Prof. Vladimir Vinokur, PhD, DS c,
President, St.Petersburg Balint Society
This article is based on our experience of providing and analysing the effectiveness of numerous Balint groups, which were developed in Russia since 1995 after the establishment of our Balint Society, and on the many fruitful discussions devoted to this subject with those involved in this process.
Balint groups, named so after Michael Balint (1896–1970), well-known all over the world, primarily Hungarian, later English psychoanalyst, were established on the base of seminars for physicians under his leadership in London since the early 50-ies. From the very beginning
the groups were aimed at the higher effectiveness of the physicians’ activity but as well at the improvement of their communication with the patients and of the prevention of physicians’ burnout.
It became a really helpful tool in the development both of the patient-centered medicine as well as of the “human face of the medical care”. During several past decades the fundamentals, which were structuring the group process, essentially developed, but some principal positions, related to the principal goals and objectives of the groups, group technology, and leadership remain stable. For example, it strongly applies to the rule, that Balint group tends in it’s activity to stress not on the clinical analysis but on the different aspects and peculiarities of the physician-patient communication.
We are convinced that very often effectiveness of clinical management is defined and even directed not by the peculiarities of the case but by the “limitations” of the physician. A Balint group helps realize them via better understanding of feelings, expectations, psychological defences, behavioral reactions of both participants of the “play” – the patient and the physician. This responds very much to Balint’s idea that, in order to become really successful, every doctor has to maintain the ability to hear what patients sometimes say without words, so the physicians have to start from the aim and a skill to hear this “speech” inside themselves, to become attentive and sensitive to their inner world, involved into the communication with a patient.
That’s why there are some strong limitations of Balint group:
- It is not for clinical solutions and not for case management, so it does not teach people in the group how to deal with the difficult, or unclear or incurable case.
- It does not help solve all the problems with the patients, especially on the personal level.
- The group does not provide any kind of psychotherapy for its participants.
And of course the basic limitation and the challenge of the Balint technology is the necessity to have a specially trained and skilled group leader.
Summarizing different resources and potentials of Balint groups we suggest it is important to emphasize the advantages the group offers as in their technology:
— it supplies the secure environment for the more deep and effective physician’s awareness in what is going on in the hidden aspects of the communication in their daily practice;
— the group stimulates an increasing attention to the patients who are considered as “difficult” or “upsetting”, as Balint wrote, who are the source of different uncomfortable feelings of a doctor and whom he/she tends and tries to avoid. So the care of such patients becomes more successful.
— the group provides the effective way out for the anger, anxiety, fears, sadness and other frustrating feelings in their work.
— the group is developing the new ways of thinking and thus a new level of understanding of the patient. The group can help physicians think about and tolerate more about what is otherwise uncertain, unrealized and so – frustrating in their daily work.
— it supplies an emotional and intellectual support to the physician, who presents the case in the group. Many of those who work in the health care and feel different sufferings of their patients are nearly unable to accept the support from their colleagues. So the group helps people realize that the art and the courage to accept the support are very much related with the possibility to offer and to carry out the help.
— it helps develop the physician’s self-esteem.
— the group is preventing an evident potential to prevent or at least to decrease the level of professional burnout.
The outcomes of our studies on the role of Balint groups in burnout coping in physicians show compliance with other researches published earlier (R.Addison, K.Bobay, B.Maoz and others).
— we consider Balint groups to be an important element of the secure and effective educational and clinical environment especially in the most challenging clinical areas (for example, in psychosomatic medicine).
Many European countries (as well as the USA, Israel etc.) use Balint groups in the process of education and professional training for health careers so these groups are the part of the pre- and postgraduate curriculum. The department of medical psychology of North-West state medical university I’m working at has also implemented the groups into our postgraduate training programs and curriculum. Our long-term experience of Balint groups’ work shows that they help successfully to carry out the task related to the necessity to convert the process of continuing professional education, where a teacher or a lecturer is the main person, into continuing professional development, where the principal acting person is a physician himself.
We believe all this brings us the great advantage and benefit which could be described by Charles Warner: “One of the most beautiful features of our life – to realize the impossibility to help sincerely other people without delivery the same support to yourself” (translation of the Russian version of the citation).
Buletinul Asociaţiei Balint, vol. xiv., nr. 53, 2012