Atlas›Domain V · Systemic, relational, group & community›Guide 139
Guide V-139

Integrative community therapy (Brazil)

Adalberto de Paula Barreto, Airton Barreto1987Pirambu favela, Fortaleza, Brazil
A 49 · L 30 · M 2125 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the in-person roda (circle) of Terapia Comunitária Integrativa (TCI) as set out by its creator Adalberto de Paula Barreto and ABRATECOM (Associação Brasileira de Terapia Comunitária Integrativa). The sources are Silva, Barreto et al. (2020), ABRATECOM's social-technology submission to Fundação Banco do Brasil (c. 2023), the Ministry of Health's Portaria 849/2017 and the Goiás state protocol (2022, revised 2024). Mote technique follows the Londrina training pole (Martini, c. 2013). Online rodas follow the 2020 ABRATECOM-era adaptations. The stages and rules of the roda, the 240-hour minimum training and TCI's inclusion in the national policy in 2017 are confirmed by the Goiás protocol, Portaria 849/2017, an ABRATECOM presentation to the Chamber of Deputies (Silva MZ 2021) and Brazilian theses and reports, which also put session length at about 1½–2 hours. Barreto's manual Terapia comunitária passo a passo (editions cited as 1996, 2005 and 2008 4th ed.; English edition 2019) and ABRATECOM's online protocol have no publisher preview or public copy, so details that only they would settle stay [uncertain]. No published TCI crisis protocol exists in the public sources, so 5.6 remains [synthesis].

What it is. TCI is a structured, open community circle, not a psychotherapy. Its authors say plainly that it is "not a group psychotherapy" and "not a clinical practice" [source: Silva, Barreto et al. 2020, p. 347]. It began in Pirambu, a large favela in Fortaleza, Ceará, Brazil. Adalberto Barreto, a psychiatrist and anthropologist at the Federal University of Ceará (UFC), started it with his brother Airton Barreto, a human-rights lawyer, holding informal meetings with medical students under a cashew tree. It was formalised through a UFC extension project and the Movimento Integrado de Saúde Mental Comunitária (MISMEC) in 1988, and became Projeto Quatro Varas in the 1990s. ABRATECOM was founded in 2004 [source: Silva, Barreto et al. 2020, pp. 342–345; ABRATECOM/FBB]. Portaria 849 of 27 March 2017 added TCI to the SUS's National Policy on Integrative and Complementary Practices (PNPIC). It describes TCI as an intervention in social groups that builds solidarity networks from the community's own resources, held in a circle for horizontality, and based on five axes: Freire's pedagogy, communication theory, systemic thinking, cultural anthropology and resilience [source: Portaria 849/2017, annex]. [uncertain] The start year differs between sources. 1987 is the most widely cited: in an ABRATECOM presentation to the Chamber of Deputies (Silva MZ 2021) and in theses citing Barreto (Costa, UFMG, p. 11; Santos et al. 2022, citing Barreto 2008). Silva, Barreto et al. 2020 give 1985, and ABRATECOM/FBB gives 1986. This guide uses 1987.

How change is thought to happen. People bring suffering into speech, in a horizontal circle where no one advises, judges or interprets. The group then shares lived strategies for getting through similar pain. Two things follow: (a) suffering is put into context as part of family, social and cultural systems, so that "all those involved in the situation are part of the problems" [source: Silva, Barreto et al. 2020, p. 346]; and (b) each participant's own competence for getting through is drawn out and given value, which builds a solidarity network in the community. Barreto's catchphrase for the core idea is that a community with problems also has solutions [source: Di Nicola interview with Barreto, 2024]. Another saying used in rodas expresses why people should speak: when the mouth is silent, the organs speak; when the mouth speaks, the organs heal [source: Goiás protocol 5.3.3; Silva, Barreto et al. 2020, p. 347].

Who may run it. Only therapists who are trained or in training at ABRATECOM-recognised training poles (Polos Formadores) may run rodas under the TCI name. Each roda needs a therapist and a co-therapist [source: Silva, Barreto et al. 2020, p. 348].

  • Anyone over 18 can train, whatever their academic background.
  • Training totals at least 240 hours at an ABRATECOM-recognised training pole [source: Silva, Barreto et al. 2020, p. 353; ABRATECOM/FBB; Silva MZ 2021; Goiás protocol]. Many poles offer it as a 360-hour specialisation instead. Theory may be taught in person or hybrid, but the practical and experiential parts must be in person [source: Silva MZ 2021].
  • Both detailed sources include a 60-hour practicum of 30 rodas and 80 hours of supervised intervisão (peer supervision).
  • [uncertain] The two sources split the rest of the hours differently:
    • Silva et al.: 100 hours of theory modules (including self-esteem work).
    • ABRATECOM/FBB: 50 hours theory and 50 hours experiential work, over about 6 months.
  • A licensed psychotherapist is not automatically qualified. To run TCI under its name, complete this training. Otherwise, refer clients to local rodas.

2. Framework

TCI has no course of treatment with phases across sessions. The structure that matters is the order of stages inside each roda, sometimes called its "liturgia". Rodas are open and ongoing, usually weekly, and each one stands alone.

Format [source: ABRATECOM/FBB; Silva, Barreto et al. 2020; Gaete & Gois 2020; UFPE report]:

  • Attendance: drop-in. People choose whether to be present, and may arrive late or leave and come back.
  • Group size: ABRATECOM sets no upper limit. Its costing assumes about 30 people per weekly roda; online rodas averaged 13–15.
  • Staff: at least two therapists, a therapist and a co-therapist.
  • Settings: health units, schools, churches, associations, prisons, streets, parks, and online.
  • Space: a circle, with at least 2 m² per person.
  • Session length: about 1½–2 hours, but no primary source fixes it. A family-medicine case report gives 1–2 hours [source: Oliveira & Savi 2013]. A UFMG monograph citing Camargo (2005) gives about two hours, weekly, with roughly 15 minutes for the protagonist to tell the story [source: Costa, UFMG, pp. 18–19]. A UFPE report gives stage timings that add up to about 105 minutes: welcome 10, choosing the concern 15, context 20, sharing 40, closing 20 [source: UFPE report]. [uncertain] Barreto's manual may set a duration. [synthesis] Plan for 90–120 minutes, plus time afterwards for individual talks and the team review.
  • Number of sessions: there is no fixed count or end point. One primary-care roda ran 22 times over 8 months with 72 different people [source: Gaete & Gois 2020, p. 490].

Stages of a roda. ABRATECOM's own submission says "six stages" but lists five, plus a separate team review [source: ABRATECOM/FBB]. Sources name them differently: the Goiás protocol calls stage 2 "Desenvolvimento" and stage 4 "Problematização", while ABRATECOM calls stage 4 "Partilha de experiências". [uncertain] One undergraduate report puts the mote under "contextualização". The order below follows ABRATECOM, Silva et al., Gaete & Gois and Martini.

  1. Acolhimento (welcome). Usually led by the co-therapist.
    • Goal: create a safe, warm circle; explain TCI and the rules; celebrate good news; warm up with music and movement.
    • Move on when the rules are stated and the group is settled. The co-therapist then hands over to the therapist.
  2. Escolha do tema / da inquietação (choosing the concern). Led by the therapist.
    • Goal: invite several people to name briefly what is making them suffer. Summarise each one back, ask who identifies with which and why, then vote on a single concern.
    • Move on after 3–4 concerns (Goiás) or 4–5 concerns (Martini), once the vote is taken and everyone has been thanked.
  3. Contextualização (context).
    • Goal: the chosen person (the protagonist) says more, and participants ask only questions that clarify the situation and the feeling at its centre. The therapist collects keywords for the mote.
    • Move on when the therapist has found the strongest feeling or keyword and checked it with the protagonist.
  4. Problematização / partilha de experiências (sharing).
    • Goal: the therapist poses the mote, a question to the whole group. People talk about their own similar experiences and what helped them. The protagonist listens and is not addressed directly. The therapist notes the strategies and resources named.
    • Move on when time is nearly up or the sharing has run its course.
  5. Encerramento (closing).
    • Goal: the group stands in a circle for a ritual of togetherness (ritual de agregação). The therapist gives positive connotation to each person who spoke, participants say what they are taking away, and songs or poems may be offered. Any needed referral to the service network follows.
  6. Apreciação / avaliação / intervisão (team review, after the roda, without participants).
    • Goal: therapists review their own feelings, how each stage was led, the choice of mote, what was missing in the network, and what to prepare for next time. Then complete the records [source: Martini c. 2013, p. 244; Goiás protocol 5.6; Gaete & Gois 2020, p. 488].

Related formats (see 4.22–4.24):

  • Self-esteem workshops ("Resgate da Autoestima" / "Cuidando do Cuidador"), often about 2 hours of experiential exercises followed by about 1 hour of roda [source: Boaretto & Fazenda 2015, p. 54].
  • Separate circles for children, adolescents and families [source: Benetti c. 2012].
  • Online rodas, run under an ABRATECOM protocol since March 2020 [source: ABRATECOM/FBB; Silva A.L.P. et al. 2020].

3. Guiding principles

[source: Silva, Barreto et al. 2020, pp. 345–350; Gaete & Gois 2020, pp. 485–488; Martini c. 2013; ABRATECOM/FBB; Goiás protocol; UFPE report, as tagged]

The five theoretical pillars

  • Systemic thinking. Read every problem as part of its family and social context, and never single out one "problem" person.
  • Pragmatics of human communication (Watzlawick, Beavin & Jackson). All behaviour, including symptoms, communicates something. Listen for what the suffering is signalling, and speak clearly and sincerely yourself.
  • Cultural anthropology. Treat local, ancestral, Indigenous, African-descended and migrant knowledge as resources, and never rank cultures.
  • Paulo Freire's pedagogy. Do things with people, not for them. Ask questions rather than give answers; your role is closer to an educator's than an expert's.
  • Resilience. Pain and loss can be turned into competence. Look for how people got through, not only for what hurt.

The therapist's stance

  • Horizontality. Each person is the specialist in their own getting-through, and "Cada um é doutor de sua própria vivência" (each person is the doctor of their own experience) [Martini, p. 244]. You add no expert opinion.
  • Not the saviour. Do not offer ready-made answers or set yourself up as a rescuer [Martini, p. 227]. A physician's existing authority needs actively flattening [Gaete & Gois, p. 493].
  • Emotions, not problems. Focus on the feeling, not the factual problem to solve [Silva et al., p. 349].
  • Go beyond the complaint. The complaint is a shell over the real pain [Martini, p. 228]. Use questions to reach the feeling underneath.
  • The art of asking. Questions are your main tool, and they should open hope. Barreto wants questions that let people glimpse something lasting [Di Nicola interview 2024].
  • Diversity, not consensus. Do not push the group to agree, because consensus can hide power relations [Martini, p. 228].
  • Positive connotation. Name the effort, courage and competence in each person's account [Goiás 5.5; Gaete & Gois, p. 488].
  • Speaking prevents illness. Present speaking about suffering as protective [Gaete & Gois, p. 488; Goiás 5.3.3].
  • Freedom of presence. People choose whether to attend and may come and go [Silva et al., p. 348; UFPE report].

The rules of the circle

State these at every roda [Silva et al., p. 350; ABRATECOM/FBB; Goiás 5.2.1; Gaete & Gois, p. 488]:

  1. Silence while another person speaks.
  2. Speak only of your own experience, in the first person ("I").
  3. No advice, no judging, no speeches or sermons, and no analysing or interpreting others' stories. Silva et al. and ABRATECOM add the last two.
  4. The culture rule: songs, jokes, proverbs, poems and popular sayings linked to the theme are welcome.

The UFPE report adds that what is said in the roda stays in the roda (confidentiality). [uncertain] This is not in the published ABRATECOM rule lists.

The whole community's resources

  • Network-building. The sharing stage aims to form local support networks. Note the resources people mention and link people to services [Silva et al., p. 349; Martini, p. 244].
  • Care for the carers. The team reviews itself after every roda, and caregivers' own self-care (Cuidando do Cuidador) is part of the model [Martini, p. 244; Silva et al., pp. 352–353].

4. Intervention inventory

The items follow the order of a roda, then the post-roda tasks and related formats. Steps are paraphrased from the sources cited in each item. Example language is illustrative unless it is a short, cited Portuguese quote with a translation.

4.1 Preparing the roda

  • Purpose / when: before every roda, so the circle is physically and organisationally safe.
  • Steps:
    1. Book a welcoming space with about 2 m² per person, and set chairs in one circle with no table in the middle.
    2. Agree in advance who is therapist and who is co-therapist.
    3. Have the materials on hand: music, and optionally mats or snacks [source: ABRATECOM/FBB].
    4. In services, set up a referral route in. In Goiás, patients are scheduled after a global assessment, and late arrivals are accepted [source: Goiás protocol 5.1].
    5. Prepare the attendance record. Goiás uses a roda record sheet; online and national use is the SisRodas system [source: Goiás 5.6; Silva A.L.P. et al. 2020, p. 401].
    6. [synthesis] Before the first roda in a service, agree with the clinical team how a participant at acute risk will be passed on the same day (see 5.6).
  • Watch for: rooms where people can be overheard, and seating that puts staff apart from participants.

4.2 Welcome and explaining TCI

  • Purpose / when: opening of the acolhimento. The co-therapist leads it [source: Goiás 5.2; Gaete & Gois 2020, p. 487; Martini c. 2013, p. 222].
  • Steps:
    1. Greet people warmly, by name where possible.
    2. Explain briefly what TCI is: a space to share suffering and how people have got through it, not a place for advice or treatment.
    3. Mention that speaking protects health.
  • Example language (illustrative): "Welcome. This is a circle where we talk about what is weighing on us, and about what has helped us get through hard times. Nobody here is the expert on your life except you."
  • Watch for: newcomers who expect a lecture or a medical consultation. Restate the purpose plainly.

4.3 Stating the rules

  • Purpose / when: every roda, during the acolhimento. This sets the frame that makes the circle safe [source: Silva, Barreto et al. 2020, p. 350; Goiás 5.2.1; Martini, p. 222].
  • Steps:
    1. State the four rules (section 3) one at a time.
    2. Add a local proverb or saying that fits each rule. Martini advises including regional sayings.
    3. [synthesis] Check for understanding with a show of hands.
  • Example language (illustrative): "When one person speaks, the rest of us listen. We speak about ourselves, saying 'I', not 'you should'. We don't give advice, judge or preach. And if a song, a saying or a joke comes to mind that fits, you can share it."
  • Watch for: later breaches. Refer back to the rules gently and neutrally (see 5.3).

4.4 Celebrating life

  • Purpose / when: acolhimento. It starts the roda from resources and joy rather than problems [source: Goiás 5.2; Martini, p. 222; ABRATECOM/FBB].
  • Steps:
    1. Ask whether anyone has a birthday, an achievement or good news to celebrate.
    2. Celebrate together, for example with a song or applause.
  • Example language (illustrative): "Before anything else, does anyone have something to celebrate this week, a birthday, an achievement, some good news?"
  • Watch for: pressure on people who have nothing to celebrate. Keep it optional and brief.

4.5 Warm-up dynamic

  • Purpose / when: end of the acolhimento. It "breaks the ice" and lightens the group through the body [source: Silva, Barreto et al. 2020, p. 348; Goiás 5.2; Gaete & Gois, p. 487].
  • Steps:
    1. The co-therapist leads a short activity with music, gestures, a game or light movement.
    2. [synthesis] Offer seated alternatives, and check for mobility limits and touch preferences first.
    3. The Goiás risk map lists falls and blood-pressure surges among its risks [source: Goiás protocol 9.0].
  • Watch for: discomfort with touch, physical limitations, and cultural or religious objections to some music or dance.

4.6 Handing over to the therapist

  • Purpose / when: the transition from acolhimento to choosing the concern [source: Martini, p. 222].
  • Steps: the co-therapist introduces the therapist who will lead the roda. The therapist greets the group and picks up on the sayings already used.

4.7 Inviting concerns

  • Purpose / when: start of the escolha do tema stage [source: Martini, pp. 222–223; Goiás 5.3; Gaete & Gois, p. 488].
  • Steps:
    1. Ask who would like to speak about something that is troubling them, taking their sleep or making them suffer.
    2. A proverb can prompt people to speak. Goiás uses Barreto's saying about the mouth and the organs (section 1).
    3. Ask each speaker for a short "manchete", a headline of the suffering, not the whole story.
    4. If a headline is too thin to grasp, ask one clarifying question [Martini, p. 223].
    5. Take 3–4 concerns (Goiás) or 4–5 (Martini).
  • Example language (illustrative): "Who would like to share something that is keeping you up at night? Just the headline for now, in a sentence or two."
  • Watch for: people launching into a full story. Gently ask for the headline and say there will be time later.

4.8 Restitution (summarising back)

  • Purpose / when: after each concern is named. It confirms understanding and shows the speaker they were heard [source: Martini, p. 223; ABRATECOM/FBB lists restitution as part of this stage].
  • Steps:
    1. Summarise each concern briefly in the speaker's own key words.
    2. Check that the summary is right. Martini's formula is "fulano deixa ver se eu entendi" ("so-and-so, let me see if I understood") [p. 223].
  • Example language (illustrative): "Maria, let me see if I understood: you are worn out caring for your mother, and you feel no one helps. Is that it?"
  • Watch for: a summary that interprets rather than reflects. Use the speaker's words.

4.9 Identification and voting

  • Purpose / when: after all concerns are summarised. The group itself picks one concern [source: Martini, p. 223; Goiás 5.3; Gaete & Gois, p. 488; UFPE report].
  • Steps:
    1. Ask the circle which of the concerns touched them most, and why. Martini's wording is "Qual desses temas lhe tocou mais na roda de hoje e por que?" ("Which of these themes touched you most today, and why?") [p. 223].
    2. Repeat the themes in the order they were raised.
    3. Hold one vote, counted by show of hands.
    4. Announce the most-voted concern.
  • Watch for: voting by loyalty or to protect someone.
    • [synthesis] If a near-tie leaves someone visibly distressed, acknowledge them and offer to talk after the roda (4.10).

4.10 Thanking and availability

  • Purpose / when: right after the vote. It honours the people whose concern was not chosen [source: Martini, p. 223; ABRATECOM/FBB].
  • Steps:
    1. Thank everyone who shared.
    2. Say that the team is available after the roda to anyone who wants to talk.
  • Example language (illustrative): "Thank you to everyone who shared. All of these matter. If you'd like to talk more about yours, we'll be here after the circle."

4.11 Contextualisation questioning

  • Purpose / when: stage 3. It lets the protagonist say more and helps the group understand the context and the core feeling [source: Martini, pp. 223–224; Gaete & Gois, p. 488; Silva, Barreto et al. 2020, p. 349; Goiás 5.3].
  • Steps:
    1. Invite the protagonist to tell more.
    2. Open the floor to questions from the participants and the therapist. The protagonist may choose not to answer any question [Goiás 5.3].
    3. Keep only questions that help the person remember, organise ideas or make sense of things.
    4. Set aside evaluative, corrective or discriminatory questions, and advice disguised as a question [Martini, p. 224].
    5. Meanwhile, listen actively and write down keywords and the strongest feelings [Gaete & Gois, p. 488].
  • Example language (illustrative): "What questions would help us understand Maria's situation better? Questions only, no advice." To redirect: "That sounds like a suggestion. Can you turn it into a question?"
  • Watch for: the group drifting into solving the problem.
    • Silva et al. stress that the focus is on emotions, not problems [p. 349].

4.12 Building the mote

  • Purpose / when: end of the contextualisation. It turns the protagonist's core feeling into one question for the whole group, the bridge Martini describes from therapy IN the group to therapy BY the group [source: Martini, pp. 224–225]. Barreto calls the mote "o coração da terapia" (the heart of the therapy) [source: Barreto 2005, cited in Marchetti 2015, no page given].
  • Steps:
    1. From your notes, pick the most charged keyword or feeling, for example being overloaded, betrayed or without a way out.
    2. Check your hypothesis with the protagonist. Martini's example is "Você se sente culpado?" ("Do you feel guilty?") [p. 225].
    3. Phrase the mote broadly enough that many people can identify with it. Gaete & Gois: the mote should be "more general, so that more people identify" [p. 488, paraphrased].
    4. Choose the type: Camargo (2005) distinguishes the all-purpose "coringa" mote, which invites identification, from the "symbolic" mote built on a metaphor or keywords [source: Costa, UFMG, pp. 19–20] (see 4.13–4.14).
  • Watch for: a mote that is too specific (such as "Who has a son who uses crack?"), which shuts most people out. [synthesis] This example is illustrative.

4.13 The all-purpose mote (mote coringa)

  • Purpose / when: the default mote. Martini recommends it for a new therapist's first ten rodas, or whenever it fits [source: Martini, p. 225; Goiás 5.4; Silva, Barreto et al. 2020, p. 349].
  • Steps: pose it to the whole group, and then repeat it every time a new person starts to speak.
  • Example language (cited): "Quem já viveu algo parecido e o que fez para superar?" ("Who has lived through something similar, and what did they do to get through it?") [Martini, p. 225; Goiás 5.4].
  • Watch for: answers that drift into advice, which breaks the second half of the rules. Re-ask the mote in the first person.

4.14 Symbolic and theme-specific motes

  • Purpose / when: once the therapist is experienced. Built from the protagonist's keywords, these motes focus the sharing on the feeling at the centre [source: Martini, pp. 225–244].
  • Steps:
    1. Turn the keyword into a question about who has felt that way and what they did to get through it.
    2. Repeat the mote each time the speaker changes [Martini, p. 229].
    3. You may pose a second mote from another angle if the first one runs dry [Martini, p. 227 ff.].
    4. Martini's article lists over 170 example motes. Do not copy the list; build your own from each roda's keywords.
  • Example language (cited, Martini):
    • "Quem já se sentiu sem saída e o que fez para superar?" ("Who has felt there was no way out, and what did they do?") [p. 232].
    • "Quem já se sentiu sobrecarregado e o que fez para superar?" ("Who has felt overloaded...?") [p. 233].
    • For grief: "De onde tiro forças para superar a dor da perda?" ("Where do I draw strength to bear the pain of loss?") [p. 229].
  • Watch for: Martini also lists motes on thoughts of death and suicide attempts [pp. 231–232].
    • [synthesis] Use these only if the team has a risk-response plan in place, because they can bring active risk to the surface (see 5.6).

4.15 Leading the sharing (problematização / partilha)

  • Purpose / when: stage 4. The group shares lived strategies for getting through, which builds resilience and a local network [source: Silva, Barreto et al. 2020, p. 349; Gaete & Gois, p. 488; Goiás 5.4; ABRATECOM/FBB].
  • Steps:
    1. Pose the mote.
    2. The protagonist stays silent and listens. No one addresses them directly, and the therapist asks them no questions [Goiás 5.4; Gaete & Gois, p. 488].
    3. Invite people to speak in the first person about their own similar experience and what helped.
    4. Write down the strategies and community resources mentioned. They feed into the closing and the network [Goiás 5.4].
    5. Repeat the mote at each change of speaker.
  • Example language (illustrative): "Thank you, João. So, again: who else has felt without a way out, and what did you do?" To redirect: "Could you tell us about a time you lived this yourself?"
  • Watch for: speakers turning to the protagonist and saying "you should". Redirect to "I".
    • Signs it is working: several people link their own stories to the mote, a range of strategies comes up, and the protagonist's posture or face visibly changes. [synthesis] These are practitioner observations, not a validated measure.

4.16 Culture rule: songs, proverbs, poems, jokes

  • Purpose / when: any stage. It brings in popular knowledge and the emotional resources of the local culture [source: Silva, Barreto et al. 2020, pp. 345–350; Di Nicola interview 2024; Goiás 5.2.1].
  • Steps:
    1. Invite songs and sayings that link to the theme.
    2. Use proverbs yourself to open speech or to reframe. Barreto says he uses proverbs a lot, calling them knowledge produced over centuries [Di Nicola 2024].
    3. Let participants start a song when it fits.
  • Watch for: jokes at someone's expense. The rule allows respectful jokes only [Goiás 5.2.1].

4.17 Ritual of togetherness (ritual de agregação)

  • Purpose / when: the closing. It turns individual stories into a felt sense of belonging [source: Martini, pp. 243–244; Gaete & Gois, p. 488; Silva, Barreto et al. 2020, p. 349; UFPE report].
  • Steps:
    1. Invite everyone to stand in a circle, shoulder to shoulder.
    2. People may hold each other around the shoulders and sway gently side to side. Commonly a closing song is sung. The UFPE report describes the group closing with an embrace in the circle.
    3. Variant: concentric circles, with the people who spoke standing in the inner circle while the group sways around them [source: Camargo 2005, cited in Costa, UFMG, p. 20].
    4. [synthesis] Make physical contact and the inner circle optional. Offer standing or sitting, and holding hands or no touch.
  • Watch for: trauma survivors and others for whom being held, or being placed at the centre, is aversive.

4.18 Positive connotation

  • Purpose / when: during the closing ritual. It names the strength in each account [source: Gaete & Gois, p. 488; Goiás 5.5; Martini, p. 244].
  • Steps:
    1. While the circle stands, the therapist goes back over what was shared.
    2. Name the courage, effort and determination in each contribution, especially the protagonist's courage in exposing their pain.
    3. Acknowledge the community as a whole.
  • Example language (illustrative): "Maria, thank you for the courage to open your heart. João reminded us that asking for help is strength. Ana showed us faith can hold us up. Today this group showed it has its own medicine."
  • Watch for: generic praise. Name a specific strength that each person said or showed.

4.19 The "what I take away" round

  • Purpose / when: the closing, after positive connotation. It consolidates learning [source: Martini, p. 244; Gaete & Gois, p. 488; Goiás 5.5; UFPE report].
  • Steps:
    1. Ask each person what lesson or feeling they are taking from the roda.
    2. Gaete & Gois add that people may name who prompted the reflection.
    3. People may sing or recite a poem.
  • Example language (illustrative): "In one word or sentence, what are you taking home from today's circle?"
  • Signs it is working: people report learning from others' stories, not from the facilitators.

4.20 Referral and individual follow-up after the roda

  • Purpose / when: after the closing, for concerns that need more than the circle [source: Martini, p. 244; Gaete & Gois, p. 492; Silva, Barreto et al. 2020, p. 352; Goiás protocol 9.0].
  • Steps:
    1. Be available after the roda for private conversations.
    2. Where needed, refer people to the service network: the psychosocial care network (RAPS), psychology, social assistance and so on. The Goiás protocol's risk map names emotional instability as needing appropriate referral, but gives no procedure [Goiás 9.0].
    3. In one primary-care team, some people were seen by the doctor the next day or referred to psychology, nutrition or physical education [Gaete & Gois, p. 492].
    4. In a large dataset, 11.5% of participants were referred on [Silva et al., p. 352].
    5. Check that referrals happened. One evaluation model (Camargo 2005) re-asks after 30 days whether a person referred to a service was actually seen [source: Costa, UFMG, p. 21].
  • Watch for: participants who leave quickly after disclosing something serious. [synthesis] Have the co-therapist approach them before they go.

4.21 Team review (apreciação / intervisão) and records

  • Purpose / when: after every roda, without participants. It supports learning, quality and care for the team [source: Martini, p. 244; Goiás 5.6; Gaete & Gois, p. 488; ABRATECOM/FBB; Costa, UFMG, pp. 20–21].
  • Steps:
    1. Each therapist names their own feelings and resonances from the roda.
    2. Review how each stage was led and whether the mote was a good choice.
    3. List what could be improved, which links in the network were missing, and what to arrange for the next roda.
    4. Fill in the roda record and any clinical notes the service requires. Goiás uses its record sheet and patient progress system; SisRodas is used nationally.
    5. Optional: Camargo's (2005) evaluation adds a control sheet and an impact questionnaire on social ties, self-esteem and whether referrals were attended, repeated after 30 days. A supervisor may also review how the therapist led the roda [source: Costa, UFMG, pp. 20–21].
  • Example language (illustrative): "What moved me today was…; I think the mote could have been…; next week we should bring the address of the women's support centre."

4.22 Online rodas

  • Purpose / when: when people cannot meet in person. Online TCI began in March 2020 [source: Silva MZ 2021; ABRATECOM/FBB]. ABRATECOM reported about 41,000 online rodas in 16 countries by August 2023 [source: ABRATECOM/FBB; Silva A.L.P. et al. 2020, p. 400]. One project alone held over 1,600 online rodas between March 2020 and July 2021 [source: Silva MZ 2021].
  • Steps, from the published sources:
    1. Use a video platform. Published reports used Zoom, Google Meet or Jitsi Meet on phones, tablets and computers. One university project posted the link on its social-media page and took open demand, with no entry criteria [source: Peloso-Carvalho et al.; Pontes et al. 2021].
    2. Keep the same stages: welcome (each person gives their name and where they are joining from), celebrating life, a warm-up (music or a game), explaining the roda and its rules, naming concerns and voting, contextualisation, the mote and sharing, and the closing with the ritual and positive connotation [source: Pontes et al. 2021]. Trainee rodas need a trainer therapist present to count as practicum [source: Peloso-Carvalho et al.].
    3. Invite people to keep their camera on if they are comfortable, and to stay muted except while speaking, to cut interruptions and background noise [source: Pontes et al. 2021]. If a connection is poor, ask people to switch off their camera, and use the chat as a fallback channel [source: Peloso-Carvalho et al.].
    4. After each roda, write field notes on who came, the main concerns and the coping strategies named [source: Pontes et al. 2021], and register the roda (SisRodas) [source: Peloso-Carvalho et al.; Silva A.L.P. et al. 2020, pp. 400–402].
  • [uncertain] ABRATECOM's online protocol is not public. The published reports of online rodas (Pontes et al. 2021; Peloso-Carvalho et al.) give no confidentiality or risk rules, so the adaptations below are synthesis. Note that the practical and experiential parts of training must be in person, even where theory is hybrid [source: Silva MZ 2021].
  • Suggested adaptations [synthesis]:
    • Vote with numbered reactions or the chat.
    • Do the closing ritual seated, on camera, with a shared song.
    • State confidentiality, and ask people to use headphones in a private space.
    • Before starting, collect each participant's location and an emergency contact, so you can respond to acute risk.
  • Watch for: people who drop off after a disclosure. [synthesis] Follow up by message.

4.23 Self-esteem and caregiver workshops (Resgate da Autoestima / Cuidando do Cuidador)

  • Purpose / when: complementary experiential sessions from TCI training, attributed to Barreto, aimed at caregivers' self-care and self-esteem [source: Boaretto & Fazenda 2015, pp. 54–56; Benetti c. 2012, p. 108; Silva, Barreto et al. 2020, pp. 352–353].
  • Format:
    • In Londrina: weekly, about 2 hours of experiential exercises followed by about 1 hour of roda, for health workers, run by two trained facilitators.
    • Facilitators prepare the room and materials in advance and reflect as a team afterwards.
  • Steps: [uncertain] The individual exercises are in Barreto's Cuidando do Cuidador manual (2008), which has no public copy, so they are not described here.
    • The published sources mention body-based, playful and art activities with a sharing segment [Benetti, pp. 105–109]. Projeto Quatro Varas also offered massage therapy, medicinal plants, art therapy and yoga [Silva et al., pp. 352–353].
  • Watch for: exercises that touch on early memories or the body can stir strong emotion. [synthesis] Run them only if trained in them, with an exit option for each person.

4.24 Circles for children, adolescents and families

  • Purpose / when: for young people and families [source: Benetti c. 2012, pp. 108–125].
  • Steps:
    1. Run three formats: parents only (Cuidando do Cuidador), children only (Cuidando de Si Infanto-Juvenil, ages 7–14), and parents with children (Cuidando de Nós).
    2. Adapt activities to the children's developmental stage, using play, drawing, dance, drama and crafts.
    3. Let the group choose at each meeting whether the next one is a roda or an experiential session.
    4. Staff take part as community members, not as experts.
    5. Make parental participation voluntary.
  • Watch for:
    • Activities that frustrate because they do not fit the children's age [Benetti, pp. 111, 123].
    • [synthesis] Follow safeguarding rules, especially on physical contact and on who helps with care. Benetti describes a child volunteer giving massage, with no safeguards stated; do not copy this.

4.25 Placing TCI in a primary-care pathway

  • Purpose / when: for a clinician setting up rodas in a health unit [source: Gaete & Gois 2020, pp. 489–494; Silva, Barreto et al. 2020, p. 352].
  • Steps:
    1. Offer the roda as an open entry point for mental-health concerns. Referrals can come from doctors and community health agents.
    2. Hold it at a time that suits the target group. Moving to a later slot helped mothers who collect children from school.
    3. Link it to a follow-up slot.
    4. Record attendance and onward referrals.
  • Watch for: Gaete & Gois's team made attending the roda a condition for getting a prescription-renewal slot.
    • [synthesis] This conflicts with the principle that presence is freely chosen [Silva et al., p. 348]. Prefer invitation over making attendance a condition of care.

5. Handling problems

The published TCI sources address only a few of these problems: silence, thin accounts, inappropriate questions, low attendance, referral and connectivity. None of the public Portuguese sources (the Goiás protocol, Portaria 849/2017, an ABRATECOM presentation, Brazilian theses and reports) gives a TCI procedure for crisis, suicide risk or violence. Everything else is marked [synthesis]: the writer's guidance, consistent with the TCI rules and standard group and risk practice.

5.1 Nobody wants to speak, or the circle goes silent

  • From the sources:
    • Martini suggests a mote for moments of silence: "O que faço para não ter problemas?" ("What do I do so as not to have problems?") [Martini, p. 241]. It invites people to share prevention and self-care.
    • A proverb can prompt speech [Goiás 5.3.3].
  • [synthesis]
    • Lengthen the warm-up.
    • Lower the stakes by asking for a single word about how people arrived today.
    • Accept that a roda can run on a lighter concern.

5.2 Low or falling attendance

  • From the sources: in one primary-care team, some weeks had no roda because nobody came. The team responded by:
    • moving the roda to a later slot that suited mothers;
    • recruiting through doctors and community health agents [Gaete & Gois 2020, pp. 490–494].
  • [synthesis]
    • Hold the roda at a stable time and place.
    • Ask regular attendees to bring someone.
    • Avoid making attendance a condition of care (see 4.25).

5.3 Advice-giving, sermons, interpreting, or talking about others

  • From the sources: the rules forbid it, and the mote keeps the focus on first-person experience. Martini advises discarding evaluative or corrective questions [Martini, p. 224; Silva, Barreto et al. 2020, p. 350].
  • [synthesis]
    1. Interrupt gently, and thank the person for wanting to help.
    2. Restate the rule.
    3. Ask them to share a time they lived something like it.
    4. If it keeps happening, the co-therapist can sit beside them and, during the closing, give positive connotation to their wish to help.
  • Example language (illustrative): "I can see you really want to help Maria. In this circle we help by sharing our own story. Has something like this happened to you?"

5.4 One person dominates, or the protagonist keeps re-entering

  • [synthesis]
    • Use the headline rule (4.7) early.
    • Thank the person, then repeat the mote to invite other voices.
    • In the sharing stage, remind the group that the protagonist listens in silence [Goiás 5.4; Gaete & Gois p. 488], and that there will be space in the closing.
    • Offer to talk after the roda.

5.5 Overwhelm: crying, panic, dissociation, a surge in blood pressure

  • From the sources: the Goiás risk map lists emotional instability needing referral, falls, and hypertension triggered by emotion. It gives no procedure [Goiás 9.0].
  • [synthesis]
    • Crying is usually a welcome part of a roda. Allow silence, offer tissues, and let the group hold the moment without rushing in.
    • For panic or dissociation, the co-therapist quietly sits beside the person and offers grounding (feet on the floor, slow breathing, looking around the room). Offer a short break outside, accompanied.
    • For physical symptoms (chest pain, fainting, a very high blood-pressure reading in a health unit), stop and get medical help.
    • Afterwards, check in privately and refer if needed.

5.6 Disclosure of suicidal thoughts, self-harm, violence or abuse

  • From the sources: Martini lists motes about thoughts of death and suicide attempts [pp. 231–232]. No public TCI source gives a crisis protocol: not Silva, Barreto et al. 2020, the Goiás protocol (which only names emotional instability as needing referral, 9.0), Portaria 849/2017, the reports of online rodas, the UFPE report or the UFMG monograph. A Fiocruz professional-master's dissertation by a TCI therapist notes that rodas can bring up needs for medical or psychological follow-up, even psychotic episodes, and that these are taken up through the therapist's link with the Family Health team and other local services; it gives no steps, and stresses that community therapists are not trained to treat deep trauma or illness [source: Pereira 2021, sections 4.1 and 5.3]. [uncertain] Barreto's manual may contain guidance. A Brazilian psychotherapy source outside TCI describes crisis handling in three phases: ask about and explore intent and plan; understand, validate and welcome, involving family where possible; then refer and follow up, documenting all contacts [source: Fukumitsu 2014, pp. 273–274].
  • [synthesis]
    • In the room: do not explore method details. Acknowledge the person's courage and keep the roda going safely.
    • During the sharing: steer the mote toward what keeps people alive and where they draw strength.
    • During the closing: the co-therapist stays with the person.
    • Assessment: before they leave, a clinically qualified team member carries out a standard risk assessment in private, covering current thoughts, intent, plans, past attempts, protective factors and access to means.
    • Safety plan: agree one, including lethal-means counselling (safe storage or removal of means, and involving a trusted person). Add the names and numbers of two support people.
    • Hand-over: pass the person to the local crisis or mental-health service following the service's protocol. In Brazil this is usually the CAPS or primary-care team in the RAPS, with SAMU (192) for emergencies and CVV (188) for listening support. Do not leave an acutely at-risk person alone. Outside Brazil, use the local crisis service; crisis lines include 988 (US) and Samaritans 116 123 (UK and Ireland).
    • Violence or abuse: follow mandatory reporting and safeguarding duties, especially for children, older people and intimate-partner violence.
    • Confidentiality: state its limits when presenting the rules, along the lines of Fukumitsu's clause: "Manterei o sigilo desde que não haja risco de vida" (I will keep confidentiality unless there is a risk to life) [Fukumitsu 2014, p. 271]. Say that the team will act if someone's life or safety is at risk.

5.7 Stuck sharing: the group stays in complaint or problem-solving

  • From the sources: the complaint is a shell over the deeper pain. Use questions to get past it, and focus on the emotion rather than the problem [Martini, p. 228; Silva et al., p. 349].
  • [synthesis]
    • Go back to your keyword notes and pose a second mote at the level of the feeling (4.14).
    • Ask for a moment when someone got through it, even partly.

5.8 The therapist's urge to rescue or to act as the expert

  • From the sources: do not set yourself up as the saviour [Martini, p. 227]. A physician running a roda needs to actively give knowledge back to the group [Gaete & Gois, p. 493]. If the lead therapist is too moved to go on, the co-therapist takes over, and the therapist's own resonances go to intervisão (peer review with the training team) [source: Pereira 2021, sections 1, 5.1 and 5.3].
  • [synthesis]
    • Notice your urge to give information or treatment advice, and save it for an individual follow-up.
    • Use the team review (4.21) to name your resonances.
    • Clinicians who are mainly psychotherapists should avoid interpreting or diagnosing in the circle, because that breaks rule 3.

5.9 Ruptures: a participant feels unheard, judged, or exposed

  • [synthesis]
    • If it happens in the roda: acknowledge it at once and restate the rules.
    • If someone was hurt by another member's comment: name it in positive-connotation terms ("you were brave to share; that comment didn't follow our rules") without shaming the speaker.
    • If the concern was not chosen or someone feels overexposed: offer individual time afterwards (4.10).
    • Repair with the whole group: at the next roda, restate the confidentiality expectation and reaffirm the voting process.

5.10 Conflict between members, or concerns about known people in a small community

  • [synthesis]
    • Remind people to speak of themselves, not to name or describe third parties.
    • Discourage concerns about a specific person in the room.
    • If two people are in open conflict, the therapist does not mediate it in the roda. Offer a separate conversation or mediation.

5.11 Cultural or religious friction

  • From the sources: cultural anthropology asks you to value every culture without ranking them, and to welcome diversity without forcing consensus [Silva et al., pp. 345–346; Martini, p. 228].
  • [synthesis]
    • When someone presents their faith or practice as the answer for others, treat it as their own first-person resource. Then re-pose the mote so others can share theirs.

5.12 Online problems: connection, privacy, risk at a distance

  • From the sources: when a connection is poor, ask people to switch off their camera, and use the chat as a fallback [Peloso-Carvalho et al.].
  • [synthesis]
    • Collect each person's location and an emergency contact.
    • Ask people to join from a private space with headphones.
    • Let the co-therapist watch the chat and the video tiles for distress, and message people privately if needed.

5.13 Non-adherence and drop-out

  • [synthesis] Because the roda is open, missing sessions is not a failure.
    • In services, a brief follow-up contact from the team after a person's first roda helps retention.
    • Clients in individual therapy can be invited to bring what they took from a roda into their sessions.

5.14 Scope limits: who needs more than a roda

  • [synthesis] The published sources give no exclusion criteria [Silva et al. 2020]. Pair the roda with individual care, or do not use it as the main intervention, for:
    • acute psychosis or mania;
    • severe intoxication;
    • active, high suicide risk;
    • situations where a perpetrator and a victim might attend the same roda.

Sources

Main sources

Further pages:

Books and other works cited

  • Barreto AP. Terapia comunitária passo a passo. Fortaleza: Gráfica LCR. Editions are cited as 1996 (Costa), 2005 (Marchetti) and 2008, 4th ed. (Goiás protocol). This is the core manual. It has no publisher preview or public copy, so details that only it would settle are marked [uncertain].
  • Barreto AP (2019). Integrative Community Therapy: Step by Step (English edition).
  • Barreto AP (2008). Manual Cuidando do Cuidador (cited by Benetti).
  • Barreto A, Grandesso M. Community therapy: a participatory response to psychic misery. Dulwich Centre Publications, 2010, issue 4 (founders' English account of the stages of a roda; content not used here)
  • Camargo (2005), cited through Costa, UFMG.
  • Watzlawick P, Beavin JH, Jackson DD (1967). Pragmatics of Human Communication. New York: Norton. This is the communication-theory pillar.
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