"The patient’s needs determine the conversation in peer counseling"

Article 26 of the UN Convention on the Rights of Persons with Disabilities asks for the support of persons with disabilities in the form of so-called peers, who are in the same situation. The concept of peer counseling is therefore increasingly being implemented. Educational researcher Dagmar Marth has counseled persons with amputations both in a voluntary and professional capacity for nine years. REHACARE.com spoke with her about the Peers im Krankenhaus (PiK) project (English: Hospital Peers).

Mrs. Marth, how did the idea of Hospital Peers develop?

Dagmar Marth: The initial idea for Hospital Peers originated with Dr. Eckhard von Hirschhausen. During a meeting with several stakeholders in healthcare and physicians at the summer festival of the German Federal President, he came up with the idea of supporting a peer initiative as a patron. During the past two years, a task force consisting of representatives of Germany’s statutory health insurer AOK, the German Statutory Accident Insurance, the Federal Amputees Association of Germany, the Emergency Hospital Berlin (ukb) and the ukb’s long-standing peer counselor. The first training program for Hospital Peers was prepared in collaboration with these partners and took place in November of 2014.


How does peer counseling work?

Marth: The peer conversations take place at the hospital in the patient’s room or in an appropriate, safe environment. The patient’s needs and questions determine the conversation and its contents.

Each patient tackles and copes differently with amputation and based on many different criteria. One should never compare what one person does better or worse than another. Factors that influence how people cope with an amputation include the person’s age, the type and level of the amputation and his/her previous profession for instance. A violinist, who needs to have two fingers amputated for example, is facing an entirely different life situation than a pharmacist who is able to continue his/her job this way. Adapting to this new situation also depends on the patient’s personal resources and personality. It also matters how the family and relatives deal with this event, since family is a fundamental support for most patients. These various components influence the process of coping with amputations and the related psychological and social consequences.

The patient seeking advice owns "the stage", meaning the patient and his/her questions dictates the topics of conversation based on his/her personal situation. Generally, the conversations at the hospital take places up to three times during a patient’s stay and are a service provided by volunteers. The Emergency Hospital Berlin also offers counseling for prosthetic rehabilitation. Depending on what the patient needs, peer counseling can also be done by a professional.

What positive effects can peer counseling have on patients after limb amputations?

Marth: The goal of counseling is to motivate, support and encourage amputees to take charge of their lives again. This is called empowerment, "giving encouragement" to keep on living life fully. Showing interest, real attention, unconditional appreciation, empathy and active listening are the pillars of these conversations. Peer counseling is meant to support the patient in the process of coping and adapting to the new situation and altered body awareness and the related physical, psychological and social impacts.

"The most important element of peer counseling is the example of another person, who is my equal. The colleague as a role model has a more influential and stronger effect than the best expert who doesn’t have a disability," says Sigrid Arnade. Thanks to his own experiences and having to learn how to cope with his own situation, the peer has developed concepts, problem solving skills and strategies that a non-affected person simply cannot have. This is why it is easier for peers to understand fellow patients, whereby the person seeking advice feels more accepted – "...he knows how I feel!". This creates a level of trust and credibility.

The advantages of peer counseling are the role-model effect, peer and patient being equals, mutual understanding due to a shared experience and the peer’s informational edge. The peer is also able to provide support during the prosthetic fitting process and offer tips and strategies. Some patients don’t know that the prosthetic fitting process can sometimes be tedious, since the stump initially keeps changing. The peer is able to better understand the potential emotional impact of the amputation such as feelings of guilt or a sense of shame, low self-worth, worries about how the environment will react or fears about the future.

It makes a difference whether you share a mutual experience or whether you can only talk about it. The difference is in the patient feeling accepted just the way she is or whether she feels all alone in this new situation. Expanding and utilizing networks – by referring patients to self-help groups – is just as important as the one-on-one counseling sessions.

Are there plans to expand the project and establish it all over Germany?

Marth: The next PiK training is scheduled for November 13 and 14, 2015. The focus of the current PiK Initiative is on counseling persons with traumatic amputations. Yet the plan is to expand this project to include other diseases and injury areas, for instance persons with spinal cord injuries. Ultimately, peer counselors are meant to be available all over Germany.

What does inclusion mean to you?

Marth: For me, inclusion means promoting people based on their skills, potentials and talents and facilitating their equal participation in life and in our society. That is a great goal. Inclusive schools, inclusive jobs or inclusive recreational opportunities exemplify how the needs of persons with disabilities can be met. Nevertheless, persons with disabilities still have a hard time finding a job in our society for example. Persons with disabilities need more energy, more time or assistance to perform everyday tasks. They need the encouragement and support of the community. The crucial part in the process of inclusion is to observe and investigate which needs, potentials and limitations persons with disabilities have to create adequate jobs or suitable recreational activities for example. The work of persons with disabilities should get the same recognition, acceptance and pay as the work of people without disabilities. The debate about the right to equal pay and savings is also far from over for persons with disabilities. There needs to be inclusion in this area as well.