ORIGINAL RESEARCH

Resonances of a group in the lives of women in a mental health service

Larissa de Almeida Rézio^I; Priscilla Daleffe de Moraes^II; Cinira Magali Fortuna^III

^I Nurse. Master's Degree. PhD Student, University of São Paulo. Federal University of Mato Grosso. Brazil. E-mail: larissarezio@hotmail.com
^II Nurse. Graduated. Civil Servant. Brazil. E-mail: daleffemp@gmail.com
^III Nurse. PhD. Professor, University of São Paulo. Brazil. E-mail: fortuna@eerp.usp.br
^IV Thanks to the Foundation for Research Support of the State of Mato Grosso and to the National Council for Scientific and Technological Development.

DOI: https://doi.org/10.12957/reuerj.2018.11359

ABSTRACT

Objective: to examine how a group resonated in the lives of women attending a mental health service in Mato Grosso state. Method: a descriptive, qualitative approach was applied through semi-structured interviews of five women, from April to June 2012, after approval by the research ethics committee. The theoretical framework was based on operative groups and psychosocial care. Results: the women's group assisted in social reintegration, autonomy-building, and reestablishing social and family ties. The group's gender homogeneity helped participants identify, and develop and maintain interpersonal ties, and encouraged them to remain in the service. Conclusion: the study confirmed the operative group's importance as a working tool in mental health care, where its repercussions aligned with psychosocial care and women's needs.

Descriptors: Mental health services; Group processes; Women's health; Nursing care.

INTRODUCTION

The consumption of psychoactive substances (PAS) has always existed over time, not being restricted to the male gender.¹ Nowadays, as an aggravating factor in this process, the preservation of self-image related to prejudice and social stigma vis-à-vis women who consume PAS has as a consequence the hidden use¹ and the delay in the search for treatment. However, there is a predominance of studies on chemical dependence for the male gender, under-representing the situation of women.²

Being a woman and a PAS user is still a problem not addressed by public health policies. Despite the increasing number of women users of PAS, there are few strategies that favor their treatment and stay in the Psychosocial Care Centers (CAPS - Centros de Atenção Psicossocial) with specific care for alcohol and other drugs (CAPSad). These are aimed at the social reinsertion and the construction of autonomy of the PAS users, through group activities (operative group, therapeutic, among others), as the main working instrument, stimulating the access to work, leisure, exercise of civil rights and strengthening family and community ties.^3,4

The preventive and care policies need to advance, based on the plurality and specificity of each gender.⁵ We still experience the hegemony of a moral discourse that often prevents the understanding of wholeness, leaving citizenship, autonomy, and gender-specific issues in public policies in the background.⁶

When we talk about CAPS being available in a territory, we must think beyond the physical mapping of a community, - but in the space where life happens and is processed, with its singularities, and which is marked by many types of relations: social, power, struggle, and history.⁷

From this, during the participation in the Work Education for Health Program - Mental Health, Crack and other Drugs, in discussion with the CAPSad team, it was decided to hold a specific group for women, seeking their participation in the treatment process, sharing their stories, relationships, and singularities, making this group a place of power and extension of their territory/their home.

The relations formed from a group allow the integration/interaction between the members, the elaboration of new knowledge and the questioning about oneself⁸ favoring the self-awareness and personal formation from the contact with the other.

The group activity is the main therapeutic tool in CAPSad, with a relevant role in the search for autonomy and social reintegration, but most of the time it is performed in a mixed group (men and women).

It is important that women users of PAS are assisted in specific programs that are attentive to the varied dimensions of their problems, since they may not feel free to speak freely when they are among men (and vice versa).⁹

Thus, the objective of this study was to analyze the group's resonance in the life of the women of a mental health service in Mato Grosso.

THEORETICAL - METHODOLOGICAL REFERENTIAL

We started from the group concept of the Argentine school, which has a dynamic structure, a group of people reunited by constants of space and time, articulated by a mutual internal representation, in which roles are attributed and which have explicit and implicit tasks to be performed.^{10, 11}

The explicit task is usually the reason why people gathered together, for example, in a handicraft manufacturing group, is the production of objects. ¹¹ In order to carry out their explicit task, they develop relationships and need to work on implicit tasks, such as on the problems arising from differences of ideas, power, and others.

Each member of the group has certain conceptions and values that have been constituted throughout life, and which form a given matrix. This matrix is not always flexible and the group will need to build together a set of knowledge called Conceptual, Referential and Operational Scheme (CROS). ^10,11 The constitution of a common CROS in a group allows the elaboration of the tasks in a collective way and gains of quality in the group process.

The operative group technique aims at developing learning from the bond with the other, in a critical perspective of the reality based on communication. Learning implies transformations of the self and of the reality.¹¹

In the Pichonian theory, the therapeutic process is closely linked to the learning of new ways of signifying yourself, the other, and life. ¹¹ The group operates by developing the task and themselves as a group in a single time.

Method

Descriptive study of a qualitative approach.¹² The data collection was carried out with five participants from the CAPSad women's group from Cuiabá - MT, from April to July 2012, who had participated in at least seven meetings. It was considered seven encounters as the average established in group activities¹³, and to encourage the establishment of bonds¹¹ and the exchange of experiences.

The charm of the group was held weekly, lasting one hour. Six women used to participated on average, in addition to three coordinators (psychologist, nutritionist and nursing academic). At the beginning of each meeting there was talk about the daily life and feelings regarding the use or not of PAS. Afterwards, the professionals would suggest the resumption of the theme proposed by the women in the previous encounter. Subjects such as beauty, self-care, self-esteem, feeding, culture, work, women's health and handicrafts were worked on.

The data source was the women's statements, collected through a semi-structured interview script, seeking to identify the resonances of the group in their lives and what motivated them to remain in the group.

The psychosocial care and operative groups were used as the theoretical reference, and for the treatment of the data, the thematic content analysis was used, in which it was necessary to carry out the ordering of the data from the nuclei of sense, "whose presence or frequency means something to the analytical object aimed";^12:316 then the themes raised were classified, from which the categories were extracted and the final analysis was carried out.

Two empirical categories were identified: the group as a possibility of social reinsertion, autonomy and reestablishment of bonds; and the importance of the women's group in a mental health service.

The interviews were recorded and performed individually, in a room at the CAPSad with the prior consent of the participants, through the signing of the Free and Informed Consent Term (FICT), which guarantees anonymity and freedom to withdraw. The project was approved by the Research Ethics Committee of the University Hospital Júlio Müller (UHJM) under the registry No. 173/CEP-HUJM/2011.

For guaranteeing their anonymity, it has been assigned randomly to each participant the letter E (interview), followed by an Arabic numeral (1, 2, 3, etc.), for example: E1, E2, E3, E4 and E5.

RESULTS AND DISCUSSION

A group focused specifically on women, built and planned for/with them in a contextualized way was important not only for the permanence in the service and treatment, but mainly in the achievement of the purpose of the psychosocial care, such as the construction of autonomy and social reintegration of people in psychological distress or in use of PAS. ^3,4 The feeling of acceptance and identification that was developed also favored the construction of a bond, mutual support, recovery of the self-esteem and social relations.

The group as a possibility of social reintegration, autonomy and reestablishment of bonds

The social reintegration is considered to restore social bonds once compromised by the abuse of PAS, as well as the individual's ability to exercise their right to citizenship, being motivated to resume their activities as work, leisure, education, sports and culture.^{4, 14, 15}

The care should be directed to the territory of each subject and to a network that includes services and devices, such as work, leisure and family, so it is possible to deinstitutionalize the care, reintegrate/reinsert people using PAS, recognizing their singularities, complexities, diversity and heterogeneitye.⁷

The group of women allowed the incentive to return to work and other activities, restoring social bonds and stimulating their autonomy, thus enabling the social reintegration.

There was a production of projects on the Pichonian side, because when working on the group task, to link, communicate, it is possible to glimpse possibilities. This meets the objectives of social reintegration, through partnerships with health network devices. For this purpose, activities can be articulated with the family health units (FHU), building partnerships on the production of care through the generation of work and income, which facilitates when it is not restricted to a single health service.¹⁶

A study shows that 69.9% of the women using PAS did not have paid employment.¹⁵ Returning to work or receiving incentive to enter the labor market produces resonances in the lives of these women, which can contribute to the improvement of the quality of life, generating recognition and satisfaction.

This is also part of a life project that can be revised and reconstructed, regardless of income and socioeconomic context. To review and revive these projects that were forgotten, as studying, for example, implies moving towards a plan and/or a goal in a given temporality,¹⁷ which can favor the permanence in the treatment and recover the self-management of their own life.

By producing something and establishing a social relation through this product, there is a way for their human, citizen and autonomy construction.

According to the Argentine school of groups, being with the other to develop a common task allows an exercise of otherness in which the other is considered in their similarities and differences, with a discrimination of the self and its needs.¹¹

As a person reestablishes their previous activities or achieve new goals, they are also exercising their autonomy, their decision-making power, creating bonds and managing their relationship networks.¹⁸

It is considered that the reestablishment of the family bonds is an important factor for the success in the treatment,¹⁸ since the family is an essential component as a resource of the context of these women,¹⁹ in which they may be protective or not, depending on the level of social aggregation or disaggregation of the environment in which the users live.¹⁵

In this study, it was identified that by participating in the women's group, the participants began to re-establish affective/family bonds and to build new bonds between the participants, initiating a process of integration within the group and in the family.

The family support is essential for the permanence of the users in the service, and for the restructuring of their lives, being one of the motivators for the withdrawal of drugs and the search for recovery. ²⁰ Thus, the work done in the CAPS achieves greater prospects of success when there is encouragement and support from family members. ¹⁸

However, it is important, in the group experience, to discuss the quality of the bonds existing in the social network of each one, and to stimulate the construction and/or maintenance of those that are consistent with what they seek.^{18, 21}

Another fundamental aspect highlighted in a study with nurses is that the support and embracement received by women have encouraged the valuation of a comprehensive care.²²

In addition to the stimulus of resumption of the professional life and family support, self-esteem is a preponderant factor for the reestablishment of social bonds, since, the woman begins to like herself more, to love herself, to feel good the way she is; and she can also make a greater investment in self-care regarding her health.

The recovery of the self-esteem is essential for the success of the treatment in order to collaborate for the withdrawal from the PAS, in an autonomous and participative way, and not imposed; it improves the social relations, self-care^20,23 and the reelaboration of opinions and beliefs, making them more critical about the environment where they live. ²⁴

The importance of the women's group in a mental health service

The experience in a group can allow the exchange of experiences, the feeling of mutual understanding, support and the creation of a bond between the participants,²⁵ and this influence is perpetuated as a reference to build a network of social relationships capable of offering support and continence to their life projects.²⁶

The group's main function is to provide support to the participants' needs and distress, in a space where the coordinator hears the group's speech, embraces the participants and imposes limits, as integration happens between them.^{25, 26} In order do so, the coordinator must carry out a planning of the activities of the group, and a group agreement among everyone.¹¹

The group format includes agreed elements, such as the duration and frequency of the meetings, whether or not new participants are admitted during the meetings, and whether it will be homogeneous (it gathers people of the same sex/gender, or of the same age group, or of the same pathology, etc.) or heterogeneous (it involves variations that do not necessarily have a standard for participants), although it is considered that every homogeneous group has its heterogeneity.²⁴

Thus, the activities become at the same time welcoming and organized, generating in the individuals the feeling of support and responsibility in their participation, structuring their sense of individual, group and social identity.¹³

Among the characteristics of the format, it was possible to identify the group bringing together women as a factor that impacted their lives positively.

The possibility of meeting regularly and being able to develop and maintain interpersonal bonds produces the feeling of support in the face of the anguish experienced.²⁵ In the homogeneous group field, it is common the identification among the participants, due to sharing similar experiences, exposing events and facts of life.^{24, 26} That is, it is essential that the gender/sex variable is considered in the construction of singular therapeutic projects.¹⁵

The identification with a certain activity and the sensation of pleasure when executing it favor the success of the treatment and the permanence of the user in the service.

This feeling generates the sense of belonging, although it is important that from such identifications, the participants can discriminate what is healthy and harmful to them, so that they can choose what is beneficial to them.^{13, 25} That is, the organization of the meetings on the same day and time allows a greater participation of the users and, consequently, the development of the feeling of belonging to the group, and it also stimulates the identification with the other women of the group.

The therapeutic factor that exists in the group composed only by women is the result of the possibility that, through established bonds, they identify with each other's suffering, see themselves as partners and overcome, together, prejudices, social rejections and support themselves in the search for continuity of their existential trajectories. ^{13, 22, 24}

This type of group can improve the understanding of the female universe, providing listening and speaking without judgments²³ in an environment where its participating members coexist with the same problem.

In this way, the potentiality present in the group for women is evident, due to the common feeling of acceptance, identification and to be able to speak without fear. Consequently, it contributes to the formation of support, feeling of belonging to the group, the reconstruction of the self-esteem and the creation of a bond between them, highlighting the importance of care for women in homogeneous groups.

CONCLUSION

The operative group favors the social reintegration of the clients served by strengthening of the existing links (family and social) and the creation of new ones (with other women) during the participation in the group, as well as stimulating the return to daily activities, including to study and to work. Thus, it is highlighted the importance of this tool for the follow-up of women in CAPSad.

As a new strategy for the permanence of women users of PAS in CAPSad, the women's group can generate a significant advance and improvement in the treatment outcomes of this population, since from the present study it was possible to verify that the women's group has stimulated aspects that are indispensable in psychosocial care.

In addition, this study contributes to the work of the nurse, as they coordinate groups in their care practice, which can use this tool to assist women in different services.

It is possible to consider as a limitation of this study the analysis of a specific experience in a single scenario and with a reduced sample. However, its relevance for reaffirming the group as a tool for the care of women in CAPSad should be emphasized.

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