Hands Up

Integrative Community

Therapy/

terapia comunitária integrativa

About Ict/tci

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what is ict?

Integrative Community Therapy (ICT, also known as Terapia Comunitária Integrativa or TCI) is a unique large group dialogic therapeutic modality that requires only short-term training, can accommodate groups from 15-200 people, and can be performed successfully in an online format. ICT was created by psychiatrist/anthropologist Dr. Adalberto Barreto in response to an increased need for meaningful community-based mental health services in the extremely low-income neighborhoods (also known as favelas) of Fortaleza, Brazil. This modality is based on a five-step participatory structure that elicits therapeutic community conversation and knowledge-sharing in groups of 15 or more. The primary benefits are community building, promoting a sense of “shared suffering,” providing a space of inclusion and diversity, sharing experiences to promote healthy coping strategies, and creating and reinforcing social/support networks. By emphasizing community-building in a shared environment, ICT creates a forum for solidarity, collective healing and proliferation of resiliency. 

 

Today, Brazil has over 42 training centers that have trained 37 thousand community therapists nation-wide and ICT is offered across Latin America, Africa, Asia and Europe as a first-line treatment for patients who present to their primary care physician with mild to moderate mental health complaints as a supplement to medical management. Research examined surveys from 12,000 participants and found 88.5% reported that they had successfully resolved their primary mental health complaint.

 

The goal of our project is to train a cohort of community members who can facilitate this practice in English and bring this much-needed service to the Southwestern Pennsylvania region and the English-speaking world more broadly. By training a cadre of community mental health workers in ICT, Visible Hands Collaborative hopes to subsequently create a new and sustainable stream of mental health services provided with, by and for the community that increases access while minimizing stress to existing systems.

 

why ict?

Integrative Community Therapy is based on the teachings of Paolo Freire, cultural anthropology, Resilience Theory, Theory of Human Communication and systemic thought. This practice asserts that liberation from systemic oppression occurs most completely when individuals maintain ownership of their personal and communal narrative. ICT applies this idea by facilitating patients’ agency in contextualizing their own mental and spiritual healing and encourages participants to create and share their narratives in a safe space in which they are empowered, through community input and collective story-telling, to become the protagonists of their own stories. In this practice, horizontal and circular sharing between participants with an equally valid but broad and diverse range of knowledge, is prioritized over vertical methods, in which some authority bestows knowledge or solutions upon a receiver of said knowledge in a top-down manner. Once the individual becomes the owner of narrative and knowledge, she feels more capable of facing problems in her life. The theory of practice asserts that solutions to a community’s biggest challenges are hidden within broken networks that must be rebuilt and reintegrated into shared community understanding. As such, the community acquires agency to replace its dependence on perceived systemic authorities.

Each ICT session takes place in 5 parts:

1. Welcoming – Arrival and orientation, celebration of holidays and birthdays, and discussion of rules of engagement.

2. Voting on Session’s Topic – participants are invited to propose topics for the session based on what they are struggling with in their daily lives. Once several proposals have been considered, participants vote on which topic they would like to discuss as a group. Individuals are asked to introduce themselves before proposing a topic.

3. Contextualization – The person whose topic is chosen is asked to provide more details about what their specific struggle is. Participants are invited to ask questions. The topic is then broadened to incorporate experiences from all group members.

4. Sharing – individual participants are asked to share their own experiences with the theme. They can share their ways of coping but are asked not to “give advice.” Instead, they can provide details of their own narrative. Anyone and everyone is asked to share, and poetry, singing and other forms of expression are also encouraged.

5. Concluding Ritual – Traditionally, the group stands in a circle, holds hands and recites a prayer or concluding statement.

By emphasizing community-building in a shared environment, ICT creates a forum for collective healing and proliferation of resiliency. The practice of ICT provides a novel and robust approach to bottom-up community-based group therapy. The participatory and emancipatory elements of ICT implicate its use as a powerful tool to empower members of disenfranchised communities who suffer from mental illness.

the evidence

Research on this practice is relatively new and has only become more common in the past 10 years. The majority of research on the topic is conducted by Brazilian researchers, with primary focus on qualitative outcomes. These studies provide data on outcomes among those who are treated. There is no research using randomized control trials, and therefore the following outcomes are sensitive to endogeneity from selection bias. Despite this, the research has pointed to positive outcomes. There have been some quantitative studies which I have included here:  

  • The most developed research program use of was performed by a group of researchers in 2004, 2007 and 2009 using surveys from ICT participants from across the country. Of the 12,000 participants who were surveyed in 2004, only 11.5% required referral to an outside specialty service, while 88.5% reported that they had successfully resolved the issue that brought them to ICT. Similarly, in 2008, of the 5200 who participated, 87.8% resolved their initial complaint by attending ICT and only 12.2% required further intervention. Based on these survey data, Barreto and his team concluded that by providing preventive and primary care-based ICT services, they had successfully diverted community members away from expensive and excessive specialty services that often have harmful adverse health effects (Barreto et al., 2011). 

  • Silva et al. (2016) assessed mental health in the elderly population and found that elderly individuals who attended ICT sessions regularly were less likely to have a Geriatric Depression Scale (GDS) score ≥5. 

  • Garcia (2018) showed a 20% decrease in SRQ scores after 12 weeks in a cohort of 115 patients who each attended an average of 3.5 sessions ICT over that time. Moreover, the decrease in SRQ was associated with a higher baseline SRQ score. This study also showed an increase in quality of life for participants.

  • Lemes et al. (2018) described ICT participation in incarcerated male patients with substance use disorder and showed a significant increased resilience and use of social support networks, leading to improved stability.

  • Lemes et al. (2020) studied ICT groups in drug rehab centers and showed participants’ displayed growth in domains of social support, self-esteem and resilience. 

  • Andrade et al. (2010) showed increased resilience and decreased use of prescribed psychotropic medications in patients who were referred to ICT through their primary care physician. 

  • Silva (2016) showed an increase in self-esteem and healthy social ties in a group of 11 mental health service users who attended at least 6 ICT sessions. 

  • Assis et al. (2017) observed improved self-esteem and self-empowerment in female participants of a ICT group who are victims of domestic violence. 

Additional studies, most often using oral histories and semi-structured interviews, show that benefits of ICT contributed to: 

  • Strengthening of individual resilient attributes such as self-empowerment, increased autonomy, self-esteem through reanalyzing narratives of life circumstances in a more positive light and empowering individuals to make change (Menezes Jr et al., 2019; Caricio, 2010; Cordeiro et al., 2011). 

  • Practice of social networking encourages rebuilding and reinforcement of family, social, community and spiritual ties (Cordeiro et al., 2011; Filha et al., 2009; Menezes Jr et al., 2019; Fontes, 2020).

  • Shared examples of use of resilience skills leads to changes in behavioral health and improved psychological integration and rehabilitation (Carvalho et al., 2013).

  • Sense of empowerment, improved self-esteem and behavioral changes in senior citizens via collective expression of suffering and sharing of resilience strategies (Andrade et al., 2010). 

  • Greater education about medications and integration of care through open discussion about the purpose for and use of psychotropic prescriptions (Souza et al., 2011). 

Additional studies have shown that providers and professionals-in-training benefit from facilitating ICT sessions through provision of social support networks and creating a deeper understanding of participants’ struggles and unique competencies (Jatai & Silva, 2012; Carvalho et al., 2013). Healthcare workers have reported increased communication, understanding and humanistic care due to participation in ICT with patients (Neder & Pinheiro, 2010).

 

additional resources

​Text Resources: 

  • Andrade, F. B. D., Filha, M. D. O. F., Dias, M. D., Silva, A. O., Costa, I. D. C. C., Lima, É. A. R. D., & Mendes, C. K. T. T. (2010). Promoção da saúde mental do idoso na atenção básica: as contribuições da terapia comunitária. Texto & Contexto - Enfermagem, 19(1), 129–136. doi: 10.1590/s0104-07072010000100015

  • Barreto, A. (2011). Terapia Comunitaria Na ESF/SUS. Retrieved April 4, 2020, from https://pt.scribd.com/document/270489889/terappia-comunitaria-na-ESF-sus-pdf

  • Barreto, A. (2012). Terapia comunitária: passo a passo (4th ed.). Fortaleza: Gráfica LCR.

  • Burlingame, G. M., Seebeck, J. D., Janis, R. A., Whitcomb, K. E., Barkowski, S., Rosendahl, J., & Strauss, B. (2016). Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy, 53(4), 446–461. doi: 10.1037/pst0000090

  • Burnes, T. R., & Ross, K. L. (2010). Applying Social Justice to Oppression and Marginalization in Group Process: Interventions and Strategies for Group Counselors. The Journal for Specialists in Group Work, 35(2), 169–176. doi: 10.1080/01933921003706014

  • Caricia, M. (2010). Terapia Comunitária: um encontro que transforma o jeito de ver e conduzir a vida (dissertation). Joao Pessoa.

  • Carvalho, M. A. P. D., Dias, M. D., Miranda, F. A. N. D., & Filha, M. D. O. F. (2013). Contribuições da terapia comunitária integrativa para usuários dos Centros de Atenção Psicossocial (CAPS): do isolamento à sociabilidade libertadora. Cadernos De Saúde Pública, 29(10), 2028–2038. doi: 10.1590/0102-311x00000913

  • Cezario, P. F. (2015). Integrative Community Therapy and its benefits for primary ... Retrieved from https://www.researchgate.net/publication/290649366_Integrative_Community_Therapy_and_its_benefits_for_primary_care_an_integrative_review

  • Cordeiro, R. (2011). Terapia Comunitária Integrativa Na Estratégia Saúde Da Família: Análise Acerca Dos Depoimentos Dos Seus Participantes. Revista Da Universidade Vale Do Rio Verde, 9(2), 192–201. doi: 10.5892/ruvrv.2011.92.192201

  • de Assis, N. M. (2017). Grupo de empoderamento e terapia comunitaria para mulheres em situacao de violencia domestica: relato de experiencia (Vol. 16). Sobral: Sanare.

  • Filha, M. D. O. F., Lazarte, R., & Barreto, A. D. P. (2015). Impacto e tendências do uso da Terapia Comunitária Integrativa na produção de cuidados em saúde mental. Revista Eletrônica De Enfermagem, 17(2). doi: 10.5216/ree.v17i2.37270

  • Fontes, B. A. S. M. (2020). A terapia comunitária enquanto instrumento para a construção de práticas de cuidado: uma abordagem a partir das redes sociais. Ciências Sociais Unisinos, 55(3). doi: 10.4013/csu.2019.55.3.10

  • Garcia, L. D. S. L. (2018). Case Study of a Psychosocial Mental Health Intervention in Sao Paolo (dissertation).

  • Giffoni, F. A. D. O., Vieira, A. C. C., Matos, A. B. M., & Barbosa, J. D. S. (2015). Terapia Comunitária como intervenção na Saúde Mental. ID on Line REVISTA DE PSICOLOGIA, 9(28), 61. doi: 10.14295/idonline.v9i28.365

  • Guimarães, F. J., & Filha, M. D. O. F. (2009). Repercussões da terapia comunitária no cotidiano de seus participantes. Revista Eletrônica De Enfermagem, 8(3). doi: 10.5216/ree.v8i3.7079

  • World Health Organization. (2008). Integrating mental health into primary health care a global perspective. Geneva, Switzerland.

  • Jatai, J. M., & Silva, L. M. S. D. (2012). Enfermagem e a implantação da Terapia Comunitária Integrativa na Estratégia Saúde da Família: relato de experiência. Revista Brasileira De Enfermagem, 65(4), 691–695. doi: 10.1590/s0034-71672012000400021

  • Lemes, A. G., Nascimento, V. F. D., Rocha, E. M. D., Moura, A. A. M. D., Luis, M. A. V., & Macedo, J. Q. D. (2018). Terapia Comunitária Integrativa como estratégia de enfrentamento às drogas entre internos de comunidades terapêuticas: SMAD Revista Eletrônica Saúde Mental Álcool e Drogas (Edição Em Português), 13(2), 101–108. doi: 10.11606/issn.1806-6976.v13i2p101-108

  • Lemes, A. G., Rocha, E. M. D., Nascimento, V. F. D., Volpato, R. J., Almeida, M. A. S. O., Franco, S. E. D. J., … Luis, M. A. V. (2020). Benefícios da terapia comunitária integrativa revelados por usuários de substâncias psicoativas. Acta Paulista De Enfermagem, 33. doi: 10.37689/acta-ape/2020ao0122

  • Menezes Jr., J. O. (2019). O IMPAICTO POSITIVO NA PRODUÇÃO DO CUIDADO E ATENÇÃO EM SAÚDE MENTAL ATRAVÉS DA TERAPIA COMUNITÁRIA INTEGRATIVA. Retrieved from http://temasemsaude.com/wp-content/uploads/2019/09/19412.pdf

  • Neder, C. R., & Pinheiro, S. D. A. (2010). Terapia Comunitária em ambulatórios universitários. O Mundo Da Saúde, 34(4), 520–525. doi: 10.15343/0104-7809.20104520525

  • Oliveira, D. S. T. D., & Filha, M. D. O. F. (2011). Contribuição dos recursos culturais para a terapia comunitária integrativa na visão do terapeuta. Revista Gaúcha De Enfermagem, 32(3), 524–530. doi: 10.1590/s1983-14472011000300013

  • Oliveira, S. M. D., Junior, J. O. M., Junior, S. V. D. S., Dias, M. D., Fernandes, M. D. G. M., & Filha, M. D. O. F. (2017). Rodas de terapia comunitária: construindo espaços terapêuticos para idosos em comunidades quilombolas. Revista De Enfermagem Da UFSM, 7(4), 712. doi: 10.5902/2179769220299

  • padrão, P. S. (2010, February 26). A terapia comunitária como política pública. Retrieved from https://consciencia.net/a-terapia-comunitaria-como-politica-publica/

  • Silva, N. E. K. E., Paro, C. A., & Silva, M. V. D. (2019). Terapia Comunitária Integrativa Como Tecnologia Social: Avanços E Desafios. Revista Temas Em Educação, 28(1), 150. doi: 10.22478/ufpb.2359-7003.2019v28n1.41848

  • Silva, P. (2016). A Terapia Comunitaria como estrategia de intervencao para o empoderamento de usarios de Caps em processo de alta (dissertation). Joao Pessoa.

  • Souza, G. M. L. D., Silva, P. M. D. C., Azevedo, E. B. D., Filha, M. O. F., Silva, V. C. L., & Espinola, L. L. (2011). A Contribuição Da Terapia Comunitária No Processo Saúde – Doença. Cogitare Enfermagem, 16(4). doi: 10.5380/ce.v16i4.23030

  • Terapia Comunitária se torna ferramenta essencial para o tratamento de pequenos conflitos. (2008, May). Retrieved from http://189.28.128.100/dab/docs/publicacoes/revistas/revista_saude_familia18.pdf