Balint Group Process

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Balint Group Process

• An Introduction to Balint Group Work

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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

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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

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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

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

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Characteristics of a Balint Group

• Usually fixed membership
• Usually two co-leaders who are paid by the group
• Focuses on the doctor-patient relationship

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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

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Ground Rules
Confidentiality
Respect, Turn Taking
Avoid advice
No criticism
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The Group Convenes
Leader
Leader
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Calling for the Case
Leader
Whos got a case?
Leader
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Cases

• Patients we
• Take home with us
• Lose sleep over
• Feel conflicted over or feel strongly about
• Feel ambivalent about or we dont want to see
  again for some reason

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Cases

• 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.

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Presentations are spontaneous

• no clinical notes
• no preparation
• the presenter speaks for around 5 minutes

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Group Process
Leader
I do.
Leader
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The Case Arrives
Leader
Sophie is a 79 yr old blind woman.
Presenter
Leader
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Clarifying Questions
Leader
Are there any questions of fact?
Presenter
Leader
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The Presenter gets to Listen
Leader
Lets let the presenter just listen while we work
the case'
Leader
Presenter
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The Group Starts Working
Leader
I imagine Sophie to be
Leader
Presenter
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Imagining Patient and Doctor
Leader
If I were the doctor, I might feel
Leader
Presenter
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Group Exploration Continues
Leader
This image just popped into my mind of a
Leader
Presenter
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Functions of Group Members

• To
• explore the doctor-patient relationship
• look inward, be imaginative, creative,
• look for less conscious aspects

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Functions of Group Members

• To attend to and share about the case their
• thoughts, images
• fantasies, associations
• hypotheses

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Functions of Group Members

• to differentiate their own experience
• from that of the presenter
• to further the groups empathic understanding

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Balint Leaders

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

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Balint Leaders

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

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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

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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

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Benefits for clinicians

• Explore difficult or troubling situations
• Refine crucially important patient-doctor
  relationship skills
• Hear and learn from others cases

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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

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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

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Resources

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