1. An Introduction to Balint Group Work
Balint Group Process
An Introduction to Balint Group Work

2. 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

3. 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.
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 Today, more than 50% of the family practice residencies have adopted Balint training as part of their curriculum.

4. 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

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

6. 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

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

8. 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

9. Ground Rules Confidentiality Respect, Turn Taking Avoid advice
No criticism

10. 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

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

12. 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

13. 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.

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

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

16. 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

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

18. 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

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

20. 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

21. 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

22. Functions of Group Members
To:
explore the doctor-patient relationship
look inward, be imaginative, creative,
look for less conscious aspects

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

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

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

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

27. 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

28. 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

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

30. 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

31. 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

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