O Método Terapia Ocupacional Dinâmica e a Atenção Psicossocial: um estudo qualitativo com terapeutas ocupacionais do Sistema Único de Saúde

Abstract

Psychosocial Care (PC) can be understood as a paradigm, field and public policy for collective mental health, actively guiding the Brazilian psychiatric reform. PC brings together a theoretical and practical framework to expand the concept of care beyond the remission of symptoms, integrating subjective and social dimensions through reception, bonding, singular therapeutic project (PTS), expanded clinic, harm reduction, intersectorality and territoriality. In Brazil, Occupational Therapy plays an active role in the transformation processes of the mental health field, composing multidisciplinary teams throughout the Psychosocial Care Network (RAPS). In PC, the valorization of inter and transdisciplinary work and community actions for achieving autonomy and citizenship, on one side, places discussions on the clinic and the specific contributions of professional practices, such as that of occupational therapists, on the other side. Aimed at building specific theoretical and practical knowledge for Occupational Therapy, the Dynamic Occupational Therapy Method (DOTM) has been developed since the 1970s by Jô Benetton and collaborators. The DOTM has a theoretical-conceptual and methodological framework that allows occupational therapists the freedom to think and act creatively in different situations, considering the singularities of the target person and/or collectives amidst the dynamic movements of the triadic relationship (occupational therapist, target person and activities). The intervention processes supported by the DOTM are operationalized by the composition of the situational diagnosis, the management of the dynamic movements of the triadic relationship, the construction of new meanings through the analysis of activities and the expansion of health spaces, everyday life and social insertion. Objective: Seeking to discuss the possibilities of the occupational therapy clinic in Brazilian PC, this research explores and describes the relationship between the DOTM and PC in the context of public health. Methodology: This is an exploratory-descriptive research with a qualitative approach, which included 17 occupational therapists who work and/or have worked in RAPS facilities, with completed clinical specialization in DOTM, who answered an online questionnaire to identify sociodemographic, training and professional performance data with two narrative questions about the relationship between DOTM and PC. Ten of these professionals also participated in a semi-structured qualitative online interview. Numerical data were analyzed descriptively and by simple statistics, and narrative data received thematic analysis. Results: Most participants identified themselves as cisgender, white women, with a salary range between R$4,000.00 and R$8,000.00, and a weekly workload ranging from 31 to 40h, followed by 21 to 30h; with specialization in the field of mental health; and clinical training at DOTM between 2011 and 2020, followed by 2001 and 2010. The participants work/worked in various RAPS facilities, mainly in the State of São Paulo, with the participation of professionals from Ceará, Rio Grande do Sul, and Rio de Janeiro. The qualitative results cover four major themes: 1. Understanding PC and difficulties and challenges in everyday work at RAPS: between precariousness and resistance in sustaining care; 2. Occupational Therapy in PC, its contributions to RAPS, specific difficulties and challenges, and discussion about core and field; 3. DOTM and PC in epistemological and paradigmatic dialogues and contributions of DOTM to the operationalization of care in PC, theoretical-methodological support for core practice and strengthening of professional identity; 4. Difficulties and/or challenges between DOTM and PC, and the precariousness of RAPS. Final considerations: It was possible to deepen the debate on historical and epistemological relations through theoretical-methodological associations between concepts of PC and DOTM, such as conceptions of health and expanded clinical practice, PTS and situational diagnostic, harm reduction and the desire of the persons. Difficulties and distances identified reveal much more precariousness, absences, and/or deficiencies in public policies and their implementation. This research revealed how DOTM can favor the operationalization of PC objectives, highlighting the dynamism and flexibility of its applicability in different contexts. The findings highlight that DOTM promotes a non-dichotomous articulation between core and field practices, suggesting that a well-systematized core practice can expand, collaborate, and strengthen field practices without losing its identity.