An Intensive Training for Balint group leaders,

B. Maoz Jonesboruogh, East Tennessee, November 9 ± 13, 2006

Tagungsbericht
The conference was perfectly organized. There were about 50 in. The members of the faculty met several times during the
participants. All were teachers in departments of Family medici- conference.
ne, who conduct Balint groups with residents. The main work
was done in small groups of about 8 ± 10 participants and always Some participants did their ªfinal examinationsº for becoming a

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two co-leaders. We had 9 Balint groups during these days. At
every group one of the participants presented a ªcaseº (a rela-
tionship with a patient). The group discussed this presentation
for about 45 minutes; thereafter we discussed the process that
had occurred in this group session, the style of the leaders, etc.
The two official leaders of the group conducted the first and last
presentation-session, but stayed with the group all the time and
conducted all the discussions that took place after the presenta-
tions. There was thus a rotation of leaders, so that every partici-
pant got the opportunity to demonstrate how he/she leads a
group. Of course almost every participant also presented (spon-
taneously) a ªstoryº.
They intentionally did not use ªfish bowlº groups. They explained
to me that the dynamic process in the outer group of the obser-
vers is very much different from the dynamic of the inner group
and that there were always tension and frustrations after a ªfish
bowlº session.
They were no lectures (only one or two short talks). In the lager
group they discussed practical and general questions and issues
concerning Balint groups. The questions were written down
and given to the members of the faculty before the meeting.
There were a lot of evaluation forms that we were asked to fill
leader, in these small groups.
Concerning the content, many issues that we all know in general,
were discussed in a very accurate and precise way. So that some
things became really clear for me for the first time, although I am
engaged in Balint work for more than 30 years.
Let me share with you the notes that I made after finishing this
very interesting training:
The subject of B.G.s is the doctor ± patient relationship. 27
What is an inter-human relationship? It is a keen communica-
tion between two people, in our case, between a physician and a
patient. This communication is always partly conscious and part-
ly not. It happens partly in the ªhere and nowº and partly in our
memory and fantasy (transference and counter-transference
processes).
When a doctor has some difficulties and/or troubles with a cer-
tain patient he/she may decide to present this problematic rela-
tionship in a B.G. The doctor always presents a certain aspect and
a certain passage in a certain sequence of this relationship, a sto-
ry that he understands only partly, while feeling that there is
something additional, behind the facts, which makes him/her

Vita
Studium der Medizin. Spezialisierung: Psychiatrie und Psychotherapie, Tel Aviv Israel, Spezielle Interessen
und Forschungsgebiete: Sozial-Kultur-anthropologische Psychiatrie, Psychosomatik, Verbindungen zwischen
Allgemeiner-(Primärer) Medizin und Psychiatrie, Balint-Gruppen

Institutsangaben
Israel

Korrespondenzadresse
MD PhD Benyamin Maoz ´ Professor emeritus ´ Ben Gurion University of the Negev ´ Beer Shewa ´
16, Haela Street ´ POB 2640 ´ Even Yehuda Isreal 40500 ´ E-Mail: bmaoz@zahav.net.il

Bibliografie
Balint 2006; 7: 27±28  Georg Thieme Verlag KG Stuttgart ´ New York
DOI 10.1055/s-2006-931519
ISSN 1439-5142
 uneasy. A part of the relationship that he/she describes remains
thus unconscious and therefore disturbing.
A group of (4 ± 12) peers or colleagues, together with a leader and
a co-leader (preferable of two genders and two different profes-
sions) listen without interruptions, in an empathic and safe at-
mosphere, to this presentation and will later on discuss it.
Only a doctor who is able to listen to, and to be in touch with his/
her own personality is also able to listen empathically to a story
and a dilemma of a colleague.
The also partly unconscious processes, which occur in the group,
while this discussion takes place (lasting usually between 45 and
Tagungsbericht
75 minutes), are characteristic for a small group.
The members of the B.G., where the case has been presented, dis-
cuss this story using free associations. Thus expressing freely
what this case has evoked in them and how they perceived it in
their fantasy, they may identify with a certain part of it or with
certain persons that were described. They are asked not to give
advice. The presenter, after finishing the presentation, and after
answering some strictly informative questions, is asked to re-
main silent for a while. He/she has a chance to listen, to observe
and reflect. In a later stage he/she will be invited back, to share
the group discussion.
The main thing is: that the subject and the focus of this discussion
will remain always this specific doctor ± patient relationship. Not
a discussion of medical diagnosis or treatment, not of organizatio-
nal or administrative issues, not of legal or ethical problems and
also not just giving general support, even when needed.
28
Participants may tell the group personal issues, as long as these
are relevant to a relationship with the patient they represented.
But a Balint group is not a therapeutic group. (Sometimes, here in
Israel, we agreed to work on a doctor-doctor, or doctor-nurse re-
lationship, but then also on the non conscious, emotional, aspect
of this relationship).
It is the task of the leaders, to watch carefully that the focus will
be the presenter's relationship with the presented patient. If nec-
essary they may try, by their interventions to bring back the dis-
cussion to this relationship. They may keep the equilibrium be-
tween a ªdoctor centeredº and a ªpatient centeredº discussion.
They may thus remind the group not to forget the doctor or the
patient. But their interventions must be as short as possible, usu-
ally not real detailed interpretations, so that the group can do the
main work and the leaders remain mainly facilitators.
The leaders have to listen very carefully to the presented story,
not only intellectually but with all their empathy using their
Maoz B. An Intensive Training ¼ Balint 2006; 7: 27 ± 28
knowledge, experience, emotional intelligence and imagination.
They should become aware of the images that this presentation
has evoked in them and at the same time be alert for certain
clues in the presentation, as: slips of the tongue, changes of voice
and expression, blind spots, etc. The presented story is somewhat
like a dream, being partly conscious and partly unconscious.
When they see that the group has not come to the central images
they have thought about and experienced, they will intervene and
see if after this redirection the group is doing the work. Only when
important aspects of the presented relationship were not related
to, the leaders may mention and explain them.
When the group is able to explore the unconscious part and to
express it, then this process is usually very powerful, more
powerful than an intervention of the leaders.
In a good working B.G. the unconscious part of the presented
relationship (which has troubled the presenting doctor!) beco-
mes at least partly conscious. So that the doctor who had pres-
ented will see his/her case at the end of the session in another
and new light and in a new perspective.
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This new inside later-on usually has also an influence on the co-
ming encounters between the doctor and this patient.
We may hear about this change in following group sessions. (Fol-
low ups).
It is not always necessary that the presenter will tell the group at
the end of the session what he /she had gained in this B.G. discus-
sion. Things should be left open¼
In young B.G.s, or in B.G.s with residents or students, the leaders
may be more active and more teaching.
It is very important that the leaders will afterwards review and
discuss among themselves critically what had happened in this
B.G. session, concerning the case that was presented and the pro-
cess which has developed in the group. Sometimes Balint group
leaders may do this work in a supervision group (A meta-Balint
group).
As there are quite clear criteria of a good and of a progressing B.G.
these processes can be evaluated by careful qualitative research
methods and B.G. leaders can be trained systematically.
B.G.s are an art, every leader leads it somewhat different and
every group is different. It is a container of narratives and creates
its own narrative. But this art is based on scientific principles.
The basic thinking is psychoanalytical, but its application is prag-
matic, flexible and not dogmatic.