Experiences from a Balint group intervention with urban public school teachers.

Background: U.S. teacher shortages have more than tripled since the 2012-2013 school year, to over 110 000 teachers needed in 2016. At the conclusion of the 2011-12 school year, 13.8% of public-school teachers left their position. Approximately 50% of the public-school teachers cited the inability to manage their roles as the primary factor for leaving. Purpose: The purpose of this study was to examine the influence of participation in a 6-month Balint group experience on a novice teacher's self-efficacy, experience with burnout, and intentions to persist in the classroom. Research Design: A converged mixed-methods approach was used. Each question was explored with a corresponding qualitative and a quantitative dataset. Data Collection: Qualitative data included (a) a semi-structured focus group; (b) field notes shared from the co-facilitator and Balint group leader; (c) semi-structured debriefs with the Balint group leaders; (d) open-ended questions on the pre and post-test reflection forms, and (e) semi-structured interviews with 3 participants that served as a form of member checking. Quantitative data included pre and post-test and monthly reflection forms that were collected at the conclusion of each meeting. Teacher's self-efficacy, experience with burnout, and intentions to persist in the classroom. Study Sample: Eight teachers volunteered for the group after an email solicitation to all the teacher development program's members. Results: This article examines sources of stress for new teachers, themes that came up in the Balint group that reflect the stress and its impact, and changes in felt burnout, self-efficacy, an intent to persist in teaching. Teachers faced similar stressors to professionals in the medical field. Conclusion: Balint offers an opportunity to addres the social and emotional needs teachers face.

Introduction of Balint Groups as a Reflective Practice Method.

Cynicism and burnout are well-described among new medical school graduates. At the new medical school in Washington state, the trend toward placing importance on wellness and creating a culture of healing was present from the outset. To encourage reflective practice, Balint groups were introduced as a method to teach students to think deeply about patient relationships and to address particular curricular objectives, including to demonstrate empathy for healthcare trainees and for patients, and to practice active listening skills in the context of the student Balint groups. The approach presented here will focus on the introduction of Balint groups into the pre-clerkship curriculum as a longitudinal tool to prepare students to use the method with more facility in their clerkships. The presentation at the 2022 American Balint Society Annual Meeting highlighted the introduction of Balint groups to the clinician faculty using the Intensive on the Road format, the introduction of Balint groups to pre-clerkship medical students, and the use of Balint groups in the pre-clerkship curriculum. The operational aspects, including faculty recruitment and retention, as well as student groupings and scheduling, were addressed in the context of the overall theme of monitoring student progress toward open communication about their challenging patient relationships. Programmatic evaluation and current trends were emphasized, along with the anticipated evolution and future directions of the program at our community-based medical school.

The Goldilocks of Social Justice Education: Balint Groups as a Curricular Intervention to Support Equitable Health Care.

While there is consensus within the medical profession on the importance of ensuring future physicians are well versed in issues of social justice, there is little consensus on how to best achieve this. Traditional methods of didactic lectures or case-based learning, with an emphasis on the transmission of knowledge, run the risk of reinforcing the very inequities they are aiming to disrupt. The classroom experiences do not call on trainees to act on issues of social justice beyond discussing imagined actions in a carefully constructed case. Balint Groups offer an alternate pedagogy that align with a more interpretative style of teaching and offer an opportunity for meaningful engagement with issues of social justice. In Balint Groups, students are engaged in cases where the presenter has participated directly in the clinical encounter. While these cases tend to focus on relational dilemmas between the doctor and patient, the dilemma can also highlight an internal dilemma between competing professional identities - such as the biomedical expert and the socially conscious professional. Imagined agency is removed and the group is tasked with reflecting on the dissonance created by these two competing identities. While the use of Balint Groups as a curricular intervention offers exciting opportunities to promote social justice, there are cautions. First, Balint Groups operate within the dominant discourse of medical education and facilitators must be sensitive to how this may position the presenter; second, it cannot be forced - it must arise from the case presented.

Research Cum Training: Assumptions, Balint's Method, and Future Directions.

Michael Balint conducted several multi-year training programs for general practitioners designed to teach lessons from a psychoanalytic perspective on the relationships doctors have with their patients and contribute to their healing skills. This group process evolved, and it was described along with an elaboration of significant researched observations of interferences in those relationships. There were several other similar multi-year experiential group endeavors conducted and/or inspired by Michael and Enid Balint which were designed to further investigate the subtleties in relationships between doctors and patients. However, none have been done since the late 1990's. Instead, research about the impact of Balint group impact has been dominated by the evidence-based approach to all medical research, and it has been typified by variations on randomized controlled, double blind research methodologies. A recent literature review has highlighted the limited results of such studies along with questions about methodological approach. However, the authors continue to support the search for appropriate dependent variables to validate the value of Balint groups for physicians. This paper identifies and examines the implicit assumptions that underly current research efforts. In addition, there is an exploration of Michael Balint's approach to "research cum training" along with describing his assumptions and the results of his research approach. In addition, recommendations are made to extend the work of the work of uncovering healing dynamics in doctor patient relationships.

Balint groups and narrative medicine compared to a control condition in promoting students' empathy.

BACKGROUND: The perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students' empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS: Students who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session. RESULTS: Data from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): - 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants' characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (ß = 2.673, P = 0.030). CONCLUSIONS: Balint groups may promote clinical empathy to some extent among medical students, at least in the short run.

Supporting trainees in challenging learning environments - is there a way?

The working and learning environment within the NHS is challenging. 46% of GPs report emotional exhaustion, and trainees experience burn-out with higher prevalence than expected. Attending Balint groups (BGs) has been suggested to prevent burnout and compassion fatigue, helping GPs to thrive in their jobs. For this pilot service evaluation of BGs for GP trainees we used qualitative research methodology including surveys, participant observation, and semi-structured interviews. Fonagy's concept of resilience was used as the theoretical frame of reference. The data-led analysis identified trainees having burn-out sensations: un-met expectations for their training; their need for more support and the value of attending the BGs. Trainees experienced BG as a safe place, allowing open discussions and honest accounts of anxieties, facilitating clinical learning and learning skills of reflection as an important supplement to normal training. The theory-led analysis showed that BG sessions taught trainees new approaches to improve elements that are assessed as key in the selection process for GP training and as Fonagy described as characteristic for people with resilience. As a result of this project, a number of trainees expressed interest in continuing Balint group work. Trainees were recruited to an ongoing monthly BG, within the GP training scheme. However, due to budget restraints, difficulties with new interest and failing to find a non-training GP facilitator in the local area, the group has floundered.

Balint 2.0: A virtual Balint group for doctors around the world.

Objective Balint groups have shown promise in addressing clinician-patient relationships, clinician burnout, referral practices, and psychological mindedness. However, their traditional format of in-person sessions limits their ability to meet the needs of clinicians practicing in locations without trained Balint leaders. We report on a pilot of an international, internet-based Balint group in collaboration between the World Organization of Family Doctors regional Young Doctors Movements and the International Balint Federation. Method Balint 2.0 arose through interest of the Young Doctors Movements leadership, who approached the International Balint Federation for assistance. Initial discussions and some trialing of videoconference platforms led to monthly group meetings over the internet. Surveys evaluated each individual session as well as quarterly progress of the group. Survey items were borrowed from existing surveys in use by the American and German Balint Societies. Results Session surveys demonstrated the effectiveness of the videoconferencing platform for convening a Balint group, with a majority of participants expressing agreement with survey items evaluating each session. Quarterly survey responses were more positive reflecting agreement with outcomes seen from in-person Balint groups. Conclusions The Balint 2.0 pilot has demonstrated the ability of a Balint group to successfully convene over the internet and reach the common outcomes of a Balint group meeting in-person. The Young Doctors Movements and International Balint Federation plan to expand this work based on this successful pilot. We hope that others may also be able to build on this success with the result that Balint groups are available to clinicians in areas where they might not otherwise be accessible.

The role of Balint group training in the professional and personal development of family medicine residents.

This paper presents a study based on the participation of PGY2 and PGY3 family medicine residents in Balint seminars that occurred twice monthly for 24 months. Balint groups were cofacilitated by leader pairs experienced with the Balint method. Prior to residency graduation, 18 of 19 eligible resident physicians (94.5%) completed 30- to 60-min semistructured interviews conducted by a research assistant. Resident physicians were told that these individual interviews concerned "…how we teach communication in residency." The deidentified transcripts from these interviews formed the raw data that were coded for positive (n = 9) and negative (n = 3) valence themes by four faculty coders utilizing an iterative process based on grounded theory. The consensus positive themes included several elements that have previously been discussed in published literature concerning the nature of Balint groups (e.g., being the doctor that the patient needs, reflection, empathy, blind spots, bonding, venting, acceptance, perspective taking, and developing appreciation for individual experiences). The negative themes pointed to ways of possibly improving future Balint offerings in the residency setting ( repetitive, uneasiness, uncertain impact). These findings appear to have consistency with seminal writings of both Michael and Enid Balint regarding the complex nature of intrapsychic and interpersonal skills required to effectively manage troubling doctor-patient relationships. The implications of findings for medical education (curriculum) development as well as future research efforts are discussed.

Facilitated Learning Groups: an initiative to enhance psychiatric training in South Australia.

OBJECTIVES:: Facilitated Learning Groups (FLGs) were introduced by the South Australian Psychiatry Branch Training Committee in 2016 to provide support for trainees. These incorporated Balint group principles but also had roles that extended beyond a traditional Balint group. This paper reports an evaluation of these groups after their first 12 months. METHODS:: An evaluation form was sent to all trainee participants, seeking quantitative and qualitative feedback about their experience. RESULTS:: The majority of trainees found the FLGs to be beneficial. A thematic analysis of the written feedback revealed several key benefits for the participants, including having access to a senior psychiatrist who was outside of training and supervision, mixing with trainees across years and regions, and the capacity to discuss difficult work environments. CONCLUSIONS:: A forum for trainees to develop reflective practice and discuss challenging issues, which is not involved in their assessment, was experienced positively by the majority of participants and should be considered for wider adoption across Australia and New Zealand.

Psychodynamic Leadership Approach and Leader-Member Exchange (LMX): A Psychiatric Perspective on Two Leadership Theories and Implications for Training Future Psychiatrist Leaders.

An increased emphasis in recent years on psychiatrists as healthcare leaders has not only drawn attention to the skills they can bring to this role but has also raised questions about how to best train and prepare them to assume leadership responsibilities. Such training should not be conducted in isolation from, and oblivious to, the wide-ranging expertise in human behaviour and relationships that psychiatrists can bring to the leadership arena. The aim of this theoretical paper is to draw attention to how psychiatrists can use their existing knowledge and skill set to inform their understanding of leadership theory and practice. In particular, the Psychodynamic Leadership Approach and Leader-Member Exchange theory are compared and contrasted to illustrate this point. The former represents a less well-known approach to leadership theory and practice whereas the latter is a widely familiar, conventional theory that is regularly taught in leadership courses. Both are underpinned by their emphasis on leader-follower relationships-and human relationships more broadly-and are intuitively appealing to psychiatrists endeavouring to understand aspects of organisational behaviour in the healthcare settings in which they work and lead. The application of these theories to assist reflection on and understanding of professional and personal leadership behaviours through leadership-oriented Balint-style groups and 360-degree appraisal is proposed. It is hoped that this paper will serve to stimulate thought and discussion about how leadership training for future psychiatrists can be tailored to better harness their existing competencies, thereby developing richer formative learning experiences and, ultimately, achieving superior leadership outcomes.

Balint groups - helping trainee psychiatrists make even better use of themselves.

OBJECTIVE: The paper presents a pilot study of Balint group work to establish it as a potential training tool in psychiatry. The aim was to test whether, in the training setting, it was possible for a cohesive group to form, such that trainees could make use of a Balint group experience. METHOD: Nine psychiatry trainees were offered three 90-minute Balint sessions and provided written feedback. RESULTS: The trainees reported unanimously that group participation was a positive and worthwhile experience. They began to feel supported by their colleagues and experienced the method as an effective way to manage stress and anxiety. They reported that they experienced doctor-patient interactions in a different way, which appeared to correspond with a greater understanding of the patient's experience. CONCLUSIONS: The pilot suggested that, within the public health training setting, a cohesive group could form such that trainees were able to make use of a Balint group experience. It suggested that this practice could be beneficial in managing the stresses, isolation and intense feelings of working with patients in this setting. The feedback indicated that the group helped trainees 'think differently' by fostering self-awareness and so furthered their development of psychodynamic skills.

Balint groups: an Australasian perspective for psychiatrists.

OBJECTIVE: This paper aims to provide a brief overview of the history and scope of the Balint movement; to outline how Balint groups work; to describe what is entailed in leading a Balint group; and to give a brief overview of the current state of Balint work in Australia and New Zealand. CONCLUSIONS: Balint groups provide a unique setting in which clinicians can learn how to deal well with challenging doctor-patient relationships and the feelings evoked in clinical practice. Balint work is relatively undeveloped in Australasia. There is scope for involvement by psychiatrists and trainees as both participants and facilitators.

Reflective practice and psychotherapy case experience of Specialty Doctors and Associate Specialists (SAS) working in psychiatry: UK-wide survey.

AIMS AND METHOD: To survey nationwide opportunities for Balint-type and reflective support group participation and psychotherapy training among doctors classified as Specialty Doctors and Associate Specialists in psychiatry ('SAS psychiatrists') and the professional benefits and barriers to access. RESULTS: Approximately 9% of SAS psychiatrists responded, from all UK regions. A minority reported participating in a Balint-type group (27.3%) or reflective practice/support group (30.9%), and only 6.5% were not interested in participating. Although 44.8% planned to see a psychotherapy case, most reported barriers, particularly time constraints, job plans and lack of support. The 22.1% who reported already gaining psychotherapy case experience reported many benefits, including becoming a better listener (84.8%), more empathetic (81.2%), enjoying work more (78.8%) and overall becoming a better psychiatrist (90.9%). CLINICAL IMPLICATIONS: The reported interest in Balint group and psychotherapy training opportunities exceeded existing provision; psychotherapy case experience benefited professional development and self-reported clinical capabilities. Healthcare trusts and boards need to consider more actively supporting SAS psychotherapy training and reflective practice.

Balint groups: an effective tool for improving health professionals' perceived well-being.

BACKGROUND: Physician burnout is a common problem that negatively impacts their well-being and patient care. Balint groups (BGs) deal with doctor-patient relationships. Previous studies that have demonstrated the positive effects of BGs are descriptive and based on small sample sizes. This study aims to evaluate the perceptions of health professionals who participated in BGs, determine the impact of BGs on their personal and professional well-being, and identify the factors related to these positive outcomes. METHODS: On January and February 2023 the authors have distributed a questionnaire to 142 healthcare providers in a conference and internet networks. Most respondents were family physicians. RESULTS: Participation in BGs is seen to have a positive impact on healthcare professionals' perceived well-being and professional development. Respondents who had participated in the BG reported a reduction in burnout, increased empathy, and enhanced professional identity and relationships with patients and colleagues. The study also highlighted the importance of duration of participation in BG, with attendance longer than 5 years linked to significantly more positive outcomes compared to less than 1 year. In a logistic regression analysis two factors were significantly associated with self-reported well-being: attending BGs for more than five years and perceiving BGs as a means of relieving burnout. CONCLUSIONS: The findings suggest that medical organizations should encourage the regular availability of BGs to support physicians' well-being.

Balint groups' possible role in self-care and job satisfaction of general practitioners-A qualitative study.

BACKGROUND: Concerns are growing when it comes to the shortage of primary care physicians, therefore it seems necessary to take a closer look at job satisfaction and self-care as one of many influences on career choice. A higher job satisfaction reduces the risk to experience burnout and job-related stress and in addition it will contribute to staying in the profession. The objective of this study is to investigate the impact of regular participation in Balint groups on job satisfaction and self-care among general practitioners. METHODS: Descriptive qualitative study with semi-structured expert interviews of 7 general practitioners. Thematical analysis of data and narrative summary. RESULTS: A total of 402 coded segments were categorized into 8 main themes and 39 subthemes. Interviewees emphasized changes in self-care and job satisfaction as a result of Balint work and mentioned Balint work as a burnout prophylaxis for themselves. Competences that were learnt or improved through Balint work were described as well as aspects such as feedback and connection with colleagues or professional challenges and difficulties. CONCLUSION: The results of the study give rise to the assumption that regular participation in Balint groups might help to improve self-care, resilience, and contribute to job satisfaction. Further research is needed before a general recommendation can be made. Many positive aspects were described by the experts, while no harmful negative influences of Balint work were identified.

Reflective practice in psychiatric training: Balint groups during COVID-19.

Reflective practice is increasingly being recognized as an important component of doctors' professional development. Balint group practice is centered on the doctor-patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

Psychodynamic Psychiatry in Singapore.

The authors provide an overview of the history of psychiatric services and training in Singapore, and the more recent introduction of psychodynamic psychotherapy training for psychiatric residents. They describe the current state of psychodynamic psychiatry services in the public healthcare system, including efforts at fostering psychodynamic thinking in nonpsychiatric community partners via community mental health integrated care programs and activities such as Balint Groups. They discuss current challenges in psychodynamic practice, such as the impact of language and culture on the Singaporean individual's receptiveness to psychodynamic psychotherapy, as well as systemic challenges in funding and expanding psychodynamic services. They highlight future directions, including challenges and opportunities for the local psychodynamic community in Singapore.

Meaning in Life, Subjective Well-Being, Happiness and Coping at Physicians Attending Balint Groups: A Cross-Sectional Study.

This study aimed to measure the scores of well-being, subjective happiness, sense of meaning, and coping in Romanian physicians and the potential impact on them of systematically attending Balint groups. Eighty participants (33 men, 47 women, mean age 38.90, SD 9.73) were included in the study. From them, 43 had systematically attended a Balint group in the last two years, while the others represented the controls. All participants were administered the Meaning of Life Questionnaire, the Job-related Affective Well-being Scale, the Brief COPE Scale, and the Subjective Happiness Scale. t-tests and MANOVA were used to compare the group scores and the impact of Balint training on the study variables. Results showed that Balintian participants had a lower use of denial and self-blame and were more oriented towards the seeking of emotional and instrumental support. They also reported higher scores in high pleasurable-low arousal emotions, positive emotions, and in the perception of the presence of meaning. Still, when considering other additional predictors (gender, age), the distinct impact of Balint training remained limited to the preference for certain coping mechanisms. These results could stimulate the use of Balint groups as a tool for the physician's formation programs.

Is Balint training associated with the reduced burnout among primary health care doctors?

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory - Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.