Intentional Peer Support

1. Introduction

Version followed: IPS as currently taught by Intentional Peer Support (IPS Central): Core Training based on Shery Mead's curriculum Intentional Peer Support: An Alternative Approach (2014 edition), the IPS Core Competencies self-assessment tool (dated 1-4-17), Mead's IPS Co-Reflection Guide (2015 file; its pages are marked © Mead 2014, earlier editions 2005/2007/2008) and the IPS co-reflection format (2022). Task and principle names follow the current Core Training page; older and alternative wordings are noted in section 2. Sections 2, 3, 4.10, 4.16 and the training details rest on the Core and Advanced Training pages, the Co-Reflection Guide, IPS's co-reflection "Getting started" resource, a 2018 IPS workshop description (NARPA), two training announcements (2010, 2022) and the abstract of Mead, Hilton & Curtis (2001); the crisis, suicide and altered-state items (4.11, 4.13, 4.14, section 5) also draw on Mead & Hilton's 2002 article on peer support in crisis (Santé mentale au Québec). The 2014 Core Training workbook is sold only with the training and has no public copy, so its exercises are not covered [uncertain: workbook exercises; IPS's current training procedures for suicide conversations and conflict; facilitator requirements].

What it is. Intentional Peer Support (IPS) is a framework for peer relationships, not a therapy. It was founded by Shery Mead, who began a peer support programme in New Hampshire in 1995 and, by her account, saw peer work sliding into "doing what had been done to us" in services; she responded by defining practice, training and self-reflection, which became IPS [source: Pathways Vermont interview with Mead, 2024]. Mead directed three New Hampshire peer programmes, including what she describes as the world's first peer-run crisis alternative (peer respite) [source: Kennedy & Mead 2019]. IPS describes itself as building relationships in which two people look together at how each has learned to operate in the world [source: IPS 2014 presentation, Copeland Center].

Plain statement for clinicians. IPS is practised by peer supporters (people using their own lived experience of psychiatric services, trauma or distress) in one-to-one support, groups, warmlines and peer respites. A psychotherapist does not "deliver IPS" to a client. Your realistic roles are: (a) referring clients to IPS-informed peer services or respites; (b) working alongside IPS-trained peer staff in a team; (c) attending Core Training yourself (it is open to anyone) and adapting its principles to your own relationships, which is [synthesis] and should not be called IPS peer support [source: IPS Core Training page; Implementing IPS page].

How change happens. IPS locates change in the relationship rather than in the individual: when two people change how they talk, listen and make meaning together, both see themselves differently, and that new way of relating spreads to other relationships and communities. Peer support is framed explicitly as social change, not as a better service [source: Kennedy & Mead 2019; IPS 2014 presentation]. Mead's Co-Reflection Guide describes IPS as a way of thinking about and being in purposeful relationships that does not start from the assumption of a problem: both people look at how each learned to make sense of experience and use the relationship to try new ways of seeing, thinking and doing [source: Co-Reflection Guide 2015]. Mead, Hilton and Curtis's 2001 theoretical paper frames peer support as building "a new cultural context for healing and recovery": people given psychiatric labels are socially excluded and come to take on a patient identity, and peer communities that understand these cultural forces can work for personal, relational and social change [source: Mead, Hilton & Curtis 2001, abstract only]. Crisis is treated as an opportunity to learn, grow and connect rather than something to be contained [source: IPS Advanced Training page; D'Isselt 2013].

2. Framework

IPS has no phases, session counts or fixed session format. Its structure is three principles (shifts in stance) and four tasks (things the relationship works on continuously, in any order) [source: IPS Core Training page].

The three principles (shifts)

From helping to learning (together).
From individual to relationship.
From fear to hope (and possibility).

The four tasks

Task	Goal	Signs it is happening
Connection	A felt sense of being in it together; trust that allows both people to learn	Warmth and curiosity both ways; disconnections are noticed, named and repaired
Worldview	Understanding how each person came to know what they know	Talk shifts from "what's wrong" to "what happened"; meaning-language replaces diagnostic language
Mutuality	A relationship that works for both people; power and responsibility negotiated	Both people share, both voice needs and limits, risk and responsibility are shared
Moving towards	Energy directed at what people want to create, not at what they want to avoid	Conversation about values, hopes, a shared direction rather than symptom removal

[source: IPS 2014 presentation; IPS Core Competencies 2017; Core Training page]. IPS describes connection as a cycle of connection, disconnection and reconnection rather than a stage that is completed [source: IPS 2014 presentation]. Wording versions. The current Core Training page names the tasks Connection, Worldview, Mutuality and Moving Towards, and the principles Helping to Learning, Individual to Relationship and Fear to Hope. A 2018 IPS workshop (Dech & Penney, NARPA) words them as establishing connection, understanding worldview, creating mutuality and moving towards instead of moving away, with principles from helping to learning together, from a focus on the individual to relationship, and from fear to hope and possibility. A 2010 five-day training led by Mead listed the third task as "mutual responsibility" and called co-reflection "co-supervision" [source: Core Training page; NARPA 2018; Wichita State CCSR 2010].

What each task looks like in practice (indicators in Mead's Co-Reflection Guide, paraphrased) [source: Co-Reflection Guide 2015]

Connection: being open, interested and curious; sharing relevant stories; noticing when and why you disconnect; reconnecting; helping the other person value self-reflection.
Worldview: drawing out the other person's view of what is going well and why; knowing your assumptions and how they could get in the way; considering how the other person sees you (e.g. your role); listening for the story behind the story; noticing judgment, power and privilege.
Mutuality: understanding worldview; sharing your own experience; making sure both people's needs are met; giving and hearing reflective and critical feedback; sharing responsibility for the relationship.
Moving towards: co-creating a vision of where you want to go; planning steps; learning and growing together; evaluating together; agreeing a moving-towards goal and ways of holding each other accountable.

The guide applies these indicators to the co-reflection relationship between practitioners. Using them as markers inside the peer relationship itself follows IPS's consistency-at-every-level principle but is my extension [synthesis].

Formats in which IPS is used [source: Behavioral Health News 2013; Pathways Vermont 2024; Implementing IPS page]

One-to-one peer relationships (community, inpatient, outpatient teams).
Peer-run crisis respites, e.g. Manhattan Crisis Respite Center (opened January 2013 with the NYC Department of Health; seven guests; peer greets at the door, no reception desk; guests come and go freely) and Second Story respite (California), which IPS Central cites as using IPS.
Warmlines and phone support.
Co-reflection groups among practitioners (see 4.16).

Training and delivery requirements (programme-level). [source: IPS Core Training, Advanced and Implementing IPS pages]

Core Training: 40 hours (5 days in person or 10 days virtual), interactive, based on Mead's workbook; open to anyone in traditional or alternative settings.
Co-reflection: ongoing regular practice after Core (earlier called co-supervision); introduced in Core, deepened in Advanced. IPS's "Getting started" resource suggests formal sessions weekly, fortnightly or monthly plus informal ones as needed, in groups or pairs, inside or outside the workplace; ideally participants have done Core, it is strongly recommended that trained peer workers lead it, it can include current service users, and it is best kept separate from line management [source: Core and Advanced pages; Co-Reflection Getting Started].
Advanced Training: 24 hours (3 days in person or 6 virtual), for Core graduates (or with a brief IPS refresher), tailored to the organisation or community; covers applying IPS in real settings, co-reflection, and a crisis focus (crisis as opportunity, trauma-informed practice, conflict and challenging situations, flexible boundaries, proactive crisis planning, programme evaluation), especially for respites [source: Advanced page]. The co-reflection "Getting started" resource describes Advanced as four days and as including skills for leading co-reflection [uncertain: length differs between versions].
Facilitator (Train-the-Trainer) course: 5 days; produces organisational trainers who teach Core inside their own organisation. A Managers & Supervisors training also exists.
Fidelity and certification: no licensing, practitioner certification or formal fidelity audit under the IPS name was found. The Core page lists no prerequisites and mentions no completion credential; the Advanced page and the co-reflection resources mention none; the Core Competencies tool is a 1–5 self-rating instrument; co-reflection sessions run by IPS Central issue attendance certificates only to full participants. Organisations are asked to read IPS's "Information for organizations" document before booking, and trainings use IPS Central's materials (a 2022 Vermont statewide Core charged a per-participant fee for IPS Core materials) [source: Core page; Advanced page; Pathways Vermont 2022 event page]. The Facilitator Course, Training Program Guide and Managers & Supervisors pages are not drawn on here, so facilitator prerequisites and any licensing of materials remain [uncertain]; some US states use IPS within peer-specialist certification [uncertain: not verified].

Moving between "phases". Not applicable. In practice [synthesis]: a relationship is attended to through whichever task is live: if disconnection appears, return to connection; if a judgment appears, return to worldview; if one person is carrying the work, return to mutuality; if conversation circles a problem, invite moving towards.

3. Guiding principles

[source: IPS Core Training page; NARPA 2018 workshop description; IPS Core Competencies 2017; IPS 2014 presentation; Co-Reflection Guide 2015; Kennedy & Mead 2019; Pathways Vermont 2024]. IPS publishes three named principles (the first three bullets). The remaining bullets are stance commitments drawn from IPS materials and Mead's writing, not a numbered list IPS publishes.

From helping to learning. Treat the other person as a capable co-learner and adult, not someone to advise or fix; both of you are expected to learn. Practical meaning: replace "what should they do?" with "what are we both learning here?"
From individual to relationship. Ask what the relationship needs, not only what the person needs; invite feedback on how it is working for each of you. Practical meaning: when things go badly, look at the pattern between you before looking at the person.
From fear to hope and possibility. Fear-based relating is predictive, prescriptive and power-imbalanced; hope-based relating looks at where you are heading and what you can create. Mead links fear to coercion. Practical meaning: notice when risk anxiety is driving your next move and name it.
Practise not knowing. Hold assumptions loosely and listen from a "position of not knowing" (Mead, Pathways 2024). Practical meaning: ask how someone came to their view before offering yours.
Trauma awareness: "what happened?" not "what's wrong?" Practical meaning: listen for the untold story behind behaviour and labels.
Language that explores meaning. Avoid clinical, diagnostic and labelling language; recognise its impact. Practical meaning: ask what a word like "depression" means to this person instead of assuming.
Power is named and negotiated, not hidden. Recognise and own your power and privilege (role, pay, title, education, freedom to leave) and invite exploration of its impact. Practical meaning: say aloud the power you hold in this conversation.
Shared risk and responsibility. Responsibility belongs to you, me and the relationship; share risk rather than taking control. Practical meaning: decide together how you will handle hard situations.
Personal limits rather than fixed boundaries. Mead prefers limits each person names and negotiates over imposed boundaries, to avoid "othering" people (Kennedy & Mead 2019, p. 52). Practical meaning: state your limit as yours and why, not as policy.
Intentional sharing and mutual vulnerability. Share your own experience when there is connection and trust and when it serves the relationship. Practical meaning: share to connect, not to redirect focus to yourself.
Self-reflection: "What is my part?" Use friction to look at your own agendas, default responses and assumptions instead of blaming the other person for your discomfort.
Tolerate uncertainty, sit with discomfort, hold multiple truths. [source: IPS 2014 presentation]. Practical meaning: you do not need to resolve which version of events is "true" to stay connected.
Crisis as opportunity. Crisis is a chance to connect, keep mutuality and build a culture of healing, rather than a trigger for risk-management that keeps people stuck [source: IPS Advanced page].
Peer support as social change. The aim is changed conversations, understanding and communities, not just better services. Practical meaning: question practices (coercion, filtered information) that reproduce harm.
Consistency at every level. Co-reflection and supervision should model the same principles as the peer relationship [source: Co-Reflection Guide 2015].

4. Intervention inventory

How to read this section. IPS does not publish discrete "techniques" with scripts; it publishes relational practices (the competencies and training topics). Each item below is one of those practices as IPS Central, Mead or IPS-based services describe it. Step sequences are my operationalisation for use in a session or peer contact [synthesis], built only from the practices the sources name. All example language is illustrative. Items 4.1–4.14 are written for an IPS-trained peer supporter; a therapist adapting them should read 4.17 first. The Core workbook may contain further exercises not listed here [uncertain].

4.1 Building connection

Purpose: Create a felt "we're in it together" and the trust that lets both people learn [source: IPS 2014 presentation; Core Competencies, competency 1]. Use from the first contact onward.
Steps: (1) Show warmth, openness and curiosity about the person's experience and view. (2) Look for common ground rather than dwelling on differences. (3) Where relevant and there is some trust, offer a piece of your own related experience (see 4.6). (4) Ask how the conversation is landing. (5) Early on, talk openly about roles and what each expects, to reduce assumptions and later disconnection [source: Maine peer guide 2022].
Example language (illustrative): "I'd like to get to know how things have been for you, not just the reason you were sent here." "I've had nights like that too; what was it like for you?"
Watch for: Connection that is one-sided (you know everything about them, they know nothing about you); connection that depends on agreeing with each other. Working: the person brings up things they had not planned to, and both people can disagree without breaking contact.

4.2 Noticing disconnection and reconnecting

Purpose: Disconnection is expected; noticing and repairing it, by owning your part, is a core skill [source: Core Competencies, competencies 1 and 4; Co-Reflection Guide 2015, connection prompts].
Steps: (1) Notice your own signals of disconnection (boredom, irritation, rehearsing advice, the other person going quiet or agreeing flatly). (2) Ask yourself what you were thinking and feeling when it happened. (3) Name it transparently and tentatively. (4) Own your part without blaming. (5) Ask what would help you both reconnect. (6) Later, in co-reflection, review what pulled you away and how you got back.
Example language (illustrative): "I think I lost you a minute ago, when I started suggesting things. I jumped in. Can we go back to what you were saying?"
Watch for: Naming disconnection as the other person's fault ("you shut down"). Working: the conversation regains energy; the person may correct your reading, which is also connection.

4.3 Exploring worldview: "what happened?" and the untold story

Purpose: Understand how the person came to know what they know, with trauma awareness, instead of assessing what is wrong with them [source: IPS 2014 presentation; Core Competencies, competency 3; Kennedy & Mead 2019, p. 51].
Steps: (1) When the person describes a problem, a label or a belief, get curious about its history. (2) Ask what happened, and how they came to see it this way. (3) Listen for what is not being said (the untold story). (4) Use the person's words rather than translating into diagnosis or symptom language. (5) Reflect back the meaning you hear and check it. (6) Do not try to correct the worldview; you may later offer your view as another perspective (see 4.12).
Example language (illustrative): "When you say you're 'bipolar', what does that mean in your life?" "How did you come to think people can't be trusted? What happened?"
Watch for: Curiosity becoming interrogation; using "what happened" to dig for trauma the person has not chosen to share. Working: the person starts telling a story rather than a case history.

4.4 Examining your own worldview and judgments ("What is my part?")

Purpose: Your reactions say as much about your worldview as about the other person; owning them prevents imposing your story [source: Core Competencies, competencies 3 and 8; Copeland 2014 slide: "What's going on here? If that's your assumption, what might you say or do?"].
Steps: (1) Notice a judgment or strong reaction ("they're manipulative", "they're not trying"). (2) Pause and separate observation from evaluation. (3) Ask: what assumption am I making, and where did I learn it (family, training, privilege, my own history)? (4) Ask: if that is my assumption, what would I say or do, and what else could I do? (5) Ask with curiosity what your part is in the pattern. (6) Bring the episode to co-reflection.
Example language (illustrative, to self or in co-reflection): "I'm calling her 'resistant'; what I actually saw was her not answering my question."
Watch for: Self-reflection turning into self-blame or endless processing. Working: you respond with curiosity rather than control, and you can describe the other person without labels.

4.5 Shifting from helping to learning together

Purpose: Replace the helper role (I know what you need) with co-learning [source: Core Competencies, competency 2; IPS 2014 presentation; Pathways Vermont 2024].
Steps: (1) Notice the pull to advise, reassure or fix. (2) Hold it and ask what the person wants from this conversation. (3) Treat them as an adult who can make their own decisions. (4) Say what you are learning from them. (5) If they ask for advice, you may share what worked for you as your experience, not as a prescription, and ask what fits for them.
Example language (illustrative): "I notice I want to jump in with ideas. Before I do, what are you hoping for from talking today?" "I hadn't thought about it that way; that changes how I see my own situation."
Watch for: Withholding all input in the name of "not helping" (abandoning rather than co-learning). Working: the person generates their own direction; both people report learning.

4.6 Intentional sharing of lived experience (mutual vulnerability)

Purpose: Build trust, offer a different perspective, and make the relationship mutual [source: Kennedy & Mead 2019, pp. 51–52; D'Isselt 2013].
Steps: (1) Check there is some connection and trust. (2) Ask yourself whether the story serves the relationship now. (3) Share briefly and concretely, including how you made sense of it. (4) Hand the focus back. (5) Be open to being challenged by them, as they are by you. Mead contrasts this with the clinical policy of not sharing, which she argues can hide power [source: Kennedy & Mead 2019, p. 52].
Example language (illustrative): "When I was in hospital, I called what happened to me 'a breakdown' for years. Later I started calling it something else. I'm curious what you call it."
Watch for: Sharing to fill silence, to rescue, or to make the person comparable to you; disclosures that leave the person feeling responsible for you. Working: the person shares more, and the meaning of the shared experience opens up (e.g. Mead's illustration of two peers exploring how each came to call their experience "depression" rather than trading coping tips).

4.7 Naming and negotiating power and privilege

Purpose: Make power visible so it can be negotiated fairly [source: Core Competencies, competency 5; Core Training page; Maine peer guide 2022].
Steps: (1) Identify the power each person holds: pay, job title, organisational credibility, access to records, ability to leave the setting, education, race, class, gender, sexuality. (2) Name your own power plainly. (3) Ask how it affects the relationship for them. (4) Agree what you can share or change (e.g. what you write, who you talk to about them, decisions you can influence). (5) Revisit when something shifts (crisis, paperwork, a meeting with clinicians).
Example language (illustrative): "I'm paid to be here and you're not, and I write notes that others read. I don't want to pretend that isn't there. How does it affect what you feel you can tell me?"
Watch for: Naming power as a ritual and then acting unilaterally; a peer worker absorbing the organisation's power without noticing. Working: the person challenges or corrects you; decisions are visibly negotiated.

4.8 Negotiating personal limits (instead of fixed boundaries)

Purpose: Keep the relationship working for both people without "othering" anyone [source: Kennedy & Mead 2019, p. 52; Core Training page "negotiating boundaries and limits"; Maine peer guide 2022].
Steps: (1) Notice when something does not work for you (contact out of hours, a topic, a request). (2) State it as your limit, in terms of your own feelings and needs rather than policy. (3) Ask what the person needs. (4) Look for an arrangement that works for both. (5) Where an organisational rule is non-negotiable, say so honestly and own it rather than disguising it as your preference. (6) Revisit later.
Example language (illustrative): "I've noticed I get tense when calls come after ten at night, and then I'm not much use to you. Can we work out something that works for both of us?"
Watch for: "Flexible" limits that drift into unsafe practice (Mead's own example: a respite worker drinking with a guest led the team to agree no drinking on shift, then used the episode for co-reflection [source: Kennedy & Mead 2019, p. 52]). Working: the person can also state limits to you.

4.9 Checking how the relationship is working (relationship feedback)

Purpose: Shift focus from the individual to the relationship; the relationship only works if it works for both [source: Core Competencies, competency 4; IPS 2014 presentation; Maine peer guide 2022].
Steps: (1) Periodically, and whenever something feels off, ask how the relationship is working for them. (2) Say how it is working for you. (3) Ask what the relationship needs from each of you. (4) Agree one small change. (5) Notice the small everyday moments where mutuality shows up and name them.
Example language (illustrative): "How is this working for you, meeting like this? For me, I'd like us to talk a bit less about appointments and more about what you actually want."
Watch for: Polite "it's fine" answers where power is uneven; ask in more than one way or at a later point. Working: concrete requests come from both sides.

4.10 Giving and receiving feedback

Purpose: Address difficulty honestly without breaking connection [source: Core Competencies, competency 9; Co-Reflection Guide 2015, pp. 9–11].
Steps (giving): (1) Give feedback when there is connection, and ask permission first. (2) Check whether the other person remembers the event the same way. (3) Start with something genuinely positive, put the harder point in the middle, end on what you are moving towards. (4) Describe what you observed, not your judgment. (5) Check your power and privilege (role, tenure, education) and whether your view reflects bias. (6) Ask how their view makes sense to them and hold both perspectives.
Steps (receiving): (1) Notice defensiveness and breathe. (2) Listen without assuming you know what they mean. (3) Assume the feedback contains some truth. (4) Thank them and say what you will try. (5) Ask what you could move towards that builds on your strengths.
Example language (illustrative): "Can I tell you something I noticed last week? I really valued how you spoke up in the group. Afterwards, when Sam disagreed, it looked like you left the room. Is that how you remember it?"
Watch for: Feedback that is really a verdict or a managerial correction. Working: the other person engages rather than defends; the relationship feels closer afterwards.

4.11 Shared risk and mutual responsibility agreements

Purpose: Replace one-sided risk management with risk and responsibility the two people hold together [source: Core Competencies, competency 5; Core Training page; Pathways Vermont 2024 (Mead: "sharing risk and mutual responsibility for the relationship"); Maine peer guide 2022].
Steps: (1) Early in the relationship, before a crisis, talk about how the two of you will handle very hard situations (medical emergencies, abuse, suicidal feelings, self-harm); Mead and Hilton describe this proactive planning as two-way, with each person learning how the other has come to make sense of their experience rather than going through symptom or risk checklists [source: Mead & Hilton 2002]. (2) Each says what they can and cannot carry and what they would want from the other. (3) Agree what stays between you and when and how outside support would be involved; the Maine guide recommends that if outside help is needed, the person chooses who, ideally someone who will not take matters out of their hands. (4) Negotiate guidelines that protect the relationship and say who does what; do not use safety contracts, which Mead and Hilton argue move control to the helper and leave the person feeling powerless [source: Mead & Hilton 2002]. (5) Where a written crisis plan exists, use it as a shared reminder of what you agreed (as in Mead's respite example). (6) Revisit after any crisis.
Example language (illustrative): "If things got really bad and you were thinking of ending your life, what would you want from me? And here's what I'd need to be able to stay with you in that."
Watch for: Agreements that promise confidentiality an employer or law does not allow; state any mandatory limits on day one [synthesis]. Working: in a crisis both people refer back to the agreement and neither feels ambushed.

4.12 Holding multiple truths and offering another view

Purpose: Stay connected while seeing things differently; challenge meaning without dismissing it [source: IPS 2014 presentation (tolerate uncertainty, sit with discomfort, hold multiple truths); Kennedy & Mead 2019, p. 51 (peers challenge each other's meaning rather than problem-solve); Co-Reflection Guide 2015, worldview prompts].
Steps: (1) First show you understand how their view makes sense given what happened. (2) Ask whether they want to hear another way of seeing it. (3) Offer your view as your view, with where it comes from. (4) Do not require agreement. (5) Ask what it was like to hear.
Example language (illustrative): "I can see why, after what happened, it makes sense that you expect people to leave. Can I tell you how it looks from where I'm sitting? It may not fit."
Watch for: "Another view" that is advice in disguise. Working: the person can hold your view alongside theirs, or tells you why it doesn't fit.

4.13 Crisis as opportunity (including peer respite practice)

Purpose: Use crisis to connect, keep mutuality and learn, rather than to stabilise or contain [source: IPS Advanced page; D'Isselt 2013; Pathways Vermont 2024; Kennedy & Mead 2019].
Steps (as described by Mead and Hilton and by IPS-informed respites): (1) Welcome the person as a guest, not a patient (e.g. a peer at the door, homelike setting, freedom to come and go) [source: D'Isselt 2013]. (2) Do not aim to stabilise or advise; aim to understand what the crisis means. Listen to the story as it is told, without judging it, and validate feelings before exploring the experience with open questions [source: Mead & Hilton 2002]. (3) Stay with the person, sharing relevant experience to reduce isolation without imposing your interpretation, and without fear of unusual behaviour (Mead's account of peers staying with a man over several days at the New Hampshire respite without forced treatment) [source: Mead & Hilton 2002; Pathways Vermont 2024]. (4) Follow the person's own cues about what they need, alternating stepping in and stepping back so you stay present without taking over [source: Mead & Hilton 2002]. (5) Notice when your own fear or discomfort is pushing you towards control or a power struggle; say honestly when you feel uncomfortable or unsafe, and stay [source: Mead & Hilton 2002; D'Isselt 2013]. (6) Keep clinical information unfiltered and hold any conversations with family or professionals only with the person's consent and presence [source: D'Isselt 2013]. (7) Negotiate house rules with guests rather than imposing them. (8) Afterwards, revisit the relationship and plan together for future crises (crisis planning is an Advanced Training topic), and move towards what the person wants [source: Mead & Hilton 2002; IPS Advanced page].
Example language (illustrative): "I don't need you to calm down for my sake. I'd like to understand what this is like for you right now."
Watch for: Physical danger or medical emergency, which needs immediate outside help regardless of model [synthesis]. For altered states or unusual beliefs, Mead and Hilton's account is to validate the fear, respond to what the person asks for (in their example, a helper took a man's fear of a smoke-detector light seriously and, at his request, helped him cover it) and avoid labelling the experience as illness [source: Mead & Hilton 2002]; IPS's current Core and Advanced pages do not list the topic [uncertain]. Working: the person describes the crisis as meaningful, and they leave with more connection than they came with.

4.14 Conversations about suicide and self-injury

Purpose: Talk openly and humanly about suicidal feelings and self-injury, rather than through screening questions, so the person is not silenced by fear [source: Core Training page, which lists navigating conversations about suicide and self-injury among the skills taught; Maine peer guide 2022]. Mead and Hilton describe discussing suicidal feelings openly rather than treating them as grounds for a safety contract or police involvement, with the helper admitting their own discomfort and staying present instead of retreating into risk analysis [source: Mead & Hilton 2002]. IPS's current training procedure is not public; the steps below are built from that stance and the Maine guide [uncertain].
Steps: (1) Invite the conversation directly and without alarm. (2) Ask about meaning: what the feelings are about, what they are trying to say or do for the person. (3) Share relevant experience if it helps connection (see 4.6). (4) Refer to the shared-risk agreement (4.11). (5) Where self-injury continues, the Maine guide describes offering harm-reduction conversations about care of injuries and practices, if the person wants them. (6) Be honest about your limits and about any duty you have to involve others.
Example language (illustrative): "Sometimes when people talk like that they're thinking about killing themselves. Is that where you are? I can hear it; I'm not going to panic."
Watch for (clinician and supervisor): IPS-style openness does not remove the employer's or the clinician's duty of care. Any clinician involved should complete a standard risk formulation (current intent, plans, preparation, access to lethal means, protective factors), agree a safety plan collaboratively, do lethal-means counselling about safe storage or removal, and make sure the person has crisis contacts such as 988 (US) or Samaritans 116 123 (UK and Ireland), while keeping the conversational stance IPS describes [synthesis]. Working: the person discloses earlier and more fully because the conversation does not automatically trigger loss of control.

Related peer model for referral (not IPS): Alternatives to Suicide. Groups began in 2009 at the Western Mass Recovery Learning Community; its training director describes the model as sharing IPS's values but separate from it. Weekly groups meet in non-clinical settings, co-facilitated by two people who openly identify with their own suicidal thoughts (at least one trained in the three-day Alt2Su training), and are open only to people who have had suicidal thoughts. Conversation explores why the person thinks of suicide and why they have stayed alive, as an alternative to risk assessment; advice is given only on request; people who are hospitalised or attempt suicide are welcomed back [source: Community Psychology interview with Mazel-Carlton]. Before referring, find out how the local group handles confidentiality, which the source does not describe [uncertain], and keep your own risk formulation and safety plan in place [synthesis].

4.15 Moving towards: creating a shared vision

Purpose: Direct energy toward the lives people want rather than away from what they fear [source: Core Competencies, competency 7 ("Task 4"); IPS 2014 presentation; Core Training page ("creating a vision"); Maine peer guide 2022].
Steps: (1) Notice when talk is moving away from (avoiding symptoms, hospital, relapse). (2) Ask what they would want instead. (3) Share your own values and hopes too (it is mutual). (4) Co-create a direction for the relationship, not an individual treatment goal. (5) Plan small next steps and check them together. (6) Drop deficit language when describing progress.
Example language (illustrative): "We've spent a lot of time on what you don't want to happen again. What would you like more of in your life?"
Watch for: Moving towards being used to skip over pain. Working: plans are phrased as wanted outcomes, and the person's energy rises when discussing them.

4.16 Co-reflection (practitioner peer reflection)

Purpose: Keep practice consistent with IPS values through a cycle of learning, practising and reflecting; it is not therapy, judgment, gossip or managerial correction [source: Co-Reflection Guide 2015, pp. 3–4, 12; Co-Reflection IPS format 2022].
Steps (IPS Central 2022 format, paraphrased; about 90 minutes, range 1–3 hours): (1) Open with a quote or poem. (2) Confirm all attendees have done Core. (3) Explain co-reflection and its intention. (4) Agree a group agreement (keep the stories, take the learning; openness to different worldviews; no experts, all learners; other needs). (5) Introductions round, including what inspires each person about peer support. (6) Each says what they want from the session. (7) Discussion starting with what is working (a recent surprising connection, an example of mutuality, challenges of practising IPS locally). (8) One or two topics raised by participants; validate and relate, stay curious, no advice or problem-solving. (9) Closing round: one takeaway each. (10) Harvest: what worked and what to change. (11) Close.
Additional elements from the 2015 guide: build a positive, practical learning environment and agree shared interests first; a discomfort agreement (what each needs to stay engaged when it gets uncomfortable, including confidentiality and how to raise problems with the process); a shared list of IPS values with examples; practising feedback with scenarios; bringing examples of one's own use and misuse of IPS, and of IPS one has observed, framed by the four tasks. The guide also suggests evaluating practice together through narrative inquiry (the stories people tell about themselves), appreciative inquiry (building on strengths, visions and hopes) and ethnography or auto-ethnography [source: Co-Reflection Guide 2015].
Example prompts (paraphrased from the 2015 guide): recall a strong connection and how you knew it was mutual; recall a broken connection and how you responded; name the assumptions you brought into an uncomfortable conversation; recall falling into the helper role; replay a conversation where you shifted from moving away to moving towards.
Watch for: Sessions sliding into case management, venting about "difficult clients" or operational business. Working: participants name their own part and leave with a specific practice intention.

4.17 Clinician procedures: referring to, working alongside and adapting IPS [synthesis]

The sources describe what peers do, not what therapists do. Everything in this item is my synthesis, built on the IPS principles above and on the practices of the IPS-based services described (Manhattan Crisis Respite, NH respite, the Maine peer workforce guide).

Purpose: Let a therapist use IPS-informed peer support well without colonising it.
Steps (referral and fit): (1) Find out whether the local peer service or respite is actually IPS-trained (ask whether staff did Core Training and whether they hold regular co-reflection). (2) Describe peer support honestly: a mutual relationship with someone who has lived experience, not a junior therapist, not a case manager. (3) Good fit: clients harmed or alienated by services, clients who want to make their own sense of their experience, clients isolated or facing repeated admissions who would accept a respite stay. Poorer fit for now: clients who want a structured symptom protocol only, or who cannot yet tolerate a two-way relationship; they can still be offered it. (4) Ask the client what they hope for and what they fear about it. (5) Arrange referral with the client present and with their consent about what you pass on.
Steps (working alongside peer staff): (1) Expect and respect that peer staff may decline to receive or relay clinical information about the person secondhand, because it shapes the relationship (the Maine guide describes peers asking clinicians not to share medication histories with them). (2) Do not ask peer workers to monitor adherence or report on the person; that converts mutuality into surveillance. (3) Hold joint conversations with the person present. (4) Agree in advance, in writing, how risk information flows between peer and clinical staff, and make sure the person knows the limits of confidentiality on both sides. (5) Use team language that avoids labels ("the person", not "the borderline in bed 4"). (6) Join or host co-reflection if invited; do not use it to supervise peers clinically.
Steps (adapting principles in your own therapy): Name it as IPS-informed, not IPS peer support. Transferable practices include: "what happened" framing (4.3), naming your power in the room (4.7), relationship check-ins (4.9), owning your part in ruptures (4.2), stating limits as your own (4.8), and asking about meaning in suicidal communications while still completing a risk formulation (4.14). Self-disclosure (4.6) should follow your profession's ethics code and serve the client.
Example language (illustrative): "There's a peer respite run by people who've been through crisis themselves. It's not treatment; it's a place to stay and talk with people who get it. Would you want to hear more?"
Watch for: Referring because you want a cheaper case manager; overriding the peer relationship whenever you feel anxious. Working: the client reports feeling less alone and more in charge, and peer and clinical staff can disagree openly.

5. Handling problems

Sources: the Co-Reflection Guide (2015) and Core Competencies cover feedback, disconnection and self-reflection; Kennedy & Mead (2019) covers limits; D'Isselt (2013) and Pathways Vermont (2024) cover crisis. Items marked [synthesis] are my own guidance.

Stuck relationship (talk circles the same problem). Return to moving towards: ask what the person would want instead, and share what you want from the relationship (4.15). Co-reflection prompts ask how a disconnection might be used to shift a stalled dynamic: name the stuckness itself as something you are both in [source: Co-Reflection Guide 2015, pp. 5–6, 9].
"Resistance". IPS does not use the concept; treat it as disconnection or a clash of worldviews. Ask what is going on, what you are assuming, and what your part is (4.2, 4.4). Avoid labelling statements about the person [source: Core Competencies 8; Co-Reflection Guide 2015, p. 4].
One-sided relationship (you listen well but never share, or the other way round). The guide's example of a supporter who listens well but rarely voices her own needs is treated as a failure of mutuality. Name it and negotiate what each needs (4.9) [source: Co-Reflection Guide 2015, p. 8].
Overwhelm (either person). Say so honestly; staff in IPS respites are expected to name when they feel unsafe or uncomfortable [source: D'Isselt 2013]. Slow down, reduce to presence, and agree what would help now. For a client who is dissociating or highly activated, use ordinary grounding and pacing, offered as a choice [synthesis].
Non-adherence (missed meetings, not following plans). In IPS there is no prescribed plan to adhere to; treat absence as information about the relationship. Ask how meeting is working for them and renegotiate frequency or format (4.9) [synthesis based on competency 4]. For clinicians: do not route medication or attendance monitoring through peer staff [synthesis].
Ruptures and conflict. Own your part, name the disconnection, ask what would help reconnect (4.2); use the feedback method (4.10). The Co-Reflection Guide uses case vignettes on conflict (one on slipping into a victim role in a dispute) and discussion questions on handling disagreement and giving feedback across different worldviews; use these in co-reflection after a conflict [source: Co-Reflection Guide 2015]. Conflict and challenging situations are an Advanced Training topic within its crisis focus [source: IPS Advanced page]; IPS's detailed conflict procedure is not given in the materials [uncertain].
Limits crossed (out-of-hours demands, socialising, alcohol, money, romance). State your limit as yours and negotiate (4.8). When an incident happens, the team agrees a clear rule where needed and uses the episode for co-reflection, as in Mead's respite example [source: Kennedy & Mead 2019, p. 52]. Sexual or financial relationships between a peer worker and the person supported, and any coercion, are not open to negotiation [synthesis].
Suicide risk and the confidentiality conflict. IPS-informed peer guidance treats suicide conversations as confidential by default and resists clinical screening [source: Maine peer guide 2022]. Clinicians, and peer workers employed in clinical services, usually have legal and policy duties to act on imminent risk. Resolve this in advance: state limits of confidentiality at the start, build a shared-risk agreement (4.11) that names when others would be involved and who the person would choose, and when risk is imminent, act while keeping the person informed and involved as far as possible [synthesis]. Do not let the IPS stance become a reason to skip risk formulation, safety planning or lethal-means counselling about storage or removal [synthesis].
Medical emergencies, violence, abuse disclosures. Raised in the Maine guide as situations for shared-risk agreements; the sources give no procedure [uncertain]. Follow safeguarding and emergency law and policy, involving the person as far as safety allows [synthesis].
Clinical team pulls peers into the helper or monitoring role ("co-optation"). Mead describes peer work sliding into "doing what had been done to us"; the antidote she names is defined practice, training and self-reflection [source: Pathways Vermont 2024]. Practical response: regular co-reflection, protecting peer roles from surveillance tasks, and managers trained in IPS (Managers & Supervisors course) [source: IPS training pages; synthesis for the specific protections].
Hearing "difficult client" talk from colleagues. The Co-Reflection Guide includes this as a practice scenario; respond with curiosity about what happened to the person and what the colleague's part might be, not with counter-judgment [source: Co-Reflection Guide 2015, pp. 11–12, 16].
Disclosure that backfires (the person feels burdened or compared). Acknowledge it, take responsibility, return focus, and review in co-reflection whether there was enough connection and trust first (4.6) [source: Kennedy & Mead 2019, p. 52; synthesis].
Altered states or unusual beliefs. Mead describes peers at the New Hampshire respite staying alongside a person in an extreme state over several days, without forced treatment and without telling him what it meant [source: Pathways Vermont 2024; Mead & Hilton 2002]. Mead and Hilton's crisis practices apply: respect the story as told, validate fear before exploring, follow the person's cues about what would help, and alternate stepping in and stepping back (4.13) [source: Mead & Hilton 2002]. IPS's current Core and Advanced pages do not list the topic [uncertain]. Stay curious about meaning (4.3), and attend to basic needs and physical safety [synthesis].
Respite misuse or drift. Mead names risks that waiting lists make people see themselves as fragile and that respite could turn into a holiday and lose its purpose [source: Pathways Vermont 2024]. Keep stays purposeful and discuss with guests what they want from the stay [synthesis].
Co-reflection going wrong (defensiveness, blaming, gossip). Revisit the discomfort agreement and group agreement, ask permission before feedback, focus on specific interactions not people, and keep it separate from line management [source: Co-Reflection Guide 2015, pp. 3–4, 9–12; Co-Reflection IPS format 2022].

Sources

Sources:

Books and papers cited:

Mead, S. (2014). Intentional Peer Support: An Alternative Approach (Core Training workbook). IPS. Supplied with the training; no public copy [uncertain].
Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: a theoretical perspective. Psychiatric Rehabilitation Journal, 25(2), 134–141 (abstract; see above).
Mead, S., & MacNeil, C. (2006). Peer support: what makes it unique? International Journal of Psychosocial Rehabilitation. [not used for any claim]
MacNeil, C., & Mead, S. (2005). A narrative approach to developing standards for trauma-informed peer support. American Journal of Evaluation. [not used for any claim]
Mead, S., & Hilton, D. (2002). Voies nouvelles en psychiatrie. Situation de crise et soutien entre pairs . Santé mentale au Québec, 27(1), 83–101 (Érudit)

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