Balint Groups

What is a Balint Group?

Balint group is formed of clinicians who meet regularly to present clinical cases in order to improve their understanding of the clinician-patient relationship. During these facilitated discussion sessions, the group members uncover various different aspects of the patients and clinician’s emotional state along with the impact it has on their relationship.

The purpose of Balint Groups is not about trying to find practical or clinical solutions. It is about discussing the emotions, emotional reactions and thoughts that come with consultations and interactions with the patients both from a doctor’s and patient’s perspective.

What is the History of Balint Groups?

Balint groups are named after the psychoanalyst Michael Balint (1896-1970). Balint Groups started as GP case presentation groups involving 8-10 doctors. The case presentations were followed by group discussions facilitated by a psychoanalyst leader. The main aim was to understand the emotional content of the doctor-patient relationship.

Who attends the Balint Group?

Balint Groups is facilitated by experienced clinicians.

Psychiatry core trainees are advised to attend Balint Group on a regular basis as it is a requirement of the RCPsych core training curriculum.

GP trainees, Foundation Year doctors, and non-training junior doctors are actively encouraged to attend the Balint Groups as it improves their understanding of psychiatry and triggers reflective practice.

There are also medical students, specialist registrar and consultant-led Balint groups running in the UK.

What are the ground rules of a Balint Group?

It is important to establish ground rules at the start of a Balint group. Here are the general rules:

  • Everything said in the group will be treated as strictly confidential whether it is about patients, colleagues or group members themselves. (The exception to this is if there were serious concerns about conduct or safety, the facilitator would then talk to the group member after the group to discuss how this should progress).
  • Everyone should be listened to and everyone’s contribution should be respected.
  • Group members will commit to regular attendance of the group as much as possible for the period of time specified.

 What actually happens in a Balint Group?

There are multiple ways to run a Balint Group depending on the facilitator, but most commonly this is what happens:

  • The members and facilitator sit in a circular arrangement.
  • The facilitator invites members to volunteer for a case presentation.
  • One person presents a case. (10 min)
  • The group listens to the story and are allowed to ask some questions for clarification of facts. (5 min)
  • The presenter is then asked to sit and listen to the group members reflecting on what they heard in a psychoanalytical manner. (20-30 min)
  • The presenting member is invited back to the discussion to reflect on their experience of hearing the group discussion. (5-10 min)

What kind of cases can I bring to the Balint Groups?

A vast variety of cases can be presented in a Balint group and there are no specific guidelines on the nature of the case. Balint Group cases are basically focused on the emotions of the clinician and patient arising within the consultation rather than the clinical content.

Here are a few general examples:

  • Patients who make the doctor feel confused, helpless, sad or uncomfortable.
  • Patients with complicated personal or social histories which may be hindering their recovery.
  • Patients with medically unexplained symptoms or psychosomatic symptoms.
  • Patients with behavioral symptoms which are confusing or unexplainable for a doctor.
  • Clinical situations where a doctor feels conflicted, anxious, uneasy or powerless.

 What is the difference between a Balint Group and a Case-Based Discussion Group?

These terms are often used interchangeably. If we are being complete ‘purist’ about things, the Balint group focuses more on the emotional responses to the Doctor-Patient relationship. A Case-based discussion group focuses on a case from a psychological and psychotherapeutic perspective. If we are being realistic, then the group experience that you will encounter is a bit of both of those aspects.

What formal assessments can be carried out in the Balint Groups?

Case-Based Discussion Group Assessment (CBDGA) has been developed by the RCPsych to provide structured feedback on a trainee’s attendance and contribution in a Balint Groups.

The expectation is that a core trainee should attend a minimum of 30 Balint groups on a regular basis and provide evidence that they have done so.

Where can I read more about Balint Groups?

UK Balint Society-  https://balint.co.uk/

American Balint Society – http://www.americanbalintsociety.org/

RCPsych Psychotherapy training and CPD

https://www.rcpsych.ac.uk/workinpsychiatry/faculties/medicalpsychotherapy/trainingandcpd.aspx#training

In summary:

What a Balint group is … What a Balint group is not…
Safe, supportive, confidential and hopefully enjoyable!An opportunity to reflect on the Doctor-Patient relationship and the emotional responses this provokesAn opportunity to present cases in a less formal manner focussing more on psychological concepts.

A forum to discuss cases from a psychotherapeutic perspective.

A place where trainees can develop self-awareness and feel confident to reflect on their own emotional responses.

A place to engage in opportunistic learning of key psychotherapy concepts.

A forum to help you become more confident at formulating cases from a psychological point of view.

An opportunity to ‘whet your appetite’ to pursue higher levels of psychotherapy training.

It is not formal supervision for individual psychotherapy cases. If you are working with a client to provide individual psychotherapy, you will be required to separately arrange formal supervision for this.

It is not a forum for making decisions about any individual patient’s care. This rests solely with the patient’s care team.It is not a course on how to use individual models of psychotherapy. There is plenty of scope for opportunistic learning but you will not be a fully fledged ‘psychotherapist’ once you have attended the groups. You will, however, be a more psychologically minded doctor!

 Also see Balint in very brief 

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