This work takes place in the field of Brazilian Psychiatric Reform, in which transforming the traditional ways of caring requires confronting the obstacles, among which we highlight the chronification phenomenon on the professional practices and on the users movements in the substitutive services. Research was developed with the purpose to analyze these processes and was accomplished in a specialized mental health clinic taking as a theoretical-methodological reference the institutional analysis perspective. The methodological procedures were: bibliographical research; analysis of the services records; participant observation and registers in the field's notebook; conversation circles with the teamwork. We observed that the teamwork routine is revested in tensions, varying between distinct poles: specialisms X experimentation, verticality X horizontality, demands centralization X co-responsibility, despolitization X empowerment, compassion X solidarity. The analyses aim the everyday crash between the Psychosocial and Hospitalocentric Paradigms, the need to invest on changing the management tactics, politicizing the working procedures.
psychiatric reform; strategy of psychosocial attention; ways of work; management