Balint Group Process An Introduction to Balint Work The American Balint Society www.AmericanBalintSociety.org

Collaborators Ritch Addison, PhD Greg Troll, MD Jillian Romm RN, LCSW Chiara Ghetti, MD Jeff Sternlieb, PhD

Outline What is or who was Balint? What is and isn’t a Balint Group? Balint Method Group Process and Discussion Functions of Balint Groups Opportunities, Resources

Who was Balint? What is Balint? (Do you mean “Balance”?)

Michael Balint Born in 1896 in Budapest, son of a GP Psychoanalytic training in Berlin and Budapest, emigrated to London, worked at the Tavistock Clinic He and his 3rd wife, Enid, began the training/research seminars for GPs after WW II 1957 “The Doctor, his Patient and the Illness” published Balint groups are named after Michael Balint. Born in Budapest in 1896, son of a GP. It is in this book that he develops his ideas regarding the psychological implications of general practice and the method of training physicians to appreciate these implications and gain an understanding of the doctor/patient relationship. Balint groups exist world wide, the International Balint Society was founded in 1970, and the American Balint Society was founded in 1990. Today, more than 50% of the family practice residencies have adopted Balint training as part of their curriculum.

“At the center of medicine there is always a human relationship between a patient and a doctor.” -Michael Balint On of Balint’s core assumptions is that

What a Balint Group is not Psychotherapy Group Encounter Group Traditional Case Consultation Group M&M Conference Topic Discussion Group Personal and Professional Development Group Not prescriptive, didactic, advice giving

Characteristics of a Balint Group Ideally fixed membership Closed Group Two co-leaders Focus on doctor-patient relationship Power of the group Preference for an ongoing case Less conscious aspects of relationship

Ground Rules Confidentiality Respect, Turn Taking Avoid Advice Ownership

The Group Convenes Leader Leader Composition: small groups of 6-12 participants, members are clinically active providers defined group leader, usually a physician with active clinical contact and a psychologist or mental health provider Leader

Calling for the Case Leader Who’s got a case? Leader The group begins with: who’s got a case? Leader

Cases Presentations are spontaneous Patients we have ongoing relationships with Patients who we feel conflicted or strongly about Patients that leave us feeling unfinished, who we lose sleep over Patients who we “take home” with us Patients that bubble up in the moment

Group Process Leader I do. I do. Leader a member volunteers to present the details of a case Leader

Angela is a 79 yr old blind woman…. The Case Arrives Leader Angela is a 79 yr old blind woman…. a member volunteers to present the details of a case Leader Presenter

Are there any clarifying questions? Leader Are there any clarifying questions? Leader Presenter

Why don’t we let the presenter just listen while we work the case The Presenter gets to Listen Leader Why don’t we let the presenter just listen while we work the case The group begins with: who’s got a case? Leader

The Group Starts Working Leader I imagine Angela to be… a playful conversation ensues, often based on “I” statements Leader Presenter

If I were the doctor, I might feel… Imagining Patient and Doctor Leader If I were the doctor, I might feel… participants explore the patient, the doctor, their roles and relationship Leader Presenter

This image just popped into my mind of a… Group Exploration Continues Leader This image just popped into my mind of a… participants openly hypothesize about the dynamics which could exist for each character Leader Presenter

Functions of Group Members Explore doctor-patient relationship Look inward, be imaginative, creative, look for less conscious aspects Attend to and share thoughts, images, fantasies, associations, hypotheses Differentiate one’s own experience from presenter’s Further empathic understandings

Functions of Balint Leaders Create and maintain a safe space Structure and hold the group over time Protect presenter and group members Encourage reflection, empathy and compassion Attend to group development Debrief with co-leader after each group

Functions of a Balint Group To provide a safe place for emotional reflection on troubling cases To help presenter consider other understandings about the case To look at blind spots, assumptions To help members feel less isolated, less shame, more open to learn To help members grow and develop

Benefits for Clinicians Explore difficult or troubling situations Refine crucially important patient-doctor relationship skills Hear and learn from others’ cases Connect with others Experience the power of a group Remember what matters about our work Avoid burnout, increase engagement and resilience

Upcoming Opportunities Healing, Mindfulness and Compassion: Ratna Ling, April 19-21, 2013; October 11-13, 2013 18th International Balint Congress: Heidelberg, Germany, September 7-11, 2013 Next Balint Intensive Training: Long Beach NJ: October 17-20, 2013

Resources American Balint Society http://www.americanbalintsociety.org/ International Balint Federation http://www.balintinternational.com/ raddison@sonic.net 707-576-9813