This is a descriptive-exploratory, cross-sectional study with a qualitative approach (Flick, 2019), using the Clinical-Qualitative Method (Turato, 2013) as a methodological reference and the Psychoanalysis of Link Configurations (Berenstein & Puget, 2008) as a theoretical framework. The Clinical-Qualitative Method is based on the confluence of clinical, existentialist and psychoanalytic positions and constructs. It is appropriate for research problems that emanate directly from health practices, offering interpretations and analyzing meanings that patients and professionals elaborate in their shared experiences of the health-illness-care process. Psychoanalysis of Link Configurations is a Franco-Argentine theoretical strand of psychoanalysis, which integrates the triple dimension of links: the subjective space, the intersubjective space – that is, between one subject of the unconscious and another subject, and the transubjective space – which is the sociocultural space.

The investigation was conducted at a specialized care service for EDs located in a university teaching hospital linked to the Unified Health System. The service has professionals, researchers, residents and interns from five areas of knowledge: Psychology, Psychiatry, Occupational Therapy, Nutrition and Nutrology. Health actions are guided by the Singular Therapeutic Project of each patient and discussed in weekly team meetings. Interventions are conducted individually and in groups and include patients and family caregivers. The investigator was immersed in the field for eight months prior to data collection in order to acquire familiarity with the environment and its players, as recommended by the Clinical-Qualitative Method (Turato, 2013).

The results allow us to understand the meanings attributed by the health team to the reconfigurations implemented in the specialized ED service during the first wave of the COVID-19 pandemic. The assessment corpus was divided into three themes: 1) The day the earth stood still: feelings in the face of the unexpected; 2) Let’s not stray too far, let’s go hand in hand: decision-making and service reorganization; 3) Nothing will be the same again: looking at the past, thinking about the future. The themes, subthemes and excerpts of the talks have been summarized in Chart 1.

The first impact described by participants was a reaction of surprise and disbelief, when they realized that it was no longer possible to continue on the usual path. When COVID-19 cases began to increase exponentially in the country and non-pharmacological measures to contain the virus were enacted, including physical distancing, some common reactions could be seen across the population, such as the fear of getting sick, of losing loved ones, of having to be away from loved ones, or even the fear of transmitting the infection to acquaintances in vulnerable groups. These emotional reactions were also shared by professionals, as were negative feelings such as frustration, helplessness, irritability, anguish, and sadness (Weintraub et al., 2020).

Among healthcare professionals, these reactions may have been even more exacerbated, as reported by the group of participants in this study. At that time, faced with the unpredictable, many professionals reported having felt “paralyzed”, feeling that they lacked the resources to deal with such a challenge, experiencing uncertainty, fear and insecurity. In fact, the combination of the COVID-19 pandemic with other diseases and the incidence of psychological distress generated consequences from a socio-environmental point of view, further increasing the vulnerability of the population (Weintraub et al., 2020).

One of the most significant disruptive consequences was the disruption of care networks. Physical distancing, as a basic measure to contain the pandemic, dismantled personal support networks, restricting support from family and close friends, as well as social protection networks in the field of public policies, such as schools and access to health services (Birman, 2020; Fundação Oswaldo Cruz, 2020). Once the population’s care network was weakened, experiences of suffering at an individual and collective level became enhanced, triggering stress, anxiety and feelings of impotence and helplessness in the face of an unknown and frightening threat to the continuity of life (W. A. Oliveira et al., 2020).

The sudden outbreak of a state of public calamity and the loss of the world as we knew it can lead to the emergence of what Puget (2005) calls an event. For the author, an event refers to events that exceed a given previous structure of containment and that introduce a disruptive novelty, significantly changing or breaking the world that was assumed to be ensured, in a temporality that is typical of Kairós and not of Chronos. It is a time of decision in the here and now, which introduces a fracture in the linearity of chronological time. Abrupt changes in social life and objective events with a high destabilizing potential have serious subjective consequences, since they plunge individuals into the chaos of the world’s unpredictability.

Puget (2015) argues that every bond involves a quantum of unpredictability, which the author called the Principle of Uncertainty. Although present in all of us and inherent to social coexistence, we usually endure uncertainty because we have groups to which we belong that provide us with some minimum guarantees of survival, with a certain prediction of continuity (Santos, Valdanha-Ornelas, et al., 2020). In this sense, when some specific event breaks the usual chronology of existence as we knew it, imposing a cut, an inflection point in which rupture, discontinuity, the unpredictable and the feeling that we are facing an irremediable fact prevail, a traumatic situation ensues.

Trauma, according to Freud (1920/2010), occurs when an experience of high emotional intensity exceeds the psyche’s capacity for metabolization and containment. Puget (2015) adds that experiences of discontinuity, such as the health crisis triggered by the new coronavirus, can mobilize a traumatic dimension at the social level, as uncertainty exceeds the group’s capacity for containment, both at the intersubjective and transsubjective levels, and is unable to maintain the continuity of the sense of belonging and social protection necessary for the psychic processing of the traumatic event.

Birman (2020) argues that the discontinuity experienced, especially throughout 2020, had the potential to radically transform modes of existence and sociability, especially in their temporal dimension, reconfiguring the experience of linear and chronological historicity. In fact, in view of the results of this study, we can state that the challenges and difficulties of health workers were heightened at that time. Experiencing discontinuity and without being able to count on support from the institutional and government agents, or from the health system, which was overwhelmed and on the verge of collapse, professionals found themselves in a “leaky network”, subjected to a situation of profound helplessness.

According to Laplanche and Pontalis (1998), this state of discomfort refers to the early development phase of the human newborn who is completely dependent on others to satisfy his/her basic needs and to establish the foundations of his/her subjectivity. In the adult who can count on a fully developed psychic apparatus, the state of helplessness can be experienced as a prototype of the traumatic situation, since it refers to the archaic states of tension and anguish triggered by the loss and separation of the primary object. The feeling of helplessness becomes clear when one of the professionals says that she was unable to obtain support from her personal base network in the face of an emergency situation she experienced with a patient and that, in light of this, she realized that she would not be able to face that type of challenging situation without the support of the multidisciplinary team.

While patients found themselves deprived of their support networks, which may have been an aggravating factor for their health condition (Clark Bryan et al., 2020; Nisticò et al., 2021; Papandreou et al, 2020; Schlegl et al., 2020; Termorshuizen et al., 2020), professionals also perceived their personal networks as weakened. According to the reports obtained, group work was a pillar that proved essential to sustain resilience in the face of the helplessness to which they were subjected. For the psychic apparatus to remain intact, minimum social guarantees are required that support the continuity of the feeling of belonging and bonding work, which nurtures the conditions that allow the individual to deal with the uncertainty inherent in the encounter with otherness (Puget, 2015; Santos, Valdanha-Ornelas, et al., 2020).

From the perspective of the Psychoanalysis of Bonding Configurations, belonging can be conceptualized as a feeling and intimate conviction that we are part of a group (family, group, community or social), fueling an expectation of reciprocity based on the sharing of similar characteristics among group members and the identification of aspects that differentiate us from others, as postulated by Freud (1921/2011) with the narcissism of small differences (Nunes, 2021). Therefore, the protection produced by belonging to the group seems to have allowed professionals to not have to cling so tenaciously to their defensive mechanisms in the face of the scenario of uncertainties introduced by the pandemic. This seems to have favored the team to start working towards seeking to produce joint and innovative solutions. Participants highlighted that the pandemic showed the importance of group unity and to cultivate a cooperative spirit to maintain the continuity of care, offering another model of care to people using the service.

It was possible to notice that some participants realized, at different times, that nothing would ever be the same again, since the professionals, as individuals, and the team as a whole had been touched and transformed by the experience. Faced with the socio-humanitarian crisis, they realized that the transformations can be thought of in two ways: what they had to change in order to metabolize the stress during the crisis and, on the other hand, what these changes produced as an effect on their subjectivities, that is, what consequences the disruptive experiences had on the way they related to themselves and the world.

One of the lessons learned by participants was that, through the shared management of emotions and group work, it was possible to forge a possible way to move forward with care. According to one participant, the crisis triggered by the pandemic was different from previous crises, although it also brought potential and openings for change, since it led the team to reflect on how they would organize themselves as players and agents promoting health.

Resumption of team meetings online and the possibility of talking with other team members via messaging appears to have helped strengthen the horizontal bond between team members. With the return to in-person activities, some of the changes experienced in the previous period were incorporated into the service, such as maintaining groups on social media and using online resources for meetings when necessary. This reality followed the trend of other health services in the country and around the world (Datta et al., 2020; Davis et al., 2020; Graell et al., 2020; Plumley et al., 2021), which incorporated strategies for remote meetings between teams during the health crisis.

Another lesson learned was to have the necessary flexibility so that care could be reconfigured under the conditions prevailing at the time, since professionals had not received prior training in the use of digital platforms for care purposes. As one FG participant pointed out, the patients treated at the service have very rigid personality characteristics and difficulty in socializing and forming and maintaining a therapeutic bond (Oliveira-Cardoso & Santos, 2019; Santos, Valdanha-Ornelas, et al., 2020). Therefore, the flexible posture of professionals proved to be an essential requirement for apprenticeship because, contrary to the patients’ usual way of functioning, it was able to favor relational openness and availability for dialogue and, consequently, favored the therapeutic bond (Simonds & Spokes, 2017), an essential ingredient both for treatment and for the well-being and mental health of team members (Souza & Lopes, 2022).

From a bonding, intersubjective perspective, Roussillon (2019) corroborates this idea, arguing that, given the “anorexia” of affective relationships and the fragility of patients’ ability to transform and metabolize their affective-emotional experiences, the clinician needs to develop genuine contact. This contact is made possible by a Malleable Medium (the clinician himself), which can gradually favor transformations and enable access to symbolization processes.

This clinical-qualitative study sought to understand the meanings attributed by professionals from the team specializing in EDs to the reconfigurations implemented in the service during the first wave of COVID-19. Through data collected in sessions with focus groups with 23 professionals from a reference service, these meanings were revealed and they were divided into three thematic axes: at the beginning dominated by perplexity and paralysis in the face of uncertainty; then the time the health team reorganized itself as a group and set about the task of reinventing itself, initiating the reconfiguration of care; and finally, when it was possible to implement and calibrate technology-mediated care and learn from the new experience as it developed.

Regarding the first theme, it was possible to perceive that the excess of uncertainty and instability generated a scenario of uncertainty, in which there was the combined effect of the health crisis, the damage caused by neoliberal policies in the precariousness of the health system and the negligence of the federal government in the reckless management of the pandemic. This “perfect storm” environment generated intense perplexity and increased the level of uncertainty experienced by health professionals. The unusual situation caused suffering among professionals, as reported in the groups, configuring a continuum of traumatic experiences of loss and unacknowledged grief.

Healthcare professionals were exposed to extreme circumstances during the pandemic and faced challenging situations with virtually no support or clear guidelines on how to proceed, especially since the chaotic scenario of the first year of the pandemic only gradually became clearer. In this context of helplessness and uncertainty, the multidisciplinary team, as one of the groups to which healthcare workers belong, was able to join forces and offer the minimum guarantees necessary to come up with creative and innovative solutions to ensure the continuity of care. Healthcare is built on a network, and the network proved to be very fragile and markedly unstable. However, the team’s cohesion appears to have been a promising factor that allowed hope as well as revitalization of the bonds. This provided sufficiently good conditions to rethink the care model and enhance confidence in its effectiveness.

Once the critical phase was over, the team members were able to ask themselves: what are we going to derive from this extreme experience? The professionals thought: we have lost a lot and we still have a lot of grieving overcome, but we have also survived these two years and learned a series of skills that have made us stronger. This liminal context acted as a driving force, which drove the paradigm shift with the discovery of new ways of sharing to take care of life: our own and that of other vulnerable people.

Among the lessons learned, the participants in this study highlighted three points: 1) The essential nature of sharing and group cohesion for decision-making, providing support to cope with individual insecurities and enabling the maintenance of service; 2) It is possible to make good use of the online modality, despite its limitations, and the service was able to reinvent its practices and “change wheels while the car is moving”; 3) The importance of being flexible, realizing that impasses can admit different solutions, and that this difference can bring both difficulties and potentialities that were previously unthinkable.

Through the investigators’ interaction with the health professionals who collaborated with the research, a consistent set of data was produced and reviewed, highlighting the potential of the bonds established and reconfigured between team members, which redesigned the clinical practice developed with patients with EDs. The participants reflected on the clinical practice of EDs, articulated from their multidisciplinary practice remodeled throughout the COVID-19 pandemic crisis. In this sense, the use of the group as a dialogic context seems to have favored a relational space that allowed professionals to reflect on the changes in their practices; at the same time this was a moment of sharing and mutual recognition of the potentialities and weaknesses faced.

The findings brought to the fore the usually silenced voice of health team members. By cultivating a space for listening to the multiple experiences and feelings experienced in the processes of caregiving, the results offer support for managers and health professionals committed to strengthening the Unified Health System, helping them to improve encounters with users in caregiving in crisis situations.