Balint groups as reflecting teams

1
Balint groups as reflecting teams

• A dialogue between
• John Nessa (from Bergen)?
• and
• Harald Kamps (from Berlin)?

2
I (John) am here because...

• I am a devoted GP who has a fundamental belief in
  the primacy and healing potential of the
  doctor-patient relationship.
• I am from Norway, where the Balint groups have
  disappeared.
• I work with doctors who either dont know the
  Balintian movement or think about Balint groups
  as out-of-date practice.
• I am convinced that the Balintian group
  supervision method is an ideal frame for group
  supervision of GPs.

3
General practice in Norway

• Some few Balint groups in the 1970s
• Disappeared in the 1980s
• Strong interest for psychiatry
• Strong interest for the doctor-patient
  relationship
• Impulses from Family therapy and social
  constructivism
• The reflecting team two participants talking
  together, the third one listening

4
Reflective function

• Reflecting-in-practice means letting future
  behaviour be guided by a systematic and critical
  analysis of past interpretations, actions and
  their consequences.
• Reflective function mentalization
• Doctors professionalism to be more reflective,
  develop their reflective competence and function
• Reflection is important for learning from
  experience.
• Balint groups Structure and atmosphere for
  reflective learning

5
Are we still Balintians?

• All GP has an interactional (somebody like to
  call it a psychotherapeutic) aspect.
• Psychological mindedness is hard won.
• The basic Balintian principles are still true
• 1. Fundamental belief in relationship
• 2. Explore feelings in groups
• 3. Moral courage in the therapeutic moment
• 4. Trusting the butterfly effect the small
  change that makes a big difference

6
I (Harald) am here because.

• I have the same devotion to the healing potential
  of the doctor-patient relationship.
• I am now from Germany, where Balintian groups are
  a must for most of the GPs for their basic
  psychosomatic education.
• Many of my colleagues follow a Balint group for
  many years.
• I am concerned about, that the Balintian group
  supervision method can confirm a dualistic
  thinking about soma and psyche.

7
Reflecting casuistic

• I want to present how quality circles can work as
  Balint groups and
• that we have to find a language which fits to
  general practice (without all the Freudian
  Gegenübertragungs-words).
• Thure von Uexkuells integrated medicine
• He avoided the term psychosomatic
• Based on the theory of biosemiotics, system
  theory and constructivism

8
Reflecting casuistic (1)?

• Group a moderator (e.g. a skilled GP), group
  members and one of them is presenting
• the patients history (max 15 min)?
• History of the disease
• History of the patient
• History of patient-doctor-relations

9
Reflecting casuistic (2)?

• Group discussion leaded by the moderator
• 1) what is special with the history and 2) why?
• 3) more questions to the patient?
• 4) how would you understand the history based on
  your professional background?
• 5) Imagine you are the patients doctor how would
  you proceed with the patient?
• 6) first now again to the presenter what do you
  do with the feed back?
• 7) how would you evaluate the moderation?

10
Link to Uexkuell Academywww.int-med.de
11
Some concluding remarks

• We need continously to develop a language
• which fits to GP, and not restrict our
  interpretations to one tradition only
• Small groups and quality circles can easily be
  combined with a Balintian approach.
• Small group activities need a structure to
  capture and control the group dynamics.
• The Balintian method provides such a structure.
• When Balintian groups fail, it is either because
  of an inappropriate way of talking about key
  issues, or lack of competent leadership .

12
Feasible Balint groups an attempt for a
definition

• Groups consisting of clinicians of equal standing
• who meet regularly by free will to discuss,
• to better understand themselves as clinicians,
• their own clinical work
• and the interactional process with the patient.
• In the context of the group,
• the participants are invited to respond
  spontaneously to what they sense, think and feel
  in an athmosphere of confidence and support.

13
Balint groups, definition (2)?

• In order to facilitate their work,
• the clinicians co-operate with an external
  consultant, whom they give the role of being a
  group leader.
• This person should be familiar with the working
  situation of her colleagues
• and be able to add a psychodynamic or biosemiotic
  dimension to the group discussion