Some of the interesting abstracts from the 12^th INTERNATIONAL BALINT CONGRESS in Portoroz, Slovenia October 2001

WHAT IS A BALINT GROUP? 
Chris Mace MD, MRCPsych, Hilary Hearnshaw, PhD, Frances Griffiths, PhD (Warwick, UK)
Background: Since Balint groups were introduced in Britain, they have continued to have a dedicated following and to be scattered throughout the UK.... more

BALINT GROUPS IN ISRAEL
Prof. Benyamin Maoz (Beersheva, Israel)
The first Balint groups in Israel were established in the late fifties. Since then sporadically Balint groups have existed in various areas of the country.... more

THE PSYCHOSOMATIC APPROACH IN GENERAL/FAMILY PRACTICE 
Blazekovic-Milakovic S., Teuber M., Spehar-Stojanovic S., Tiljak H., Kumbrija S., Grbic E. (Zagreb, Croatia)
Comparative, prospective study lasting 15 months was performed. Possibililities of general/family practitioner to identify the patient by psychosomatic approach and the treatment effects were studied.... more

CAN HOSPITALS EMBRACE BALINT?
A STUDY OF A PICU`S RESPONSE
Polly Blacker (Sheffield, UK)
This paper draws from experience with a project proposing the introduction of multidisciplinary Balint Groups as a pilot-scheme within the Pediatric Intensive Care Unit of a Children's Hospital which proved difficult to carry out.... more

BALINT GROUPS FOR TRAINESS IN PSYCHIATRY
Jette Task Nielsen, Lars Thorgaard (Risskov, Denmark)
We have used the Balint-group (BG) for trainees in psychiatry to have their clinical work supervised. By presenting “a case” from their daily clinical work; BG is studying the special doctor-patient relationship (DPR) presented.... more

DO GPS BENEFIT FROM BALINT GROUP-PARTICIPATION?
Dorte Kjelmand, dr. med. (Eksjö, Sweden)
Objectives: Do general practitioners benefit from participating in a Balintgroup?
Design: a combined qualitative-quantitative questionnaire answered by general practioners, half of  whom had paticipated for more than one year in Balintgroup.... more

BALINT METHOD – SOURCES OF EFFICIENCY
E. Grbic, S. Blazekovic, S. Kumbrija, S. Stojanovic-Spehar, S. Supe (Sisak, Croatia)
It is estimated about 20% to 50% of patients with the somatic-psycho-social syndrome in general practice, and half of them are not diagnosed.... more

AN INNOVATIVE BALINT GROUP FOR EARLY RESIDENTS IN PSYCHIATRY 
Kir Levin, dr. Med., Stanley Rabin, PhD (Beersheba, Israel)
Psychiatric residents treat patients with severe and acute psychopathology early in the residency program. Within the program however, there is often very little time ... more

BALINT ORIENTED GROUPS FOR ISRAELI MEDICAL STUDENTS
A.     Lauden, S. Arbell, H. Shalit, B. Maoz (Beer-Sheba, Israel)
The Health Sciences Faculty of the Ben Gurion University has emphasized since its foundation a holistic approach in medicine including the teaching of communication skills. ... more

A MODEL FOR TRAINING OF BALINT GROUP LEADERS – THE SWEDISH PROGRAMME
Anita Häggmark, (Stockholm, Sweden)
A Follow-up of a report presented at the Oxford Congress 1998. ... more

JUNIOR BALINT WORK IN HUNGARY
Maria Szirtes, Eva Harmathy, Kornelia Bobay (Budapest, Hungary)
Junior Balint groups have taken an important part in medical education at the Behavior Science Institute of the Semmelweis University (Budapest) since 1994. ... more

AN EVALUATION OF BALINT AND BALINT-LIKE GROUPS
Mandel, mr; Prof. B. Maoz, md; Meira Berger, me; Yael Narde, msw
(Maccabi Health Service, Israel; Ben Gurion University, Beer Sheva, Israel)
One of the difficult tasks related to the art of conducting Balint groups, is evaluating their actual results. ... more

BALINT GROUP AS AN ANTIDOTE TO PROFESSIONAL AND HUMAN ALIENATION

Kornelia Bobay, (Budapest, Hungary)

Michael Balint organized his groups for general practitioners. But in our age many specialists meet the same patient. They deal with only a part of the body and of his sicknesses. Their relationships are different from each others to the same patient and their professional languages are different from each others too. They meet each others by correspondence about their patient. That is the way to alienation of experts from each others and from the real problems of the patient. Author gives a report about own experiences about Balint groups where there were different specialists, psychologists and hospital-clergymen and university students together. The different thinking schemes of different experts disappeared there. They thought about the patient by emotional way similarly to each others. It was a special therapist-patient-group relationship and atmosphere of the group. University students brought new fresh ideas while they learned from their elder colleagues. The different experts talked the same emotional language and they could understand each others as experts and as human beings too. A questionnaire was made and it was significant by chi test that they became more empathy to each others and to the patients on holistic way by this from of the Balint group.

DO YOU WANT TO HEAR THE STORY OF MY LIFE?

Dr. John Salinsky, dr. med. (London, UK)

WHAT IS A BALINT GROUP?

Chris Mace MD, MRCPsych, Hilary Hearnshaw, PhD, Frances Griffiths, PhD (Warwick, UK)

Background: Since Balint groups were introduced in Britain, they have continued to have a dedicated following and to be scattered throughout the UK. While it is widely assumed that all groups following procedures described by Michael and Enid Balint, it has been unclear how comparable one group is to another in practice. As preparation to an evaluative study, we sought to define contemporary norms for the structure and process of current Balint groups in the UK.
Method: Leaders of all Balint groups known to the London Balint society were asked to complete a short postal questionnaire. This provided data on the timing, organization, membership and leadership of currently disbanded Balint groups. Leaders were also asked to contribute information on the allocation of time within group sessions and the perceived functions of each group.
Results: Current practice indicated a divergence between groups provided for experienced practitioners and those for trainees. The former were more likely to have a psychoanalytic psychotherapist for a leader, to discuss fewer cases per session and to concentrate on the doctor-patient relationship. Trainees’ groups tended to be shorter and to include discussion of questions promoted by the material or the members’ concern as well as exploration of relationships and feelings.
Conclusions: These differences in practice suggest that there is no longer a single model of a Balint group. Significant modifications seem inevitable when it is a vehicle for basic professional training rather than continuing professional development with established practitioners. Further work is needed to ascertain whether this is reflected in practice in other countries and in groups whose members are undergraduates or other non-doctors. In all settings, it seemend that groups were less likely to survive when a new leader lacked personal experience of Balint groups. Further research might identify the kinds of preparation that are most helpful to new group leaders.

BALINT GROUPS IN ISRAEL

Prof. Benyamin Maoz (Beersheva, Isreal)

THE PSYCHOSOMATIC APPROACH IN GENERAL/FAMILY PRACTICE

Blazekovic-Milakovic S., Teuber M., Spehar-Stojanovic S., Tiljak H., Kumbrija S., Grbic E. (Zagreb, Croatia)

Comparative, prospective study lasting 15 months was performed. Possibililities of general/family practitioner to identify the patient by psychosomatic approach and the treatment effects were studied.
Psychosomatic approach was followed up in forty patients in two separate groups by observation methods and analysis. The control group was treated by classic somatic approach. There was no significant difference among the patients by sex, age and diseases.
The group of patients where psychosomatic approach was applied, which involved supportive psychotherapy, showed significant decrease in symptomathology. Subjective evaluation of psychic and somatic status showed better results in the treated group than in the control group.

CAN HOSPITALS EMBRACE BALINT?
A STUDY OF A PICU`S RESPONSE

Polly Blacker (Sheffield, UK)

This paper draws from experience with a project proposing the introduction of multidisciplinary Balint Groups as a pilot-scheme within the Pediatric Intensive Care Unit of a Children's Hospital which proved difficult to carry out. As a preliminary stage I had interviewed 62 of the clinical staff; I then produced a report for them. An incentive to explore the psychoanalytic theory about thinking and some of the existing literature discussing unconscious processes involved in clinical hospital work came from this experience. The Balint Group process aligns very closely to understandings about the development of thinking and its facilitation. Thinking, in this sense, concerns the effort to gain emotional knowledge in relationship with others and is essential for effective clinical work. This paper will examine the responses of the management and the clinical staff to the project and explore some of the unconscious processes that may affect their attitude towards such a multidisciplinary reflective space. In conclusion I will consider how Balint Groups might be introduced more widely into the clinical arena and, specifically, be accepted by the multidisciplinary teams of the Clinical Governance framework within hospitals.

BALINT GROUPS FOR TRAINESS IN PSYCHIATRY

Jette Task Nielsen, Lars Thorgaard (Risskov, Denmark)

We have used the Balint-group (BG) for trainees in psychiatry to have their clinical work supervised. By presenting “a case” from their daily clinical work; BG is studying the special doctor-patient relationship (DPR) presented; with the aim to increase understanding of the problems of the patient and the doctor in this unique DPR. This emotional knowledge can lead to crucial changes of attitudes in the doctor, and when the doctor subsequently treats the patient in a different manner, the patient will also have the possibility to change. The BG deals with the counter transferences, and throughout this work it become possible to develop a greater capacity to empathies and understand the patient
Two courses of BG´s have now ended. The participants and a control group have filled in comprehensive questionnaires for evaluation. Up to now the results suggest that participation in the BG has been of great importance to both the professional and the personal development of the trainees. The participants have had the greatest positive changes, in particular, in the area of DPR and relationships with colleagues and organizational relations. Finally, in the clinical setting there is no other place to thoroughly discuss and investigate difficult and complicated DPR´s. BG is now an offer to all trainees in psychiatry in the County of Crhus, and we recommend it to be compulsory in the training of psychiatric specialists.

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DO GPS BENEFIT FROM BALINT GROUP-PARTICIPATION?

Dorte Kjelmand, dr. med. (Eksjö, Sweden)

Objectives: Do general practitioners benefit from participating in a Balintgroup?
Design: a combined qualitative-quantitative questionnaire answered by general practioners, half of  whom had paticipated for more than one year in Balintgroup. A visual analogue scale was used for the quantitative evaluation and using the T-test compared the results. The results were compared to a previous investigation of general practitioner's view of their working situation to ensure the representativeness of the control group.
By analyzing the qualitative parts with open questions and choice of role examples the doctors were divided into groups according to their doctor style: holistic, instrumentalist or intermediate. Using the T-test the results of the quantitative questions of these groups were compared.
A psychologist interviewed five long-time Balint doctors.
Setting: Southeast region of Sweden, general practitioners in public primary care.
Participants: 26 general practitioners having participated for more than year in Balintgroup (20 answered, 77%) and 26 general practitioners with similar working conditions without having had the opportunity to join a Balintgroup (21 answered, 81%).
Results: The questionnaire showed that the Balintdoctors felt more in control of the work situation, e.g. taking coffee breaks (P< 0,01) and being involved in decision making (P< 0,05). The Balintdoctors less often thought that the patient should not have come (P=0,01) and were less inclined to refer patients or to take unnecessary tests in order to put an end to the consultation (P=0,01) and less often found psychosomatic patients a time consuming burden (P<0,01) The differences increased with longer time in Balintgroup (more than 1,5 years). The holistic doctors were more often Balint participants (7 out of 8) and had higher scores in handling psychosomatic patients (P<0,005) and satisfaction of work (P<0,05) than the instrumentalist doctors (2 out of 8 were Balint participants). The female doctors showed higher satisfaction of work (P<0,05) and feeling of controlin the word situation (P<0,005) when being in Balintgroup (8 doctors) than not (4 doctors). The male doctors in Balint group (12 doctors) had higher feeling of control (P<0,005) and competence handling psychosomatic patients (P<0,005) than the non Balint male doctors (16 doctors).
In the interviews the doctors reported development of control and well-being in the consultation, awareness of own feelings, increasing interest in the whole patient and better control in the whole working situation.
No negative of Balintgroup participation were found.
Conclusions: Differences were shown between the two groups that suggest a positive effect of participating in Balint group in terms of satisfaction of work, control of working situation and feeling of competence in handling psychosomatic patients. Longitudinal studies are needed to show change in individual doctors and possible effects on patients.

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BALINT METHOD – SOURCES OF EFFICIENCY

E. Grbic, S. Blazekovic, S. Kumbrija, S. Stojanovic-Spehar, S. Supe (Sisak, Croatia)

It is estimated about 20% to 50% of patients with the somatic-psycho-social syndrome in general practice, and half of them are not diagnosed. Our undergraduate study educates us perfectly about somatic disease, but many of our patients come with mental health problems. If G.P. is not sensible to recognize that problem, he “provides” an unsatisfied patient.
I was in dead end with one of my patients, had no idea where to go and what to do. She was visiting me so often, that the moment I saw her chart, I felt I could not tolerate her problems. Every time I felt frustrated and guilty.
In the Balint group I learned how to gather up my strength and listen to my patients in a relaxed manner, especially those that made me upset and frustrated. Balint group taught me how to talk to my patients and their families. I got rid of the spasm, and the shell about having to be unmistakable, of that negative narcissism which has frozen the patient-physician relationship.

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AN INNOVATIVE BALINT GROUP FOR EARLY RESIDENTS IN PSYCHIATRY 

Kir Levin, dr. Med., Stanley Rabin, PhD (Beersheba, Israel)

Psychiatric residents treat patients with severe and acute psychopathology early in the residency program. Within the program however, there is often very little time or opportunity to discuss emotions that these early exposures arouse. The aim of our presentation is to describe a Balint group for twelve residents in psychiatry. Our group aimed to help residents to become aware and sensitive to their feelings and to encourage sharing within an open, tolerant and caring atmosphere. Here they could honestly express their conflicts and ambivalence relating to their interactions with their patients, their professional peers and the system in which they worked.
The group met for over two years, the facilitators being a psychiatrist (KL) and a clinical psychologist (SR). Condideration was taken of the importance of collaboration between the two professionally different group leaders and the impact it may have had on the residents. During the Balint exposure the residents learned to appropriately express their emotions and indicated their positive satisfaction with issues raised and in the group process. They felt the group had helped them to understand themselves better, as well as their interactions both with their patients  and the system in which they worked. This improved their professional efficacy and identity. A core group of residents who identified particularly positively with the group procide a nucleus for future Balint activity.

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BALINT ORIENTED GROUPS FOR ISRAELI MEDICAL STUDENTS

 A.     Lauden, S. Arbell, H. Shalit, B. Maoz (Beer-Sheba, Israel)

The Health Sciences Faculty of the Ben Gurion University has emphasized since its foundation a holistic approach in medicine including the teaching of communication skills. Since 1996 fourth year students, who recently joined the clinical rotation, take part in a compulsory balint oriented program that is called “Emotional Processing”. During 8-10 sessions, in small groups, 1-3 leaders (from mental and health professions) conduct discussions about emotional experiences, which the students brought up from the various wards. The main subjects include: omnipotence vs. helplessness and uncertainty; levels of emotional connection with patients; anger and frustration during rotations, conflicts of loyalty, dealing with death and losses, coping with stress, team work, and hierarchy among colleagues.
We shall tryto present our experience with these groups.

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A MODEL FOR TRAINING OF BALINT GROUP LEADERS – THE SWEDISH PROGRAMME

Anita Häggmark, (Stockholm, Sweden)

A Follow-up of a report presented at the Oxford Congress 1998.
A group of nine leaders completed their two-years-long course in March 2000. This training has been evaluated and we are planning for a new one in 2002.
The paper will discuss what´s special with the Swedish model:
° The combination of students GPs and psychotherapists are trained together.
° The same group being trained together for two years, one full day a month.
° The schedule of each day has been the same:
° Lecture/seminar on topics relevant for a Balint group leader, such as aspects of psychoanalysis, interventions, group and organization dynamics and psychosomatic medicine.
° Self-experience group – being in a group here-and-now and talking about it with a specially trained group leader.
° Supervision in small groups for discussing the students work with the groups they are leading.
The experiences and evaluation of this program will be discussed in this paper. What did the new leaders think about if afterwards? And how do the experiences the training of group leaders in the future?

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JUNIOR BALINT WORK IN HUNGARY

Maria Szirtes, Eva Harmathy, Kornelia Bobay (Budapest, Hungary)

Junior Balint groups have taken an important part in medical education at the Behavior Science Institute of the Semmelweis University (Budapest) since 1994. The members of the Junior Balint Groups are medical students from the 3^rd-6^th years of their university studies. The number of participants is about 100-120.
Since 1994  60 papers of these medical students were nominated for the Ascona Prize, among which 6 won prizes. This year 1^st and 2^nd prizewinners were medical students from Hungary (from the universities of Pecs and Budapest). Prof. Luban Plozza founded the Budapest Junior Balint Prize for Hungarian medical students in 1997.
In Junior Balint Groups we can recommend options and directions of patient-doctor relationship of managing ethnical, age group problems, etc. Junior Balint Groups can take a considerable role in helping students to confront incurable diseases and to look death in face.
The aim of the Junior Balint Group is to evolve a psychosomatic approach in practice.

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AN EVALUATION OF BALINT AND BALINT-LIKE GROUPS

Mandel, mr; Prof. B. Maoz, md; Meira Berger, me; Yael Narde, msw
(Maccabi Health Service, Israel; Ben Gurion University, Beer Sheva, Israel)

One of the difficult tasks related to the art of conducting Balint groups, is evaluating their actual results. Measuring “objective” parameters, such as improved medical care, is virtually impossible. Trying to evaluate the efficacy of both “classical” Balint groups with primary care physicians and Balint-like processes conducted with medical directors (also physicians), we have resorted to the rather common method of self-evaluation questionnaires. We asked about burnout, care of patients and coping with the doctor´s feelings, as well as about a general evaluation of the group´s contribution.
Due to our rather smal sample, we lack clear statistical significance, but there are strong trends. Primary care physicians, who joined the groups voluntarily, as well as family medicine residents, expressed the higher degree of satisfaction. There was no indication that the actual care of patients was directly affected by working in the groups, but there were clear indication of less burnout, most notably in the fields of doctor´s awareness to their own feelings and particularly in their avility to cope with feelings of helplessness. Interestingly, doctors with a high degree of burnout were less capable of benefiting from the groups, while residents, who suffered less from burnout, noted high benefits in that field. In all parameters, there was a marked rise in the sense of well being related to the group`s work after more than two years of participation.
If those results can be reduplicated and validated, we may tend to conclude that Balint groups may be of greatest value when offered voluntarily, especially to residents and primary care specialists in the earlier stages of their career. The evident benefits of such groups is likely to be in the field of physicians` feelings, burnout and quality of life – direct effect on patient care may be, as described in previous literature, very elusive indeed. It seems important – as it not always the current common practice – that Balint groups should best be continued for at least three or four years.

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