Restoring the Core of Clinical Practice: What Is a Balint Group and How Does It Help?

Book Title: Restoring the Core of Clinical Practice: What Is a Balint Group and How Does It Help?

Author: Laurel Milberg and Katherine Knowlton

Publication Information: Independently Published, 2019, 59 pp., $14.50 paperback

If you think of this monograph only as an introduction to Balint groups (which it primarily is), you may be inclined to acknowledge its value for someone else but less inclined to read it yourself. If you consider reading it as an approach to understanding the complexities of healing relationships, you begin to appreciate anew the intricacies of connecting with another human being who happens to be struggling with health challenges.

Restoring the Core of Clinical Practice succeeds in its intended goal of describing the specifics about Balint groups, and it provides multiple participant quotes and examples of the benefits of Balint group participation. In logical order, it explains who its audience is and isn’t, enumerates necessary and sufficient conditions for groups to experience these benefits, describes the specific and unique roles and tasks of group leaders and group members, identifies strategies that are useful in starting Balint groups, and finally, names resources that can be helpful. It includes all anyone needs to know about what they are getting into and what to expect from being in a Balint group.

However, there is a curiosity in this manual that parallels the curiosities in Balint groups themselves, and sometimes the curiosities that occur in doctor-patient relationships as well. There is a subtext suggesting that exploring and understanding doctor-patient relationships takes more than teaching an algorithm to master empathy, for example. It takes a unique set of conditions that allow and support participants’ potential to learn from the inside out, from their own perspective and experience about their own rich potential to be their patients’ uniquely designed healing agent. These group norms that the authors name include well-trained leaders, regular dedicated time and space, strict confidentiality which allows even socially inappropriate thoughts and feelings to be aired, cultivating a nonjudgmental atmosphere, encouragement to speculate, and an emphasis on divergent thoughts and feelings. These are the components of an emotionally safe learning environment, and as Restoring the Core of Clinical Practice suggests, there are no other similarly structured or systematic learning opportunities in medical education or even in practice. It is no coincidence that this is the kind of environment needed for patients to have a truly healing relationship with one’s physician, as well.

There are numerous key Balint group learning pearls that also have parallels to doctor-patient relationships. These are less explicit but implied or hinted-at lessons that are crucial for any primary care professional. Examples include the ubiquity of uncertainty and ambiguity, the development of emotional muscle, the layers of emotional impact for both patient and physician, the primacy of the therapeutic relationship—exhibit #1 in the art of medicine, and the nature of a contract, too often implicit, between group leader and participant or doctor and patient.

What is missing? There are some unavoidable missing pieces, not because the authors failed in their intended goal, but rather because there are limits to one’s ability to describe the experiential nature of being in a Balint group. Further, there is not just one experience that would suffice; everyone has their own comfort level in groups and therefore their own experiential trajectory. It is common for people to hear or read a description of a Balint group and then participate in even a single demonstration, and their understanding and reactions are as different as night and day.

One unattainable perspective is to write an introductory book from the eyes of a beginner. By definition, once you can write knowledgeably about any subject, you are no longer a beginner! In thinking about my first Balint group experience, I ask myself how helpful this book would be. The helpfulness of this book would be a function of one’s needs to be fully informed, warned, and prepared for this experience. Sticking my toe into this water was ultimately an expression of trust and a willingness to take a risk. Reading this book ahead of time provides a clear idea of what to expect. However, it cannot provide perspective on other unknowns like who else is in the group and confidence in the leader’s ability to guide the group’s evolution. The visual learner might appreciate a brief diagram or chart that outlines the steps of the process (eg: leader asks for a case, case presentation, clarifying questions, presenter observes only, group discussion, presenter reenters, end of daily group).

Readers of Restoring the Core of Clinical Practice will have enough information to reduce their uncertainty. Ultimately, Balint group participation is like climbing a pyramid of anxiety management one step at a time while having faith that approaching the pinnacle, case by case, you will be reassured that you are not alone and that you continue to be the healing force that your patients need, and faithfully return to experience.