Sunday, March 5, 2017
The Power of Ideas - Bridging a Gap?
If you did not attend the American Balint Society’s (ABS) 2nd National Meeting in July, 2016, you missed a lot! You missed the opportunity to spend several days with a group of folks who speak the same language (Balint-ese, I’ll call it), and there were great paper presentations, reports on new directions and programs the ABS is creating, Enid Balint essay contest winners and, of course, we all participated in Balint groups that met for each of the four days. Our next National meeting will probably be held in 2018. Details will be on the ABS web site when it is scheduled and announced. In the meantime, if you need a Balint fix, I encourage you to attend the International Balint Congress to be held in Oxford, U.K. from September 6-10, 2017. Check out the IBF website for more details (there’s a link on the side of the blog and on the ABS website).
And “we now return you to: The Power of Ideas!”
At last summer’s ABS National meeting, two presentations that profoundly impacted me were the invited Keynote presentation by John Salinsky from the U.K. - our society’s midwife (mid-husband?) - and a theoretical paper by John Muench. Neither paper knocked my socks off at the time, but I have had the opportunity to read and reread them (Shameless Commerce: you too will have an opportunity to read them in an upcoming issue of the International Journal of Psychiatry in Medicine).
Salinsky’s Keynote (“What Really Happens in Balint?”) was entertaining - as he always is. However, as usual, I did not fully appreciate the wisdom of his observations. Among his comments about what really happens in a Balint group is the notion that there may be different levels of impact from participation in Balint groups. John suggested they could be called Gold, Silver and Bronze levels (in this Olympic year - 2016), and he went on to identify a number of characteristics of each level.
This idea intrigued me! So, I recently began a conversation with John about these levels, and he shared with me that one source of this idea was embedded in Michael Balint’s curiosity about physicians who discontinued attending his seminars (A Study of Doctors by Michael and Enid Balint and colleagues and published in 1966). Recently, I, myself was wondering why everyone who attended Intensives with me was not as excited or passionate about Balint groups as I was - a similar question focussed on people’s differing reactions to the Intensive or to the Balint seminar experience.
So, one unanswered (and possibly unasked) question is: “What accounts for the differing ways that Balint Leader Training Intensive participants or even ongoing Balint group members are impacted by that experience?” The answer is not obvious based on the participant evaluations which are universally positive. Another way to think about this question might be: What draws people to Balint? and What keeps people at a distance? As one might imagine, I have some thoughts about ways to research and answer that question! Maybe you have some ideas too - feel free to chime in about your ideas in comments at the end.
A second question to consider is: “Can the delineations between Bronze, Silver and Gold levels be distinct enough for these levels to be meaningfully useful?” While I encourage the reader to consider what the content of such levels might be (we all know the value of fresh eyes!), I will also tease you with a promise to share my own variation on John’s very useful beginning - ‘coming attractions.’
John Muench’s presentation (“Balint Work and the Creation of Medical Knowledge”) intrigued me in some very different ways, and he totally lost me at the time of the presentation. For me, it was the kind of talk that really required more context than the allotted amount of time could provide. I thought he could have even used an extra slot to provide context for his context. John briefly outlined a history of scientific inquiry and discussed revolutions in scientific thinking along with an exploration into epistemology - the study of where knowledge comes from (Kuhn, 1963, Toulmin, 1990). Having a chance to read the paper at my own pace helped to open up these ideas (again, look for the upcoming issue of IJPM). In particular, John discusses the humanist - rationalist dichotomy or dimension, and the resultant tyranny (my word) of evidence based medicine manifested in the primacy or even exclusivity of placebo controlled, double blind studies. As you might guess, John describes the failure of medicine to incorporate the kind of experience and knowledge creation that a mature, regularly meeting Balint group produces. He does so using Aristotle’s distinction of types of knowing, and in particular, references ‘phronesis,’ a type of practical knowledge which might be viewed today as professionalism. This is distinguished from ‘techne’ which fits more in the realm of the rationally justifiable. If you are interested in diving into this, John would recommend Aristotle’s Nicomachean Ethics, and in particular Book VI, Intellectual Virtue (or maybe he would say “Just read my paper.”).
While I might not have done justice to John’s paper, the idea of Balint groups as a creator of knowledge may modify one’s thinking and approach to documenting the impact of Balint group participation. Maybe, instead of trying to measure someone’s score on a scale of empathy or burnout or even job satisfaction, we might want to think about how could we describe the new knowledge that is created. The Van Roy et. al.’s literature review of Balint related publications (2015) suggested that more, well designed qualitative research studies were necessary to document the Balint group participation impact. Now, does it make sense to think more about Salinsky’s three levels of impact and how we might develop such a scale of qualitative changes experienced by Balint group participants? If one proposes a qualitative shift in the way a physician thinks about their patient, measuring more or less of any variable (empathy, burnout, psychological mindedness) is by definition quantitative and insufficient. Michael Balint, himself, spoke about a small but significant change in the doctor’s personality. Let’s use our experience to define the nature of these changes. We see them; we even experienced them ourselves. How shall we describe them in ways that capture these qualitative changes?
Stay tuned for the following Coming Attractions:
My next blog post with Salinsky’s three Olympic-named levels and my thoughts about a next step!
The IJPM issue this summer focussed on the ABS 2nd National Meeting
The IBF’s International Balint Congress in Oxford, U.K. - September 6-10
The next ABS Balint Leader Training Intensive in Pittsburgh - October 2017
The ABS 3rd National Meeting - Summer 2018 - to be scheduled
And your own thoughts and reactions which I invite you to share in the comments section of this blog post - Thank You!