A construção de sentidos nas intervenções em Terapia Ocupacional

Abstract

This review research was based on the results of another review study that sought to understand the applicability of a Brazilian meaning making technique in occupational therapy interventions, Associative Path, of the Dynamic Occupational Therapy Method. In order to broaden the international dialogue, a theoretical, exploratory and scoping review study was carried out to understand how the construction of meanings has been approached in occupational therapy interventions. The review identified 29 studies, 22 were qualitative surveys (75%) and 18 used interviews as a tool for data collection (62%), which seems to favor the understanding of the participants' experiences of the interventions. The field of knowledge concentrated 51.7% in Mental Health (8 works) and Gerontology (7 works), to which we hypothesized the possibility that these fields of action focused more on reflections on the meaning of the individual' experiences, searching for a more meaningful life. The qualitative results indicated that meaning making in occupational therapy interventions demands: to know the individual, his/her identity and his/her beliefs about him/herself; to identify desires or needs for an intervention that meets person’s goals; to provide a suitable, supportive, safety and structured physical environment; to sustain hope as a way of glimpsing possibilities and perspectives; to offer spaces for reflection and self-criticism to recognize the experiences of significance; to assume a responsible and attentive practice that helps individuals to change their perspectives of meaning and to connect to their social contexts; to foster a work that is doable, creative and challenging, that allows the construction of new skills and the exercise of autonomy; to offer feedback. Interventions were most valued when participants felt recognized and respected for what they are and for their own ways of doing; when they resumed (even doing otherwise) or exercised new occupational roles and perceived themselves connected with other people - professionals and peers. The gaps identified were: fragile theoretical support for meaning and meaning making; few studies addressing certain characteristics that support meaning making such as: the importance of an extended time in treatment to take care of self-stigma; the place of hope in the therapeutic process; the concept of empowerment; the influence of gender on preferences and on occupations; few systematization of procedures that favor the construction of meanings; inexistence of the explicitness of the work of the occupational therapist in relational procedures; few research on the construction of meanings by people who live with target individual; and few discussion on concepts of health, normativity and occupational therapy. In addition, a theoretical study was carried out seeking to establish dialogues between the author of the Dynamic Occupational Therapy Method, Jo Benetton, and the author of the Occupational Perspective of Health, Ann Wilcock - author widely cited in the review studies. This scope research sought to map the key elements present in the meaning making process in the interventions in occupational therapy and is expected to favor the expansion of the understanding on this subject and to instigate new investigations.