Plantão psicológico

1. Introduction

Version followed: the person-centred plantão psicológico as first run at the Serviço de Aconselhamento Psicológico of the Instituto de Psicologia, Universidade de São Paulo (SAP-IPUSP) and systematised by Rosenberg (1987) and Mahfoud (1987), together with Tassinari's "plantão-processo" (1999/2003). Later variants are named where used: the phenomenological-existential line (Morato, LEFE/SAP-IPUSP), the PUC-Campinas line (Cury), and Vasconcelos's (2009) typology. The founding texts themselves are not drawn on (Rosenberg 1987; Mahfoud 1987; Mahfoud 1999/2012; Tassinari 2003). Their content is reported here through Brazilian journal articles that quote them [uncertain where noted].

What it is. Plantão psicológico ("psychological duty" or walk-in service) is a service format, not a manualised therapy. Psychologists (in clinic-schools, often supervised trainees) stay available at a fixed, publicised place and set times. Anyone can walk in without an appointment, a referral or a prior diagnosis, and is seen at or near the moment they need help [source: Palmieri & Cury 2007; Mozena & Cury 2010; Tassinari 2012]. Mahfoud (1987) describes it as professionals "à disposição de quaisquer pessoas que deles necessitem" (available to anyone who needs them), which asks of the psychologist "uma disponibilidade para se defrontar com o não planejado" (a readiness to face the unplanned) [quoted in Tassinari 2012].

History (verified as far as possible). Several sources date the first Brazilian plantão to 1969 at SAP-IPUSP, inspired by North American walk-in clinics [source: Palmieri & Cury 2007; Tassinari 2012; Scorsolini-Comin 2015]. Tassinari says it began as a different kind of intake ("recepção diferenciada") to deal with a very long waiting list. Rachel (also spelled Raquel or Rosemberg) Rosenberg is named as the person who developed it [source: Mozena & Cury 2010; Chaves & Henriques 2008]. [uncertain] The sources disagree on the date. Nunes & Morato (2008) put SAP's founding in 1968. Mozena & Cury (2010) place the plantão in the late 1970s and early 1980s. Chaves & Henriques (2008) say only "the 1960s". The first published systematisation is Rosenberg's 1987 volume. Instituto Sedes Sapientiae opened a plantão in August 1980, coordinated by Rosenthal [source: Linares 2001]. Oswaldo de Barros Santos is sometimes named as founder, but none of the sources mention him: [uncertain]. From the late 1990s the model spread to clinic-schools, hospitals, schools, prisons, judicial services and communities [source: Mozena & Cury 2010; Tassinari 2012].

How change happens. Drawing on Rogers, the premise is that when someone in acute distress meets congruence, unconditional positive regard and empathic understanding, they can clarify what they are going through and what help they want. They can then find their own resources and next step, even in a single encounter [source: Tassinari 2012; Palmieri & Cury 2007; Mozena & Cury 2010]. Tassinari says the encounter "se completa em si mesmo" (is complete in itself) [quoted in Tassinari 2012]. The aim is not to resolve the crisis or reorganise a life. It is to offer a space where the person can speak, hear themselves and be heard without judgement, and leave clearer about their situation and their options [source: Mozena & Cury 2010; Chaves & Henriques 2008].

2. Framework

There is no phase manual. The structure lies at two levels: the service, and the single encounter with its possible follow-ups.

Service level [source: Palmieri & Cury 2007; Mozena & Cury 2010; Schmidt 2004; Linares 2001]

Fixed, publicised duty hours and a known location, so that clients know when and where a plantonista will be available (Cautella 1999 and Morato 1997, as cited in Palmieri & Cury 2007). Example settings: two plantonistas on Thursdays and Fridays, 9:30–17:30, in a general hospital (Palmieri & Cury 2007); two afternoons a week for nine months in a legal-aid service (Mozena & Cury 2010).
First come, first served. Anyone who presents is received, including people outside the catchment area, who are heard and then referred on (SAP-IPUSP after 1993 regionalisation) [source: Schmidt 2004].
In clinic-schools, trainees staff the plantão with an on-site supervisor and later group supervision (details in Section 4).

Encounter level. This is a typical sequence assembled from the sources, not a formal protocol. Steps 1–4 often overlap [source: Schmidt 2004; Tassinari 2012; Barbosa & Casarini 2021; Chaves & Henriques 2008]:

Welcome (acolhimento). Goal: the person feels received as a person, not as a case.
Listening and accompanying. Goal: the person can put their experience into words at their own pace.
Clarifying the request. Goal: the plantonista and client together build an explicit statement of what is wanted ("construir em parceria o esclarecimento do pedido de ajuda") [Tassinari 2012].
Response. Goal: compare the need as the client sees it with what the plantonista and the service can offer [Schmidt 2004]. This can include exploring possibilities the person has not yet considered.
Closing. Goal: summarise, state that the service remains available, and agree the next step jointly.

Possible outcomes [source: Schmidt 2004; Mozena & Cury 2010]:

a single encounter and no further contact;
a return visit (retorno) with the same plantonista;
an internal or external referral;
the start of psychotherapy, under various contract types.

Session count and length

No fixed length. Tassinari (2012) says time and returns "dependem de decisões conjuntas" (depend on joint decisions). Schmidt (2004) says length also depends on how many plantonistas are on duty and how full the waiting room is.
About 50 minutes is a common reference point. Sessions of 50–80 minutes are reported, usually with one or two returns [source: Mozena & Cury 2010].
Barbosa & Casarini (2021) describe returns that are not scheduled, are client-initiated and are unlimited in number.
Variant [source: Paparelli & Nogueira-Martins 2007]: a private-university clinic modelled on IPUSP uses three phases: an intake to identify the complaint, a time-limited follow-up of up to 10 sessions, and a closing with discharge or referral. Not every client goes through all three.

Criteria for moving on. The sources give no formal criteria. Implied markers [source: Palmieri & Cury 2007; Mozena & Cury 2010; Barbosa & Casarini 2021]:

Close after one encounter when the person has clarified the request and leaves with a sense of their own next step.
Offer a return when something stays open and the person wants to come back.
Refer when the person wants continuing care or needs something the service does not provide, such as psychiatric care or a specialist assessment.
Palmieri & Cury give one criterion for whether an encounter was therapeutic: the client felt free to express themselves (or to hold back) and could reframe the difficulty as reflection on new possibilities.

Named variants. Vasconcelos (2009), as summarised by Tassinari (2012), describes three kinds:

the "bureaucratic" plantão, defined only by time and place;
the "focal" plantão, a one-off help that works much like triage;
the "interventive" plantão, which equals Tassinari's plantão-processo and is the version followed here.

The LEFE/Morato phenomenological-existential line also counts informal conversation, looks and silences in institutional settings as clinical action [source: Nunes & Morato 2008]. Mahfoud's 1999 school study identified phases within encounters, running from "the client presents the question" to "the client decides to act". The full phase list is [uncertain] [source: Linares 2001].

3. Guiding principles

Availability for the unplanned (Mahfoud 1987). Practical meaning: come to each duty without an agenda and be ready for any request, age or level of severity, and for this being the only meeting [source: Tassinari 2012; Chaves & Henriques 2008].
The person, more than the problem. Mahfoud describes a space "para as pessoas, mais do que para os problemas" (for people more than for problems). Practical meaning: attend to how this person is living the situation now, not to classifying the complaint [source: Palmieri & Cury 2007].
Accompany the process; do not conduct it (Amatuzzi 1990, "acompanhar esse processo, e não conduzi-lo"). Practical meaning: follow the client's direction and do not steer towards your own hypothesis [source: Palmieri & Cury 2007].
Each encounter is a whole (Rosenberg: "um universo único"; Tassinari: complete in itself). Practical meaning: work as if there will be no next session. Do not leave a half-opened intake [source: Palmieri & Cury 2007; Tassinari 2012].
Rogers's core conditions: congruence, unconditional positive regard, empathic understanding. Practical meaning: offer a warm, non-judgemental, genuine presence. This is the main intervention, "um jeito de ser (e não de fazer)" (a way of being, not of doing; Wood 2008) [source: Tassinari 2012; Mozena & Cury 2010].
Always respond to the request, even when the service cannot meet it (Schmidt). Practical meaning: plantão is not triage. Nobody leaves with just "not here"; everyone leaves with a clarified request and a concrete pathway [source: Schmidt 2004; Mozena & Cury 2010].
Not a substitute for psychotherapy (Rosenberg 1987). Practical meaning: do not use the plantão as a waiting room or a pre-therapy assessment. It is help in its own right, and it is also not long-term treatment [source: Palmieri & Cury 2007].
Immediacy. Receive the person at or near the moment of need. Practical meaning: keep waiting to a minimum and protect duty time from other tasks [source: Tassinari 2012; Chaves & Henriques 2008].
Predictability of the offer. Practical meaning: keep the same days, hours and place, publicise them, and let clients know the service remains a point of reference [source: Palmieri & Cury 2007; Mozena & Cury 2010].
Shared decisions about time, returns and referral. Practical meaning: ask the client rather than impose a session length or a follow-up plan [source: Tassinari 2012; Barbosa & Casarini 2021].
Referral is secondary. Practical meaning: do not rush to refer. The encounter itself comes first, and referral follows from it [source: Tassinari 2012].
Whoever comes is the client. Practical meaning: if someone comes about a child, spouse or colleague, work with the person in the room and with their own distress about it [source: Mozena & Cury 2010].
Confidentiality and impartiality ("sigilo" and "isenção"). Practical meaning: in workplaces and institutions, keep the plantão visibly separate from management and HR [source: Palmieri & Cury 2007].
Ethical clarity about the service's purpose (Cury 1999). Practical meaning: do not let the institution use the plantão for its own ends (efficiency, control, cutting costs) [source: Palmieri & Cury 2007; Linares 2001].
Three-sided design (Mahfoud 1987): the institution, a professional available for the unplanned, and the person seeking help. Practical meaning: negotiate the service with the host institution as well as with clients [source: Palmieri & Cury 2007].
Flexible setting; power shifted to the client. Practical meaning: adapt room, time and format to the context, and keep the decisions in the client's hands [source: Tassinari 2012].
Care over control; readiness of the senses (phenomenological-existential line). Practical meaning: put up with unpredictability and treat the crisis as a place where meaning gets made [source: Nunes & Morato 2008].
Not solving the crisis. Practical meaning: hold back from advice and ready-made solutions. Help the person find their own resources [source: Mozena & Cury 2010; Barbosa & Casarini 2021].

4. Intervention inventory

Plantão has no proprietary techniques. Its "interventions" are the person-centred responses used inside a walk-in encounter, plus the service-level and team-level procedures that make the format work. Everything below is described by the sources cited. The step-by-step breakdowns put those descriptions into usable order, and are [synthesis] where the source gives only the element and not the sequence. All example wording is my own (illustrative) unless it is in quotation marks with a citation.

A. Setting up the duty (service level)

4.1 Establishing a predictable duty

Purpose and when to use: before launch, and on review. A walk-in service only works if people know when and where the plantonista will be, and the plantonista is actually there [source: Palmieri & Cury 2007, citing Cautella 1999 and Morato 1997].
Steps:
1. Fix days, hours and a room. The sources describe two-person shifts in fixed weekly slots.
2. Secure a private room. A shared room (such as a library) is workable but compromises privacy [Mozena & Cury 2010].
3. Agree who greets walk-ins (receptionist or plantonista) and where people wait.
4. Set up a simple record form to fill in after each encounter, for service monitoring [Mozena & Cury 2010].
5. Arrange supervision cover for the whole shift (see 4.15).
Example language (illustrative, for a poster): "Psychological plantão: Tuesdays and Thursdays, 2–6 pm, room 12. No appointment needed. Come when you need to talk."
Watch for: plantonistas being pulled into other tasks during the shift, and hours that clash with when the target group can come. Shift workers were hard to reach in the hospital study [Palmieri & Cury 2007].

4.2 Publicising the service and negotiating with the host institution

Purpose and when to use: when opening a plantão in a hospital, school, court or workplace. Mahfoud's three-sided view means the institution is a party to the service, not just the venue [source: Palmieri & Cury 2007; Linares 2001; Nunes & Morato 2008].
Steps:
1. Meet the institution's leaders and staff. Clarify what the plantão is and is not: not psychotherapy, not an assessment for management, and confidential.
2. Agree that the plantão is kept separate from HR and management. Employees in the hospital study asked for this [Palmieri & Cury 2007].
3. Publicise through several channels:
  - posters and leaflets, with the receptionist handing leaflets to visitors, and the social worker and an intern pointing distressed clients to the service (legal aid) [Mozena & Cury 2010];
  - staff word of mouth and posters (psychiatric hospital) [Linares 2001];
  - music, pamphlets and a short skit during school recess (Mahfoud's school project) [Linares 2001].
4. Make it explicit that people may self-refer, without going through teachers or managers (as in the school project) [Linares 2001].
5. Watch for the institution's hidden request, for example to manage "problem" people. Revisit the agreement if one appears [Nunes & Morato 2008].
Example language (illustrative, to a school head): "Students will be able to come on their own. What they say stays with the plantonista, except where someone's safety is at risk. We will report usage numbers, never content."
Watch for: staff resistance or boycotting, which happened in the school project [Linares 2001]; clients arriving who do not know what a plantão is [Mozena & Cury 2010]; and in workplaces, mistrust that the service reports to management [Palmieri & Cury 2007].

B. The encounter

4.3 Welcome (acolhimento) and the open opening

Purpose and when to use: the first minutes of every encounter. Make the person feel received and free to bring whatever brought them, with no requirement to present a "proper" problem [source: Schmidt 2004; Chaves & Henriques 2008; Linares 2001].
Steps:
1. Greet the person in the waiting area and take them to the room.
2. Briefly say what the plantão is: a space to talk now, confidential, with no obligation to come back. The sources note that clients often arrive not knowing this [Mozena & Cury 2010].
3. Open with an unstructured invitation rather than an intake questionnaire [synthesis, consistent with Mahfoud's "available for the unplanned"].
4. Let the person begin where they want to.
Example language (illustrative): "Welcome. This is a space to talk about whatever is on your mind today. We have time now. Where would you like to start?"
Watch for: the urge to fill in forms or take a history first. The sources contrast plantão with triage and psychodiagnosis [Schmidt 2004; Scorsolini-Comin 2015]. Signs it is working: the person settles and starts speaking in their own words.

4.4 Empathic listening and accompanying

Purpose and when to use: throughout. This is the core of the encounter. "Ouvir implica acompanhar" (listening means accompanying) and staying "atento, presente" (attentive, present) (Chaves & Henriques 2008, drawing on Amatuzzi).
Steps:
1. Attend to the words and also to affective tone, posture, facial expression and how these shift during the session [Barbosa & Casarini 2021].
2. Follow the person's direction without introducing your own topics [Amatuzzi 1990, via Palmieri & Cury 2007].
3. Hold your personal reactions. If the story echoes your own, note it and set it aside for supervision [Chaves & Henriques 2008].
4. Allow silences.
Example language (illustrative): "Take your time." "Go on, I'm following you."
Watch for: "hollow" listening that only echoes back what was said. Chaves & Henriques warn against listening that becomes like an echo. Signs it is working: the person goes deeper, names feelings, and sometimes relief is visible. In one case the client left "menos angustiada, sorrindo" (less anguished, smiling) [Chaves & Henriques 2008].

4.5 Empathic reflection

Purpose and when to use: whenever the person expresses something felt but not fully said. It conveys understanding and helps them hear their own experience [source: Barbosa & Casarini 2021; Tassinari 2012].
Steps:
1. Pick out the felt meaning, not just the content.
2. Offer it tentatively, as your understanding, and check it.
3. Accept corrections and re-reflect.
Example language: from the sources, "It seems to me that you were caught by surprise" (Barbosa & Casarini 2021, English version). Illustrative: "So under the anger there is a lot of fear of losing them. Is that close?"
Watch for: reflections that interpret or lead. Signs it is working: the person says "yes, exactly" and elaborates, or corrects you and gets more precise.

4.6 Clarifying the request (building the demand together)

Purpose and when to use: once the person has had space to tell their story, usually in the middle of the encounter. The first conversation helps the person clarify what they are suffering and what help they are looking for (Schmidt 1999, cited in Chaves & Henriques 2008). Demand is constructed in dialogue, not given in advance [source: Nunes & Morato 2008; Tassinari 2012; Schmidt 2004].
Steps:
1. Separate what the person complains of (queixa), what they are asking for (pedido), and what they need. They are often different.
2. Explore their resources and expectations. Schmidt defines "acolher" as attention to complaint, resources and expectations [Schmidt 2004].
3. Name the request back together and check it is right.
4. Consider the social, family, work and bodily factors bearing on the request [Tassinari 2012].
Example language (illustrative): "You came because of the fights at home. If today could help with one thing, what would it be?" "It sounds like you are not asking how to fix him, but how to stay standing yourself."
Watch for: imposing your own idea of the "real" problem. Signs it is working: the person can say in one or two sentences what they want, and it often shifts from what they first said.

4.7 Exploring possibilities in the "momento-já" (the present moment)

Purpose and when to use: after the request is clear. Tassinari describes plantonista and client looking together, in the present moment, for possibilities not yet explored. She assumes the person can better understand their immediate situation (Tassinari 2003, cited in Scorsolini-Comin 2015) [source: Tassinari 2012].
Steps:
1. Ask what the person has already tried, and what has helped even a little.
2. Invite them to imagine options. Do not supply them.
3. Follow their sense of what feels possible now.
4. Let the person decide what, if anything, to do. Mahfoud's school study describes encounters ending when the client "decides to act" [Linares 2001].
Example language (illustrative): "Given all this, what feels possible for you this week?" "What would you need in order to take that step?"
Watch for: sliding into advice or problem-solving. The sources say plantão does not aim to solve the problem with ready-made answers [Barbosa & Casarini 2021; Mozena & Cury 2010]. Signs it is working: the person, not the plantonista, names a next step.

4.8 Explanation and information

Purpose and when to use: when the person needs factual information to decide: what the service offers, how other services work, or what a referral involves. Barbosa & Casarini list reflection, care and explanation as the three core interventions [source: Barbosa & Casarini 2021; Scorsolini-Comin 2015].
Steps:
1. Give information briefly and plainly, only when it is needed for the person's decision.
2. Be honest about limits.
3. Check what they make of it.
Example language: from the sources, "Here in the clinic we do not offer specific services for dyslexia" (Barbosa & Casarini 2021, English version). Illustrative: "…and here is where that kind of assessment is available, and how to ask for it."
Watch for: information turning into a lecture or into advice. Signs it is working: the person can make an informed choice.

4.9 Closing the encounter

Purpose and when to use: at the end of every encounter. Leave the person with a whole experience, a clear next step and the knowledge that the door stays open [source: Barbosa & Casarini 2021; Mozena & Cury 2010; Tassinari 2012].
Steps:
1. Signal the approaching end. Length is agreed jointly: about 50 minutes is the usual reference, but it can be longer [Mozena & Cury 2010; Tassinari 2012].
2. Summarise what was understood and what the person decided [Barbosa & Casarini 2021].
3. Set out the options: no follow-up, a return, a referral, or psychotherapy [Schmidt 2004]. Decide together.
4. State the duty days and hours, so the service stays a point of reference [Mozena & Cury 2010; Chaves & Henriques 2008].
Example language (illustrative): "Before we finish: today you got clearer that what you want is to talk to your sister first. You can stop here, come back on a duty day, or I can point you to ongoing therapy. What suits you?"
Watch for: ending abruptly, or holding on beyond what the person wants. Signs it is working: the person chooses an option and leaves calmer.

4.10 Return encounters (retornos)

Purpose and when to use: when something is still open and the person wants to continue for a short time. Returns are typically one or two [Mozena & Cury 2010]. In other services they are client-initiated and unlimited [Barbosa & Casarini 2021]. Schmidt mentions returns with the same plantonista [Schmidt 2004].
Steps:
1. Agree on whether to return, with whom and when. The sources describe this both ways: on the plantonista's next duty, or unscheduled with the client deciding.
2. On return, start again from where the person is now, not from your notes.
3. Review together whether further returns, a referral or ending makes sense.
Example language (illustrative): "I'm here on Thursdays. If you want to continue this, come back and ask for me."
Watch for: returns quietly turning into unplanned long-term therapy. The plantão is not meant to replace psychotherapy [Rosenberg 1987, via Palmieri & Cury 2007]. A missed return followed by a later visit is normal [Linares 2001].

4.11 Referral (internal and external)

Purpose and when to use: when the person wants ongoing care or needs something the plantão cannot provide, such as psychiatry, a specialist assessment, social or legal services, or services in another area [source: Schmidt 2004; Mozena & Cury 2010; Barbosa & Casarini 2021; Palmieri & Cury 2007].
Steps:
1. Let the need for referral come out of the encounter. Tassinari treats referral as a secondary aim [Tassinari 2012].
2. Explain the options and how to reach them: names, addresses, how to ask, likely cost and wait.
3. Check the person's willingness and the obstacles in the way.
4. Keep the plantão available as a reference meanwhile [Mozena & Cury 2010].
5. Keep an up-to-date list of referral resources. SAP-IPUSP kept a register of affiliated low-fee practitioners [Schmidt 2004].
Example language (illustrative): "Weekly therapy would fit what you're describing. These two places offer it at low cost. Meanwhile, you can come back here on any duty day."
Watch for: referral used to end an encounter early; referral into a public network that cannot respond [Schmidt 2004; Paparelli & Nogueira-Martins 2007]. Signs it is working: the person leaves with a concrete, feasible next step.

4.12 Working with third-party complaints, families and institutions

Purpose and when to use: when the person comes about someone else, comes with a relative, or the request is really the institution's [source: Mozena & Cury 2010; Palmieri & Cury 2007; Paparelli & Nogueira-Martins 2007].
Steps:
1. Treat whoever came as the client, even if the complaint is about someone else [Mozena & Cury 2010].
2. Where the service allows it, see family members on request. The hospital plantão saw employees' children, spouses and parents [Palmieri & Cury 2007].
3. Offer guidance, clarification or indirect work with families or institutions where that is the realistic help [Paparelli & Nogueira-Martins 2007].
Example language (illustrative): "You've told me a lot about your son. How are you holding up with all this?"
Watch for: becoming an agent of the absent party or of the institution.

4.13 Recording each encounter

Purpose and when to use: right after each encounter, for continuity of care if the person returns, for supervision, and for service monitoring [source: Mozena & Cury 2010].
Steps:
1. Fill in the service form: date, plantonista, the request in brief, outcome (closed, return, referral), and any risk noted.
2. Write process notes for supervision.
3. Keep records confidential and separate from institutional files [synthesis].
Watch for: records drifting into diagnostic labels, which runs against the plantão's stance.

4.14 Screening and responding to acute risk [synthesis]

Purpose and when to use: whenever the person mentions not wanting to live, self-harm, harm to others, abuse, or acute psychosis. The sources report such clients but describe no formal risk procedure. Barbosa & Casarini (2021) report a client with suicidal ideation and prior attempts who received empathic listening, a suggestion of psychotherapy and an offer of follow-up. Paparelli & Nogueira-Martins (2007) say these cases often cannot be treated effectively in the clinic. This entry is therefore my synthesis of standard practice, adapted to the plantão stance.
Steps:
1. Ask directly and calmly about suicidal thoughts, intent, plans, past attempts and protective factors, within the empathic conversation.
2. If risk is present, involve the duty supervisor at once (see 4.15).
3. Build a brief safety plan with the person: warning signs, coping steps, people to contact, crisis lines and services.
4. Do lethal-means counselling (safe storage or removal, with the person's agreement).
5. Arrange a same-day or prompt referral: for example a CAPS (psychosocial care centre), an emergency service, or the CVV helpline in Brazil, or local equivalents.
6. If risk is imminent, do not let the person leave alone. Follow your local emergency and legal duties.
7. Record the assessment and the actions taken.
Example language (illustrative): "When you say you don't feel like living, are you having thoughts of ending your life?"
Watch for: the non-directive stance turning into avoidance of risk questions. Asking directly is compatible with empathy.

C. Team and training procedures

4.15 On-site and group supervision

Purpose and when to use: every shift, especially with trainees. It contains anxiety, supports decisions on risk and referral, and serves as training [source: Nunes & Morato 2008; Paparelli & Nogueira-Martins 2007; Chaves & Henriques 2008; Schmidt 2004].
Steps (forms described across the sources):
1. Have a field supervisor present in the plantão space during the shift, with a general clinical supervisor for each project [Nunes & Morato 2008].
2. At the start of the year, the supervisor sees the first client while trainees watch through a one-way mirror [Paparelli & Nogueira-Martins 2007].
3. During the shift, the supervisor supports, guides, discusses, and takes over the encounter if needed, with or without the trainee present [Paparelli & Nogueira-Martins 2007].
4. Run group supervision afterwards. Reported group sizes are about 12 trainees per three-hour shift [Paparelli & Nogueira-Martins 2007], or groups of at most 8–10 [Schmidt 2004]. A weekly university supervision is also described [Chaves & Henriques 2008].
5. Hold study groups linking practice, theory and research (the SAP and LEFE tradition) [Nunes & Morato 2008; Schmidt 2004].
Example language (illustrative, supervisor to trainee): "Before you go in: you don't need to solve anything. Listen, help them clarify what they want, and call me if you hear risk."
Watch for: trainees' fear of making mistakes and of the unknown. Trainees described supervision as reassurance [Paparelli & Nogueira-Martins 2007].

D. Setting-specific procedures described in the literature

4.16 School plantão (Mahfoud's project)

Purpose and when to use: plantão in a school with trainee interns. [uncertain] Reported only through Linares's (2001) review of Mahfoud (1999).
Elements:
- promotion through music, pamphlets and a recess skit;
- free access for students, with no referral by staff;
- availability in all three school shifts on weekdays and on Saturday mornings;
- life-history interviews adapted from Huizinga's method;
- use of song and poem excerpts;
- an affective-education material for drug prevention;
- case analysis that grouped student requests into 15 categories plus an "indeterminate" one, and traced phases within encounters.
Watch for: staff resistance; consent and confidentiality for minors (follow local law) [synthesis].

4.17 Hospital plantão (psychiatric and general)

Purpose and when to use: inpatients, families and staff [source: Linares 2001; Palmieri & Cury 2007].
Elements:
- a plantão for patients, with family and staff services added later (psychiatric hospital, Cautella 1999);
- a staff plantão run by an outside professional for ethical reasons;
- in the general-hospital service for employees, a later split into two arms, plantão and psychotherapy, with plantão remaining the main demand.
Watch for: reported limited effectiveness with severe depression, catatonic states and serious delusions [Linares 2001]. In these cases, coordinate with the medical team [synthesis].

4.18 Institutional and phenomenological-existential practice (LEFE/Morato line)

Purpose and when to use: plantão in institutions (for example justice or education), understood as clinical action that is not limited to formal sessions [source: Nunes & Morato 2008].
Elements:
- presence in the institution's everyday spaces;
- informal conversation, looks and silences counted as clinical acts;
- individual care that is not process-based, arising from the situation itself;
- attention to the institution's own request.
Watch for: if the institution allows no attention at all to individuals, the request cannot be worked with in this frame [Nunes & Morato 2008].

5. Handling problems

Each item is tagged by its source, or as [synthesis] where it is my own guidance.

Client expects ongoing therapy, or is frustrated by the limited format [source: Linares 2001; Paparelli & Nogueira-Martins 2007]. Explain at the start what the plantão offers (see 4.3). At the close, set out the real options: a return, a referral, or psychotherapy (see 4.9 and 4.11). Acknowledge the frustration empathically rather than defending the service [synthesis].
Client wants a ready-made answer ("receita pronta") [source: Paparelli & Nogueira-Martins 2007; Chaves & Henriques 2008]. Reflect the wish for relief. Then turn to what the person already knows and has tried (see 4.7). In Rogers's terms, as the sources apply them, reorganising a life in one encounter is unlikely, and the aim is clarity and support. Illustrative: "You'd like me to tell you what to do. I can see how exhausted you are. Let's look together at what you already sense might help."
Client doesn't know what a plantão is, or arrives with a legal, medical or administrative request [source: Mozena & Cury 2010]. Explain briefly what the space is. Then listen for the emotional side of the practical request. In legal aid, emotional distress often came wrapped in a legal question.
Request the service cannot meet (for example a diagnosis, a specialist assessment, or medication) [source: Barbosa & Casarini 2021; Paparelli & Nogueira-Martins 2007]. Say so honestly. Work with the related concerns the person brings. Give concrete referral information. Note that the clinic may have no psychiatrist and public access may be poor.
Client is silent, or cannot say why they came [synthesis]. Normalise this, allow the silence, and reflect what is visible: "It's hard to know where to begin." Never push for a complaint. The sources accept an "indeterminate demand" as a category [Linares 2001].
Stuck encounter, going in circles [synthesis]. Reflect the circling itself. Go back to clarifying the request (see 4.6): "We keep coming back to this. What would you most want to leave here with today?" If it is still stuck, offer a return so the person can think in between.
Plantonista anxiety, fear of error, fear of the unknown [source: Chaves & Henriques 2008; Paparelli & Nogueira-Martins 2007]. Before the shift: brief with the supervisor. During the encounter: return attention to listening, which is how anxiety eased for the trainee in Chaves & Henriques. After: bring it to group supervision.
Urge to fix or advise [source: Mozena & Cury 2010; Barbosa & Casarini 2021]. Remind yourself of the principle that plantão does not aim to resolve the crisis. Swap the advice for a reflection or a question about the client's own options.
Personal resonance (the story touches the plantonista's own life) [source: Chaves & Henriques 2008]. Notice it, set it aside during the encounter, and take it to supervision or personal therapy.
Suicide risk, self-harm, acute psychosis, catatonia, severe depression [source: Linares 2001; Paparelli & Nogueira-Martins 2007; Barbosa & Casarini 2021, all of which report such cases without a protocol]. Follow 4.14 [synthesis]: direct questions, the supervisor involved immediately, a safety plan, lethal-means counselling (storage and removal), an active and accompanied referral to crisis or psychiatric services, and documentation. Do not let the non-directive stance delay protective action.
Non-return / not knowing whether the person will come back [source: Barbosa & Casarini 2021; Chaves & Henriques 2008]. Treat each encounter as complete. State your availability clearly at the close. Do not chase people who walked in, unless risk was identified [synthesis].
Rupture: the client feels unheard, judged or misread, or withdraws [synthesis]. Palmieri & Cury count the client's freedom to say what they want, or to hold back, as a sign that the encounter helped. Check out loud ("I may have got that wrong"), accept the correction, and re-reflect. If the person wants to leave, respect it and restate that they can return.
Physical closeness and touch [source: Barbosa & Casarini 2021]. Barbosa & Casarini report hand-holding and a hug with a client who was uneasy with touch, and argue that it did not distort the relationship. [synthesis] Let the client lead, ask before touching, and discuss any touch in supervision.
Third-party complaints ("my son", "my husband") [source: Mozena & Cury 2010]. Work with the person present (see 4.12).
Drift into triage, bureaucracy or waiting-list management [source: Schmidt 2004; Nunes & Morato 2008]. Remember the defining difference: plantão always responds to the request, whereas triage only checks whether client and service fit. Review the service when forms, quotas or institutional procedures start to crowd out listening.
Weak referral network; clients waiting after brief care [source: Schmidt 2004; Paparelli & Nogueira-Martins 2007]. Keep a low-fee practitioner register (SAP-IPUSP). Build ties with public and anti-asylum services. Be open with clients about waiting times, and offer returns while they wait. Schmidt warns that such workarounds can take political pressure off the state.
Staff overload and reactive, emergency-driven routines [source: Schmidt 2004]. Push the institution for resources and staff. Resist productivity targets. Limit how many encounters each plantonista does per shift [synthesis].
Institutional misuse or resistance (the institution's hidden request, HR involvement, efficiency targets, staff boycotts) [source: Nunes & Morato 2008; Palmieri & Cury 2007; Linares 2001]. Renegotiate the agreement (see 4.2). Keep the service independent of management. Do not tie the number of sessions to institutional efficiency (Cury 1999b, via Palmieri & Cury 2007). If the institution allows no space for individuals, the plantão may have to end.
Several people waiting at once [source: Schmidt 2004 notes that length depends on the waiting room; the handling is synthesis]. Tell waiting clients the likely wait. Shorten encounters jointly where safe, and offer a return. Prioritise anyone in acute risk.
Shared or unsuitable room [source: Mozena & Cury 2010; Palmieri & Cury 2007]. Push for a private room. Meanwhile, protect confidentiality (sign on the door, set hours). Note the trade-off: a visible location can raise awareness of the service.
Minors in schools; confidentiality and its limits [synthesis]. Agree with the school, and with parents or guardians as local law requires, how consent and confidentiality work and where their limits lie (risk and safeguarding). Tell students those limits plainly at the start.

Sources

Sources:

Further reading (not drawn on) [uncertain]:

Rosenberg, R. L. (Org.) (1987). Aconselhamento psicológico centrado na pessoa. São Paulo: EPU.
Mahfoud, M. (1987). A vivência de um desafio: plantão psicológico. In Rosenberg (Org.), 1987.
Mahfoud, M. (Org.) (1999; 2nd ed. 2012). Plantão psicológico: novos horizontes. São Paulo: Companhia Ilimitada.
Tassinari, M. A. (1999). Plantão psicológico centrado na pessoa como promoção de saúde no contexto escolar (MSc dissertation, UFRJ).
Tassinari, M. A. (2003). A clínica da urgência psicológica (doctoral thesis, UFRJ).
Tassinari, Cordeiro & Durange (Orgs.) (2013). Revisitando o plantão psicológico centrado na pessoa.
Morato, H. T. P. (Org.) (1999). Aconselhamento psicológico centrado na pessoa: novos desafios.
Cury, V. E. (1999). Plantão psicológico em clínica-escola. In Mahfoud (Org.), 1999.
Vasconcelos, T. P. A. (2009). A atitude clínica no plantão psicológico (MSc dissertation, Universidade de Fortaleza).
Amatuzzi, M. M. (1990). O que é ouvir. Estudos de Psicologia, 7(2).

← Previous · III-031Humanistic integrative counselling Next · III-033 →Desarrollo Humano training