1. Balint Groups May 2014

2. What are they about? ► Train GPs in psychological aspects of work ► Have a trained leader ► Discuss material from their practices ► Focus on doctor patient relationship

3. History ► Developed by psychiatrist Michael Balint ► Worked with GPs in London 1950s after emigrating from Hungary ► Practised as a psychoanalyst ► Wrote “The Doctor, his patient and the illness”

4. “The Doctor, his patient and the illness” ► Physical, psychological, social aspects of the consultation ► Doctor’s apostolic function ► Entry Ticket ► Hidden Agenda ► Collusion of anonymity ► The “drug doctor”

5. “the drug, doctor” ► Patient responds to not just “drugs” But ► The person of the doctor ► The atmosphere the doctor creates ► What the interaction means to both of them

6. The doctor Responds to ► Person of the patient Producing

7. A response which can be a source of both difficulty in their interaction and and also of important information about a patient also of important information about a patient

8. The Balint Group Explores such issues through detailed discussion of participants accounts of their interactions with patients

9. So ► The Balint group helps GPs learn to understand and skilfully utilise the doctor- patient relationship ► (gives more insight )

10. It helps the patient but what about the doc?

11. What does the literature say? Increased ability to cope with ► difficult doctor-patient interactions ► Psychological challenging situations ► Mental Health issues ► Reduced work related stress ► Increased professional satisfaction

12. Essentials of a Balint Group ► Small (6-10 participants) ► Defined leader (trained)- ultimate responsibility to ensure group functions ► Members have clinical contact with patients ► Group material based on a current case- giving cause for thought

13. Essentials of a Balint Group ► Discussion focuses on the relationship between presenting doctor and his patient ► Case notes not used ► Group NOT for personal therapy ► Small group rules apply ► Purpose is to increase understanding of the patient’s problems NOT to find solutions

14. Few key points ► Problem solving is actively discouraged ► No rights or wrongs ► Expression of personal opinions ► Learner-centred facilitation

15. It starts with a gift! ► The case presented is often referred to as “a gift” ► You honour the gift by sticking with the case (i.e. don’t get side tracked – similar case of another member ► This case gets everyone's full attention for an agreed time

16. Fantasise ► Once you know no right or wrong can come up with any observations on the case ► Free association helps people think laterally – give new insights

17. Case presented ► Then short period of time follows for any factual clarification with the presenter by the group

18. Sit back six inches! ► Facilitator asks presenter ► Presenter does this ► Rest of group know presenter is not available for discussion for a period of time (20-30 mins)

19. Benefits of this ► Avoids interrogation ► Allows group to consider case dynamic for themselves ► “safe-harbour” for presenter ► Stops presenter cutting group members short

20. After case discussion ► Presenter invited back into the group- moves chair back

21. The presenter can… ► Comment on the process ► Comment on points raised ► Provide feedback to group members ► Clarify additional points ► Leave the case as it is Choice is with the presenter

22. Remember ► Often significant emotional component on behalf of presenter ► Discussion may have raised sensitive areas for presenter ► Facilitator needs to make sure presenter is okay- if issues raised then is acknowledged and appropriate referral arrangements made

23. What about the patients rights! ► If a group gangs up against the patient ( i.e. their behaviour unacceptable)- facilitator represents possible needs the patient may have e.g. “I wonder what someone in in this position may feel?” “Is a need being met for the patient by this behaviour?” Keeps it NON- Judgemental

24. It still lives on ► Developed over the years ► International Balint Federation ► Groups and Societies in many countries