Editorial 2009

EDITORIAL 2009
What do we learn from taking part in a Balint group? The group experience is described as training but what are we being trained to do for our patients?  Are we really being trained at all?  At the beginning of a group’s life, the members feel that the principal benefit is the opportunity to discharge some of the anxiety and distress accumulated by a fortnight of close encounters with unhappy and demanding patients.
A Balint group is typically receptive and non-judgmental; a sympathetic hearing is guaranteed to begin with; even if your colleagues’ helpful suggestions begin to sound a bit challenging later on.  And some of their ideas may give you hope for a fresh approach that will  jolt that difficult patient out of the repetitive pattern that you find so frustrating.
Because we really want our patients to change. We hope to communicate our understanding across to them in a flash – which will induce transformation and bring about healing.  We would like our ’somatising’ patient to realise that his disagreeable bodily sensations can be dispersed if he can only gain access to the emotions that they represent.
We would like our anxious patients to calm down and conquer their fear. They might do this by reconnecting adult fears with childhood experiences (psychodynamic) or by learning techniques to deal with them such as those of Cognitive Behavioural therapy. We would like them to talk about their sadness, to cry freely in our presence and, eventually, to come to terms with their loss. The lonely should find new and fulfilling relationships or repair old ones. Those whose existence seems bleak and pointless should find meaning at last.
It would be nice, wouldn’t it? And sometimes it really does happen. But not all that often and probably not entirely due to our therapeutic efforts. More often, it is the doctor, not the patient who changes. As we relax in the nurturing environment of the group we find our empathy for the patient beginning to flower. And with empathy comes greater tolerance. Perhaps this patient is not so bad after all. I quite like her in a funny sort of way. When we see her again we are more prepared to give her room to just be herself (much as the group does for us).  As we listen to those vague accounts of ‘giddiness’ or tingling feet  or stabbing pains in all sorts of places, we are less inclined to dismiss them as  ’psychosomatic’ and more likely to think: I’ve had those too and they are not nice. We are in a better frame of mind to experience what Carl Edvard Rudebeck has called ‘bodily empathy’. The patient may well appreciate this sharing of her bodily experience. But where do we go next?   Some patients seem unreasonably eager to run to specialists for reassurance. This can be irritating to the doctor and even hurtful to her feelings. She has prescribed the best treatment, including generous doses of the drug ‘doctor’, but the patient is still unsatisfied. He
remains unconvinced that his symptoms are harmless. Again, Carl Edvard Rudebeck can be helpful. He points out that a symptom involving any organ or part of the body can seem like a terrible threat to continuing bodily function. Tingling in the feet may suggest to an elderly patient that he is going to lose the ability to walk; those stabbing eye pains which we know are harmless (through our disease based education) seem like the first signs of blindness, giddiness will lead to a stroke and pains in the left side of the chest to heart attack and death.  Again bodily empathy comes to the rescue. Have we never had those fears? Never had a strange sensation that won’t go away? Never accepted an antibiotic from a fellow doctor, ‘just to be on the safe side’?  Of course we have. And we have been grateful for the attention of the kindly specialist to whom we have referred ourselves because we don’t want to bother our GP over nothing.
So let’s not feel too bad about letting our patients go to see a specialist even if we can’t justify it in terms of the risk of organic disease.  We might even allow them a favourite medicine ‘of no proven value’. Hopefully, when our patient no longer has to fight with the doctor, he will relax and allow us to see some of his nicer qualities.  We, in return, will feel a greater warmth for this previously tiresome, even dreaded patient.
Maybe he will tell us about his family; about the wife who died, or the son who went abroad and never gets in touch. Another may reveal his disappointed hopes. Nurtured by the doctor’s new way of seeing and feeling, a younger patient may start to spread his wings and attempt to fly. Just a short distance to begin with, while we hold our breath. And if he crashes? Or never even takes off? We will be disappointed. But life is difficult and our patients often resemble Chekhovian characters who are high on good intentions but low on achievement. Never mind. We have still been there with them as a friend, as a witness and as a doctor.  Relaxation, tolerance and bodily empathy are some of the qualities we can learn from the Balint group that will help our patients.
John Salinsky
Reference
Rudebeck, Carl Edvard (1999) ‘The Doctor the patient and the body’ in Proceedings of the 11th International Balint Congress 1998 (ed. J Salinsky) Limited Edition Press, Southport

What do we learn from taking part in a Balint group? The group experience is described as training but what are we being trained to do for our patients?  Are we really being trained at all?  At the beginning of a group’s life, the members feel that the principal benefit is the opportunity to discharge some of the anxiety and distress accumulated by a fortnight of close encounters with unhappy and demanding patients.

A Balint group is typically receptive and non-judgmental; a sympathetic hearing is guaranteed to begin with; even if your colleagues’ helpful suggestions begin to sound a bit challenging later on.  And some of their ideas may give you hope for a fresh approach that will  jolt that difficult patient out of the repetitive pattern that you find so frustrating.

Because we really want our patients to change. We hope to communicate our understanding across to them in a flash – which will induce transformation and bring about healing.  We would like our ’somatising’ patient to realise that his disagreeable bodily sensations can be dispersed if he can only gain access to the emotions that they represent.

We would like our anxious patients to calm down and conquer their fear. They might do this by reconnecting adult fears with childhood experiences (psychodynamic) or by learning techniques to deal with them such as those of Cognitive Behavioural therapy. We would like them to talk about their sadness, to cry freely in our presence and, eventually, to come to terms with their loss. The lonely should find new and fulfilling relationships or repair old ones. Those whose existence seems bleak and pointless should find meaning at last.

It would be nice, wouldn’t it? And sometimes it really does happen. But not all that often and probably not entirely due to our therapeutic efforts. More often, it is the doctor, not the patient who changes. As we relax in the nurturing environment of the group we find our empathy for the patient beginning to flower. And with empathy comes greater tolerance. Perhaps this patient is not so bad after all. I quite like her in a funny sort of way. When we see her again we are more prepared to give her room to just be herself (much as the group does for us).  As we listen to those vague accounts of ‘giddiness’ or tingling feet  or stabbing pains in all sorts of places, we are less inclined to dismiss them as  ’psychosomatic’ and more likely to think: I’ve had those too and they are not nice. We are in a better frame of mind to experience what Carl Edvard Rudebeck has called ‘bodily empathy’. The patient may well appreciate this sharing of her bodily experience. But where do we go next?   Some patients seem unreasonably eager to run to specialists for reassurance. This can be irritating to the doctor and even hurtful to her feelings. She has prescribed the best treatment, including generous doses of the drug ‘doctor’, but the patient is still unsatisfied. He

remains unconvinced that his symptoms are harmless. Again, Carl Edvard Rudebeck can be helpful. He points out that a symptom involving any organ or part of the body can seem like a terrible threat to continuing bodily function. Tingling in the feet may suggest to an elderly patient that he is going to lose the ability to walk; those stabbing eye pains which we know are harmless (through our disease based education) seem like the first signs of blindness, giddiness will lead to a stroke and pains in the left side of the chest to heart attack and death.  Again bodily empathy comes to the rescue. Have we never had those fears? Never had a strange sensation that won’t go away? Never accepted an antibiotic from a fellow doctor, ‘just to be on the safe side’?  Of course we have. And we have been grateful for the attention of the kindly specialist to whom we have referred ourselves because we don’t want to bother our GP over nothing.

So let’s not feel too bad about letting our patients go to see a specialist even if we can’t justify it in terms of the risk of organic disease.  We might even allow them a favourite medicine ‘of no proven value’. Hopefully, when our patient no longer has to fight with the doctor, he will relax and allow us to see some of his nicer qualities.  We, in return, will feel a greater warmth for this previously tiresome, even dreaded patient.

Maybe he will tell us about his family; about the wife who died, or the son who went abroad and never gets in touch. Another may reveal his disappointed hopes. Nurtured by the doctor’s new way of seeing and feeling, a younger patient may start to spread his wings and attempt to fly. Just a short distance to begin with, while we hold our breath. And if he crashes? Or never even takes off? We will be disappointed. But life is difficult and our patients often resemble Chekhovian characters who are high on good intentions but low on achievement. Never mind. We have still been there with them as a friend, as a witness and as a doctor.  Relaxation, tolerance and bodily empathy are some of the qualities we can learn from the Balint group that will help our patients.

John Salinsky

Reference

Rudebeck, Carl Edvard (1999) ‘The Doctor the patient and the body’ in Proceedings of the 11th International Balint Congress 1998 (ed. J Salinsky) Limited Edition Press, Southport