategies worked for them when they were struggling, maintain accountability in the weekly check-ins between sessions and celebrate small wins with the client.

Through discussions with colleagues and observations within mental health services, I have become aware of differing approaches to peer work, which led me to reflect on how it is positioned across service settings. In some clinical environments, particularly more traditional or medically oriented services, the peer worker role can be underestimated or viewed as secondary to clinical work. However, in my experience, their contribution to engagement and implementation of therapeutic work has been significant. Some of my fondest memories in therapy have been that of clients in their last session revealing that they were apprehensive to give therapy a try but how much more comfortable they felt knowing that they had a support person with them on that new and unknown journey.

Working alongside peer support workers has also prompted me to reflect on my own practice, particularly around how I build rapport with clients and translate therapeutic plans into everyday life. It has highlighted the limits of the therapy room and the value of the support that extends beyond it. In turn, peer workers have shared specific ways in which they have learned from working alongside therapists. For example, one peer worker reflected on becoming more comfortable with silence, noting that they had previously felt the need to “fill every gap”, but had come to see how pauses can allow clients space to process. Others have spoken about learning how to regulate themselves between sessions during particularly hectic days, as well as the importance of “leaving something in the tank” at the end of the day to avoid burnout.

Since peer workers often use self-disclosure from their lived experience more openly, collaborative work with therapists can also help refine when such a disclosure is helpful and when it may shift focus away from the client. Additionally, peer workers have commented on the level of restraint used by counsellors, particularly in resisting the urge to immediately offer solutions, and instead allowing the client’s perspective to guide the session. As therapists, we are trained to sit with the discomfort for some time and avoid rushing solutions, and this can be different from the more action-oriented approach of peer support. I have also observed the ways in which clinical frameworks and boundaries can offer additional support to the peer support practice. For example, in situations where a client’s needs become particularly complex, clear role boundaries and access to clinical supervision can support peer workers in deciding when to step back, seek guidance, or involve other members of the care team.