Balint Group Orientation

1. Balint Group Orientation Kara Z. McDaniel, NCC, LPC Behavioral Medicine Emory Family Medicine

2. Balint Groups: History • Balint Groups • Developed by psychoanalysts, Michael and Enid Balint, in the 1950s • Michael Balint • born in Budapest in 1896 • son of a general practitioner • After completing psychoanalytic training in Berlin and Budapest, he emigrated to Scotland and then moved to London • It was in London that Michael and his wife began training-research seminars now known as Balint Groups

3. Balint Groups: History • Balint Groups Continued • Michael Balint visits USA in 1960s • Concepts adopted in 1970s and 1980s • Groups formed in training settings • American Balint Society formed in 1990 • Society prioritized training for leaders • Credentialing system introduced in the year 2000

4. Balint Groups: History • Aim • to help physicians cope with their patients’ problems as well as the problems they may have with their patients. • Focus • Doctor-patient relationship • What does the relationship mean? • How can the relationship be used in a helpful manner? • Why is there a break-down in the relationship at times in which the doctor and patient fail to understand one another?

5. Balint Groups: History • Methods • Under the guidance of psychoanalysts, physicians were invited to present cases from their practices • Early on, physicians were encouraged to have extended interviews prior to presenting a case • Later, the Balints became more interested in what occurred between a doctor and his/her patient during brief consultations. • Emphasis shifted from psychotherapy to discourse of family practice.

6. Balint Groups: Format • Format • Meet once a month for approximately one hour • occurs over a three year period • Problem cases are explored and discussed in depth • Agenda is set based on specific cases brought to group • Problems that impede the management of a particular case • Interference with physician’s comfort level as a family physician • Specific issues that may be addressed • Psychological problems • Personality problems • Problems within doctor-patient relationship • Patients’ family problems • Problems between physician and colleague

7. Balint Groups: Format • Focus on specific issues and clinical situations • Death and dying • “thick chart patient” • angry patient • patient noncompliance • suicidal/homicidal patient • somaticized patient • scapegoat recognition • awareness that identified patient may not necessarily be the member of the family who needs the most help • sometimes a child’s symptom is a sign of a much greater problem occurring within family • learning how to communicate and listen effectively

8. Balint Groups: Format • Create a learning environment • explore and validate perceptions of the emotional factors that not only play a role in illness but may also interfere with the management of illness • Sensitization • effects of emotional factors and personality types on the relationship between physician and patient • Define one’s role as a family physician by exploring challenges with fellow colleagues • All physicians have certain ways in which he/she responds to different patients and specific types of problems • goal is to examine these approaches and explore alternative ways in which to respond

9. Balint Groups: Standard Rules • Group rules • Confidentiality • Honesty • Ownership • Respect • Explore meaning, not problem solving

10. Balint Groups • Balint vs. Support Groups