Balint Groups
May 2014
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
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”
“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”
“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
The doctor
Responds to
► Person
of the patient
Producing
A response which can be a source of both
difficulty in their interaction
and
also of important information about a patient
The Balint Group
Explores such issues through detailed
discussion of participants accounts of their
interactions with patients
So
► The
Balint group helps GPs learn to
understand and skilfully utilise the doctorpatient relationship
► (gives more insight )
It helps the patient but what about
the doc?
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
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 casegiving cause for thought
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
Few key points
► Problem
solving is actively discouraged
► No rights or wrongs
► Expression of personal opinions
► Learner-centred facilitation
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
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
Case presented
► Then
short period of time follows for any
factual clarification with the presenter by
the group
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)
Benefits of this
► Avoids
interrogation
► Allows group to consider case dynamic for
themselves
► “safe-harbour” for presenter
► Stops presenter cutting group members
short
After case discussion
► Presenter
invited back into the groupmoves chair back
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
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
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
It still lives on
► Developed
over the years
► International Balint Federation
► Groups and Societies in many countries