1. n “…what is too often missing in the day-to-day existence of a physician is the commitment to carve out a clearing for reflection- reflection about the stresses of the day, about patients, about life as a physician, about the ideals that brought one to medicine, about what one cares about, what matters and has meaning, and how one can express that meaning in one’s professional and personal life…” R.B. Addison. Stress and Burnout.

2. An Introduction to BALINTGroups Assembled by representatives of: The American Balint Society

3. ….Introducing a tool to address Dr. – Patient relationships for Family (and other) Physicians.

4. Balint….Michael Balint n Born in 1896 in Budapest n After completing psychoanalytic training in Berlin and Budapest, emigrated to Scotland and moved to London where he worked at the Tavistock Clinic. n He and his wife, Enid began the training- research seminars, now called Balint groups n 1957 “The Doctor, His Patient and the Illness”

5. One of Michael Balint’s core assumptions is that: “at the center of medicine there is always a human relationship between a patient and a doctor.”

6. In addition, Balint said that “…reflection on our observations can lead to better understanding… Understanding makes us better physicians”

7. Unique Characteristics n Structured leader and group member roles. n Single case focused discussion. n Emphasis on divergent thinking. n Focus on Dr.–Pt. Relationship.

8. Unique Characteristics (cont.) n No case notes or preparation. n Focus on continuity patient. n Ideally, the group is on going. n The group is closed. n The leader has specialized training

9. Competencies (ACGME) Addressed by Balint Work n Improves listening skills with both patients and colleagues n Allows you to sit with uncertainty (and complexity) without feeling the need to tease it apart n Encourages integrative thinking n Reveals group dynamics n Encourages empathy

10. Competencies Addressed by Balint Work (cont.) n Encourages reframing n Encourages thinking outside the box n Method for expressing frustration, pain and joy n Encourages camaraderie with group members n Encourages intimacy with group members

11. Competencies Addressed by Balint Work (cont.) n Improves observation powers n Shows value of being and not doing n Encourages reflection n Encourages self-evaluation n Improves satisfaction of all practicing clinicians

12. Leader GROUP COMPOSITION

13. n Keep discussion focused on the physician and patient relationship n Redirect discussion, as necessary n Encourage speculation n Act as a time keeper n Ensure an atmosphere of safety Leader The : Leader

14. Confidentiality Respect Ownership Honesty GROUND RULES

15. Leader GROUP PROCESS Who’s got a case?

16. Leader GROUP PROCESS I do.

17. Leader Presenter GROUP PROCESS Angela is a 79 yr old blind woman….

18. CASES  Patients we have ongoing relationships with  Patients who raise inner conflict or strong feelings  Patients that leave us feeling baffled or confused  Patients we take home and think about

19. Leader Presenter GROUP PROCESS

20. Leader Presenter GROUP PROCESS Are there any clarifying questions?

21. Leader Presenter GROUP PROCESS I imagine Angela to be…

22. Leader Presenter GROUP PROCESS If I were the physician, I would feel…

23. Leader Presenter GROUP PROCESS If I were this patient, I would….

24. WHY BALINT FOR THE FAMILY PHYSICIAN? n the characteristics of the patient doctor relationship are universal n as Family Physicians we are involved in many situations which evoke powerful emotions n addresses numerous ACGME requirements for professionalism

25. WHAT BALINT IS NOT n M+M n Case discussion group n Support group n Group therapy

26. WHY DO BALINT?? n to understand the patient as a person…like ourselves! n to improve our self awareness. n to learn self-reflection. n to improve our ability to communicate.

27. WHY DO BALINT?? to share our experiences as physicians. n to nourish ourselves and enable others to make discoveries. n to rediscover the meaning and purpose of being a physician.

28. Resources: Balint Groups – Group Processes n American Balint Society http://americanbalintsociety.org http://a Balint Leader Training and Certification n A.K. Rice Institute for the Study of Social Systems www.akriceinstitute.orgwww.akriceinstitute.org n The Tavistock Primer II, Hayden, Charla, and Molenkamp, Rene, AKRI