An Introduction to Balint Group Work Balint Group Process An Introduction to Balint Group Work

Collaborators American Balint Society Ritch Addison, PhD Greg Troll, MD Jillian Romm RN, LCSW Chiara Ghetti, MD Jeff Sternlieb, PhD Revised and edited for the BSANZ Di Nash Hamish Wilson

Dr 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 Balint groups are named after Michael Balint. Born in Budapest in 1896, son of a GP. 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.

Early ideas Michael and his 3rd wife, Enid, began the training/research seminars for GPs after WW II to help GPs respond to the societal burden of trauma and its effects on patients and their families Realised they were also researching the doctor patient relationship 1957 “The Doctor, his Patient and the Illness” published, largely from group notes 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.

Michael and Enid Balint “At the center of medicine there is always a human relationship between a patient and a doctor.”

Balint Group work is not: a psychotherapy group an encounter group a traditional case consultation group a topic discussion group a place for prescriptive advice or didactic teaching

Characteristics of a Balint Group Usually fixed membership Usually two co-leaders who are paid by the group Focuses on the doctor-patient relationship

Characteristics of a Balint group The power of the group develops over time Members present an ongoing ‘case’ (patient or client) Focus on less obvious or less conscious aspects of relationship

Ground Rules Confidentiality Respect, Turn Taking Avoid advice No criticism

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 Patients we: ‘Take home’ with us Lose sleep over Feel conflicted over or feel strongly about Feel ambivalent about or we don’t want to see again for some reason

Cases leave us feeling unfinished ‘bubble up’ in any moment in our day Case are patients are also clients or patients who: leave us feeling unfinished ‘bubble up’ in any moment in our day Are ‘heartsink’ in some way for us.

Presentations are spontaneous no clinical notes no preparation the presenter speaks for around 5 minutes

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

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

Are there any questions of fact? Clarifying Questions Leader Are there any questions of fact? Presenter Leader

Lets let the presenter just listen while we ‘work the case' The Presenter gets to Listen Leader Lets let the presenter just listen while we ‘work the case' The group begins with: who’s got a case? Leader Presenter

The Group Starts Working Leader I imagine Sophie 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 To: explore the doctor-patient relationship look inward, be imaginative, creative, look for less conscious aspects

Functions of Group Members To attend to and share about the case their: thoughts, images fantasies, associations hypotheses

Functions of Group Members to differentiate their own experience from that of the presenter to further the group’s empathic understanding

Balint Leaders create and maintain a safe space structure and hold the group over time protect the presenter and group members from intrusion

Balint Leaders encourage reflection, empathy and compassion attend to group development debrief with co-leader after each group

Functions of a Balint Group provides a safe place for emotional reflection on troubling cases helps the presenter to consider other understandings about the case

Functions of a Balint Group looks at blind spots and assumptions helps members to feel less isolated, less shame offers a way to new types of learning helps members to grow and develop

Benefits for clinicians Explore difficult or troubling situations Refine crucially important patient-doctor relationship skills Hear and learn from others’ cases

Benefits for clinicians To connect with others To experience the power of a group To remind ourselves what matters about our work To avoid burnout, increase engagement with others and increase resilience

Balint opportunities and training join a Balint group in your area, or a Skype group train with BSANZ Leadership Accreditation Pathway BSANZ Annual Balint Group Workshop International Balint Conferences and Congresses

Resources Balint Society of Australia and New Zealand balintaustralianewzealand.org American Balint Society americanbalintsociety.org International Balint Federation balintinternational.com