Balint Groups

Balint groups – which are named after their creator, Michael Balint – are a group work method for doctors and members of the other care and helping professions. The aim of these groups is to educate practitioners about the psychological dimension of their relationships with patients, with a view to enhancing both their role as carers and their professional well-being.

Born in Budapest in 1896, Michael Balint – the son of a family doctor – worked briefly as a biochemist after completing a degree in medicine. He trained in the psychoanalytic method under Sandor Ferenczi, a student of Freud’s, and practised as an analyst in Budapest until 1939, when he moved to England as a refugee. After the war, he took up a position at the Tavistock Clinic in London, where from the early 1950s, he and his second wife, Enid, began to work on the training of GPs, leading to the development of the Balint groups. Balint’s most important work, The Doctor, His Patient, and the Illness, was published in 1957, and ever since, the training of British family doctors has reflected the influence of his ideas.

The Balint group is a tried and tested group training method, originally devised for the psychological training of family doctors and subsequently adapted to meet the needs of other practitioners. While it originated within a model of care based on the doctor-patient dyad, it has evolved over time in response to the profound changes that – in recent decades – have transformed medicine, primary care, and welfare, and consequently the work of the family doctor: more specifically, the care relationship now encompasses a set of relationships involving dyads, groups and networks, and has become more complex and demanding, both professionally and emotionally.

The conceptual assumptions informing the “Balint method” are as follows:

1. the most frequently prescribed “drug” is the doctor in person, whose “pharmacology” however is largely unknown;
2. although much of the work of family doctors and other practitioners has to do with “psychological” cases, no specific training in this domain is provided at medical school;
3. medicine is strongly focused on disease and symptoms, but much less on the person who is ill, and practically not at all on the carer-patient relationship, although issues in this relationship frequently cause dissatisfaction and anxiety in both parties to it, and frequently lead to diagnostic and therapeutic errors;
4. experience, common sense, and good will are not enough to make a good care professional;
5. the modern healthcare system requires practitioners to possess new emotional and relational skills, without which their work can be ineffective, unsafe, and overwhelming.

Originally aimed primarily at family doctors in light of their specific work, which is based on long-term care relationships that can be intimate and emotionally intense, the approach has been extended and adapted to hospital doctors, nurses, health technicians, medical students, psychologists, social workers, educators, and even magistrates, teachers, and managers of social services and healthcare institutions. In general terms, the method has proved useful for all the helping professions, given its focus on:

• exploring the relationship between practitioner and client;
• group action as a means of facilitating thought;
• learning based on experience and not just intellectual knowledge.

The objectives of the Balint method may be summarized in four points:

• Enhancing the care relationship
• Supporting the carer and their work
• Safeguarding the practitioner’s professional well-being
• Providing training in group work

The expected outcomes include:

1. identification of the emotional factors implicated in the practitioner-patient/client relationship (a domain that usually goes unaddressed in practitioner training) and acknowledgement of the role of emotion in diagnosis and treatment;
2. enhanced ability to work in groups, gain professional growth from the experiences of self and others, and cooperate via the management of personal and professional differences and conflicts;
3. better quality communications, which is particularly crucial in an age of information overload when technology tends to dominate at the expense of the “human system of care delivery”, leading to the increasing dehumanization of medicine.

The Balint method is not designed to be a tool for healthcare management or resource optimization, nor is it intended to turn doctors and nurses into psychiatrists or psychotherapists; nevertheless, its observed positive effects include a variety of improvements in the care system:

• more effective management of error and risk (as a result of reduced anxiety and enhanced cooperative relationships)
• better use of economic resources (because a good doctor-patient partnership reduces the demand for and reliance on inappropriate therapies and investigations – “defensive medicine”)
• mitigation of work-related stress and burn-out, helping practitioners to take more satisfaction in caring for their regular patients.

Balint sessions, a basic training and support instrument for practitioners, are conducted with small groups of 6-12 participants, and do not focus primarily on group dynamics but rather on the collective discussion of a “problematic” clinical case presented by a participant, with the help of one or two moderators. Discussions do not primarily concern the technical aspects of treatment, as at clinical conferences or during clinical supervision, but rather explore how the care relationship is emotionally experienced by practitioner and client.

Groups meet at regular intervals, usually once every two weeks, for one-and-a-half-hour sessions, over an average of two years. Participation, preferably on a voluntary basis, may be subject to some form of pre-screening. The discussion material consists in the spontaneous presentation of a recent clinical case or institutional situation that a practitioner has found difficult. The continuity offered by the group allows participants to track developments in the cases presented and to verify over time the salience of their diagnostic hypotheses and the effectiveness of different approaches to treatment and care. Particular importance is attached to establishing an open and supportive group that fosters free communication among peers, ensuring that participants feel safe and supported, yet leaving scope for frankness and criticism. The method used to lead the group and work on the reported material is largely drawn from psychoanalysis.

Originally homogenous in composition (e.g., general medical practitioners only), contemporary Balint groups are increasingly mixed, reflecting more recent team-based and interprofessional models of care.

Balint groups have two leaders, usually a psychiatrist or psychologist with psychoanalytic training, assisted by a family doctor or other practitioner with experience of the method. The leader’s role in a Balint Group is to foster collective thinking and protect group unity, but also encourage freedom of speech and criticism, manage crises, interpret the psychological processes that come to light during the case discussions. The emphasis is placed on the leader’s role as the facilitator of a learning process, in contrast with the role of a teacher who gives a lesson or more generally the role of an expert who transmits pre-constituted knowledge to the non-initiated.

See Bibliography, Balint section.