FAQ

Who was Michael Balint? And who was Enid Balint?

Michael Balint (1890-1970) was a psycho-analyst from Hungary who emigrated to Britain in the 1930s. After the war he practiced as a psychoanalyst at the famous Tavistock Clinic in London. But to GPs (family doctors) he will always be remembered for the work he did in the 1950s and 1960s in helping them to understand their psychology of the doctor-patient relationship. Enid Balint, also a psychoanalyst was Michael’s (third) wife. She was his colleague and partner in the work with family doctors.

Didn’t Michael write a well known book?

That’s right. It was called The Doctor, his Patient and the Illness.

Sounds a bit sexist. What about the doctor and her Patient?

You have a point. But the book was written in 1957 and nearly all family doctors were male.

I was told to read it when I was training, but I never did. Isn’t it rather boring and out of date?

No. It’s actually very readable. If you give it a try you will find that the patients described on the first few pages are just the same as ones who make your heart sink today.

So why was it such a big deal in 1957?

Well, the NHS had been going about 10 years and a lot of family doctors were feeling disenchanted. There had been exciting advances in high tech medicine but that was all going on in the hospitals. Out in the community the doctors found they were dealing with a lot of patients with vague puzzling symptoms which didn’t correspond to any of the diseases they had learned about in medical school. You know the kind of thing: giddiness, pains all over, persistent sore throats, headaches, back pains, tiredness all the time…

Stop it! This is becoming depressingly familiar. How did Mike and Enid advise people to deal with all this rubbish?

I was just coming to that. They got together a small group of doctors –

Don’t tell me: they called it a BALINT GROUP?

Well, that was the name the groups were eventually given, yes. The group consisted of about eight or nine GPs who had answered an advertisement to sign up for a series of seminars on ‘the psychological aspect of general practice’. When the group assembled, Michael invited then to present the case histories of patients who were bothering or puzzling them. So the immediate gain was that they were able to share some of their worries about these difficult patients with their colleagues.

He must have been a good listener.

He was. And he taught them, by example to be good listeners too. He also encouraged them to find out a bit more about the person behind the symptoms by showing an interest in their patients’ personal lives.

That must have been a bit time consuming. Or did GPs have longer appointments in those days?

Far from it. If anything, the standard appointment was shorter – about six minutes. To begin with he suggested that they invite difficult patients to come for a long interview outside surgery hours to talk about their lives. Later on, the emphasis was more on doing things a little at a time in the course of a series of ordinary consultations.

OK, so they let the heartsinks drone on a bit about themselves. But I bet that didn’t stop them coming back with their symptoms.

Well sometimes it did – not always by any means. But the doctors began to feel differently about these patients as a result of the group discussion which followed the presentation of the case.

Discussion?

Yes, the other docs in the group would all contribute their thoughts about what was going on and what the patient really wanted. So the presenting doctor had the benefit of seven or eight other points of view. Often the others would pick up things that the presenting doctor had missed because he (or she) was too closely involved.

And what did Michael and Enid contribute? Did they psychoanalyse everybody?

Not at all. And some group members found that a bit disappointing. In fact they were very careful to avoid any psychological jargon. They didn’t go in for clever interpretations at all.

They weren’t a lot of help, then?

You are trying to give me a hard time aren’t you? Of course they were helpful but not in a didactic way. What they did was to encourage the doctors to be aware of the way the presentation made them feel. The way you feel about a patient when you hear their story will often mirror the feelings of both doctor and patient. If the patient is depressed, the group members will feel depressed too. You can also learn to catch hold of feelings such as anger or fear or loneliness. Sometimes, the presenting doctor seems to behave like the patient and it’s as if the patient is actually present in the group.

Sounds a bit weird to me. How did all this emotional stuff help the doctors to deal with their patients?

In various ways. Often, I think, they began to understand the powerful feelings which some of these difficult patients can induce in the the doctor. They stopped hating the patients when they understood them better. And the patients appreciated being listened to a bit more and treated as human beings. A few would lose their symptoms once they were able to talk about their personal problems to a sympathetic doctor. And even if they didn’t the doctors became more tolerant, realising that a cure was probably impossible.
And I’ll tell you another interesting thing….

Yes? Do go on. This good listener thing is catching…

The doctors realised how important they
were to the patients even when they appeared to be doing nothing.
Just ‘ being there’ for a patient, putting up with him, treating
him like a fellow human being could be very therapeutic. The group
seemed to give them the strength and the courage to go on being
the patient’s doctor. I certainly found it quite a surprise that I
was such an important person in some of my patients’ lives.

So you were in a Balint group? do they still go on then?

You bet. If you click on Groups you can find out how to join one or start your own.

Am I saying the name of the organisation correctly?

Don’t say: ‘BAYLINT’

Do say: BALINT (short ‘A’) or ‘BAHLINT’

When in Hungary say: BÁLINT