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Conversational resources for the expanded clinic with families in mental health

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Author(s):
Pedro Pablo Sampaio Martins
Total Authors: 1
Document type: Doctoral Thesis
Press: Ribeirão Preto.
Institution: Universidade de São Paulo (USP). Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (PCARP/BC)
Defense date:
Examining board members:
Carla Guanaes Lorenzi; Sergio Ishara; Silvia Matumoto; Emerson Fernando Rasera; Marilene Aparecida Grandesso dos Santos
Advisor: Carla Guanaes Lorenzi; Sheila Mcnamee
Abstract

Since the Brazilian Psychiatric Reform, we have witnessed an increased value of family participation in treatment. Alternatives of attention to family members in the context of services have been sought. When the challenges of bringing clinical practices into the Unified Health System are added to the debate, the concept of the expanded clinic arises, and this concept associates the notions of subjectivity and citizenship. Emphasis is placed on the importance of dealing with each concrete situation as part of contexts and social relations. A Program of Family Care in a Psychiatric Day Hospital exists in line with these concerns. This program offers several activities for families. Family Reunions are amongst these activities, and they are the specific context of this research. The contributions of a social constructionist orientation for family therapy guide family reunions with a focus on processes of meaning making. This research aimed to analyze the approximation of a practice with families (family reunions) to the notion of the expanded clinic in mental health care. The research specifically aims to: a) understand the process of meaning making in this practice, while analyzing the construction of conversational resources in the interaction, as well as their effects to the transformations of the meanings of problem and self throughout the process; and b) describe how these resources contribute to the expansion of clinical practices with families. Thirty-three family reunions (three family cases) were followed in the institution. These sessions were audio recorded, and fully transcribed, in order to constitute the research corpus. A social constructionist understanding about research practices is the methodological guide for this investigation. All sessions were submitted to a thematic-sequential analysis of the process of meaning making. We have described the negotiation and transformation of meanings about a problem that was considered, by the patient and by their family, as central to their lives. For each case, the main conversational resource constructed during the process was analyzed and described. These conversational resources are: a) inviting the social into the individual; b) weaving family dialogue; and c) knowing yourself in other voices. The analysis of each case considered: how something was constructed as a problem to be worked out; how the use of the resources was carried through; and the effects the use of this resource created throughout the case. We offer, as our thesis, a social constructionist reading of the expanded clinic, where we call attention to how the expansion of clinical practice is crafted from the effects that particular ways of interacting create in the context of practices. It is in the interactive moment that professionals and patients jointly generate understandings about who they are, what their problems are, and what they can do in relation to them, while they talk about their health issues. We discuss how the use of these resources is constructed in interactions, and how this use can contribute to the practice of the expanded clinic. We also describe clinical practices as politically committed. The research ultimately describes practical resources for those professionals interested in working within a critical and transformative frame in mental health care (AU)

FAPESP's process: 13/15185-6 - Conversational Resources for the Expanded Clinic with Families in Mental Health
Grantee:Pedro Pablo Sampaio Martins
Support type: Scholarships in Brazil - Doctorate