George S. Everly, Jr. PhD, ABPP, FACLP

Psychological health is the cornerstone of successful careers, successful marriages, effective child-rearing, and even physical health. At one or more points in virtually everyone’s life, however, their psychological well-being will be challenged.

Science tells usScience tells us that the best predictor of psychological well-being is a connection to supportive friends, colleagues, and family. But in some instances, that may not be enough. In those instances, reliance upon well-trained mental health providers can be essential.

Despite gallant efforts, however, we have failed to provide adequate access to mental health services even in the best of times. With a paucity of culturally competent and trauma-informed clinicians, combined with wait times lasting weeks and even months, we have failed to provide adequate services to many communities—especially to the underserved, to cultural, racial, and ethnic minorities, and to those who work in public safety and other emergency services. This is especially true for survivors in the wake of crises and disasters.

In addition, we have failed to remove the stigma associated with seeking mental health services. Perhaps it’s time for a tectonic shift in training and practice.

Peer Paracounseling

In 2006 while at the Johns Hopkins Center for Public Health Preparedness, I authored a paper calling for the expansion of psychological support services using providers other than mental health clinicians (Everly & Flynn, 2006). I later expanded this notion in papers authored in 2019 and in 2023 (Everly, 2019, 2023). I referred to the approach as “peer paracounseling.” In doing so, I’ve proposed the creation of a new role in the functional continuum of psychological health care. Peer paracounseling is not the practice of professional counseling, rather it is the psychological analogue of community paramedicine. Peer paracounseling may be envisioned as the functional integration of three processes: 1) subacute psychological first aid, 2) Allan Ivey’s micro-counseling techniques, and 3) Cherie Castellano’s reciprocal peer support. But in the final analysis, it’s really a form of coaching based in Albert Bandura’s social learning models. It is specifically designed to be implemented by those without other formal training in mental health.

Peer paracounseling involves an advanced skill-set which surpasses the skill-set of the crisis interventionist but is still short of the skill-set of the psychologist or social worker. It is intended to foster human resilience by filling the subacute epoch gap between acute emergent crisis intervention and extended counseling and psychotherapy. It requires advanced training beyond crisis intervention, but stops short of diagnosis and treatment.

While originally intended for emergency services, peer paracounseling may be used to expand psychological support to a wide array of peer groups such as healthcare providers, educators, military veterans, airline and other transportation professionals, corrections personnel, and even clergy. Peer paracounseling could also be considered a useful managerial skill.

The United Nations has stated that mental health is the cornerstone of the fabric of society. Anything that threatens it, threatens society as a whole, but anything that strengthens it can strength society. SAMHSA already embraces the use of community peers in dealing with specific mental health challenges. Psychological first aid has been used successfully in community settings, and even in Turkey after the earthquakes, in Ukraine during the war, and now its utility will soon be tested in the war in Gaza. Perhaps peer paracounseling can be a useful tool to expand and intensify the application of psychological support services for all those in need but who are unable to access traditional care.

© George S. Everly, Jr, PhD, 2023

References

Everly Jr, G. S., & Flynn, B. W. (2006). Principles and practical procedures for acute psychological first aid training for personnel without mental health experience. International Journal of Emergency Mental Health, 8(2), 93-100.

Everly, Jr., G. S. (2020). “Psychological First Aid (PFA) To Expand Mental Health Support and Foster Resiliency in Underserved and Access-Compromised Areas.” Crisis, Stress, and Human Resilience: An International Journal 1 (4): 227–32.

Everly, Jr., G. S. (2023). ‘‘Peer paracounseling’’ to foster resilience and reduce the burden on community mental health services. Crisis, Stress, and Human Resilience: An International Journal 4 (3): 151–61.