What are Balint groups?

Christine Christie

Michael Balint the originator of Balint Groups realised that doctor/patient relationships can be very difficult on both sides, writes Psychotherapist and Balint Group facilitator Christine Christie.

Balint wanted to provide opportunities for practitioners to think about their patients in a different way. Not purely in terms of their symptoms but as whole persons suffering understandable distress.

Following on from Ferenczi, he believed that it was the person of the GP that was more important as a curative factor than the drugs dispensed.

GPs needed to be able to reflect on their own experiences in the consulting room, not just the emotional impact the patient was having on them, but on what they enacted with patients.

Usually 8 – 10 practitioners meet on a regular basis for 90 minutes, which allows for 2 presentations. There are usually two leaders who take on certain roles, such as keeping time, facilitating a non-judgemental spirit of curiosity, noticing if the group move away from the task, or making links.

Traditionally one will have a medical background and the other an analytic background but this is not essential.

Participants are invited to present a case that has been on their mind because they were left with strength of feeling or judgements.

After their initial presentation, the leader will ask the group for any clarifications – facts concerning the case, such as “what age is the person?”, “are there any other symptoms?”, “are they married?”.

It is important the group don’t move into process at this point. This part is necessarily brief and incomplete. The presenter is then asked to push their chair back as a symbol of moving out of the group and observing the ensuing discussion.

The group now have time to free associate to the case, becoming aware of any thoughts, feelings or fantasies they have. A kind of reverie which can access unconscious material.

The group can utilise defences to avoid painful thoughts or feelings – becoming focused on the physical symptom and treatments, the patient becoming the recipient of their own projections, or splitting where the clinician is like a kind and long suffering parent and the patient is like a demanding and ungrateful infant.

Experienced groups can usually reflect on these processes for themselves without the leaders commenting on parallel process, but the leaders will ensure that the relationship is kept in mind, and will sometimes have a powerful containing function when the presentation concerns severe or multiple trauma.

The presenter then returns to the group and comments on their experiences of seeing and hearing the group discussion. Sometimes they have new ways of thinking about patients or how they function in their professional relationship. It can be a relief to be heard and not be judged.

Sometimes they remember something important they had forgotten or denied to themselves. Often they find more compassion for their patients and can listen differently when back in the consulting room.

The origins of Balint groups

Balint groups are named after the psychoanalyst Michael Balint (1896-1970). In the late 1950s, Michael and his wife Enid began holding psychological training seminars for GPs in London.

Balint encouraged the group members to hold ‘long interviews’ with their problem patients. This helped the doctors to concentrate on becoming good listeners. Subsequently the focus changed to studying the relationship between doctor and patient in the context of every day ordinary-length consultations.  

The groups met once a week for a number of years so that patients and their progress could be followed up. The continuity also enabled group members to feel at ease with other.

About Michael Balint

Michael Balint was born 3rd December 1896 to a well off Jewish family in Budapest. His father was a GP and Michael also studied medicine although that was interrupted when he was conscripted during the First World War. He was discharged following a serious hand injury and resumed his medical studies.

He came to psychoanalysis after reading Freud’s ‘Three Essays on Sexuality’ and ‘Totem and Taboo’ and he and his first wife Alice moved to Berlin in 1919, where he treated psychosomatic disorders by psychoanalysis at the Berlin Charity Hospital.

He also undertook an analysis with Hans Sachs but found him too didactic. He and Alice returned to Budapest in 1924 and both entered analysis with Ferenczi. From then until 1939 he played a key role in the Hungarian Psychoanalytical Society.

He was also already collaborating with general practitioners but this fizzled out due to state intervention.

Michael, Alice and their son John came to Manchester in 1939. The next few years were personally tragic as Alice died suddenly, a brief second marriage ended, and his parents committed suicide rather than die in the gas chambers.

He joined the Tavistock Clinic in 1948 and with his third wife Enid, brought psychoanalysis to the world through the development of Brief Focal Psychotherapy in the NHS, seminars for the treatment of Psychosexual disorders with the Family Planning Association (later to become the Institute of Psychosexual Studies), a discussion group for those engaged in marital work (a forerunner of the Tavistock Institute of Human Relations) and upon ‘retirement’, seminars with general practitioners and medical students, which became Balint Groups.

Although he contributed much through his psychoanalytic writing – concepts such as the ‘basic fault’, benign and malignant regression, narcissism as a secondary phenomenon, ocnophilia/ philobatism in object relations and counter transference.

Benefits of Balint Groups

What does participation in a Balint group do for a group member?

The first and most easily obtained benefit is to have a safe place where you can talk about interpersonal aspects of your work with your patients.  The group will be sympathetic and they will all have been in similar situations themselves.

Balint group experience can help to avoid professional ‘burnout’.

Balint groups encourage clinicians/therapists to see their patients as human beings who have a life and relationships outside the consulting room.

Balint groups often help members y reach a deeper level of understanding of their patients’ feelings and their own.  They may realise that certain patients or emotions may resonate with what is going on in the own inner and outer lives.  This may be causing problems which the doctor can learn to avoid or even to turn to therapeutic advantage.

About the author

Christine Christie is a Psychoanalytic Psychotherapist and Group Analyst in private practice in Belfast. She has been in practice since 1990.

Her first individual training combined psychoanalysis and body work which led to an interest in working with psychosomatic conditions, the subsequent topic of a Master’s thesis.

Other areas of interest have been domestic violence, addictions, and the impact of the conflict in the North on both our patients and ourselves as practitioners.

She became involved in Balint work at the request of a colleague Dr Glenda Mock, and they have co-led groups for GPs in a community setting, Psychiatrists in a hospital setting, and a long running group in private practice comprising GPs, Psychiatrists, Psychologists and a Dentistry background.

Also, with Dr Marie King they have organised 4 successful bi-annual Balint weekend events in Belfast. She also co leads at other Balint training events and supervises Balint Leaders in the NHS and educational settings.

Having taught for many years on Counselling and Psychotherapy courses at Queens University, and been a Co-Director of Abbotsford Institute, a private psychotherapy centre for 10 years, she is content to now focus on clinical work. Although from a Klein/Bion background, her clinical work would be seen as relational. When not working she enjoys gardening, science fiction and playing in a chamber group.

Christine will present on Balint Groups at the 2019 IPAA Conference on May 11th.