group-therapy

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“I love our Balint group!”

This was the cry of one of the receptionists yesterday afternoon at the Health for All Family Health Team. We had just wrapped up our “season-opener” of the monthly Balint group for our Department of Family Medicine. Her enthusiastic, unsolicited endorsement warmed the cockles of my heart – especially since this particular Balint group has been a dream come true for me.

What is a Balint group? It is named after British psychoanalyst Michael Balint. The concept is best described by one of our Toronto colleagues in an excellent piece in the Canadian Family Physician earlier this year. Dr. Michael Roberts said that:

“A Balint group is a purposeful, regular meeting among family physicians, with a trained facilitator or leader, to allow discussion of any topic that occupies a physician’s mind outside of his or her usual clinical encounters. A Balint group can have many goals. The presenter might realize a more helpful way of viewing and interacting with the patient; the group might learn to view the case from multiple perspectives (clinician, patient, relationship). The goal is to improve physicians’ abilities to actively process and deliver relationship-centred care through a deeper understanding of how they are touched by the emotional content of caring for certain patients.”

Michael Balint

We decided to start a Balint group based at the Markham Family Medicine Teaching Unit when it opened in July 2010. Since then the Balint group has met monthly as one of the highlights of our Tuesday lunchtime Global Health series. We were looking for ways to learn together about how to provide excellent clinical care and in particular how to provide culturally sensitive care in our wonderfully diverse community setting. It has been my hypothesis that this particular Balint group will be part of how we build a better health care provider, learn to provide better care and contribute to healthier communities.

We made a couple of adaptations to the classic Balint technique. Here’s what makes the Markham Balint group special:
1. We meet as an inter-professional team. This may be the most delightful part of the experience. Our group includes doctors, nurses, social workers, dieticians, receptionists, administrators – you name it! We all have a unique perspective to contribute about our interaction with patients.
2. We have selected a theme for our case presentations. We aim to focus on the provider-patient relationship in culturally discordant clinical encounters.

Here’s a sample of some of the feedback we have received from team-members:
• I learn how to approach situations with more tact and understanding.
• I learn how different people react differently to the same situation.
• I learn about different perspectives from different professional backgrounds.
• I like the safety of the group.
• There is always something new to learn from each other.

I am grateful to my colleagues who have helped coordinate this Balint group. Special credit goes to Dr. Eileen Nicolle who oversees the Global Health Lunch series. And of course the Balint group would not happen without our skilled facilitator, GP psychotherapist, Dr. Scott Allan.

I completely concur with the comments of Dr. Michael Roberts in the article cited above. The Balint-group technique is vastly under-utilized by health care providers as a means of improving our clinical effectiveness. I hope Markham’s inter-professional primary care Balint group will be around for decades to come!

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