Shaping Professional Role in Peer Support: A Qualitative Study of a Training Process

This study presents a qualitative exploration of the first national Ex-In (Experience Involvement) training programme for peer support workers (PSWs) implemented in Italy. Funded by the Ministry of Health and delivered in 2023-2024, the programme represents the first EX-IN training evaluated at a national level within a context where the PSW role is not yet formally institutionalised. Data collection included semi-structured individual interviews with 18 participants, participant observations during two residential training weekends, and a six-month follow-up telephone survey focused on employment status. Data were analysed using reflexive thematic analysis within an interpretive qualitative framework, privileging participants' meaning-making processes over predefined outcome measures. Three interpretive themes were developed: (1) from lived experience to situated knowledge, describing the epistemic repositioning through which personal biography was reworked as a professional resource; (2) proximity and boundary, highlighting how participants constructed professionalism by regulating experiential closeness, self-disclosure, and emotional involvement; and (3) between mediation and advocacy, showing how the PSW role was understood as a third position within services, requiring critical independence, ethical responsibility, and collective recognition. The training programme supported a collective reworking of personal narratives, enabling lived experience to be transformed from private biography into situated professional knowledge. Participants reported increased self-awareness, recognition of recovery trajectories, and a strengthened professional identity, fostered by the residential and participatory group-based format. At the same time, challenges emerged related to emotional sustainability, managing openness without over-identification, and maintaining autonomy in the mediating role. Overall, the findings highlight the need for training adapted to local contexts, targeted preparation of mental health professionals to support interprofessional collaboration, ongoing supervision to sustain professional boundaries, and greater job stability to enable the sustainable integration of PSWs within Italian mental health services.