Acompanhamento terapêutico com crianças: contribuições de Winnicott para a atenção psicossocial

Abstract

This study seeks to analyze the Therapeutic Accompaniment (TA) clinic with children in the context of psychosocial care, based on the concepts from Donald Winnicott's psychoanalytic theory. Mental health, as an object of study and intervention of medicine, psychology and psychoanalysis, as well as a social-political question, has been seen and reviewed from various angles throughout the ages. Since the Psychiatric Reform movement, the mental health policy in Brazil, which had tendencies towards exclusion, became a proposal based on anti-psychic principles and focused mainly on psychosocial care and rehabilitation. One of the most important results of this movement was the creation of substitutive services, especially the Psychosocial Attention Centers (CAPS). However, the care provided to children and adolescents who suffer from mental disorders continues to be precarious and scarce, compared to the services offered to adults, despite effective advances in the creation of the Child and Adolescent Psychosocial Care Centers (CAPSi). The TA is created in this context, as a modality of intervention that aims to promote the psychosocial reinsertion of those in mental suffering. The TA fits into the 'outer' clinic, beyond the institutional walls, taking advantage of any place as a treatment space. In this clinic, the city, and no longer the asylums, becomes a space of experience and accompaniment of madness, happening in the city, in the interface established from the relationship between the assisted, the assistant and the public space. Through a bibliographic research, this study aims to analyze the clinical practice of TA with children, seeking to conceptualize and describe this proposal of practice in the field of mental health, examining its relation with the principles of Psychiatric Reform and psychosocial attention. It also intends to articulate the TA practice with concepts from Winnicott's theory, discussing its possibilities as a clinical strategy in the treatment offered to children at CAPSi. The results show the historical relation of TA to the Psychiatric Reform movement and to the proposal of resocialization in psychosocial care. It is verified that there is a lack of studies on TA in CAPSi contexts, while several studies place it in school, related to inclusive education. It is argued that the possibilities of TA regarding the treatment offered by CAPSi refer to its insertion in the school environment, in which the professional needs to move between the pedagogical and therapeutic postures, considering the interdisciplinary and intersectoral character of this practice. The winnicottian concepts of holding and potential space offer possibilities of theoretical foundation to the practice of TA. The function of the assistant is characterized by the holding through the support and reception, through an empathic attitude that favors the autonomy of the assisted. On the other hand, the assistant gradually calls the assisted to reality through a relationship of trust and mediation with the environment. Based on Winnicott's theory, the study intends to contribute with the foundation of the planning and execution of this practice in psychosocial attention.