Discussion of Enid Balint's Article, Training as an Impetus to Ego Development

Mrs. Enid Balint focuses on a critical aspect of the education process. Whether one speaks of training, teaching, supervision, or (perhaps more appropriately) of learning, one is immediately confronted with the much discussed problem of how, to what extent, and whether this process can be distinguished from the processes of therapy. At least some sort of expert-novice relationship is present in all cases and, as Mrs. Balint has pointed out, mutuality of respect is a vital ingredient in the relationship. I would suggest that the process of acquisition or enhancement of professional skills is a special case of what White^1,2 has called the drive for effectance or a sense of competence and which he indicated is so vital an aspect of self-esteem. This would seem congruent with Mrs. Balint's assertion that “the acquisition of these skills is tantamount to changes in the ego.”

There is then the question of providing optimal conditions for the desired changes in the trainee. It seems significant to me that although Mrs. Balint states “… it is most necessary to avoid a teacher-pupil relationship. The doctors want to be constantly educated by the seminar even less than children do by their parents. They learn in other ways [italics mine],” she nevertheless refers repeatedly to the similarity between the processes seen in physicians participating in the seminars and the processes

seen in adolescents in interaction with their parents. She even states “… the ‘better’ doctors—those who change most often—may report in a teasing way; the leader is not an equal but the parent and is treated as such.” It seems evident that it is not a teacher-pupil relationship that must be avoided but a particular kind of authoritarian attitude on the part of the teacher, lacking in genuine respect for the autonomy of the student. In this sense