A good training based on insufficiency: Work in health care as an ethics

Introduction

Critical analyses of the prevailing training of professionals in the health field have gained density in Brazil as of the second half of the 20th century, showing an emphasis on the biological dimension, technicalization, specialisms, the fragmentation of knowledge and practices that result in restricted perceptions of the disease and care processes, in decontextualized interventions, which are apart from living conditions and the country’s health system (Carvalho and Ceccim, 2006; Ceccim and Capozzolo, 2004; Feuerwerker, 2002, 2006; Feuerwerker and Capozzolo, 2013). Especially with regard to the field of psychology, what stands out during the training process is the perspective of independent and liberal practices of the profession in private practices, providing few resources for professionals to act in other services and in other ways (Ferreira Neto, 2010; Guareschi et al., 2011).

In the 1980s, with the implementation of the Brazilian Unified Health System (Sistema Único de Saúde – SUS) in Brazil, the need for changes in the training of health professionals became heightened, as it emphasized the importance of the insertion of psychologists in the public health system. In the same period, the movement of psychiatric reform, by discussing the madness of institutionalization processes and the predominant clinical practice, also contributed significantly to the ideas of change. There arose a perspective to qualify professionals involved with the construction of new healthcare models, with the invention of other clinical interventions and care arrangements with patients and their families. These movements resulted in the definition of the New Curriculum Guidelines that, as of 2003, began to guide the training process of psychologists (Ferreira Neto, 2010; Portes, 2010).

Between 2003 and 2010, the federal government promoted a significant expansion of federal universities in the country, increasing the number of courses and vacancies in undergraduate programmes at public universities. In this period, 126 new campuses in 116 municipalities were created (Rosa, 2013). The Baixada Santista campus of the Federal University of São Paulo (Universidade Federal de São Paulo – UNIFESP) was one of them, having started undergraduate courses in physical education, physical therapy, nutrition, psychology and occupational therapy in 2006, and in 2009, the social service. With this initial composition, the Institute of Health and Society (Instituto de Saúde e Sociedade) was created. In line with the movements of changes in the training of health professionals in Brazil, the curriculum design in this Institute was organized under the perspective of qualifying professionals prepared to work in the health system, to work as a team and to offer integral care. An interprofessional educational approach was adopted as one of the central training strategies. The psychology course, in this sense, has a curriculum design with common axes involving students from other courses of the Institute (in mixed classes) and a specific axis (directed only to psychology students). Such common axes are ‘Human beings in their biological dimension’, ‘Human beings and their social integration’ and ‘Work in Health Care’ (Trabalho em Saúde – TS) (UNIFESP, 2013). While recognizing the importance of all axes to the training process, in this article, we have chosen to discuss some issues which have arisen in the common axis ‘Work in Health Care’ (TS), as we consider this axis a feature of this educational project.

The TS axis was composed with the participation of all faculty members of the Institute aiming at a common ground in the various professional areas and seeking to integrate clinical and public health. The idea is to allow students to have contact with the living and health conditions of the population, with teams of different services that provide care actions and with health policies. The aim is at a centred training – or rather, at a decentred one – involving experience, in the sense that experience tends to produce major shifts in preconceptions, leading to a critical exercise of the various dimensions of the work in health and care production: technical, subjective, ethical and political. As of the first year, undergraduate students are exposed to ‘acting’; they are encouraged to take responsibility and to carry out care interventions that overcome the fragmentation of professional acts.

The conception assumed here is that care interventions are not restricted to the application of technical and professional procedures on a ‘sick body’, but, rather, they involve understanding the context, the cultural universe, the users’ specific ways of life and opening up opportunities for dialogue with their conceptions, expectations, priorities and desires, becoming aware of themselves as agents of their own health. They also require coordination of different knowledge and practices and different services.

We chose to prioritize the inclusion of educational activities in the areas of greater social vulnerability (slums, palafitte houses, hills) in the city of Santos, where the campus is located. In the course of training, strategies aiming at exposing students to meet with users of the public health system are used as it constitutes an exercise of otherness in terms of socioeconomic status, living conditions and housing. These exercises favour the perception that health gains concreteness in the way of living of each one and it is configured according to social and cultural traits, family, beliefs and political experiences, among others. They also seek to expand the possibilities for shared actions of the various professional areas, as the complexity of health demands, as a rule, disregards disciplinary boundaries.

The teaching activities are organized in 6-month modules in order to mix students from different courses (pairs, trios or teams). Each module focuses on certain aspects and strategies, but all of them are articulated and guided by cross-cutting issues. These different strategies are aimed to enable the expansion of modes of listening, looking, producing meaning and problematizing the complex health situations related to different ways of life.

In the first and second semesters of the undergraduate programme, students conduct activities that allow them to recognize different municipal territories, which give them an overview of the various ways of life of the population and their implications for the health-disease-care. Policies and the organization of health services are also addressed. In the following terms, the emphasis is on working with singular stories of life and health. In the third semester of the undergraduate programme, students in pairs from different courses visit an individual or family in their homes in order to construct narratives of their life stories. In the fourth semester, mixed teams of students develop and implement health promotion activities with population groups. In the fifth and sixth semesters, students are organized in mixed teams to conduct therapeutic care projects. Most educational activities take place where people live. The experiences are processed in supervision spaces with teachers from different professional areas.

A survey conducted in the period from 2009 to 2011 with the first class graduates ¹ obtained information on the effects of this training strategy for work in health care. In this research, focus groups were conducted with senior students of the last year of classes and teachers of various courses, as well as interviews with the academic dean, with course and common axes coordinators. The data showed that the contact of students with complex health needs and different ways of living, combined with the challenge of performing care actions, proved powerful for the understanding and the interventions in health problems. They also indicated the production of remarkable experiences and of their differential condition in their training.

With regard to psychology students, one of the numerous aspects highlighted about the experience was that the opportunity of seeking and building knowledge with others (professionals) decreases insecurity and fear of not knowing, encouraging, thus, inventiveness:

As far as I’m concerned, I learned a lot […] like not to be afraid of not knowing something and learn how to build something with somebody else […] Today the fear of ‘not knowing’ is much less (psychology student). (Capozzolo et al., 2013b: 141)

… We had a chance to be very creative in the activities, to explore, to get ideas […] they could not even work, but the possibility to be there inventing, for me it was very good […] and it worked … (psychology student). (Capozzolo et al., 2013b: 136)

Another important aspect was to see how clinical strategies could be designed in common, according to the situation and the moment, not confined to the specific area:

… you think the patient is depressed and you will cure her depression […] I did there a technical inventory, discovered the depression of her scale […] but it had no effect like that; what else was cool was to have arranged the medicines for her, […] and this avoided a lot of trouble because she used to take the wrong medicines … (psychology student). (Capozzolo et al., 2013b: 134)

… An experience with an illiterate lady was remarkable, we made her the life line, a psychology resource, […] we reported, in pictures, the story of her life. We made a book and when she opened it, she cried. […] Maybe if I had the traditional training of nutrition I would never think of something, something so simple that brought so much happiness to someone […]. So I think it opens our eyes quite a lot […] it was significant and interesting (nutrition student). (Capozzolo et al., 2013b: 135)

Another aspect mentioned in the focus group of psychology was the fact that the field activities did not occur only after the theoretical learning. This had an implication for the students’ experience in the sense that they found themselves facing problems whose possible conduction of a specific area had not yet been learned. Hence the tendency to think that it would be better to have known before what needs to be done:

So I think we learned well in doing so, but we would have learned better if we had been better prepared with the theory before entering … (psychology student). (Capozzolo et al., 2011: 35)

However, what was perceived as an insufficiency on being previously prepared concerned, often, the experience of the technical limits, the insufficiency of resources and intervention possibilities in psychology, demanding composition and invention of actions in each situation.

After 10 years of intense experiences since the beginning of the campus, including critical moments when there was a crisis, we decided to invite the same students who had participated in the focus group research to reassess their qualification. We had a group discussion (roda de conversa) that lasted about 3 hours in mid-2015, with five graduates who responded to the invitation. After the meeting, they accepted the suggestion to write about their qualification from their current perspective and write this article with us. Three of them sent texts whose excerpts are presented here.

One of them gave more emphasis to the opportunity of field experience than to the lack of knowledge then. And he raised an issue that was also for us becoming more noticeable over the years – the issue of ethics:

The most interesting aspect of the TS (Work in Health Care) module was to be able to go to the field even with our limited knowledge! And it was wonderful to meet different people in their realities, to welcome a person and their life history, their scars, joys and sorrows. In fact, the Work in Health Care was a module that is present in my daily activities at work, now much more refined and deepened. When I think of a substrate of this module in conjunction with the specific knowledge, it is clear that we cannot think of a technique, but rather of an ethics! An ethics of encounter, an ethics of the subject, which makes us think not just of a cure, but rather in a process of health/disease, a process that is interwoven with the life history of the subject, actor and writer of himself.

Another testimony seemed to indicate the professionals’ advantages not to assume being supported by sufficient knowledge – a greater availability for meetings, a critical positioning and the maintenance of questions about the work itself:

Fortunately in college I learned that theory is not everything and that not everything needs to fit psychological theories. It scares me to see professionals so sure of themselves and their theories and often so far from their service users/patients. I joined the labour market knowing that I do not know everything, knowing that I would be called upon to take the place of a ‘psychologist know-it-all’ type of a person, and fortunately today I do not need to occupy that place. I can make room for meetings; enjoy meetings with the users with whom I experience so many things. I can sit and have a coffee in a home visit knowing the importance that exists in ‘only’ sitting and having a coffee in someone’s home. These marks I brought from the health training, my training at the university. Maybe I left college with some faults, some holes. That’s good! Indeed, no training process can be complete and I’m sure ours had many faults. But the experience of helping to build a political pedagogical project, to participate in this construction of the university, the course, the power to question and to know that nothing is stagnant. These were teachings that I bring along with me. In my work I face many difficulties, but I know that the most valuable trait I carry with me is criticism. Being able to look at myself critically, to look at the institutions critically. Being able to have a critical positioning and to know how to position myself. As for knowledge, I live these doubts intensely in my daily work, do I know how to do it, I wonder if what I’m doing is correct, is this the best way to go? I believe it is very rich, because if I already had a previously determined practice, maybe I could not put myself so willingly to care for service users. My activism is on a daily basis; my struggle for rights is in my clinical practice. I certainly learned it during my training process! Being on the streets, walking through the territory, fighting for the service users’ rights, building the network every day, it is far from being easy, but it is the lightness of my doing, naturalness of what I learned during my training process.

A third testimony considered the impact of this training at the start of her working life: absence of speeches and better structured tools. In contrast, she noticed greater openness to seek resources and a greater willingness to take risks in different territories, in addition to realizing the presence of attention and kindness in the encounter with the other. Finally, she questioned the normalization of life that can occur without noticing, to the professional, through his or her careful action:

My training in psychology was quite general, I consider it something important. On the other hand, I remember when I graduated and I began to meet people from other universities, I was scared. I felt less prepared. I had no theoretical line of choice or even psychological jargon on the tip of my tongue. Was I a psychologist? It frightened me when I thought of myself exercising what is considered the work of the clinical psychologist. I questioned if I really was present during these five years of training, because I felt I didn’t have tools. What would that be? Today, with a distance from that moment, I see it differently. I believe that my qualification gave me the basis to practice psychology in the various spaces, it gave foundation so I can look for theories and tools for my practice wherever I consider relevant. I left college with tools like curiosity, critical thinking and questioning. I realize that I acquired tools to perform my job in a transforming way, to run the risk of being fully present without using the resource to hide myself behind the title of a ‘psychologist’. I see that the major marks of my training were the experiences in the territory, in health facilities and foremost in people’s homes. You lose fear of people, we are placed in a situation where we change the parameters known, accepted, expected. But this is not ‘a priori’; I do not think that by just having these experiences within the academic curriculum that the person will be a different professional. I see it as an opportunity. Today, I’ve been working for two years in a Psychosocial Community Centre (Centro de Atenção Psicossocial, CAPS), a public health service for adults with serious and persistent mental disorders. I see my daily life as a constant reflection on what care is all about and how it is offered because I find myself weaving my work, balancing on a thin line, where a stumble can put me in a normalizing position of other people’s lives, or worse than that, a mere vigilant. I understand that my qualification built, I think in the flesh, this attention and kindness when meeting the other. If something made me natural, it would be the only certainty that we know very little when faced with someone else’s life.

The reports have not been presented with the expectation to be representative of the view of most graduates. On the other hand, they show that, at least for some, the impact of the training process was of respect to unfamiliarity and openness to inventiveness, to other ways of life and to a shared clinic. These highlights echoed concerns of faculty members and of the axis that gradually became into being shaped along these years: the common clinic whose work from different health professionals can support, a notion derived from the above-mentioned research; the primacy of the ethical dimension in healthcare work; and the constitutive insufficiency of the training process. These are aspects that, being far more products than assumptions of our political-pedagogical project, we will discuss below.

The common clinic

The name ‘common clinic’ was given to refer to the work of different professionals in health care. Not the work in parallel of these professionals, but the intervention that they decide together without taking into consideration the disciplinary boundaries, but, rather, the circumstances of the moment and the goal established. But common clinic also refers to actions and knowledge that are not the prerogative of any professional areas; they can belong to all or to none. What is also included in this clinic are the so-called non-colonized actions, which do not fit and are not claimed by any existing professions and which can be effective in any situation. They are therapeutic inventions born out of freedom that opens when professionals meet, and they do not need to reaffirm their identity (Capozzolo et al., 2013a). This clinic develops some of the healthcare work characteristics such as attention, availability, listening, openness and sensitivity to subjective productions, movements of approach and distance, implication and trust, among others.

In the case of a shared construction of knowledge required to face the demands and healthcare needs, this clinical approach establishes a dialogue space in which the protagonists act as intercessors of one another. To that extent, it is a clinic where what is at stake is a way to interfere with the problems of individuals, groups, organizations and establishments – a clinic characterized as an exercise of singular processes.

Since the sanctioning of Brazilian Unified Health System, SUS (Law No. 8080, of 19 December, 1990), the universality and equity in access to health services, as well as ‘integrity care’, appeared as SUS’ principles. Among these, the principle of integrity is what has raised the most difficult issues for health professionals since it directly affects the theoretical and technical concepts involved in health care.

The theoretical and clinical effort undertaken to give consistency and materiality to the comprehensive principle in health care has forced clinicians to review their care concepts, towards the search for an understanding of all the singular needs, certainly very complex, of each patient. The comprehensive care in assisting implies considering, as goals of care, social interaction made easy, the network in which the multiple aspects of their existence are included and their right to a relative autonomy and a decent life project (Mattos and Pinheiro, 2005).

Due to its inclusive design that prioritizes the production of life, such a clinic is marked by an ethics of hospitality (Derrida and Dufourmantelle, 2003), regarding not only the suffering and the service users’ singularity but also the knowledge that, traditionally, borders with the various specialties. An ethics of hospitality should not be confused with a passive waiting, but, rather, it should convey the necessity of a true act of visitation of otherness, and in this sense, the use of transdisciplinary is imposed. Knowledge and practices are processually constituted, simultaneously with the configuration of problems to be considered and treated. The clinic is tested to its limits, becoming inhabited by multiple voices produced in its encounter with philosophy, politics and art.

In this polyphony, what amalgamates the clinical practice is an alliance with the poor aspects which are always present in the subjective mutations – poor in the sense of a concept of existence against all static crystallization of its duration. We have known, since the 1960s with the Social Analysis and the Institutional Psychotherapy, that what the clinic receives is, on one hand, subjects with their history, their identity forms, their truths and their memories, but that is not all. It also hosts an ongoing subjective process that will be performing through the cracks of forms, there where the untimely present itself, boosting creation.

A common clinic is not synonymous of ‘expanded clinic’, an important concept of collective health that has guided changes in training and work in health care towards comprehensive care. Although the multidisciplinary team is regarded as being important, the expanded clinic seeks to widen the focus of disciplinary intervention (Hafner et al., 2010). It depends on a heterogeneous basis, and in this sense, it does not refer to what is common to all. The common aspects are not considered a starting point, nor are the results that are achieved, but, rather, resources that are invented and that are made use of. It does not depend, for example, on a conceptual agreement. If it were necessary to build such a prior agreement between professions, the common practice would only be a Babel. Yet, even without them, clinical consensus in singular situations is produced. Hence, the common clinic is, in fact, a practice and a policy.

The common clinic cannot be taught before it is carried out. It cannot prepare students and professionals for it, unless by progressive trials. It is not a know-how process, but a make-do one (Passos, 2013). Its locus is the experience, and the experience is the unexpected field, before which all anticipation proves to be insufficient and precarious. But the unexpected is not an enemy of the common clinic; it is, indeed, its best resource, to the extent that the unpredictable aspects have a great production potential of diversity. And diversity interests the clinic.

Work in health care as an ethics

We tend to think of work in health care as professional techniques applied according to the parameters of an ethics that would correspond to principles and norms of action. Hence, healthcare professions have codes of ethics that establish rights and duties. The training includes the study of such codes and even, possibly, of frequent ethical dilemmas in professional practice, but, as a rule, this occurs at specific times of the courses, almost never in a cross-cutting way. We learn that the profession is constituted by a specific knowledge and by an adopting ethics.

Another perspective would be to take the work carried out in health care – and in it, in psychology – as an ethics. The difference would reverse the figure–ground relationship between specific knowledge and ethics, in order to consider ethics as the figure. In this case, the central aspect of qualification would be the learning of the issues that inhabit the work experience. Note that in this sense, ethics would not be taken in the strict sense of a set of rules, but in the broad sense of a certain way of doing, a position held and sustained by the professionals, as well as a way to relate with the other. To a large extent, ethics would relate to how one deals with otherness (Figueiredo, 2009). And the work in health care would be situated there as it is a form of someone’s professional care.

Merhy (2002) defines work in health care as live work in action. It would happen between the professionals and the one with whom they establish a relationship of care. It is noticeable that, in the scope of psychology, work happens within a relationship frame. Thus, one might think that on the psychologists’ side, they operate provisions – overlapping the technical resources – that lead them to act in one way or another. Such provisions would correspond to the registration of ethics. We would like to comment on two of these provisions, assuming that there are many more: one on the concept of health care and another one on the bond that the professionals establish with those they take care of.

We assume that all healthcare professionals act guided by a certain conception of health, even if they are not entirely clear about it. Depending, for example, on the weight avoiding risks has under this conception, the practitioners will recognize or not as healthy certain ways of living. They may value more life in evolving states (including becoming sick) or the maintenance of indexes of clinical tests. They may have health as a life objective or, conversely, take health as a means to live. In one case, they may value the treatments of diseases that have not yet manifested (as contemporary practices that allow people to assess pathological potentiality of genetic traits), and in another, the freedom to overcome some safety limits if they are vitally valuable. Therefore, it seems different to think of health as a ‘perfect state of a bio-psycho-social well-being’, in the classical definition of World Health Organization (WHO), or to think of it as the ability to be normative, that is, to establish new standards for the operation of the body according to needs and desires (Canguilhem, 1978). In the former case, stability stands out; in the latter, variation does (Dejours, 1986).

The second provision, which we call bond, concerns the involvement of the professionals in their intervention. This would correspond to the extent of interference that they perform in one’s life and in what duration it happens. If professional help is demanded, what is considered as being allowed and what is regarded as invasive? The issue is delicate because withdrawing, not intervening and respecting the space of others, may possibly be regarded as omission. And yet, giving up on actions by the professionals could be decisive, in several moments; otherwise, they would be acting in a prescriptive and an authoritarian way. If the patients do not accept the treatment plan made to them, it is said that ‘they did not adhere to treatment’, which is often interpreted as an irrational resistance. Even the psychologists may find it difficult to understand that someone does not want to undergo a treatment when they seem to badly need it.

Here, it is implied the idea of autonomy, which stands for something that should be encouraged. Autonomy does not mean independence because the last can not be found in human relationships. Autonomy might be defined as the devolution of dependence to few people or things (Kinoshita, 1996). Health intervention could aim at the expansion of the patients’ networks (formal and informal) by providing them support, and more dependence and autonomy. Thus, integrity should not be seen as a complete and all-encompassing care, but as a recognition of the partial contribution of each and everyone for the life of all.

A good training based on insufficiency

The axis configuration Work in Health Care focuses on practices carried out by mixed groups of students from different professional fields of the early years of undergraduate programmes – when access to specific knowledge is still incipient – supervised by teachers with different conceptions of health and care, even if they seek to align themselves with a certain discourse of public health; in city spaces and areas with populations (residents of slums, hills and palafittes) that do not allow any stable setting. Out of this landscape derives the possibility of thinking a training ‘based on insufficiency’ making a shift in the idea of psychology training which is ‘good enough’ proposed by Luiz Claudio Figueiredo (1996).

The idea of insufficiency can be an affirmative possibility for training, both in that it resists the hegemonic panorama with impositive models and in that it recognizes the difficulty of compiling fair measures when taking into consideration the precariousness of the university infrastructure, of the relationship with the government, of disputes between training conceptions and social miseries.

By bringing Winnicott’s notion of ‘a good enough mother’ into the field of training in Psychology, Figueiredo is inspired by the idea of a mother who gives the baby supportive care and the necessary protection so that he or she physically subsists and is constituted psychically, but who also provides, as far as development of children’s abilities improvement, a succession of mismatches. Figueiredo points out that, for Winnicott, a mother who is not capable of that basic adaptation to the needs of the baby is very pernicious, but one that does not allow herself to fail – the overprotective type – will never give the child who is developing the space for it to grow and acquire certain experiences. Thus, Figueiredo (1996) takes to reverse these precarious aspects and affirms the possibility of leaving something to be desired – an expression that is often used negatively. The image of the ‘good-enough mother’ serves Figueiredo as a way of valuing the failure in forming relationship in psychology (either between psychoanalysts and patients or between teachers and students) that can be taken as a possible opening.

At first sight, and considering this concept, training in psychology in the module Work in Health Care could be taken as ‘good enough’ – and on attractive terms – since teachers and students, in the midst of mishaps, are willing to find the best way to provide assistance to the population. However, when processing what occurs since its implementation with increased lens, what is found, regardless of what is intended, is a qualification that is not detached of its precariousness of their locations – hills, palafittes and slums – a training which also leaves to be desired as far as the living conditions of those who are attended.

This does not mean having a plan for a weak training, but, rather, to understand and to affirm what happens in this educational process planned to be sufficient and that failing to achieve this sufficiency leads to unusual deficit directions and, at the same time, is also interesting to strengthen students towards the relationship with the professional field of assistance in health care. This failure relates, in other ways and by other means, with the problematization of ideals and training models (which try to be sufficient) overlapping the experience of the live work in action. Basing the discussion on the limits of healthcare assistance can help to divest of a certain selective doctrine that elects whether we are more or less close to the appropriate model of psychology in the health field.

How to produce psychology in health care without a psychology and a health model? Rather than giving up the models – which does not mean sinking into mere intuition or spontaneity – perhaps in the training it is interesting to rethink the model status in tension with a detaching operation by means of the practice and its precariousness, a disbelief in act, for desertion, of the ideal alternatives around us and of moulds of possibilities that are presented to us.

The circumstances in which the modules of the axis Work in Health Care occurred with regard to psychology training, as described above, have resulted in operating with the insufficient condition of not having power. It is not merely the insufficiency in relation to the idealized model that would always escape from us. In coexisting with these experiences, there are also hegemonic forces of insecurity that summon us to fall short, indebted to everything and never finishing anything. Our bet is that experiences in the field, with their fragilities, make room for a manoeuvre and can be a kind of shift in the game of a model and of a shortage.

Given this scenario, the characterization ‘good enough’ can be considered as not corresponding to what actually happens, leading us to say that it is about a training which is ‘good by insufficiency’ when, instead of taking to the field the light of the university and health, it is this modality that is seen overturned inside out, in every encounter and the dispositions in which it entangles. The outlines of a psychology in health care find themselves dismantled amid these exhaustions and stumbling. Anyway, there is something that is not ‘good enough’ that happens regardless, in the back, when we are exhausted, when something in assisting never existed and/or has expired, when we leave the line – in a bizarre limit between power and powerlessness.

For such transits like power–impotence and sufficiency–insufficiency, in the sense mentioned here, some shifts were in place, with regard to a training centred in the classroom, with a lot of investments and negotiations with teachers and health and social care services, to meet and make some demands – for example, the privilege of the action in the field in relation to theories of psychology, which are later offered to the activities in the field, and only when necessary – as well as finding concepts that match the experiences.

However, equally important is the attention, whenever possible, to the precarious aspects that a psychology course with emphasis on health care can encompass in its field experiences, which does not imply the selection of ‘good precariousness’, but, rather, the persistent problematization of the inevitable failures. Thus, a training ‘good by insufficiency’ would be the one that gives support to destabilization, handling the intrinsic precariousness to the field and life vicissitudes, at the risk that sometimes there are imbalances in the use and/or monitoring of students.

Assuming this dimension of the work is taking responsibility for their own failure, without, however, refraining from persisting in their improvement. It is assumed here that qualifying experiences are not meant to accompany students or guide them throughout all their professional training, which actually never ends. If they are able, however, to effectively preserve the incompleteness inherent to everything that is alive and to the field interference in which the professional shape (the student not complete) has not ‘stuck’ entirely (Gombrowicz, 2009), each one should assume their own uneasiness from then on.

Such a training inevitably introduces a dissatisfaction field and asserts that they are mobilizing features of each person’s work – teachers’ and students’. What accredit this assertion are the testimonials from graduates, who claim to have created willingness to meetings and the field management, through sorrows, joys and frustrations. But there are no guarantees.