After years of dreaming, planning, and researching, Peer Collective (peercollective.org), an online platform for low-cost peer counseling is now officially up and running.
This launch happens at a time in which countless people in the world are suffering and don’t have enough access to emotional support. Suicide and mental health disability are growing worldwide, and many of the leading figures in the mental health profession believe the system is badly broken.
In 2015, about a week after I published my first book, Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation, a colleague asked me a challenging question. She asked if I believed that the field as a whole would be more effective if every clinician would read my book. Based on my understanding that training doesn’t tend to improve therapist outcomes, I said no. She responded, “Then what would it take for the field to be more effective?”
I lost some sleep on this question, but eventually started imagining a world in which anyone could hit a button on their phone and be connected with a compassionate and empathetic listener. I imagined it would either be free or affordable enough that cost wouldn’t be a barrier.
At the time, I was living at a meditation retreat center in the woods of New Hampshire and caring for my wife who was dying of cancer. Founding a new ambitious project like this didn’t seem likely.
In the Belly of the Beast
A few years later, I was invited to give an author talk at the Google campus in Mountain View, CA. After my talk, I met David Yu Chen, a Google software engineer with a passionate interest in mental health. He approached me and said he wanted to develop a mental health project. I’d never met a software engineer before, and I felt like this was probably my only chance to try building my vision.
Eventually, the two of us developed and ran a peer-counseling project at Google for eight months. As a former Occupy Wall Street protester, showing up at the Google offices everyday felt gross to me. However, I learned a lot during that time. We did research on how to screen and predict which peer counselors would be effective, and how to make peer counseling approachable to a broad range of people. It was also during that time that some of the therapy researchers I most idealize joined the project, including psychologist Bruce Wampold, an expert on what makes therapy effective. However, it became clear that Google would never sponsor something radical or aimed at underserved communities. They were more interested in how our project could be used to sell Google Cloud to employers.
So in the summer of 2019, I left Google and founded Peer Collective. As of this writing, there are 30 peer counselors on the platform offering 30-minute counseling sessions for just $14. People can connect with a peer counselor who’s been through whatever issue that person is facing. They can find peer counselors who are available at nearly any hour, and talk over Zoom (which offers phone or video calls). Nearly one thousand more have applied to be peer counselors, and we’re growing slowly and carefully.
Could Online Peer Counseling Transform the Mental Health Field?
Let’s look at some of the biggest obstacles to people getting quality mental health care.
First, research shows that talk therapy is effective, but it’s too difficult to access. The average price of a therapy session in the US is $150, and in areas like New York and San Francisco, it’s closer to $250. Further, almost a third of Americans live in areas with a shortage of mental health providers. People who need care often can’t afford it, can’t find a practitioner, or have to wait months before they can get an appointment.
Peer counseling, on the other hand, is generally either free or low-cost. By creating an online platform for peer counselors, support can be available to anyone with an internet connection at whatever time works for them. I believe the biggest contribution that online peer counseling can offer is improving access.
A second major obstacle to quality mental health care is choice. Research shows that a poor match between “client” and practitioner is one of the biggest factors in people leaving mental health treatment. At Peer Collective, users can browse through our peer counselors and book a session with anyone they believe might be helpful. They can try sessions with several peer counselors until they find someone they like. They can stick with a single person for consistency, or maintain relationships with multiple peer counselors.
A final major obstacle is stigma. Our research at Google indicated that some people who are turned off by the medical paradigm of clinical mental health are much more open to peer counseling. In professional psychotherapy, the basis of the relationship is diagnosis and treatment, whereas in peer counseling, it is based on shared experience. I believe that battling stigma is complicated. However, peer-based services can be one way to counter stigma by normalizing human suffering.
Other Benefits of Online Peer Counseling
When I first spoke with Bruce Wampold, whose work in promoting the common factors model of therapy I’d admired for years, I asked him, “If you had to hire 100,000 therapists and you wanted them all to be good, how would you go about it?” He responded that he knew exactly what he would do.
He told me about the Facilitative Interpersonal Skills (FIS) assessment, which is the only type of metric that’s been shown to predict therapist effectiveness. Our team ended up creating our own process—based on FIS—to assess people who were applying to be peer counselors. In our assessment, applicants watch seven videos of highly emotionally challenging interactions while their responses are video recorded. The prompts include situations such as someone saying, “You’re acting really nice, but you’re paid to be nice, so it feels phony.” The applicants are then rated on the eight qualities that make up FIS: verbal fluency, hope & positive expectation, persuasiveness, emotional expression, warmth & understanding, empathy, alliance capacity, and alliance rupture repair. Only about 10% of peer counselor applicants pass the assessment.
When we tested this method at Google, we found that we had a high degree of agreement between different raters, and (more importantly) we could quickly predict which peer counselors were going to be good. Many researchers have suggested that if the least effective 25% of professional therapists could be removed from the field, overall outcome would improve dramatically. I believe the reason that so many professional therapists have such bad outcomes is that they never need to pass an assessment that actually predicts effectiveness.
Finally, we believe that making emotional support accessible is an issue of social justice. We’re focused on balancing affordable and accessible care with making sure that our peer counselors are paid a living wage (currently $20/hr).
Currently, we’re reaching out to underserved communities through doctors and community mental health centers so we can bring support to the people who need it most. We hope that in 5-10 years, everyone in the world will have easy access to compassionate and skillful peer counselors at the push of a button.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.