What is a Balint Group?
GP Ceri Dornan writes the first in a series on how a Balint Group can support you as a GP
When I say to people that I run Balint groups, common responses are, ‘What are they?’, ‘Balance groups?’ and ‘I thought they died out years ago’.
Dr Michael Balint and his wife Enid began their research seminars with GPs in the 1950s and the first groups were somewhat different from what we do today, but the core part of Balint work remains the same. Here is a brief explanation of the theory behind the Balints’ work.
The Balints were psychoanalysts who were very interested in what happened in GP consultations and in particular in the relationship between doctor and patient, which they believed to have considerable therapeutic potential beyond the clinical aspects of care. They introduced the idea of the ‘doctor as drug’.
Psychoanalytic theory includes the premise that we communicate both consciously and unconsciously and that unconscious communication may be experienced by the recipient in the form of emotion and somatic sensation. You will no doubt recognise the effect of being in very gloomy or elated company. Our early experience of relationships is also thought to have significant influence on the way we continue to relate to others.
In a consultation with a patient, we may experience, or be left with, many different feelings, both positive and negative. The Balints believed that by learning to notice and be curious about the meaning of these feelings, that the doctor could deepen their understanding of that particular patient and make better sense of their problems.
Their group seminars allowed participating GPs to bring case descriptions of interactions which aroused strong, lingering or stuck feelings to present to their colleagues. The purpose of the group discussion was then to share group members’ responses to the story, wonder about the meaning of their own and others’ responses and about this particular doctor patient relationship.
Teaching, problem solving, advice giving and analytic interpretation was discouraged as was probing into the personal world of the doctor. Of course some of the feelings are the doctor’s own and may or may not be acknowledged, but Michael Balint thought that over time, the doctor might undergo ‘a small but not inconsiderable change in personality’ by internally recognising aspects of themselves which might intrude on the doctor patient relationship.
For some, Balint groups have an air of mystery about them and induce fears of being exposed emotionally or of appearing ignorant about psychoanalysis. In fact, Balint groups do not use analytic language and do not require participants to have prior knowledge of analytic processes.
The ideal Balint group has a membership of the same 8 to 10 people who meet regularly, with one or two leaders. Over time, it is hoped that the group builds sufficient trust to provide a safe place to talk about matters hard to discuss elsewhere. The rule that everything brought into the group is confidential is helpful here.
The group setting means that the presenter can listen to the responses of others to the story, which may be quite different and often reflect parts of the case. The leaders, or facilitators, are there to set the scene, keep time, look after the group members and encourage the group to focus on the task of discussing the doctor patient relationship. They might invite the group to think about something important which seems to be missing in the discussions, but they are not there to give answers.
Indeed, the group may end with no solutions at all, but hopefully members take away thoughts to digest and the case presenter some new ideas and understanding of the interaction with their patient. Acceptance of the patient as they are, or that the doctor can do no more than ‘be there’ may seem to be small gains, but can lighten the load of otherwise heavy consultations. There can also be more striking realisations about the patient or within the doctor, perhaps illuminating a blind spot.
Balint work is by its nature experiential. Theory and description alone do not provide the experience which can come from being in a live group. If you are interested in finding a group or somewhere to give Balint work a try, get in touch with us at the Balint Society via firstname.lastname@example.org.
Read more about Balint work at www.balint.co.uk.
Next time: What can a Balint group do for me?