Made available in DSpace on 2016-06-02T19:24:45Z (GMT). No. of bitstreams: 1 2147.pdf: 1567833 bytes, checksum: 7c9790a7046da78d9ad80aee3242cbce (MD5) Previous issue date: 2008-10-15 / This ethnography has as an objective to comprehend the logic in which the riverside population from the low river Tapajós, Pará State, Brazil, conceive the diseases and the treatments facing the Public Health programs which seek to orient these conceptions according to an own logic, and also how they answer to that according to their cosmological system. The central question consists on knowing how they acquire the biomedical speech, the clinical practice, and the public policies in Health and associate them to their therapeutic traditional model. The ethnographic material described and analyzed here was obtained during a field research (participant observation and interviews), carried out in three periods, between 2005 and 2007, in the communities Prainha do Tapajós, Prainha, Taquara, Itapaiuna and Paraíso situated in the perimeter of a federal conservation unit, and in Santarém and Belterra cities. It is noted that the riverside population acquire the outside agents and proposed changes according to pre-existing cultural schemes and articulate the biomedical model procedures with the therapeutic traditional model, as they do not see incongruence between them, even with some tension points. The Cure local specialists and the health community agents are found as fundamental subjects of this articulation and of the therapeutic itinerary. / Esta etnografia tem por objetivo compreender a lógica pela qual os ribeirinhos do baixo rio Tapajós, estado do Pará, Brasil, concebem as doenças e os tratamentos face a programas de saúde pública que procuram orientar essas concepções de acordo com uma lógica própria, e como respondem a isso segundo seu sistema cosmológico. A questão central consiste em saber como eles apreendem o discurso biomédico, a prática clínica e as políticas públicas em saúde e os associam ao seu modelo terapêutico tradicional. O material etnográfico aqui descrito e analisado foi obtido durante a pesquisa de campo (observação participante e entrevistas), realizada, em três períodos, entre 2005 e 2007, nas comunidades Prainha do Tapajós, Prainha, Taquara, Itapaiuna e Paraíso, localizadas no perímetro de uma unidade de conservação federal, e nas cidades de Santarém e Belterra. Verifica-se que os ribeirinhos apreendem os agentes externos e as mudanças propostas segundo esquemas culturais préexistentes e articulam os procedimentos do modelo biomédico com o modelo terapêutico tradicional, pois não vêem incongruências entre eles, mesmo havendo pontos de tensão. Os especialistas locais de cura e os agentes comunitários de saúde situam-se como sujeitos fundamentais dessa articulação e do itinerário terapêutico.

Text in English / The inception of psychology as a practicing profession in 1938 brought with it a continuing scientific struggle geared towards cementing its place as a value-adding health service in the form of psychotherapy. Concepts such as Empirically Supported Treatments (ESTs), Evidence Based Treatments (EBTs) and Evidence Based Practice in Psychology (EBPP) arose out of research attempts to scientifically prove the efficacy of psychological treatment versus psychiatric medications or versus no treatment. This focus on evidence in psychotherapy partly stems from, but also influences public policy in the form of practice and training mandates as well as government and insurance funding policies for psychotherapy. At present ESTs, EBTs and EBPP are the source of polarisation among psychologists who argue for either sides of this controversy, raising questions on a practical/policy level as well as an epistemological level. This thesis differentiates between ESTs, EBTs and EBPP as well as the Common Factors approach and continues to critically investigate the advantages, practical/policy implications and epistemological critiques against these approaches. Some of the identified shortfalls resulting from unwarranted epistemological (empirical) assumptions are addressed by proposing a social constructionist model of therapeutic factors based on social constructionist- and eco-systemic theories. The proposed model allows therapists to employ EBT’s in conjunction with various other (excluded) approaches that are available in their arsenal of treatments. Clinical case studies are used to illustrate the model’s practical operation in therapeutic contexts. / Psychology / Ph.D. (Psychology)

Text in English / The inception of psychology as a practicing profession in 1938 brought with it a continuing scientific struggle geared towards cementing its place as a value-adding health service in the form of psychotherapy. Concepts such as Empirically Supported Treatments (ESTs), Evidence Based Treatments (EBTs) and Evidence Based Practice in Psychology (EBPP) arose out of research attempts to scientifically prove the efficacy of psychological treatment versus psychiatric medications or versus no treatment. This focus on evidence in psychotherapy partly stems from, but also influences public policy in the form of practice and training mandates as well as government and insurance funding policies for psychotherapy. At present ESTs, EBTs and EBPP are the source of polarisation among psychologists who argue for either sides of this controversy, raising questions on a practical/policy level as well as an epistemological level. This thesis differentiates between ESTs, EBTs and EBPP as well as the Common Factors approach and continues to critically investigate the advantages, practical/policy implications and epistemological critiques against these approaches. Some of the identified shortfalls resulting from unwarranted epistemological (empirical) assumptions are addressed by proposing a social constructionist model of therapeutic factors based on social constructionist- and eco-systemic theories. The proposed model allows therapists to employ EBT’s in conjunction with various other (excluded) approaches that are available in their arsenal of treatments. Clinical case studies are used to illustrate the model’s practical operation in therapeutic contexts. / Psychology / Ph.D. (Psychology)