Baixa escolaridade como desafio clínico para a terapia cognitivo comportamental: estudo de caso

Abstract

This article is a description, discussion of experiences, practices and theoretical approach of an internship field. The activity was developed in the Outpatient Clinic for Care of People Living with Chronic Conditions (APC). It is important to pay attention to the profile of the population that is usually seen in this Ambulatory. Being aware of the implications that race, racism, socioeconomic conditions, level of education, and the like have on the mental health of the patients followed by the APC is not a matter of choice. These aspects play a major role in the problems that come to the clinic and need to be taken into consideration. The program in question relies on the theoretical and methodological support of Cognitive Behavioral Therapy (CBT). CBT is a structured model of psychotherapy that seeks to modify thoughts and meanings, thereby also modifying emotions and behaviors in a lasting way. The focus of this work is presented from the clinical challenges experienced during the therapeutic process of a clinical case, in view of the limitations arising from the fact that CBT does not present alternatives for the care of people with low education. Like the patient in this case, who has a life story similar to that of millions of poor Brazilians who lived a childhood with a scarcity of financial resources, emotional and material support, in addition to the devaluation of study over work. An illiterate person, who, in addition to this, has had her life guided by social and material vulnerabilities that have built her up to the point of consummating difficulties and a compression barrier regarding CBT techniques and procedures, and even her own cognitions. To face the challenges it was necessary to have strategies in the therapeutic planning that would increase the likelihood of generating specific and individualized changes for the patient. The whole process was structured and guided by practices and interventions, with changes/adjustments that contemplated a clinical formulation about the patient's development and her problems, following procedures such as therapeutic alliance, psychoeducation, and behavioral activation, for example. In the literature, there are numerous techniques and solutions with descriptions of what to do about various challenges, low schooling is not one of them. This challenge is not just about dysfunctional core beliefs, but finds barriers in the most basic understanding ofself and the world. In entire books, produced by important CBT authors, it was not possible to find knowledge or literature that effectively grounded the issue of low schooling. However, even with the adversities, CBT is a significant and effective approach to cognitive development and wellness for patients. Therefore, therapists adapt to the demands of everyday life, and use this knowledge for a good practice in their work as psychologists. Even though in this case there were a considerable number of demands and adaptations along the way, it is important to point out the strength contained in the partnership. Even with a low level of education and with difficulties in understanding the techniques, the patient reached important conclusions in therapy. Gradually presenting a cognitive flexibility previously unknown.