Accelerating Best Practices in Peer Support Around the World

Relationship Styles to Enhance Mental Health Peer Support

Jewels Rhode, MPH student

Research has shown that the development of meaningful relationships is an essential part of the mental health recovery process regardless of any specific therapy type or approach. This short guide was created for peer supporters to help them develop better relationships with those they support by appreciating their relationship styles. [Download the PDF version]

Importance of Understanding Relationship Styles

Relationship styles are typical patterns of expectations, needs, emotions, and behaviors in social interactions. They can be categorized as Insecure (Anxious, Avoidant), or Secure.

Each of these relationship styles dictates different modes of behavior, some of which may present challenges when helping your peer.

Most people with mental illness demonstrate insecure relationship styles due to lack of security during times of distress in childhood, which lessened resilience during stressful times and caused emotional issues and poor adjustment. An essential component of growth and development for people with insecure relationship styles is the undertaking of alternative ways of relating to others and controlling emotions.

Peer support is an effective way to help people with mental illness move towards more secure modes of behavior, where they can deal more positively with distress.

Relationship styles are flexible, and can change in slight or major ways depending on recent experiences and recent relationships. The following techniques can help you create, maintain, and restore your peer’s feelings of security.

RS Techniques


The following fictitious case vignettes will highlight how to apply techniques of empowerment, empathy, and acceptance to peers with anxious and avoidant relationship styles.


Case Vignette 1: Patient with Anxious Relationship Style
Rachel is a 44-year old woman who has been admitted with borderline personality disorder. She has been married for two years and is the mother of a one-year old. Her father did not provide much for her family as he was disabled most of his life from complications from a chronic disease and passed away when she was 12. Her mother worked two jobs as a housekeeper to support Rachel and her four siblings. When her mother returned home from work, she was too tired to pay much attention to her children. Rachel felt that she was never good enough for her mother. As an adult, Rachel suffered from temper tantrums. These temper tantrums occurred when she felt like her husband wasn’t giving her adequate attention or appreciation. She also experiences extreme fits of jealousy. Recently, they went to a book talk together and he didn’t hold her hand. The author was an attractive woman, and this made Rachel so jealous she physically assaulted her husband when they got home. Instead of calling the police, he bought her into your rehabilitation clinic (Adapted from case study in Mikulincer, Shaver, Cassidy, & Berant, 2009, pg 312).

Strategies of Engagement
You would more than likely have no issues enrolling Rachel in peer support, as people with anxious relationship styles have a heightened need for closeness and support from others. They also experience an inevitable disappointment cycle. Therefore, in order to avoid setting unrealistic expectations, it is essential that you are reassuring yet maintain a distance.

Recovery Techniques

Encourage Rachel to reassess her perception of threatening events. Talk to her about your personal examples of how you reappraised threatening events. Ask her about her tantrum tantrums and try to problem solve alternative responses to interactions that sparked those episodes.

Having been diagnosed with a personality disorder your self you understand what Rachel is going through and empathize with her. Having learned about her feelings of maternal abandonment and neglect by her husband, you two use problem-solving skills to reveal to help encourage positive thinking about those relationships.

Throughout her life, Rachel did not feel accepted. However, with your shared relationship, in which you help her combat her fears and give her direct support you promote feelings of acceptance, which is crucial for her recovery.


Case Vignette 2: Patient with Avoidant Relationship Style
Mary is an intelligent, single, 32- year old client recently diagnosed with depression who has been in and out of your Psychiatric Rehabilitation Center in the past 6 months, but she is currently an in-patient. Dr. Bowles, her therapist has contacted you to say that she may benefit from peer support. He tells you that he has been having difficulty getting her to talk much. During the first few therapy sessions she grilled him to see if he was smart enough to help her. Eventually, she developed enough trust in him to tell him that she was unhappy about being alone. Her mom passed away a year ago, and she never had a good relationship with her father who was always away on business trips. She has one younger sister who does not live in the United States. She has not had many satisfying and stable intimate relationships in her life, as she feels people often use her so she rather stay by herself (Adapted from case study in Mikulincer, Shaver, Cassidy, & Berant, 2009, pg 305).

Strategies of Engagement
As someone who has experience clinical depression for many years and has also been in and out of rehab you feel like you can help Mary. Remember that engagement with people with avoidant styles should be slow and less intrusive to avoid overwhelming them. You should try multiple methods to engage your peer. Before or after Mary’s therapy session, you can first quickly introduce yourself to Mary and tell her about the peer support program and inform her of upcoming activities going on in the center. You can also try having lunch with her.

Recovery Techniques

The goal for Mary is to get her to develop more secure and trusting relationships. You would want to help her identify her own levels of stress and then identify numerous effective ways that she could cope with those feelings, other than distancing, denial, and distraction.

Empathize & Accept
Although, it may seem like Mary is not being receptive to your support, even small successes represents progress for her. She seems to have lacked empathy from others throughout her life. Your consistent presence will help fill a void form Mary and it will promote feelings of acceptance.


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