Therapeutic
Companionship – Social Environment as Therapeutic Space
"Therapeutic
Companionship is a clinical practice that aims to promote autonomy and social
reintegration, as well as an improvement in the patient's subjective
organization, through expanding circulation and appropriation of public and
private spaces." — Instituto A CASA
"Therapeutic
Companionship (T.C.) is a new treatment option for clients going through a
moment of intense psychological suffering. Therapeutic Companionship is a
distinctive practice in which the therapist (usually a clinical psychologist)
accompanies the patient through a wide variety of daily tasks and activities,
enabling them to deal with the conflicting issues that emerge from these
activities." — Psychologist René Schubert
"Therapeutic Companionship (TC) is a mental health clinical tool carried out by a psychologist whose goal is to promote social integration and ensure psychiatric treatment. The role of Therapeutic Companionship (TC) is to mediate and articulate the individual's relationships with other people and with mental suffering, making it possible to engage in everyday leisure activities and family relationships, helping them move forward in coping with their illness. The TC goes out, accompanies the patient to appointments, makes home visits, and coordinates a treatment network." — Psiquiatria Belo Horizonte
In Brazil, it is called "Acompanhamento Terapêutico – AT”
Article
published by Estadão on November 3, 2017: Psychologists help patients
outside the office – Therapeutic companion takes part in the client's daily
life; service helped former soccer player Casagrande overcome drug addiction
Nineteen-year-old
student João Pedro Marinho arrived home in the late afternoon and found his
12-year-old brother, Guilherme, in a situation that alarmed him. He was playing
video games with a completely unfamiliar adult, and no one else was in the
apartment. Thoroughly frightened, he thought about calling the police, but
first phoned his mother, Sandra Marinho, who was at work. She laughed and
explained: "Calm down. Your brother has a TC (Therapeutic Companion) with
him."
Just a few months
earlier, not even Sandra had heard of this type of professional. The
professional goes to the patient's home and often accompanies them to public
places — such as parks, restaurants, and parties — with the goal of providing
psychological support and improving social skills. Unlike traditional
couch-based therapy, which analyzes problems based on accounts given by the
patient, TC immerses itself in the patient's individual world, taking part in
their daily life.
Although the
practice is still unfamiliar to many, it has become popular enough to reach
television drama. In the TV Globo soap opera Pega Pega, a TC enters the
storyline to help the teenager Bebeth overcome the trauma of her mother's
death. On the day of the first session, he invites the young woman on a bike
ride, which greatly surprises her. But it is precisely this "friend"
approach that helped Bebeth — in the soap opera, just as it helped Guilherme in
real life — build a bond with the therapist more quickly.
For three years
now, Guilherme has had the support of Filipe Colombini, 32, coordinator of
Equipe AT, a São Paulo-based group of 40 professionals. "He understands
what I'm talking about. He gets my views on a particular game, for example.
He's my buddy," says Guilherme, now 15. What progress has the boy made
during this time? "I learned how to study and also became more sociable. I
was always very withdrawn," says the young man, who even organized a
gaming tournament at home with Colombini's help.
The convenience
of the in-home service has also helped greatly increase the number of TCs
working with younger clients. "I work all day. Driving my kids around
really complicates life. The TC is a convenience, as well as being
effective," says Sandra.
"TC doesn't
replace conventional therapy — it's a clinical recommendation for those who
need intervention in their daily life," explains psychoanalyst Ricardo
Gomides.
According to
psychologist Andrea Vianna, "the excessive number of activities young
people are subjected to today has driven up rates of depression and panic in
this group." She is one of the coordinators of the Therapeutic
Companionship course within the Anxiety Program at the Institute of Psychiatry
of Hospital das Clínicas in São Paulo.
TC's growing
popularity is also due to word of mouth from patients themselves. Among them is
former soccer player and commentator Walter Casagrande Júnior, 54, author of
the 2014 book Casagrande e Seus Demônios (Casagrande and His Demons), in which
he recounts his struggle against drug addiction, co-written with Gilvan
Ribeiro. In his talks, Casagrande emphasizes how important TC has been to his
stability.
"I usually
do three sessions a week with three professionals who take turns working with
me," he says. "When my girlfriend and my son aren't around, I go out
with the TCs. We go to the movies, have dinner out, and I use the time for
therapy."
According to him,
early in his treatment, the TCs helped him recognize that in certain places the
urge to have a beer, for example, would come up — but that it would also fade
away moments later. That was one of the social-reintegration techniques taught
to the former athlete. "I prefer going out with the TCs because I know
they won't behave in unpredictable ways or put me at risk," says
Casagrande.
"I suffered
from social phobia. I stopped leaving the house and had given up on my
studies," says Mário Henrique, 25, who also turned to the service. At the
start of treatment, the TC and patient establish a plan together. The young man
completed his high school equivalency, enrolled in an Engineering program, and
made friends. "My life changed a lot, and for the better."
A session with a
therapeutic companion (TC), which can last one to two hours, costs between R$50
and R$250, depending on the professional. This type of service began spreading
in Brazil through Argentine psychologists in the 1970s, according to Ricardo Gomides,
"but it was a response to psychiatric reform."
The following
decade saw the emergence of Instituto A Casa, the first TC institute in São
Paulo, grounded in psychoanalysis. "Today, there are at least 30 groups
dedicated solely to TCs," says Gomides. He is referring to groups
specializing in aging and depression. Private schools, such as Augusto Laranja
in Moema, in the southern part of the city, have also begun using companions to
teach children how to study.
Bibliographic References:
Artigo do Estadão sobre Acompanhamento
Terapêutico (2017) -
http://saude.estadao.com.br/noticias/geral,psicologos-ajudam-pacientes-fora-do-consultorio,70002070681
Instituto A CASA -
http://www.acasa.com.br/home/
Psiquiatria BH -
http://psiquiatriabh.com.br/faq-items/o-que-e-acompanhamento-terapeutico/
Acompanhamento Terapêutico: Uma Introdução
(2010) - René Schubert - https://siteat.net/rene/
Schubert, R. - Caminhando e
cantando...tecendo palavras, vivências e lugares por meio do Acompanhamento
Terapêutico (in) Estrategias e intervençoes no atendimento psicologico da
criança ao idoso. Editora Conquista, São Paulo, 2024
Este artigo é uma tradução ao ingles de um artigo anteriormente postado neste blog.
