Group work in the public health context: A proposal for training in psychology

Abstract

The entry of psychologists into the public health sector in Brazil is usually connected to a traditional clinical model, and, thus, marked by a lack of training for group work. A reflection on the training of psychologists for group work is essential. Aiming at contributing to this theme, the objective of this article is to discuss the training for group work in the public health sector. In particular, we aim to introduce a proposal for training in psychology in a Brazilian public university, covering a theoretical–practical module, as well as basic and professionalizing internship programmes.

Keywords

groups psychologist public health

Introduction

Many have written about psychologists’ incursion into health services in Brazil. Boarini (2008), Ferreira Neto (2004), Dimenstein (2000), Böing and Crepaldi (2010) and Spink (2009) state that psychologists have joined the health sector through the front door of hospitals and mental health clinics and that gradually psychology started to be present in other health areas, but still presenting problems arising from the maintenance of a traditional clinical model, an ahistorical understanding of the subject and a practice that, instead of questioning their own doing, assesses the patients and their suitability for intervention techniques. Psychologists’ practices as a transposition from the private model to the public one present the following consequences: (1) low efficacy of therapies and high dropout rate of treatment; (2) selection and ranking of the clientele; and (3) the psychologizing of social problems, as stated by Dimenstein (2000) and Spink et al. (2006).

One way to face this challenge has been to reflect on the training of psychologists who will work in the Brazilian Unified Health System (Sistema Único de Saúde – SUS).¹ The Brazilian Curricular Guidelines for Psychology Courses (Conselho Nacional de Educação, Câmara de Educação Superior, 2004), which regulate psychologists’ practices, provide for the development of professional skills and competencies for health care, among other professional skills and competencies to be developed during the course. According to this document, the qualification process in psychology must ensure that the professionals be able ‘to develop actions of prevention, promotion, protection and rehabilitation of psychological and psychosocial health, both individually and collectively, as well as to conduct their services to the highest quality standards and principles of ethics/bioethics’ (Conselho Nacional de Educação, Câmara de Educação Superior, 2004: 1).

Despite these Guidelines, there are still historical problems for psychologists joining SUS, whose training has been marked by a model of individualistic practices that have privileged a psychologizing understanding of the human being and social relevant issues. This model was used to prepare psychologists to enter the market through private practices as self-employed professionals, and as a consequence, there was no room for group work or for adaptation to the public health context (Böing and Crepaldi, 2010; Dimenstein, 1998) during the qualification process. As such, Dimenstein and Macedo (2006) point to the need to enhance psychologists’ practices, for example, introducing training aimed at the public health sector during undergraduate courses; introducing internships in mental health institutions that allow the creation of alternative practices to the traditional clinical model; and considering regional specificities as well as multi-professional and local knowledge in the service organization, and the stimulus for research projects related to the changes in the health sector. These challenges result from analyses about psychologists’ job insertion in the health sector and of the current public policies of human resources development for SUS.

It is important to highlight some efforts that have been made towards the professional development of health workers in Brazil that have been affecting the training in psychology courses. First and foremost is the Educational Program of Work for Health (PET Saúde), developed in partnership with universities and health secretaries, aiming to strengthen the partnership between teaching, services and community. This Educational Program (PET Saúde) integrates professors and undergraduate students in areas like public health surveillance, family health and mental health, by means of providing financial resources to the people involved. Others strategies concern professionals who already have a degree, namely: Multi-Professional Residencies, regulated by Inter-Ministerial Ordinance number 2.117/2005, directed to professionals who have had their degree for 2 years, backed up by senior professionals from different health sectors; and the National Policy of Permanent Education in Health, regulated by Ordinance Number 1996/2007, that consists of learning about health services on a daily basis, taking into account the problems faced during professional routines, considering the knowledge the teams already have (Dimenstein and Macedo, 2012; Ferraz, 2012; Meira and Da Silva, 2011; Scarcelli and Junqueira, 2011).

As for teaching of health in psychology courses, Guareschi et al. (2009) analysed the curriculum guidelines of different institutions and identified the predominance of an internalist view of the subject, a naturalized conception of health and an absence of a clear political positioning. This kind of training brings several obstacles to practice within a framework guided by the principles of the SUS which are based on equality and integrity.

In addition to these difficulties there is the lack of preparation of psychologists for group work. Working in public mental health institutions, psychologists are faced with a clinic geared to the collective that demands and justifies different practices. Rasera and Rocha (2010), based on a research carried out with psychologists who worked in the public health sectors, mention that many revealed the need of a daily group practice, but they did not defend it, as they did not understand it as a new practice aimed at the need of those cared for. The main justifications given by the professionals were that (1) it was an economical alternative to avoid waiting in line and (2) it provided a space where healthy behaviours could be taught, where socialization and exchange take place. Nevertheless, there was not a critical positioning about the potentiality of group work. Quite the contrary, according to the people interviewed, the professional was seen as the main actor, the one in charge of the group, while the patients/subjects were seen as passive individuals.

In a national research concerning the presence of psychologists in SUS, Spink et al. (2006) pointed out that group work was the third type of activity carried out by psychologists (10.4%), behind regular sessions (13.4%) and individual practices (42.1%). These data become even more worrisome as, regarding the types of health institutions, the ones that concentrate the greatest number of psychologists are the primary care centres (Spink et al., 2006). Thus, in a level of care where actions related to health promotion and disease prevention are expected, individual psychotherapeutic sessions are the most frequent interventions.

This lack of alignment in psychologists’ practices arises from a traditional clinic model as well as the lack of training for group work. Although the professional competencies to ‘coordinate and conduct group processes, considering individual and socio-cultural differences of their members’ (Conselho Nacional de Educação, Câmara de Educação Superior, 2004: 2) is present in the Brazilian Curriculum Guidelines, difficulties in conducting group work are still present. The seriousness of this situation has not resulted, unfortunately, in investigations that aim to understand its causes, and researches about this theme are rare (Borges et al., 2011).

Given the importance of qualified group work to change the way psychologists work in the SUS, it is essential to discuss the training of psychologists for group work. Recent Brazilian publications have dealt with support groups in hospitals (Dóro et al., 2011; Sorato et al., 2010) and group work developed in primary care regarding health promotion (Brigagão and Gonçalves, 2009; Combinato et al., 2010; Souza and Santos, 2012). Aiming at contributing to this theme, the objective of this article is to present a proposal for training aimed at group work in a psychology course of a Brazilian public university, covering a theoretical–practical module, as well as Basic and Professionalizing Internship Programmes.

The construction of a proposal for training aimed at group work

In Brazilian universities, courses of Psychology are typically composed of theoretical and practical modules. The latter ones, involving an internship programme, are divided into basic and professionalizing types of internship, and they must correspond to 15 per cent of the total course hour load (Conselho Nacional de Educação, Câmara de Educação Superior, 2004). An internship programme is characterized by a set of activities developed by a teacher so as to put students in contact with situations, contexts and institutions. The Basic Internship Programmes provide a learning opportunity of common competencies required for psychologists’ practices and the professionalizing ones involve learning the necessary competencies for working in a given area. In internship programmes, part of their hour load is dedicated to the development of activities and the other part to teacher’s supervision, in which theoretical and practical aspects are discussed to support the actions carried under the student’s responsibilities.

The psychology course wherein the training for group work will be discussed is made up of 10 school semesters, and each group has approximately 40 students admitted each semester. In this article, we will present the work experience with groups conducted in three different moments of the course: initially during the Basic Internship Programme (fifth school semester), followed by the module ‘Group Theories and Techniques’ (seventh school semester) and, finally, during the Professionalizing Internship Programme (which takes place as of the eighth school semester).

Learning how to conduct groups in the Basic Internship Programme

As mentioned previously, many authors have criticized the training in psychology courses, highlighting a technical and out-of-context teaching, which reproduces an individualizing and fragmented approach (Böing and Crepaldi, 2010; Ferreira Neto and Kind, 2010). The Basic Internship Programme has become an opportunity for practices that allow the interns to experience different working places, so that the student can be implicated in daily activities and come to grips with the demands of the population that is being cared for (Alves et al., 2010; Araújo, 2012).

In the experience discussed here, in the Basic Internship Programme (Estágio Básico – EB), the first contact that the students have with practice and with service users was planned in such a way that, through its practical component, it was possible for them to conduct observations, interviews, working with students from the Professionalizing Internship Programme, planning and developing interventions like the ‘conversation circles’ (roda de conversa) and so on. Through its theoretical component, the module offered space for text discussions, and the teacher supervised the actions based on field reports produced by the students. In these reports, data arising from ‘conversation circles’ are registered, as well, and above all, the interns’ impressions, sensations and emotions right after the sessions.

The aim was to place the students in contact with the daily life of a SUS primary care service, so that they could identify the health team working methods, in addition to recognizing the importance of dialogue in the relationship between service users and health professionals. It was also expected that the students should be involved in group practices supervised by more experienced interns so as to have contact with the different aspects of group work in the public health system.

The context of this experience is a traditional Primary Care Centre (Unidade Básica de Saúde – UBS). Primary Care Centre (UBS) is the entry point of service users to the health services and should develop actions at collective and individual levels. A UBS may work with either of the two health care models: Family Health Strategy or Traditional Model. In Primary Care Centres working within the Family Health Strategy Model, teams are responsible for the families of a territory and should think of broad health care actions that reach out the entire population in their area, so their action is defined by an active search, while in the Primary Care Centres (UBS) using Traditional Model, the provision of care takes place through a spontaneous demand.

Entering this field, observing the operation of a UBS, interviewing service users and workers and following the interventions of the interns in the professionalization module are actions that raise many questions, since the students are not usually familiarized with the SUS and with its health care policies. In addition to being distant, students often produce disqualifying judgments about workers and their practices. The moment when the students entered the field brought three challenges: bringing the students closer to SUS’ everyday context, overcoming the fear associated with the first professional practice and helping to build a critical view to professional practices, but avoiding disqualifying judgments.

After this first moment, the students of EB (Basic Internship Programme) started to follow the more experienced interns in a group intervention in the waiting room, that is, the ‘conversation circle’. The room’s physical space, in this case, was relatively wide and accommodated all the waiting service users. The chairs were arranged in rows facing a television that transmitted an open channel. The waiting room is a transit space of professionals and patients, which is an invitation to organize an open group.

In order to conduct the group, a resource to start a conversation is always chosen, like poetry, images, video or an object. The teacher always discusses with students the idea that the main objective of the group is promoting dialogue, so that consensus is not the final goal in the discussion proposed, let alone talking them into healthy lifestyles. Talking, sharing ideas, questioning concepts, circulating new possible ways of being and living are the objectives of the group, aimed at ‘health promotion’ and at the same time, enhancing the training of interns to understand the group as a space for meetings, disagreements, clashes, movements, therefore, the constitution of subjects, the constitution of speakers and listeners, the constitution of psychologists.

Planning and coordinating a group meeting, even if assisted by more experienced interns, is always reported as being distressing. This anxiety comes in the form of constant questioning during the supervision session: about the choice of a conversation starter, or the coordination/mediation strategy based on questions or the effective role of the group as a health promoter.

In order to minimize anxieties and to enhance the learning process, the supervision is turned into a theoretical study space, but fundamentally a space for reflection about practice. Writing and discussing the field diary becomes a daily mandatory activity that serves the purpose of tracking, thinking and rethinking the process. Another task during supervision consists of selecting and testing conversation starters. Building a structured interview based on issues that might possibly be raised by the conversation starter resource, even knowing that the group is unstructured and that the resource and the conversation are dynamic, is necessary to provide some security in the first exercise in conducting a group during EB. The construction of a road map that is rarely followed serves the purpose of assisting in the reflection that resources are dynamic and therefore there is no specific, singular, or expected theme, instead there is a conversation to be reflected upon.

After the experience in group coordination, based on field diaries and verbal reports, it is possible to notice that many interns turn to the road map when they cannot talk, when they do not know which direction to offer to the conversation. During supervision, the road map is an excellent opportunity for the group of interns to reflect on the fact that it is in everyday encounters that they will be faced with the place of not knowing, proposed by permanent horizontal dialogic action, and will learn to have a more careful listening, more absorbed in keeping the conversation with each other rather than being anxious to meet the expectations of the one who coordinates them.

At this time, other challenges emerge, like learning to talk and being present with the other as well as promoting reflection without imposing their personal truth. The EB allows for group’s processes in the health sector to be problematized early in their training process, so that students can try out possibilities and propose more active and creative actions in the professional daily life. Coordinating a group, understanding the meanings produced in this space, the intervention possibilities and the difficulties in asking questions that contribute to the expansion of perspectives are aspects that prove to be very relevant to both the practice and the training process, especially when we think of this experience in the context of EB. Even when considering that in the supervision session it is necessary to constantly deal with the feeling of helplessness experienced in the group, this experience calls for a collective action. The challenge of conducting groups that enable the coexistence of differences and the construction of new views on reality is also one that allows interns to give up control, to be the owner of knowledge and to be constituted as a professional based on the relations established with others.

The teaching of group work by means of a theoretical–practical module

Another curricular component aimed at the training of psychologists to work with groups is the module ‘Group Theories and Techniques’, whose objective is to present the main psychological theories on groups and to enable students to conduct group interventions. It is offered in the seventh term of the course; it has four weekly hours divided into a theoretical component and a practical one.

The module’s programme and its mode of operation are negotiated with students at the beginning of the semester. In this process, teacher and students present themselves as well as the initial proposal of the module. By way of exercises in groups, expectations about the module and the students’ and the teacher’s roles are identified. This approach makes room for negotiating the teaching and learning conditions, and encourages students and faculty members to have a co-responsibility for the success of the module.

In general, the theoretical component consists of the presentation of five theoretical perspectives, namely, Group Dynamics (Lewin, 1970), Psychodrama (Moreno, 1975), Psychoanalysis (Pichon-Rivière, 2000), Humanism (Rogers, 1978) and Social Constructionism (Rasera and Japur, 2007), involving both their general concepts and their application of concepts through texts of the main authors of these perspectives. The selection of these theoretical perspectives responds to the need for variety required by a module of introduction to the subject, and at the same time, contemplates the traditional authors of the field, as well as contemporary perspectives of group work. Didactically, a variety of pedagogical techniques are used, including dialogical forms of lecture, discussions in small groups, analysis of cases, conceptual games and interviews with professionals. The evaluation of the theoretical component is made on a continuous basis throughout the semester, together with the process of writing an essay in which students discuss an aspect of group work through an analysis of cultural products (cinema, music, comics, poetry, literature and television) where the concepts learned are illustrated and discussed. Given the introductory nature of this module, the essay writing requires that students do a literature search, in an exercise of research, expansion and deepening of the theory of their choice. During this process of writing the essay, the teacher guides, clarifies doubts on their achievement and provides an evaluation form with criteria, involving the structure of the text, the quality of writing, the formal rules of the essay, the authorship of the text, the description of the cultural product analysed, the theoretical and conceptual coverage, the relevance of the concepts, the correct use of analytical concepts, textual cohesion, reflexivity and creativity. Besides, it also boosts cooperation between students, who offer suggestions to each other during the drafting process and write a comment on the first draft. This form of assessment requires and enables an exercise of creation, a critical analysis and an authorial expression of the students.

The practical component of the module provides the participation and coordination of semi-structured experiential workshops, promoting the development of group coordination skills. The decision to work with semi-structured forms allows for a double learning: to organize the structure of the workshop in sequence, pace and content suitable to the group moment and to deal with the unpredictability of group comments after the development of the structured phase. In this component, divided into trios, students undertake the planning, development and evaluation of a workshop with the rest of the class. After theoretical and practical guidance, students build a proposal for a workshop which is improved by means of a pre-workshop supervision. While the students conduct the workshop in the classroom, the teacher observes and records all its development. At the end of the workshop, supervision is carried out. The evaluation process of the practical component of the module takes place by filling out an evaluation form involving three axes such as planning, coordination of the workshop and the impact on the group, based on the criteria: structure and creativity, room preparation, clarity and adequacy of instructions, timing of the instructions, identification of conversational openings, promotion of dialogic conditions, team rapport, flexibility and resourcefulness of the coordinators and ethics and care with the participants.

Throughout the module, the writing of reflective questionnaires is carried out as a teaching and learning strategy. Through these, students analyse the personal learning arising from the situations lived in class, at different times: the beginning of the module, halfway through the sequence of workshops and towards the end of the module. This strategy encourages reflection, promotes the recognition that teacher, colleagues, texts and experiences can be a source of learning and thus encourages commitment to their own learning process.

This practical reflexive form of teaching and evaluation focused on the group allows the students to learn from their own experience, acquiring new knowledge and developing technical skills in a contextualized, significant and transformative way.

Group coordination in the Professionalizing Internship Programme

The last curricular component relates to the Professionalizing Internship Programme, held in a mental health service called Psychosocial Community Centre (Centro de Atenção Psicossocial – CAPS), in which group activities are central to its operation. Created in 1989, the CAPS emerged as health care for people in severe psychological distress in a social-family environment that was supposed to rupture with the segregation logic of asylums. The CAPS provide services that are part of the Brazilian Unified Health System (SUS) and function daily with a multidisciplinary team, with open doors to new users who are initially accepted and admitted into the institution’s daily activities, and then directed to the activities offered by CAPS, which are almost exclusively based on group work (Brasil, Ministério da Saúde, 2004).

The work experience as part of the Professionalizing Internship Programme in a specialized mental health setting aims to place the students in contact with this kind of routine, to identify the health team’s working methods, to analyse criticisms of diagnosis and health care practices, to reflect on the person of the service user and to plan and develop multiple group activities sensitive to the context.

The inclusion of students in these services occurs as of the eighth term of the course. The permanence of the intern in the service is 10 hours per week, spread over three days, plus 4 hours per week of group supervision with the teacher throughout the term.

The early part of the internship programme involves 15 days in which the students observe the activities of the team, whether they are dealing with new cases or coordination workshops and ‘conversation circles’, in addition to team meetings. This is a period of intense anguish and at the first supervision sessions there is little space for the discussion of texts because the reports on the service users’ poverty and suffering with whom the interns are in contact are overwhelming.

From the very first day of the internship programme, the students keep a field diary with the activities observed/carried out as well as their thoughts and feelings arising from them. This diary is presented and discussed in their weekly supervision. After this initial activity, the supervisor is faced with his/her first task, which involves dealing with the fantasies that the interns have about a specialized mental health service. The knowledge about people in psychological distress that the students have built by then is aligned with a discussion of psychopathology, generated from the modules that have this purpose, and that do not prepare the students to meet people in the internship field that, beyond a diagnosis (often uncertain even for the referred doctor), also has a life story, a family with whom they can dialogue or not, a list of fears and desires, children with whom they have contact or not, a job abandoned due to illness, and a trajectory within the medical services. All this needs to be known so that the specialized service team in mental health, in which the interns are placed, can take care of the person as a whole, and not of the sick person or his/her illness. It is, therefore, a challenge in the early stage of the internship programme to introduce students to the person that is undergoing treatment.

This initial phase introduces the person, and not the psychotic or the patient with severe disorder, to the interns and therefore it is clear that the activities that they will start planning should be carried out having these people in mind. It is also during this period that the interns begin to identify the service users’ demands such as ‘We do not want to talk anymore. Every day there is a conversation circle’, or ‘there in the Community Center² we had more activities … here there is nothing to do’, or identify which users do not participate in the group activities offered by staff and end up meeting at the back of the premises in order to smoke and talk.

Based on these observations, some possibilities are drawn up together with the interns and begin the planning of a group activity in which they will be included more actively. At the end of the first month, the interns begin to plan their own activities during a supervision session. From the moment they get a better understanding of their clientele is (how many people on average will be seen at the service, their age, whether they are men or women, if the group will take place in the morning or after lunch) the interns are asked to come up with ideas for a group activity with an estimated duration of 30 to 45 minutes, which involves the use of simple materials such as paper, balloons and in some instances a stereo. Considering that many activities offered in specialized mental health services involve the discussion of symptoms and diseases and are arranged so that everyone has to speak, what the interns propose is always something meant to disclose new aspects of their lives that the other participants do not know. Thus, it is possible to talk about what is family, what is happiness, what dreams they have, what features of themselves they like, what quality in their peer they are able to identify, all manners of topics other than disease and sickness, or even propose an activity carried out in a different way from workshop which produces something mechanically, such as making tapestry to generate funds to buy products for other workshops. The interns are then assigned the task of planning further activities that will take up part of the morning or afternoon, in a total of 90 minutes.

One difficulty identified in the conduction of group work is related to the articulation of this activity with the service routine. In order for this to happen, there is an attempt, which is not always successful, to have the initial activity proposed by the interns connected with the following activity proposed by the unit psychologist and, subsequently, for the psychologist to be aware of the moment when the interns start coordinating the whole activity. The interns’ anguish about what is done in the routine of services is discussed during the weekly supervision. This includes not only the discussion of relevant texts understanding work in a multidisciplinary team but also the planning of group activities and a discussion of how to conduct them and an evaluation on the contribution of this to the development of a practice of non-segregating care.

In addition, it is important that the interns develop listening skills, take part in the home visit of a case that the team considers serious and prepare material for the discussion of a case together with other services that, articulated, try to take care of the person in crisis.

Possibilities and limitations

To end the presentation of this programme for group training in a psychology course in a Brazilian public university, it is necessary to highlight possibilities and limitations of the three curricular components: The Basic Internship Programme, the theoretical–practical module and the Professionalizing Internship Programme.

Initially, it should be noted that the training for group work presented here has become possible through the articulation between the curricular components, which requires dialogue and shared reflexions by the faculty members responsible for its daily development. This articulation allows for the constant improvement of the proposal.

The practice proposed by the Basic Internship Programme occurs only because the senior interns organize it. The ‘conversation circles’ in the waiting room are not an everyday practice of the service. On the contrary, whenever the unit makes use of the waiting room, the activity is based on giving information, whether with hand-outs or not, but fundamentally, in a lecture style. The presence of interns in the Primary Care Centre mobilizes service users and workers, who are often part of the ‘conversation circles’ and are surprised, not only because they allow people to talk, to think, but mainly because at the end of the ‘conversation circle’, the interns do not state what healthy ‘behaviours’ or ‘lifestyles’ the users must adopt. This is an important moment, which allows us to witness the effects of the presence of the interns at the health service, because along with learning with the services about their policies, their daily lives and their functioning, they also teach the service that ‘promoting health’ is not about indicating lifestyles, but rather, a chance to offer a space for dialogue and reflection on the possibility of being.

Despite the intensity of practice, the time dedicated to the Basic Internship Programme is short and the class, which is traditionally composed of 40 students, is divided into four subgroups, each of them with only 10 students, and under the responsibility of a different teacher who can choose his or her field of practice. Therefore, the learning experience might not be the same for all students. This fragmentation, which is a requirement of the discipline, makes it impossible for all students to have access to a UBS so as to have an opportunity for familiarization with the SUS’ policies and, therefore, develop a more critical view of the traditional models of health care.

With regard to the theoretical–practical module ‘Group Theories and Techniques’, students can learn and critically reflect on group theory and on group work carried out by professionals in different contexts. In addition, they become able to plan, to coordinate and to evaluate semi-structured group activities. The experiential nature of this module also allows for the learning about cognitive and affective aspects, aimed at the development of skills. Despite the specificities of the implementation and evaluation of educational processes focused on groups (Tomcho and Foels, 2012), it was observed that, throughout the semester, students reconsider the stereotypical view on group dynamics and develop appropriate ways to structure and organize group activities. However, some challenges still remain, such as dealing with the difficulty of students to break away from reductionist and technical models in order to be more critical of the instrumental type learning that is present in the teaching structure of psychology courses, and to promote the ethical and political dimension of working with groups. In this direction, there is also the challenge of learning a relational and dialogical attitude for coordinating groups as opposed to the traditional practice centred on the professional authority. In other words, it is not easy to develop dialogical postures guided by the recognition of the other, the valuation of their knowledge, the promotion of reflective conditions and by stimulating exchanges among the participants, which emphasize the relational dimension of group work (Rasera and Japur, 2007). Added to this, there is the further challenge of bringing the module closer to the contexts of professional practice so as to illustrate the flexibility, benefit and appropriateness of group working to the reality of psychologists in Brazil.

With regard to the work experience in the Professionalizing Internship Programme, the inclusion of interns in mental health service creates an opportunity for work in a multidisciplinary team. The presence of the students is seen by the teams as beneficial as they can become aware of both their difficulty in planning group activities (which are often decided in the spur of the moment), the example provided by the students who, although less experienced, devote themselves to the planning of the activity. The confrontation between the ability to plan, to execute and to evaluate group activities while being supervised contrasts with the repetitive activities, the paralysis when faced with the need for change and the chronification of professional practices (Sales and Dimenstein, 2009). The lack of planning of group activities in specialized mental health services conveys the idea that time must be fully occupied and idleness eliminated, which are characteristics of asylum type institutions (Cedraz and Dimenstein, 2005) and quite different from what is intended to achieve with the students.

By placing the interns in contact with this reality, the aims are to create a space to reflect on the purpose working with groups in mental health services and to contribute to the training of psychologists aligned with the ‘extended clinic’ (clínica ampliada) approach and the production of life which are the main features of psychosocial services. Training psychologists to be able to think critically about the activities offered in mental health services, reconfigured as possibilities of life production for people who are in intense psychological suffering, ‘implies triggering mechanisms that have the potential to break and to generate social forces capable of producing changes in the established order, in models of care and in chronic professional practices’ (Sales and Dimenstein, 2009: 821). According to these authors, this will only be possible while building up new professional skills through teaching.

Despite the challenges presented here, the proposals for group training described in this article carry the possibility of contributing to the training of professionals more aligned with SUS’ proposition. It concerns a training process that is focused on the transformation of those involved, as well as on collective changes in the modes of operation and care in the health system.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Notes

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