1. Balint groups as reflecting teams A dialogue between John Nessa (from Bergen)‏ and Harald Kamps (from Berlin)‏

2. I (John) am here because... I am a devoted GP who has a fundamental belief in the primacy and healing potential of the doctor-patient relationship. I am from Norway, where the Balint groups have disappeared. I work with doctors who either don`t know the Balintian movement or think about Balint groups as out-of-date practice. I am convinced that the Balintian group supervision method is an ideal frame for group supervision of GPs.

3. General practice in Norway Some few Balint groups in the 1970s Disappeared in the 1980s Strong interest for psychiatry Strong interest for the doctor-patient relationship Impulses from Family therapy and social constructivism The reflecting team: two participants talking together, the third one listening

4. Reflective function Reflecting-in-practice means letting future behaviour be guided by a systematic and critical analysis of past interpretations, actions and their consequences. Reflective function = mentalization Doctor`s professionalism: to be more reflective, develop their reflective competence and function Reflection is important for learning from experience. Balint groups: Structure and atmosphere for reflective learning

5. Are we still Balintians? All GP has an interactional (somebody like to call it a psychotherapeutic) aspect. Psychological mindedness is hard won. The basic Balintian principles are still true: 1. Fundamental belief in relationship 2. Explore feelings in groups 3. Moral courage in the therapeutic moment 4. Trusting the ”butterfly effect”: the small change that makes a big difference

6. I (Harald) am here because…. I have the same devotion to the healing potential of the doctor-patient relationship. I am now from Germany, where Balintian groups are a „must“ for most of the GPs for their basic „psychosomatic“ education. Many of my colleagues follow a Balint group for many years. I am concerned about, that the Balintian group supervision method can confirm a dualistic thinking about „soma“ and “psyche“.

7. Reflecting casuistic I want to present how quality circles can work as Balint groups and that we have to find a language which fits to general practice („without all the Freudian Gegenübertragungs-words“). Thure von Uexkuells „integrated medicine“  He avoided the term: „psychosomatic“ Based on the theory of „biosemiotics“, system theory and constructivism

8. Reflecting casuistic (1)‏ Group: a moderator (e.g. a skilled GP), group members and one of them is presenting the patients history (max 15 min)‏  History of the disease  History of the patient  History of patient-doctor-relations

9. Reflecting casuistic (2)‏ Group discussion leaded by the moderator: 1) what is special with the history and 2) why? 3) more questions to the „patient“? 4) how would you understand the history based on your professional background? 5) Imagine you are the patients doctor: how would you proceed with the patient? 6) first now again to the presenter: what do you do with the feed back? 7) how would you evaluate the moderation?

10. Link to: Uexkuell Academy: www.int-med.de

11. Some concluding remarks We need continously to develop a language  which fits to GP, and not restrict our interpretations to one tradition only Small groups and quality circles can easily be combined with a Balintian approach. Small group activities need a structure to capture and control the group dynamics. The Balintian method provides such a structure.  When Balintian groups fail, it is either because of an inappropriate way of talking about key issues, or lack of competent leadership.

12. Feasible Balint groups: an attempt for a definition Groups consisting of clinicians of equal standing  who meet regularly by free will to discuss,  to better understand themselves as clinicians,  their own clinical work  and the interactional process with the patient. In the context of the group,  the participants are invited to respond spontaneously to what they sense, think and feel in an athmosphere of confidence and support.

13. Balint groups, definition (2)‏ In order to facilitate their work, the clinicians co-operate with an external consultant, whom they give the role of being a group leader. This person should be familiar with the working situation of her colleagues and be able to add a psychodynamic or biosemiotic dimension to the group discussion