https://doi.org/10.37955/cs.v8i2.342
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Effects of peer-to-peer care
promotion on psychic distress and
psychological distress
Efectos de la promoción del cuidado entre pares en el
sufrimiento psíquic
Claudia Díaz Carbajal
Maestra en Salud Mental de la Infancia y la Adolescencia (Universidad Autónoma de
Querétaro, México)
psic.clau92@gmail.com
https://orcid.org/0009-0002-5917-7321
Guillermo Hernández González
Maestro en Psicología Social (Universidad Autónoma de Querétaro, México)
guillermo.hernández@uaq.edu.mx
https://orcid.org/0000-0001-68232236
ABSTRACT
The results of a qualitative exploratory research are presented, which
aims to identify the effects of promoting peer care on the strategies
with which adolescents face psychological suffering. A
psychoeducational workshop was used, which was evaluated through
the student's diary, COL log and focus group. The results include
reflections around 4 strategic axes against psychological suffering,
support networks, self-care and peer care.
RESUMEN
Se presentan los resultados una investigación exploratoria de corte
cualitativa, que pretende identificar los efectos de la promoción del
cuidado entre pares en las estrategias con las que los adolescentes
enfrentan sufrimiento psíquico. Se recurrió a un taller psicoeducativo,
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mismo que fue evaluado a través del diario del estudiante, bitácora de
COL y grupo focal. Como resultados se encuentran reflexiones en
torno a 4 ejes estrategias frente al sufrimiento psíquico, redes de
apoyo, autocuidado y cuidado entre pares.
Keywords / Palabras clave
Psychological suffering, care, peer care, mental health, adolescence
Sufrimiento psíquico, cuidado, cuidado entre pares, salud mental,
adolescencia
Introduction
Adolescence as a stage of development involves, beyond pubertal
changes, the reorganization of socialization processes, partly due to
the needs of adolescents to be read differently from childhood, and
partly due to the change of expectations that the adult world places on
them, in the words of Rosabal, et al. (2015):
It has been common in different societies and cultures that the transit
between the child and the adult, is marked by a change in expectations,
in relation not only to sexual and reproductive functions, but also to
social status, comprising a wide variety of rites and beliefs that have
sought to socially differentiate a stage of life, called adolescence (p.2).
These expectations, which are generally built on adult-centered
coordinates, propose a hegemonic vision of life at this stage, which is
often far removed from the possibilities of adolescents (Obiols, 1993).
Thus, the demands of success and well-being presented by the market
and its cultural products, which are reinforced in the spaces of
socialization, are elements that generate various forms of discomfort
in those whose daily lives place them on the margins of the model.
Castelló (2016) that in adolescence a series of emotional discomforts
linked to the context and the social system are presented, discomforts
that demand prompt attention instead of waiting for a disorder to
develop. In agreement, Rosabal et al. (2015) argue that adolescents
may exhibit risk factors and behaviors by not addressing social
pressures that make them feel uncomfortable in a timely manner.
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We then speak of everyday discomforts faced by people in adolescence,
which from Ausburguer (2002) is referred to as psychic suffering, i.e.
those forms of discomfort that do not fall under psi gnesology, and
cannot be categorized as illness. The use of psychic suffering as a
category allows placing the tensions at a subjective level, distancing it
from any attempt to pathologize, and avoiding placing it in the
coordinates of disorders.
In this sense, Augsburger (2002) states that psychic suffering is not a
predictor of a disorder, although it may precede it; thus, psychic
suffering in itself is presented as a need for attention in adolescence,
since its identification and the development of resources to mitigate it
are key in the development process.
In the case of adolescence, the sources of psychic suffering can be
identified as school problems, family situations, relationships with
partners or friends, the relevance of decision-making in their lives,
among others (Diaz-Carbajal and Hernandez-Gonzalez, 2021).
Another possible source of psychic suffering in adolescents is the idea
of thinking about their future, since it is a socially traced path:
reaching youth, achieving professional success, forming a family of
their own and living happily for the rest of their lives, pigeonholing the
ways in which adolescents could take charge of the lifestyle they would
like to have.
For Hernández-nava et al (2020), the sources of psychic suffering of
males in a rural context are crossed by gender logics; in their study,
the authors find as sources of psychic suffering family situations of
conflict, the discomfort derived from dating relationships and
community violence. In addition, it is identified that the main resource
for self-care and mutual care is alcohol consumption, which, on the
one hand, refers to hegemonic masculinity, and on the other hand,
shows the continuum between care and risk practices.
In the face of psychic suffering, it is assumed that one of the main
coping resources is the construction and strengthening of care
practices among peers, as cited by Gracia et al. (2001, cited in Orcasita
& Uribe, 2010).
Some research shows that the relationships established between
people allow minimizing the adverse effects of different stressful
situations, in addition to the fact that people in better psychological
and physical conditions were those who maintained a greater number
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of interactions or were socially integrated, as opposed to those in
conditions of isolation or little integration (p. 70).
For Pezoa (2022), care makes the interdependence of people visible
and from there ensures the sustainability of life. While for Duboy-
Luengo and Muñoz-Arce (2022) care networks are a way to remedy
the social crises we are facing, distancing care from mercantile
coordinates.
From the mental health perspective, Keller Garganté (2022) argues
that the different devices that promote mutual support and care make
it possible to share experiences related to psychic suffering, as well as
self-care strategies. The author argues that these spaces generate trust
and reciprocity, creating a safe space, free of judgment and power
relations. This is achieved from 4 fundamental norms: confidentiality,
commitment to assistance, inclusion and respect. In addition, it
proposes to look at these devices not only as a resource for the
management of psychic suffering but also as a facilitator of well-being,
enjoyment and a meaningful life.
Di Lori et al. (2016) in turn finds that mutual care practices are formed
from social interaction, based on reciprocity and interdependence,
generating a space of protection and security that allow the resilience
of difficult situations.
Previous works demonstrate the effectiveness of promoting peer-to-
peer care in the face of various phenomena that derive in psychic
suffering either by political violence (Schoof et al., 2018) , mental
health issues (Ardila et al., 2013), domestic violence,
(CONAVIM,2012) or street situation (Di Lori et al., 2016). In
particular, on peer care promotion in young people, there are works
that seek the configuration of life projects in young people who present
social vulnerability (Lavatelli et al.,2014), prevention of school
violence (Tudela de Marcos and López de Roda, 2017; Avilés and
Alonso, 2014), discomfort derived from gender demands (Hernández
and Garbus, 2018) and coping with school stressors (Mota Sousa et al.,
2022).
In all this background, peer care is shown as a powerful resource to
cope with everyday discomforts that turn into psychic suffering,
providing a safe space. Particularly in educational spaces, since it can
be the privileged socialization space for adolescents. Kokott and
Viveros (2022) argue that the promotion of care in the school
environment is fundamental for the development of democratic
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coexistence, while Rogero (2010) proposes that the promotion of care
in school institutions allows the strengthening of a culture of mutual
care in all socialization spaces, and that these practices have the
central objective of building the maturity and autonomy of the student
body.
Within the school spaces, the bonds built with peers sustain the transit
of the academic days, prevailing in some occasions outside the school
and building networks with characteristics of a functional community
in which its members mutually influence each other. These networks
are initially formed on the basis of cultural identification, tastes,
interests, common experiences, etc., so that, once consolidated, it
becomes possible to build feelings of belonging, affiliation and/or
confidentiality, thus generating care networks that will have an impact
on the development and well-being of adolescents, inasmuch as:
"Social networks (...) constitute an indispensable element for the
health, adjustment and well-being of the individual. The important
aspect of support networks is that they are emotionally significant
people for the individual and are the ones who potentially provide
social support" (Orcasita & Uribe, 2010, p.70).
Aranda & Pando (2013), refer that:
"Two types of networks can be distinguished: the informal (where the
existing interactions are mainly through the family, spouse, children,
siblings, relatives and friends), and the formal (where the interactions
provided are mainly through groups, organizations, social centers,
health centers, etc.), and where all of them, to a greater or lesser
degree, are important and necessary in any situation, whether critical
or not" (p. 240).
From the above, peer care networks provide resources that are difficult
to reach from other spaces or actors, since it is with peers that
processes of identification, belonging and protection are built in times
of adversity, to alleviate experiences of vulnerability or risk and the
accompaniment to find solutions to different situations safely
according to the needs that arise. Thus, mutual care, while preventing
exposure to other possible events of adversity, proposes that the
lessons learned from this practice be transferred to other stages of
their lives. In this sense, peer care networks also promote self-care,
given that the expectation of contributing to the support of others with
whom they live implies responsibility and the use of tools for their own
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benefit, which in turn means that the support of the networks is further
strengthened.
In the case of mutual care networks among adolescent peers, a certain
potential for action is contemplated by finding shared characteristics
among those involved, ranging from physical, sociocultural and/or
psychological conditions, which generate identification and bonding,
based on the certainty that they mutually understand each other's
conditions, as mentioned by Ardila et al. (2013) "(...) peers have a
vision of the sufferer as a similar other, and in this sense, they make
present what care is" (p. 466). From this perspective, mutual care
networks among adolescent peers are conceived as an element of
support and prevention for the experience of psychological suffering,
since they can be a source of trust and security for coping with such
discomfort, promoting mutual care.
Support or care networks, especially among peers, are an important
strategy for reducing the likelihood of risk situations arising in
adolescents; however, when viewed from the perspective of the context
in question, it is possible to recognize that, although these networks
are implicit among them, they may not be closely knit, or at the time
they do not have adequate guidance and information to provide timely
care for others, leading to situations that invalidate adolescents in
their difficult situations, or else they use strategies that put them at
risk when caring (Hernández-Nava et al. 2020).
It should be clarified that the sources and characteristics of psychic
suffering in adolescents are situated; in particular, this paper
addresses the intervention carried out with students from a high
school in the municipality of Colón, Querétaro, Mexico. The school has
an enrollment of between 230 and 280 students, mostly of rural origin,
belonging to communities where most of the inhabitants know each
other; usually the family represents an important reference for life
expectations and decision making in the short and medium term. The
form of socialization that occurs at school and therefore the
possibilities of forming care networks are influenced by community
practices, because although there is initially a certain openness to
share with those close to them their feelings, thoughts, experiences,
etc., sometimes there is some resistance to maintain this
confidentiality, and much of the gap that separates peers at this age
has to do with the fear of being exposed, pointed out and even
betrayed, because these are experiences that they carry from their
lifestyles and that they reflect in other spaces of socialization.
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In the technical report of the Psychological Attention Service of the
campus in the semester prior to the beginning of the COVID-19
pandemic, it is indicated that out of 255 students attended, 54 of them
were for academic issues, 55 were attended for school context
situations, two more students attended to receive Vocational
Guidance, 46 people presented family situations and finally 76
students voluntarily attended to receive the service for personal
situations. It is worth noting that according to the figures reported, a
large part of the student body attended the service, and it is also
observed that in some cases the academic risk is generated as a result
of intrapersonal or interpersonal situations.
Based on the above, an intervention focused on peer care was
proposed, with the following as the main objective of this work.
Materials and Methods
The results of an exploratory qualitative study are reported, where the
intervention of a workshop that promotes peer care is evaluated.
As a form of intervention, a psychoeducational workshop was used
which, as mentioned by Miracco, et. al. (2012), intends to be a
preventive device, aiming at the transmission and elaboration of
information that intends to influence a process of change on the
population in which it intervenes. The psychoeducational workshop,
had a structure of six sessions in which 14 students participated, all
self-identified as women, students enrolled in the different semesters
offered, it should be clarified that some of them knew each other
because they were in the same semester or because of previous
experiences in their high school stage.
The student's diary, COL logbook and focus group were used as
techniques to gather information. The student diary is proposed as a
narrative after each session where the participants of the intervention
describe their experience, interpretation and perspective of the work.
The LOC logbook (ordered understanding of language) is a tool that,
based on the questions "What did I feel?", "What did I realize?" and
"What did I learn?", makes it possible to recognize the effect of an
intervention on its participants. The focus group is characterized as a
group device that allows to inquire about very specific aspects of the
experience of those who participate.
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The procedure consisted of 5 stages; first, the students were invited to
participate, ensuring the voluntary nature of their participation and
requesting the signature of informed consents by the tutors. The
second stage consisted of a couple of sessions that, by means of
participatory strategies, investigated the sources of psychic suffering
of the participants.
The third stage was the implementation of the psychoeducational
workshop in six sessions, where topics related to the identified sources
of psychic suffering and peer care strategies were addressed, it should
be noted that after each session the student's diary was kept. The
fourth stage focused on the application of tools that allowed exploring
the effects of the intervention in two moments, the first one presented
as an evaluation activity within the last session, where the LOC
logbook was applied; the second one a month after the end of the
workshop, convening the focus group, which sought to identify how
they implemented the knowledge acquired during the workshop, its
efficiency and possible new positions, as well as the actions they take
in situations that mean psychic suffering in their daily life both for
them and for their peers.
Results
In the diagnostic sessions, the sources of psychological suffering
identified in the adolescent participants were: feelings of low self-
esteem, grief due to loss, family conflicts and uncertainty in making
decisions for their life project.
The adolescents identified that the predominant feelings in situations
of psychological suffering are sadness, frustration or anger; in
addition, given the lack of resources to deal with these emotions, they
may engage in self-injurious practices such as cutting themselves. On
the other hand, other attempts to resolve psychological suffering
include crying, shutting themselves away and, only in extreme cases,
seeking support from people close to them.
The participants agree that they know colleagues who go through
similar situations and that they also share experiences of having felt
discouraged from continuing to seek support due to the lack of
guidance and confidentiality among peers when they feel the need for
listening or accompaniment, since on different occasions they have felt
undervalued or disappointed when confidentiality agreements were
broken and felt judged by their listener.
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After the application of the psychoeducational workshop and
according to the instruments implemented, effects are identified
around 4 axes: strategies in the face of psychic suffering, support
networks, self-care and peer care, which are described below.
Strategies for coping with psychological distress
With regard to strategies for coping with psychological suffering, the
adolescents report that they used to use strategies to deal with their
psychological suffering, including suffering alone, keeping their
feelings to themselves and letting them pass with time. After the
reflections during the workshop, they identified that avoiding feelings
or situations of suffering could bring them greater consequences in the
short and medium term, which is why it was proposed as a new
strategy to seek support from their peers or from professionals. On the
other hand, it was found that part of their initial strategies came from
the belief that their emotions were not valid because they were
hypersensitive, or to give importance to minimal things, after the
intervention the importance of validating and making their emotions
visible, giving respect to their own processes, without omitting or
forcing them, was mentioned. In such a way that the strategies in the
face of psychic suffering that the participants found were to seek
support from peers and mental health professionals, as well as to
validate their emotions.
It was also identified in the focus group that the care strategies learned
were socialized by the adolescents to the peers with whom they relate
within the institution and outside it, and the participants also maintain
that psychological suffering accompanies situations that can occur at
any time, and that the intensity or duration will depend on the
strategies they use.
Support networks
Regarding support networks, it is found in the beginning, for
adolescents it is difficult to identify a solid support network nearby,
due to previous experiences where reciprocity or confidentiality of
peers is broken. The participants characterize a support network as
one that has the task of accompanying, listening and guiding without
judgment and in confidentiality in moments of psychic suffering; they
also recognize the risk of over-involvement in the problems of others,
so that within the workshop they construct the idea of the limit of
support, expressing that this comes when they feel that they
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"appropriate the problems" or "make others responsible for the
solutions".
On the other hand, in the workshop, they reflected on what actions are
taken when the problem exceeds the personal resources of the
network, and in view of this, it was suggested that accompanying the
search for external help, such as mental health professionals or other
instances, is part of the actions within the support network. In this area
there is an important change in the idea of building a network, since at
the beginning it was thought that the actions of the network were
dependent on what the adolescents could do, so that expanding their
possibilities of action to the search for and accompaniment in the
request for professional services provides agency to the participants on
the one hand and on the other, reduces the anguish of having to solve
everything from within the network.
However, the possibility of building support networks generated - at
first - resistance in the adolescents because their community context
regularly tends to be prejudiced, for this reason, it was feared that in
the search for a network, they could be judged or devalued in the
request for support; in view of this, it was suggested that the workshop
group itself could be a peer support network, since during the sessions,
aspects such as sympathetic listening, empathy and commitment to
confidentiality were already taking place. Thus, they find that within
the workshop they think of themselves as participants in a network in
their double possibility of giving and receiving support, thus reducing
the risks of psychic suffering.
Self-care
During the workshop, the role of self-care as a central element of
mutual care is reflected upon; at the beginning, an impossibility of
thinking of themselves in care networks is observed, either because,
although they recognize that they can care for others, they perceive
themselves with few resources in cases of events that generate psychic
suffering, or because they state that they are unwilling to receive care
actions. On the other hand, in the first instance, they prioritize their
role as caregivers, leaving aside self-care.
In view of the above, concepts of care were constructed to break the
caregiver/ cared-for dichotomy, recognizing that one can seek one's
own well-being and that of one's peers under any circumstance,
without putting either at risk or counterproductive. In addition, during
the psychoeducational workshop, self-care was characterized as a
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condition for being able to care for others, which implied for them to
recognize the risks that are generated when making decisions about
what to do with their situations of discomfort, but also to recognize
when the impositions or expectations of their context give them forms
of psychic suffering for which they are not responsible, concluding that
self-care implies knowing "what is my own and what belongs to
others", "who I am and what I want from myself", which represents the
basis for healthy and even resilient intra- and interpersonal
relationships in the daily life of adolescent girls.
Self-care, as a personal need in the face of psychic suffering, was placed
in situations of discomfort such as separation with friends or partners,
pressure from the family or community in decision making and in the
changes that daily life presents; thus phrases such as "we should not
cling to someone (...) we have to accept change so that they can be
accepted by us. ) we have to accept change so that it becomes easier"
or "I am not responsible for what others expect of me" imply that the
participants generated a starting point for taking care of themselves,
distancing themselves from the social pressure that often represents a
form of psychic suffering.
Peer care
During the psychoeducational workshop, the conditions for peer care
were built in a reflexive way; first of all, it was possible to share
experiences that generate psychic suffering in order to look at common
problems nuanced in the individual experience; from the above, two
fundamental elements in mutual care are proposed, the first one is
empathy, since having common sources of psychic suffering makes it
easy to understand the emotional field of the other, on the other hand,
the commitment of listening free of prejudices and with full
recognition of the emotions of the others. In this way, peer care was
conceived as an action that implies responsibility and respect since,
while recognizing the weaknesses of the networks in which they were
previously immersed, they themselves acquired the commitment to
respect the processes of their peers, since each one experiences their
situations differently; accompanying and listening without judgment,
not invalidating the feelings of others, recognizing that there are limits
in caring for others, and also that empathy implies the responsibility
of maintaining a line between the problems of others and one's own
were elements perceived as fundamental to not losing objectivity in
mutual care.
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It was also possible to recognize the power of peer-to-peer care, insofar
as listening to each other becomes an understanding that can distance
itself from adult-centered logics; this strengthened the participants'
capacity to accompany, care for and guide others from horizontal
coordinates.
Throughout the workshop, feelings of identification and trust were
built, which would derive in mutual support in situations of psychic
suffering, assuming that the peers can help each other in daily events
in the spaces and events they share.
In the conclusions of the workshop, the participants express that care
can be exercised in a mutual way and, within this exercise, it is
important to empathize with the other that, although they share
important similarities, each one is characterized by their individuality;
this will allow them to be sources of support without becoming judges
or supporters of any position other than that of accompanying in the
processes of psychic suffering of their peer.
The notion of mutual care networks in the adolescents who
participated in the psychoeducational workshop seems to be sustained
one month after the intervention, since the narratives of their
experiences and perspectives on what they have learned support it.
The adolescents report that they maintain contact with each other and
have managed to maintain empathy and willingness to help.
Likewise, some of them report having positioned themselves as active
agents of support for their classmates, without becoming over-
involved, managing to accompany some of them in situations of
psychological suffering. one of them mentions:
Another characteristic of the mutual care networks that they manifest
was maintained is the responsibility of being a network and respecting
their own or others' decisions, that is, considering that as a network
their limitations are in accompanying, listening and guiding without
making others' problems personal; showing availability and interest in
others while maintaining self-care.
Conclusions
Psychic suffering turns out to be a consequent effect of the inscription
of the individual to the social as mentioned by Avila (2012), who
recognizes it as that which causes the isolation of the individual
towards his or her institutions of development as a solution to the
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suffering that this causes. This affirmation is palpable in adolescents
from the identification of their sources of psychic suffering which, in
general, revolve around their relationships with others, such as: self-
esteem in the face of comparisons with others, grief at the loss of loved
ones, family conflicts derived from the expectations placed on their
children, and decision making regarding what others expect them to
decide about their lives.
According to the above and based on the studies conducted by
Hernández (2018) adolescent males in a rural municipality in the same
State of Querétaro, showed as a source of psychic suffering the
relationship with their parents and girlfriends, which leads us to
recognize again that the internal conflict that is experienced in psychic
suffering is derived from the external, however they have different
sources and ways of facing possibly derived from the establishment of
gender stereotypes, culture and also of the time.
On the one hand, female adolescents find among their strategies in the
face of psychic suffering to spend time alone in closed spaces or they
preferred to tell people they trust, in a passive way, while Hernandez
(2018), showed that adolescent males choose to express their psychic
suffering through crying, alcohol consumption or even through
violence; that is, through risky behaviors.
According to peer support networks, positive effects have been
identified among adolescents, based on what was referred to by Avilés
and Alonso (2014) who developed and tested a school support system,
whose results proved that the strength of such system is located in
making the protagonists of solutions to those involved in the peer
context, who by being sources of support also demonstrated to have
contributions in their personal growth, security and self-confidence,
traits that were identified in the adolescents participating in the
workshop, who showed openness and strengthening in their social
support skills.
With the same objective Tudela de Marcos and López de Roda (2017),
demonstrate that the development of digital media allows the creation
of efficient online spaces for the creation of remote support groups,
which, decreases the barriers to socialize support and interaction
strategies, which as a result of the confinement by COVID-19 was a tool
applied during this research, obtaining significant results in the
intervention, thus suggesting what is a viable tool for contemporary
generations that develop as digital natives.
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Based on the results obtained from the intervention carried out in the
psychoeducational workshop weaving networks of mutual care, it was
identified among high school adolescents that the sources of psychic
suffering they share are; self-esteem, mourning for loss, family conflict
resolution and decision making for the life project.
Among the strategies used by the adolescents to cope with these
situations were: being alone, keeping their feelings to themselves and
letting them pass with time, sometimes talking with people they
trusted. This leads to a comparison between the strategies used by
males and females to face their psychological suffering, since such
strategies could be based on what is socially established and allowed,
however, in one way or another, the lack of psychological, emotional
and social tools represents the risk that can be experienced in
adolescence when experiencing situations of psychological suffering
without information or some type of accompaniment.
The support networks that the adolescents identified were mainly
family and close friends, however, some weaknesses were found in
these networks, including some of the networks in their past were not
healthy for them, which caused the adolescents to show some
resistance in allowing themselves to be heard or accompanied in times
of emotional discomfort, derived from this the participants built a
concept of peer support network, based on confidentiality as a
fundamental element, listening without judgment, empathy and
support recognizing limits, as well as accompaniment and respect in
the processes of each person.
The group intervention also succeeded in identifying a possible new
peer support network among the members, which turned out to be an
option for the adolescents to experience a network consolidated in the
essential knowledge of accompaniment, guidance, and in general with
the elements they need to feel safe and in the possibility of allowing
themselves to be accompanied during their own suffering processes.
On the other hand, the adolescents socialized the strategies they built
during the workshop with the people with whom they usually related,
which showed that the tools they built are significant to the extent of
being functional in their daily lives and in their different development
contexts.
Finally, it is concluded that peer support networks are functional and
have a positive impact on adolescents as a strategy to cope with psychic
suffering, in addition to being a field of opportunity for psychology as
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a preventive strategy for mental health problems in adolescence, on
the other hand, Its areas of opportunity are the sensitization of its
members to comply with the essential principles of a network as well
as the flexible guidance or advice of mental health professionals who
can be founders of such networks without turning the relationships
into something hostile or forced, but rather adapted to the conditions
of each population.
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