Family Physicians Leaving Their Clinic—The Balint Group as an Opportunity to Say Good-bye

Balint groups and supervision groups are known to be beneficial for general practitioners (GPs), as fostering professional development, as a part of sharing mental health care and as support groups and they have a preventive effect on burnout (1-4). Shorer et al. show in their narrative how the Balint group facilitated an insight in a doctor's own feelings and needs (5).

My position for commenting this article is as a female GP, educated supervisor and Balint group leader and as a researcher on supervision groups for GPs. I brought the article to my own peer supervision group, consisting of three psychiatrists and a GP, and I have discussed it with several of my colleagues as well.

The narrative has several topics at different levels.

The case:

As in most cases in a Balint group this takes departure in a doctor- patient/family relationship. In a small community the doctor perceives one of her families loosing an 18-year old son in a car accident. She did not see any of the family members and considers whether she ought to visit them. She asks whether she, as a doctor, should invite the family and open up the issue about the loss.

The group:

The group considers the grief work as important, which is hesitantly accepted by the presenter. The group work seems to be difficult starting with uneasiness and heaviness and an intellectual discussion as a sign of distancing from the emotions which might have been evoked. After the intervention of the group leader the participants become more in contact with their emotions. By looking at the presenter they probably express empathy with the doctor.

The intervention:

Having noticed the hesitation of the presenter and the difficulties of the group work, the leader brings attention to the presenting physician and adds his knowledge of her future personal history. This brings the group onto a more personal track which is recognized by the presenter, who now sees how she herself is affected by an incipient separation process. After the process is initiated in the group, the group leader intervenes. The presenter who was outside the group, is then invited back to participate in the group.

The supervisor's role:

In this case the group leader or supervisor allows the focus to shift from the patient-doctor relationship to the doctor's relationships. The question posed of the presenter, whether she ought to visit the family, is not answered. The doctor's emotional dilemma is focused on instead. I suppose it is in the contract with the group that some of the work involves working with the personal doctor and may involve the doctor's person. In this work the professional background and competencies of the group leader is important. The supervisor skills needed include knowledge about group dynamics, how to provide an accepting and nonjudgmental atmosphere and how to be a good listener. This is a fundamental condition required to give Balint groups a sense of security.

The context:

It is a continuing group of busy physicians with regular meetings. The continuity and the sense of commitment to the group foster trust and confidence in the group's participants. The presenter coming from a small community illustrates some of the challenges this might give. The insecure environment for many of the doctors and patients may challenge the involvement of the doctors. The description of the context makes the whole situation more alive even if the specific rituals in the mourning process are not known.

The narrative as a research project:

As a research project the narrative of this case is validated by the transparency and recognisability of the case and the process.

Connecting to my own experience:

My research project from Denmark shows that significantly more women than men attend supervision groups. It seems as if women are more apt to share difficulties and disclose personal matters. A third of Danish GPs attend supervision groups with many different approaches (6). Most have used the reflecting team model (7). About a third have used the Balint method. Many stay in the groups for many years. In my study groups many have expressed the significance of working with themselves as important. All participants value the supervision group as an important part of their professional life.

1. Kjeldmand D.: The Doctor, the Task and the Group: Balint Groups as a Means of Developing New Understanding in the Physician-Patient Relationship. PhD-thesis Uppsala University 2006

2. Rabin S, Maoz B, Shorer Y, Matalon A: Balint groups as 'shared care' in the area of mental health in primary medicine. Mental Health in Family Medicine 2009;6:139-43

3. Nielsen HG & Tulinius C. (2009): Preventing burnout among general practitioners - is there a possible route? Education for Primary Care 20 (5): 353-9

4. Brondt A, Sokolowski I, Olesen F, Vedsted P: Continuing medical education and burnout among Danish GPs British Journal of General Practice 2008; 58: 15-19

5. Shorer Y et al.: Family Physicians Leaving Their Clinic--The Balint Group as an Opportunity to Say Good-bye

6. Nielsen HG, Soderstrom M.: Group supervision in general practice as part of continuing professional development. Dan Med Bull. 2011(In press)

7. Andersen T. (2007)[The reflecting team: dialogues and dialogues about the dialogues]3rd ed. Copenhagen: Dansk Psykologisk Forlag.

Competing interests:   None declared