Balint Groups: Sharing Experiences

For the past ten years I have been involved in “Balint work.” I have an ongoing Balint group composed of senior primary care physicians who meet at each other's houses in the evening twice a month to talk confidentially about challenging, interesting vignettes from their current clinical practice. They usually present one case in detail in an hour and a half. The feedback from the group as well as an exploration of the presenter's experience often result in deep interpersonal learning for all participants, myself included.

One example concerned the nighttime trip a doctor made to the hospital after a patient with AIDS had died. The patient was still in the hospital bed. The doctor's mission was to place a pair of cowboy boots on the patient's feet, because the one promise the patient had asked for was to be wearing these boots when he died. This story led to a very moving discussion, as many in the group spoke on the subject of promises made to patients in the face of death. In our post-managed care climate in the U.S., the need for interpersonal connectedness between patients and doctors is greater now than ever.

Balint groups began in post-World War II England at the Tavistock Clinic under the leadership of Michael Balint, a Hungarian-born psychoanalyst whose father had been a primary care physician. A great deal of daily human angst falls in the laps of general practice physicians. This was particularly true in post-World War II England. Balint began running fortnightly groups of general practitioners for the purpose of helping with this emotional task. A key point is that he felt the learning from the cases was mutual, what he termed “research,” and not conveyed wisdom from the analyst leader.

This model fits well with current notions of intersubjective matrix as it brings the group process and the participants' comments about their subjective experience into a generative process by which members grow in self-knowledge and perspective on their struggles with patients. The Balint group leader helps to assure that an authentic process occurs at a detailed enough level to get beyond generalizations, but by eschewing a role of concentrated authority, enables members to keep taking useful risks with each other.