Balint Group or Balint Seminar
Many types of groups used in residency training have been called Balint groups but are not. The Balint group, a unique and specific type of group case discussion, properly framed and conducted over time by a trained leader will often result in participants’ increased ability to empathize with their patients and to use theirdoctor patient interaction as a valuable diagnostic and therapeutic tool. Two additional benefits are the humanization of medicine for the doctor and the patient and an antidote to physician burnout.
The references and resources below are chosen to help residency faculty understand the Balint group process, describe it to participants and other faculty, sell it to administration, access leader training and appreciate the importance of obtaining such training, avoid problems that undermine Balint groups’ success and stay the course. Several very helpful ones are not published per se or are hard to find in print but may be accessed through the website of the American Balint Society: www.americanbalintsociety.org.
Books
Balint, M. (1971). The doctor, his patient and the illness, 2nd edition. London, UK: Surrey Pitman Paperbacks. Also published by International Universities Press, Inc. New York, 1988.
This book is dense to read and sometimes hard to come by, but the introduction to Chapter 1 and Appendix 1 are worth it. What Balint Groups are all about and how to lead, from the horse’s mouth.
Salinsky, J., Sackin, P. (2000). What are you feeling, doctor? Identifying and avoiding defensive patterns in the consultation. Abingdon, Oxon, UK: Radcliffe Press.
Examples from a real practice on why self-awareness in the doctor patient relationship is so important with reference to Balint groups as a way to learn it.
Articles
The Balint Society (2003). Balint Groups and the Balint Method. Salinsky, J.
A lucid, cogent overview of the history, method, leadership requirements, group process and potential outcomes of Balint groups by a master leader.
The Balint Society (1994). Essential and Desirable Characteristics of a Balint Group. compiled by Paul Sackin.
Helps to define the essential ingredients that make a Balint group work and discriminate it from other group training exercises.
Scheingold, L. (1988).
Balint work in England: Lessons for American family medicine. Journal of Family Practice; vol 26, (3), 315-320.
Classic article elaborating how Balint groups are conducted and led, and why they are worthwhile training for family physicians in the US.
Ornstein, P. (1977). The family physician as a “therapeutic instrument.” The Journal of Family Practice, Vol. 4, (4), 659-61.
Family physicians would be best served by training that doesn’t teach them psychiatry or psychotherapy but which helps them develop their own interpersonal skills, specifically empathy, listening, and self-awareness.
Brock, C and Salinsky, J. (1993). Empathy: An essential skill for understanding the physician-patient relationship in clinical practice. Family Medicine, vol. 25, 245-8.
Making a good case for why the skill of empathy makes for better doctors and how Balint groups can help train doctors to use empathy in practice.
Freedy, J. (2006). Professional identity development and the psychotherapeutic function of a residency Balint group. Journal of the Balint Society, vol. 34, 16-21.
Description of the personal/professional changes experienced by a participant in a Balint group. Provides insight into residents' sometimes troubling behavior toward the group exercise.
Lichtenstein, A., Lustig, M. (2006). Integrating intuition and reasoning: How Balint groups can help medical decision making, Australian Family Physician, vol. 35. (12), 987-989.
Makes a good case for how Balint group training makes doctors better, not just more empathic.
Brock, C. (1985). Balint group leadership by a family physician in a residency program, Family Medicine, vol.17, 61-3.
How to set up, run and evaluate Balint groups in residency training with special emphasis on the requirements of leadership.
Milberg, L. (1993). Some random thoughts about Balint-group pitfalls, pratfalls and pot-holes. Journal of the Balint Society, vol 21, 17-18.
How not to set up, run, evaluate and integrate Balint groups into Family Medicine Residency training. Some process, leadership and systems issues that sink Balint groups.
Johnson, A., Nease, D., Milberg, L., Addison, R. (2004). Essential characteristics of effective Balint group leadership. Family Medicine, vol. 36 (4):253-9.
Report of research isolating essential Balint leadership skills.
Kjeldmand, D., Hoemstrom, I., Rosenqvist, U. (2004) Balint training makes GPs thrive better in their job. Patient Education and Counseling, 55, 230-235.
Qualitative research that documents the alleviation of isolation physicians experience when they participate in a Balint group. Good to provide the article to administrators to bolster claims about the process and to show that Balint is an accepted activity for practicing physicians in other countries.
Margo, G. and Margo, K. Balint groups vs support groups.
Explains the differences between two groups that are often confused and mistakenly blended in residency programs
Handouts
The American Balint Society. (2007). What To Expect as a Member of a Balint Group.
A handout for new participants explaining what happens in Balint groups and how to participate.
The American Balint Society. Balint Groups and ACGME Competencies.
A delineation of how many of the RRC required competencies are met by Balint groups in residency training. Essential reading for program directors
Tools and Training
The American Balint Society (ABS) holds two Balint Leader Intensive Training Workshops a year in different locations around the US. These training sessions provide the first step in learning about the Balint Group process and developing leadership skills. A leader credentialing process provides two years of supervision by an Approved Balint Leader Supervisor and a one-year Balint Leader Education Fellowship is conducted via Zoom conferences with a small group of beginning leaders and their mentor. More information is available on the ABS website www.americanbalintsociety.org.
American Balint Society. An Introduction to Balint Groups
A Powerpoint presentation introducing the Balint purpose and method
Crossman, S. and Magee, ML. Resident Evaluation of Balint Group, Virginia Commonwealth University Family Medicine Evaluation of Balint Group Experience Survey
A form to use with residents to get feedback on their Balint experience.
Web Resources
The American Balint Society (ABS) website www.americanbalintsociety.org has;
1) a section on Balint Resources with the above articles linked to it and more
2) a section on how to get leadership training, credentialing and fellowship
The Australian Balint Society www.balintaustralianewzealand.org
The (British) Balint Society balint.co.uk/
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