Peer-Led Psychotherapy: The Time Is Now

J Clin Psychiatry 2022;83(3):21lr14366

To cite: Tomfohr-Madsen LM, Roos LE, Madsen JE, et al. Peer-led psychotherapy: the time is now. J Clin Psychiatry. 2022;83(3):21lr14366.
To share: https://doi.org/10.4088/JCP.21lr14366

© Copyright 2022 Physicians Postgraduate Press, Inc.

^aDepartment of Psychology, University of Calgary, Calgary, Alberta, Canada
^bDepartment of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
^cDepartment of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
^dDepartment of Anthropology, University of Calgary, Calgary, Alberta, Canada
^eCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
^fDepartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
^gLunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
^hCanadian Perinatal Mental Health Collaborative, Barrie, Ontario, Canada
ⁱCommunity Health Sciences, University of Calgary, Calgary, Ontario, Canada
*Corresponding author: Lianne M. Tomfohr-Madsen, PhD, Department of Psychology, 2500 University Drive NW, Calgary, AB (ltomfohr@ucalgary.ca).

See reply by O’Hara and commentary by O’Hara

To the Editor: We read O’Hara’s¹ commentary on the recent article by Amani et al² with interest and agree with the author’s review outlining the effectiveness of peer-delivered psychotherapy. However, we challenge the conclusion by Dr O’Hara that it is “not yet” time for peer-delivered psychotherapy for postpartum depression.

Safe interaction with the health care system is a privilege that numerous people do not receive. There are accessibility barriers to perinatal mental health care, which are exacerbated among many equity-deserving communities.³ For many individuals from marginalized groups, seeking mental health care has led to more harm than benefit (for example, infant/child apprehension).⁴ For people who have a deep distrust of health systems, due to historical and ongoing trauma, peer support may be the safest and most culturally appropriate way to receive evidence-based services. We strongly disagree with O’Hara’s “not yet” conclusion and instead advocate that the time is now to face the growing treatment gap for perinatal populations.

Dr O’Hara asks, “But do women really want minimally trained former sufferers delivering psychotherapy—is it ethical? Is it sustainable?” We respond by asking, “Is it ethical to deny perinatal women effective interventions?” There will never be enough specialist providers to address the treatment gap for perinatal depression, and, as O’Hara points out, there is evidence worldwide in support of peer-delivered psychotherapy.^5,6 As clinicians and researchers, it is our ethical and moral responsibility to provide perinatal women with effective interventions, and peer-delivered psychotherapy offers one patient-centered and cost-effective solution. In our patient-oriented research, participants with perinatal depression have indicated overwhelming support for this modality of therapy (Singla et al⁷ and K. Chaput, PhD; M. Vekved, BSc; S. McDonald, PhD, et al, manuscript submitted).

Further, because mental health clinicians and researchers are often in places of privilege, we should endeavor to collaborate with women with lived experience and their communities to ensure that their voices are the primary drivers of new directions in evidence-based practice.⁸ With burgeoning health care costs and rates of mental health problems, is keeping evidence-based intervention in the hands of doctoral-level psychologists sustainable when much lesser trained individuals can deliver them with therapeutic impact? Acting as a peer could be protective with respect to both clients’ and peers’ well-being and a form of empowerment,⁹ making such a model particularly sustainable.

Second, O’Hara asks, “It is the case that there is a significant shortage of trained mental health professionals. But should peers be the ones to fill the gap?” Sustainable models of peer-led supervision among multiple cadres of nonspecialist providers have been shown to be acceptable and feasible in low-resource settings.^5,7 We believe that peers should be paid for their work, in the same way that any other health care provider is compensated, and that peer support can be embedded into systems of support that can help to manage and mitigate crises as they arise. Rather than questioning the growing evidence of whether peers can deliver psychotherapy, the key question is how to overcome professional guilds and build a collaborative, stepped-care system that incorporates these patient-centered models.

We acknowledge that the authorship team and our views are influenced by a feminist lens and expertise in perinatal mental health and peer support, grounded in lived experience, and guided by a deep respect for social justice and Indigenous ways of knowing. We ask for trust that these peer workers are quite capable and deserving of making the best “use of [their] talents,” to paraphrase O’Hara. People suffering from depression deserve the choice of available good medicines.

Published online: April 27, 2022.
Potential conflicts of interest: None.
Funding/support: No direct funding or other financial support (including drug company support) or material support was received for this work.