Balint groups and the Balint method were named after the Hungarian doctor and psychoanalyst, Michael Balint.
Michael Balint, the son of a GP, is born in Budapest in 1896. He becomes a medical student at the age of 18 years, but his studies were interrupted by World War 1 when he joins the army. There he gets wounded and he returns to Budapest, where he resums his studies and obtains his doctorate in biochemistry in 1920.
Initially he wants to be a biochemist and works in biochemical laboratories in Berlin, but after hearing Ferenczi’s (1917) speaks about Freud at conferences and reading The Interpretation of Dreams he develops an increasing interest in psychoanalysis. He trains as a psychoanalyst, having as his trainer and mentor Sandor Ferenczi, a hugarian psychoanalyst and Freud’s student and works alongside as a psychoanalyst.
In 1924 he returns to Budapest, where he works as a psychoanalyst with psychosomatic patients and in 1932 he starts the first training-cum-research-group for GPs in Budapest, as he wants to find out about the possibilities the GPs had to integrate psychoanalytic ideas in their practical work. The work of these curtailed (διακόπτονται) in 1939, when due to the radical right-wing government, which controlled the work, the meetings and the discussions of the psychoanalysts, Balint is forced (αναγκάζεται) to leave Hungary and goes to Manchester with his wife and his son as refugees. Unfortunatelly, his wife dies in the same year.
Balint lives in Manchester till 1945, where he becomes Clinical Director of the Child Guidance Clinic. His research focuses on infants, their behaviour and the relationships they develop. He begins publishing his ideas about “primary love”, “primary relation” and “basic fault”.
In 1945 he moves to London and works primarily in a Child Guidance Clinics until attached to the Tavistock Clinic and strengthens his interest about the interaction between individuals. He is now convinced that doctor-patient relationship plays a major role in diagnosis and therapy. Specifically, argues that the doctor’s and the patient’s inner world interfere. Both the patient’s transference and the doctor’s countertransference have great influence on the relationship, on diagnosis and therapy.
In Tavistoc clinic he meets and marries in 1949, Enid, who is a social worker and marriage guidance counsellor and together they develop innovative teams with GPs to study the psychological implications of general medical practice. There they checked their hypotheses, that “the most frequently used drug in general practice is the doctor himself”.
At that time many of the GPs’ patients were traumatized during the war and as Balint says, « A great number of people have lost their roots and connections, the individual thus becomes more and more solitary, even lonely… any mental or emotional stress or strain is either accompanied by, or tantamount to, some bodily sensation… one possible outlet is to drop in to one’s doctor and complain…” and “It is here, then, that the doctor’s attitude about how to prescribe himself to the patient becomes decisive.”
Also, at that time the National Health Service (NHS) establishes, where for the first time free medical care is introduced, leading clinics of general practitioners to be inundated with patients whose demands were high. General practitioners, who at that time had no specific training in general medical practice were poorly equipped to cope with vague diagnoses – particularly of emotional nature – especially now that there was an atmosphere where patients believed that there was a cure for all ills, doctors felt not deriving the expected satisfaction from their work .
Balint wants to find out why this happens. He is one of the first who recognizes the value of consultation itself as a therapeutic tool. As a psychoanalyst, he understands that what happens psychologically between the doctor and the patient is important, although this is not discussed in medical textbooks of the time. This thought is placed before the era of education in the analysis of consultations and communication skills, although of course there are already doctors who recognize the importance of listening to their patients. The Balints get advertised to doctors and encourage them to join a group research-cum-training-seminar for the study of the doctor -patient relationship. The traditional Balint group is born.
Team members meet in a safe and structured environment once a week for two hours. The structure of the meetings includes the presentation of a clinical case of a general practitioner and a subsequent discussion of the emotional relationship that is formed and the forces involved.
To those who have never worked like this, this method sounded very strange and unscientific. Over time, however, and as the doctors feel freer to express their thoughts and feelings, the speculations, assumptions and fantasies of others on the relationship between doctor – patient in each presentation, brought to the surface rich material for treatment, which decongested (αποσυμφόρησε) the doctor and helped him to modify his ideas and his attitude toward the patient, thus launching (δρομολογώντας) a different path for both the therapeutic relationship and for his personal development.
Although Michael and Enid were psychoanalysts, their aim was not to turn family or general practitioners into psychoanalysts but to help them recognize and talk about their feelings, rather than repress or ignore them as a defense. To gain a psychological awareness of both their own experience and the patient’s in the therapeutic relationship and learn how to use their emotions as an instrument, “like a surgeon his knife”.
The outcome of this first group brings the creative and collaborative work of Balint entitled: «The Doctor, His Patient and the Illness», published in 1957 (Balint, 1957). This book became a key text in the renaissance of the UK General Practice in the 1960s and the Balints’ ideas achieve world recognition since then.
In continental Europe, Balint groups are considerably more widespread. In 1972 the International Balint Federation is founded, whose members are more than 32 countries. In England and Germany participating in Balint groups is part of doctors’ specialty. Balint groups are beginning to take root in the U.S. in the early 1990s, where the American Balint Society is formed and later that of Australia’s. In recent years there is a spread of Balint groups in Russia and China.
In Greece Balint groups have not had the luck they had in other European countries and the attempt to introduce them has been fragmentary (αποσπασματική) and based on private initiative of some doctors as the founder of psychosomatic in Greece, Renos Rotas. Within hospital environments, Balint groups for nurses worked for a time in EginitioHospital and groups affected by the method of Balint worked in the psychiatric department of the MetaxaCancerHospital.
Ntina Bezioula
Educational Psychologist – Psychotherapist
Bibliography
Kallergis, G. (2010) Educational – supportive group of health clinicians, Encephalos 2010, 47(4):207-213
Berk, A., Statharou, A. (2003) The function of Balint groups as a means of supporting mental health nurses. NURSING, 42(2), 137-142, 2003
Balint, E. (1985). The history of training and research in Balint – groups. Journal of Psychoanalytic Psychotherapy 1 (2): 1-9.
Balint, M. (1957) The Doctor, his Patient and the Illness, Pitman, London.2e, 1964; Millenium edition, 2000, Churchill Livingstone, Edinburgh.
Otten, H. Balint work in Germany (1998) Journal of the Balint Society 26, 16-19
Salinsky, J., Sackin, P. What are you feeling , doctor? Identifying and avoiding defensive patterns in the consultation. Oxford: Radcliffe Medical Press Ltd; 2000.