Sunday, December 27, 2015

Balint is a Culture!

More specifically, it is a culture of relationships; even more specifically, it is a culture of healing relationships between and among health care professionals, their patients and each other.  

Balint is a culture of being as well as doing - The Balint process encourages participants to be in touch with the feelings that get stirred up when they are with their patients - or the feelings that get stirred up when they are with a group of colleagues and hear a case that is presented.   These emotions that get stirred up are at least as important as the medical intervention - they are essential in helping to develop the kind of relationship essential to the healing process.  These emotions and the healing relationship that emerges are at the core of patient centered care.

Balint is a culture of slow, not fast - it takes time to recognize all that transpires in the space between doctor and patient, yet alone within ourselves about our own and our patient’s humanity.  Developing a healing relationship requires an investment of time to listen to and hear the patient’s story and then time to listen to and hear our own self talk about that story.

Balint is a culture of listening, active listening, listening to understand - it is easy to think we understand what is wrong and what is needed if we focus more on the symptom than on the patient.  

Balint is a culture of intimacy, personal and emotional safety - it is helpful to identify what we do to encourage or discourage relationships with our patients as well as with each other.

Balint is a culture of process more than product - creating an emotionally safe, non-judgmental learning environment is essential to being open to our colleagues’ perspectives.  

Balint is a culture of sharing, generosity - We all take a risk by participating, and we all trust the group leadership to protect us all from ourselves as well as each other.  It is the training of our leaders that helps us have the freedom to dig deep into each of our emotional wells to discover, to learn, and to grow.

Balint is a culture of personal and professional growth - The benefit of regular participation includes what we learn about ourselves as people as well as in our work roles.

Balint is a culture that values a diversity of points of view, that celebrates differing perspectives, that invites the less popular constructions of an experience - Often the less popular voice is the less frequently expressed voice and it may be the one we need to hear.  

   Balint is a culture that encourages, values and supports meaningful healing relationships between doctors and patients.  Participation in a Balint group led by a trained leader is an opportunity to learn about the impact that emotions have on doctor-patient relationships, to learn about our own emotional reactions to a wide range of patients and patient challenges, and to share with colleagues one’s own emotional challenges.

Becoming part of the Balint culture requires only a willingness to look at and share of oneself, be open to others’ perspectives, recognize the impact that emotional reactions have on relationships and on health, and realize that, as Michael Balint once said, the doctor is like a drug in his or her impact on patients.   Participating in Balint groups or Balint leader training provides a common experience and an immediate bond among participants, a shared language and in interest in similar goals.

Given all of these descriptors of the Balint culture, it makes no sense to me to do a group that is Balint-like or what some may call Balint-light.  Either the group will be safe enough to explore emotional reactions to patient dilemmas or it’s not.  Either a group is free of judging or it’s not.  Either a group runs the risk of marginalizing a member or it doesn’t.  Either a group member can feel safe to name and acknowledge having a socially undesirable feeling or they can’t.  Balint means a safe space - a group cannot be kind of safe or safe-like.  

If the idea of an emotionally safe group is appealing, try learning how to achieve that goal.  Balint leader trainings are one way to learn, but they are not the only way to learn about group leadership.  And it may take more than one attempt to learn, develop and eventually feel competent at group leadership.  The rewards for the group are immeasurable.