Trust takes time to build, especially with women who have experienced any form of trauma. Many projects in the Women Side by Side programme took a long time to establish trust, with 36% of organisations highlighting that it took time to build peer support groups. Building trust (between women, and between women and providers) and breaking down stigma around mental health takes time.
Peer support for women must be based on honest and authentic exchanges, which includes being realistic about what support you can and cannot provide. It is vital that you do not offer something that cannot be delivered, and that you take care to create boundaries to avoid overstretching yourself. This will help you to build up a relationship naturally.
There is also a need to be aware of differences: for example, some women of colour may only feel safe and able to trust if facilitators or peer leaders are from a similar background. There may also be hidden differences or disabilities which affect peer support, such as autism. Peer support groups need to adapt to the needs of their members.
The original Side by Side toolkit discusses in detail the importance of boundaries, containment, confidentiality and limits of confidentiality at the start of the group to establish those limits. Many Women Side by Side projects used these guidelines and spoke of how it helped women trust the space and manage their expectations.
How you can establish trust
Black, Asian and Minority Ethnic women often mistrust services and it will take time to build up trust. There is a stigma around mental health and clinical services that perpetuates mistrust in most BAME communities. This, combined with racism, discrimination and inequalities, plays a part in fuelling a sense of negativity around mental health services. It is important to highlight the difference between peer support and clinical services.
A strengths-based approach to peer support delivery, recognising that in a peer support space, different women have different skills and that work and care, can be shared across the group so that it’s a trusting, collaborative space. The following can also help:
- Freely available confidentiality information and a group agreement.
- Facilitators who are consistent and reliable.
- Putting boundaries in place and modelling good self-care.
- Ensuring that you always do as you say you will and don’t let people down: this is what many women expect from services, based on previous experience.
- Being clear about what you can and cannot do.
- Being mindful of structural inequalities and power dynamics.
- Being flexible, adapting your approach to individuals and their needs.
- Offering support on a one-to-one basis if required.
- Contacting people in advance if plans or circumstances change.
- Placing your group under an organisation that is already well-established, such as Mind. This can lend to your group additional legitimacy and accountability (unless people have had bad experiences with that organisation).
We can establish trust by creating connection. This energy exchange exercise is popular in women-only peer support groups and can help you and your members to feel connected to one another.
Preparation/equipment required: None
Space required: Small, indoors or outdoors
Group size: You will need a minimum of 3 people to do this exercise
Total time: Depends on how many people take part. Roughly 5 minutes to brief and set up; 5-10 minutes to do; 5-10 minutes to review and debrief.
Begin by asking participants to gather in a circle, standing if possible (but it can also be done seated if necessary) with approximately elbow width space from the persons on their left and right.
Everyone should start rubbing the palms of their hands together vigorously to generate heat. Do this for around 2 mins.
Then everyone places their right hand up and left hand down, with palms facing outwards.
Everyone holds their palms towards the people standing on their left and right, keeping their palms a few centimetres apart from one another’s. No physical touching is allowed.
Ask everyone to breathe into their belly, noticing the sensations moving between your palms as you stand together like this, neighbour to neighbour, person to person.
Ask participants to release after a few minutes.
Have a debrief and encourage feedback from participants about the experience.
As the Women Side by Side programme developed, it became clear that many mental health and community experiences were learning from the women’s groups about how to respond to trauma encountered by women and how to tailor their services to meet this need. Within many partnerships and groups, there has been a keen focus on understanding trauma and developing trauma-informed practice. This does not mean that traumas have to be announced or disclosed. It is about creating environments and ways of working with women that recognise the presence of trauma and the role that it might play in a woman’s life and relationships.
Understanding that the pervasive nature of trauma affects our attitudes, behaviour and choices. It means suspending judgements like “she’s aggressive/difficult/chaotic/complex” and acknowledging that some behaviours are rooted in trauma. By providing safe environments and operating in this awareness, we can avoid re-traumatising women. It enables us to build trust and create spaces for healing and recovery. Trauma-informed means giving women choices and knowledge and working with informed consent. It also means talking about what might happen and helping them to negotiate with their peers in the group to find a way to participate that works for them.
Sometimes trauma-informed practice is specific to one context or environment. For example, during the learning event in Bristol hosted by the women’s hub Against Violence and Abuse (AVA), we discussed how local research had shown that many women in Bristol did not feel safe in a room with yellow paint on the walls. This was because it triggered traumatic memories of being in the care system in the 1980s, when many children’s homes were painted yellow.
For some peer support groups, training in this area made a profound impact. Becoming more trauma-informed meant that they made huge changes in the rest of their organisation.
"Due to the impact the trauma-informed intervention has had on the women in such a short period of time, we have decided as an organisation to become trauma-informed. Our CEO and Services Manager are attending Becoming trauma-informed: A Training Course for Managers (CPD Accredited), and then training all our staff on trauma-informed practice."
Having this understanding also helped groups to improve the ways in which they addressed any challenging or difficult behaviour from members. They started to simply respond by saying, “I am here for you”.
Encouraging healthy relationships between peers
Everyone has their own story and their own emotional baggage when it comes to relationships. Research has shown we that tend to repeat the patterns that were established in our early childhood throughout our lives if we aren’t given an opportunity to change. Sometimes these patterns are healthy and sometimes they are not. In peer support, we encourage women to form supportive, mutually beneficial relationships with one another. Unfortunately, it is sometimes the case that members who have grown up in dysfunctional environments may bring those patterns into the group because it is all they know.
As facilitators, we can help women to become more aware of the way that they interact with others so that they can have a more fulfilling experience both in and outside the group. If we are not aware of how these patterns can play out in a group, we can create a space where people are bullied or enabled to behave in a way that harms themselves or others.
As facilitators, we are not immune to this ourselves and we need to make sure that we are modelling healthy interactions with others. We need to ensure that we are empowering rather than enabling or victimising others. All groups can benefit from talking through what positive relationships might look like and how individuals can play a role in facilitating that. There are some great diagrams that you can have on display in your peer support space or talk through in a relationship-themed session.
The drama triangle is a visual representation of what unhealthy relationships look like. There are also other models you can use. You may find that your group members initially fall into the role that they have been accustomed to in their life outside the group and that they can even inadvertently pull others into the triangle.
For example, if a person who feels themselves to be a victim when they are asked politely to help put some equipment away, they might regard the person doing the asking as being bossy, bullying, or mean. They might try to enlist other group members to validate their point of view or even have a word with the ‘persecutor’ on their behalf. Someone in the group who has based their identity on rescuing others might fall easily into this role. The result can be discord and division in the group.
If you can encourage women to spot these patterns and think more deeply about themselves and the role that they play in the group, you can see huge benefits. The Empowerment Dynamic is a helpful visual tool that can help you to explain what a more positive interaction might look like.
In the scenario described above, the outcome changes if everyone becomes more mindful of the roles that they play, using a new language and a new way of thinking. The Empowerment Dynamic “flips” the Victim into a Creator, the Persecutor into a Challenger, and the Rescuer into a Coach.
So, the polite request to help is constructive and the person asking is doing so to help someone else grow or learn. The person being asked to put the equipment away accepts that they are responsible for how they choose to respond and recognises that they are free to speak up with any concerns, ask questions, or suggest a different idea. The would-be rescuer becomes a coach who views others as being ultimately capable and resourceful.
The triangle offers fresh perspectives and options for responding differently, allowing us to create healthy relationship dynamics. When people change the roles that they play, they can create spaces where support and encouragement happen organically and people step out of harmful patterns into a more positive future.