1. Balint Group Process An Introduction to Balint Work
The American Balint Society

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

3. 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

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

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

7. “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

8. 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

9. 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

10. Ground Rules Confidentiality Respect, Turn Taking Avoid Advice
Ownership

11. 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

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

13. 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

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

15. 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

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

17. 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

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Resources American Balint Society
International Balint Federation