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It is now five years since Michael Balint produced his pioneer study on general practice in England, The Doctor, his Patient and the Illness. This present volume, written with his wife, Enid Balint, as coauthor, is a reformulation and continuation of this work, but now extended to include therapy by various types of specialists, doctors in Family Planning Association clinics, and a group of psycho-analysts engaged in research on 'focal' therapy. Both books are based on the training-cum-research method devised by the authors, the principle of which is the study, in a group, of the interaction between the patient and his therapist in which all clinical experiences, both mental and physical, are considered valid and appropriate to this study. The authors have chosen to restrict this book to an examination of some technical and theoretical aspects of this psychotherapeutic work, which will now be considered.
The influence of the 'setting' in which treatment takes place is an important theoretical contribution to this study. By 'setting', the authors mean 'the sum total of the fairly constant conditions, created by the doctor's individual way of practising medicine, which the patient may make use of and must accept (authors' italics). In other words, it is the therapeutic atmosphere "offered" to the patient …' Thus each type of doctor will have his particular setting for his particular type of therapeutic work, but in addition to this it appears that any particular doctor may also act in a number of different 'settings'. For example, a general practitioner may act as a physician, surgeon, obstetrician, psychotherapist, etc. and each of these roles will constitute a change of 'setting'. To complicate the concept of 'setting', it also appears that if the 'intensity of the doctor-patient relationship' alters to any marked degree there will again be a change in the 'setting'. Thus this important concept is so all-embracing that it tends to be too diffuse for a precis