Balint groups - An Australian perspective
Marion Lustig MBBS, is a psychotherapist, Melbourne, President of the Balint Society of Australia, and Honorary Lecturer, Department of Psychological Medicine, Monash University, Victoria.
Balint groups are an important, internationally established method of training general practitioners in the psychological aspects of their work. Small groups of GPs meet regularly with a trained leader to discuss clinical material from their practices, with a focus on the doctor-patient relationship. This article explains the Balint group model and its benefits and describes what is known about Balint groups in Australia, including avenues for Balint group experience available to Australian GPs.
Balint groups were developed by psychiatrist Michael Balint – who worked with general practitioners in London in the 1950s – to meet the specific and unique needs of GPs. Since then, the Balint group method has continued, developed, and become internationally recognised, with an International Balint Federation and groups and societies in many countries.
Balint introduced the metaphor ‘the drug, doctor’ – the idea that the patient responds, not just to a pharmacological substance, but to the person of the doctor; the atmosphere the doctor generates and what the interaction means to both of them. The doctor, too, responds to the person of the patient, and this response can be a source both of difficulty in their interaction and also of important information about the patient. A Balint group explores such issues through detailed discussion of participants’ accounts of their interactions with patients. Through participation, GPs learn to understand and skilfully utilise the doctor-patient relationship.
Literature about Balint groups includes descriptive accounts and reflections about their Balint group experience by participants and group leaders. Participants report increased ability to cope with difficult doctor- patient interactions, psychologically challenging situations and mental health issues; reduction in work related stress; and increased professional satisfaction. this has been done rarely in Australia. The reasons for this paucity are unclear. They might include: ignorance about Balint groups; difficulty in appreciating the value of an activity that is not didactic and solution focused; the belief that they have been superseded by other methods; the absence of more than a handful of trained leaders mainly located in urban centres; time and financial pressures on GPs; doctors’ anxieties about the requirement for detailed self disclosure of their work; and finally, perhaps the culture of medicine and the personalities of doctors impact on their willingness to participate in Balint groups, which challenge a doctor’s position of being the one with all the answers.
The Balint Society of Australia was established in 2005. Its activities include: an email newsletter, scientific meetings and workshops, a , Balint leader professional development, and networking within Australia and overseas.
Overseas opportunities available to Australians include the International Balint Federation Congress every 2 years, the annual Oxford Balint weekend, and American Balint Society Leadership Intensive workshops twice per year.
Conclusion
Balint groups have the potential to address several important needs for Australian GPs:
- They provide professional development and support for GPs’ central role in mental health care delivery as, in practice, the majority of cases presented in Balint groups are concerned with mental health issues
- Although their focus is not primarily doctors’ health, they do seem to increase doctors’ subjective sense of wellbeing and professional satisfaction and anecdotally prevent or reduce burnout
- They provide an educationally sound small group, active learning experience. Conflict of interest: an earlier version of this article appeared in the newsletter of the Australian College of Psychological Medicine and extracts appear on the Balint Society of Australia website.
References
1. Scheingold L. A Balint seminar in the family practice residency setting. J Fam Pract 1980;10:267–70.
2. Samuel OW. Aims and objectives of Balint training. Journal of the Balint Society 1987;15.
3. Elder A, Samuel O. While I’m here, doctor: a study of change in the doctor-patient relationship. London: Tavistock Publications, 1987.
4. Samuel OW. How doctors learn in a Balint group. Fam Pract 1989;6:108–13.
5. Salinsky J, Sackin P. What are you feeling, doctor? Oxford: Radcliffe Press, 2000.
6. Maoz B. Balint groups as a way to prevent ‘burn-out’ in physicians. In: Salinsky J, Otten H. The doctor, the patient and their wellbeing world wide. Proceedings of the thirteenth International Balint Congress Berlin 2003;17–28.
7. Brock C. Attitudes acquired by trainees through Balint seminars. South African Family Practice Journal 1988;9:233–5.
8. Dokter JJ, Duivenvoorden HJ, Vermage F. Changes in the attitude of general practitioners as a result of participation in a Balint group. Fam Pract 1986;3:3.
9. Laperrier S, Turgeon J. Changes by Balint group education: experience with residents in family medicine (French). Can J Psychiatry – Revue Canadienne de Psychiatrie 1993;38:507– 14.
10. Moreau A, van Laetham R. Effects of a Balint group: report on the Belgian doctors who have participated in a Balint group. In: Hopkins P, editor. Patient centered medicine 1972;73–82.
11. Rabin S, Herz M, Stern M, et al. Improving the professional self efficacy cognitions of immigrant doctors with Balint groups. Isr J Psychiatry Relat Sci 1996;33:253–9.
12. Kjelmand D, et al. Balint training makes GPs thrive better in their job. Patient Educ Couns 2004;55:230–5.
13. Turner A, Malm R. A preliminary investigation of Balint and non-Balint behavioural medicine training. Fam Med 2004;36:114–7.
14. Johnson A, Brock C, Hamadeh G, Stock R. The current status of Balint groups in US family practice residencies: a 10 year follow up study, 1990–2000. Fam Med 2001;33:672–7.
15. Otten H. Balint work in Germany. Journal of the Balint Society 1998;26:16–19.
This article first appeared in Australian Family Physician Vol 35 (8)
www.nmgpsy.com内蒙古心理网