Regression and new beginnings: Michael, Alice and Enid Balint and the circulation of ideas

This article offers a new evaluation of Michael Balint's history. It starts with his growing up in Hungary and examines the central concepts of his writing: the analytic pair, regression and the basic fault and creativity, up to and including his renowned work on the eponymous Balint groups (which forged a unique link between psychoanalysis and medicine). While his name is, of course, well known, this article aims to bring his ideas to the attention of a modern analytic audience. Having trained in the 1920s with Ferenczi, Balint brought Ferenczi's literary inheritance to England where he lived until his death in 1970. His connections to Klein, Winnicott and Lacan, all of whom respected his analytic stance, are also examined. Furthermore, this article argues that his ideas were filtered through the theoretical lens of his first wife Alice Balint and later through Enid Balint, both of whom played a key - and rarely recognised - role in the development of his thought. It ends with a brief discussion of his ideas on analytic training and his quest, successful only after his death, to publish the complete Freud-Ferenczi correspondence, together with Ferenczi's diary.     

The Balint group experience for medical students: a pilot project

Loss of empathy has been reported in medical students as they move through the clinical phases of their training. Several researchers have attempted to address this issue by exploring ways of heightening students’ awareness of the emotional, non-biomedical aspects of illness and the dynamics of the doctor–patient relationship, using a variety of reflective group discussion methods. This pilot project employed the specific group method developed by Michael Balint for general practitioners working in London after the Second World War. The pilot was based on one group of six third-year graduate students, meeting weekly over six weeks. Evaluation includes pre- and post-questionnaires, a 1000-word essay and leaders’ observations. The results suggest that the traditional Balint method needs to be modified for students at a point in their training where they have not yet been exposed to patients for long enough to develop meaningful patient relationships. Nevertheless, there was some evidence of a heightened awareness of the dynamics of doctor–patient relationships and the importance of psychological/emotional factors (including their own prejudices) when interacting with a patient. Balint-style groups could be an effective way of encouraging medical students to reflect on the importance of emotions in the doctor–patient relationship.     

Michael Balint: An Introduction

Michael Balint, who used to be known the world over, no longer gets either the fame or the influence that he deserves, and the three special issues of the journal devoted to him are meant to contribute to make him better known. I intend to draw a portrait of Balint—it will necessarily be only an outline, within the limits of the present issue—and to follow his path as a man and as a scholar.     

借助巴林特小组培训模式提高临床护理质量

通过对巴林特小组培训模式的认识和理解,并将之运用于临床护理研究,使护理人员在处理护患关系中形成新的视角和更具分析性的思考方式,从而能够更深刻地意识到自身对于患者的影响,提高换位思考的敏感性,以便更好地理解和帮助患者;同时还能促进护理人员的心理健康和减少其工作中存在的护患矛盾。这不仅可以提高患者的治疗效果和生活质量,而且还可以提升护理人员自身的职业素养。因此,巴林特小组培训模式对于实现临床护理优质服务具有重要的现实意义。     

The Balint movement worldwide: present state and future outlook: a brief history of Balint around the world

Michael and Enid Balint began running seminars for GPs (family physicians) in London in the late 1950s. Balint groups were soon started in other countries leading to the formation of the International Balint Federation. This paper describes the activities of the Federation and surveys the health and strength of the Balint movement in different parts of the world. While formal Balint training seems unlikely to become part of the official curriculum in more than a few countries, Balint's ideas will continue to be influential.     

Michael Balint: An Overview

Balint's important work extended over a period of 40 years in two directions; firstly the development of individual sexuality, and secondly, the development of object relationships, together with their relationship to psychoanalytical technique. He introduced the concept of primary love and was one of the pioneers in the thinking of the interdependence of mother and infant. He extended Ferenczi's work on therapeutic regression, introducing the concepts, among others, of benign and malignant regression, the basic fault, and the states of ocnophilia and philobatism. His applied psychoanalytic work is world famous, particularly the Balint groups for general practitioners and similar groups for marital therapists, social workers, and psychosexual counselors.     

Balint groups in undergraduate medical education: a systematic review

Objective: Though Balint groups feature increasingly in UK medical school curricula, there is no evidence-based consensus on what undergraduates might gain from participation, and how this might happen. To address this, we systematically reviewed primary research studies involving medical student Balint groups and their relationship with patient-centredness, using narrative synthesis. Data sources: Four major databases were searched from origin until 9 September 2016. The Journal of the Balint Society was hand-searched from 1971 until 9 September 2016. Study selection: English language studies reporting quantitative and/or qualitative methods examining Balint groups in medical students vs. other/no comparator. Results: Eight studies were included. Quantitative findings report statistically significant improvements to student’s empathy and intellectual interest following group participation vs. control (p = 0.03, p = 0.046, respectively). Discussion content was similar across high-income countries. There was considerable heterogeneity when students rated the efficacy of groups. All evidence had high or unclear risk of bias, or was of medium/low quality. Conclusion: Balint groups might help medical students to become more patient-centred, by increasing students’ empathic abilities and supporting their personal and professional growth. Groups are more subjectively effective when optional rather than compulsory. Discussion content is comparable to groups in continuing medical education.     

医患文化冲突分析——对医患关系紧张的新审视

医患关系始终表现为一种文化关系,医患关系紧张问题有着复杂的文化根源,当前出现的医患关系紧张问题的实质就是医患之间存在文化冲突。从文化的视角对医患文化冲突的程度、引起冲突的原因以及发生冲突的文化主体进行重新审视,以期进一步认识紧张的医患关系。     

医患关系内涵及模式:基于社会交换理论的研究

梳理了国外医患关系的相关文献,基于社会交换理论视角探析医患关系的内涵,深入剖析了医疗质量和患者信任是构成医患关系的两个重要因子,并进一步构建了简约化的四类医患关系模式,即和谐医患关系模式、改善医患关系模式、不善医患关系模式和紧张医患关系模式。认为医患关系的建立是一个动态的过程,在诊疗过程中医患关系模式之间是可以相互转换的,患者信任是构建和谐医患关系的基础,为我国和谐医患关系的建立进行了理论上的探索。     

Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians

There has been growing concern about the effects on the patient–physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called double agency. Various authors have proposed ways to restore patient centeredness to the patient–physician interaction. We have previously discussed the need to establish a patient–physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug doctor; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient–physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.     

互联网对医患关系的影响研究

从互联网对医患之间信息不对称影响的视角,分析了互联网对患者、医生和医患关系的影响,发现互联网在一定程度上扭转了医患之间的信息不时称,相较于医生,互联网对患者的影响更大,信息赋权带来了角色改变,给医生带来了挑战,并对现有的医患关系产生影响,但并没有从根本上改变现有的医患关系结构.     

老年下背痛诊断的思考

医患关系是医务人员与患者在医疗过程中产生的特定医治关系,是医疗中人际关系的核心。近年来,我国的医患矛盾有激化趋势。以心理动力学方法来描述普通医患关系中医、患双方的心理互动过程,并对维系正常医患关系所需的医、患双方的心理学特征作出设想。     

福柯哲学应用:医患关系中的微观权力分析

福柯对医学有着较高的关注度,著作中有大量对医学伦理的深入思考和分析。他的“微观权力”理论非常适合解释现今医患关系的本质,对理解医患关系的起源和实质,以及如何解决医患关系中的种种问题,给出了极为有价值的解答。这种解答是融合了现代科学技术、医学社会学、政治经济、历史以及哲学之发展的综合观点,并从中引申出人类的现代性困境。它的解决策略不同于商谈伦理、契约论、允许原则、生命伦理学规范、德性论,甚至叙事医学。     

城市居民视野中的医患关系——500份问卷的调查与思考

客观正确地认识和评价现实的医患关系,不仅是构建和谐医患关系的必要前提,也是构建社会主义和谐社会的重要内容。在对城市居民的500份问卷调查的分析研究基础上,发现了当前医患关系上中值得重视和思考的三个问题,并相应地提出三点建议。     

The adventurous emigration of the Ferencziana: Contribution to their history

Abstract

This article retraces the long winding path followed by important documents on and by Freud and Ferenczi, first crossing the European continent in the flames of war and other horrors, and later being hosted by several cities. Eventually, after Judith Dupont's gift of her Paris archives to the Freud Museum in London in 2013, the collection of papers donated by Enid Balint to the custody of this author and kept for two decades in Geneva was finally deposited in the Archives of the British Psychoanalytical Society, also in London. Some other details and anecdotes of this long trip are also evoked.     

医患关系何解？——医者患病经历文献述评

综述医者患病经历相关文献发现,医、患分野和矛盾植根于医学和医学模式本身,是在现代医学发展过程中被建构出来的,解决医患关系问题应着眼于审视和改变医学文化和医学模式内部造成医患矛盾、分歧的根本原因,创造机会打破严格的医、患角色区隔,实现病人得治、医者得安、医患共同。在医者患病经历文献中,能追溯医患同源的起点,能洞悉医患分化和冲突所在,也能看到形成医患共同体的可能性,为实现和谐医患关系指明方向。

     

医患关系不和谐的原因

由于政府监管部门的缺位与越位导致医疗市场混乱,医疗资源配置不合理与效率低下,医院为了自身利益而鼓励医务人员多收费,医务人员成了给钱治病的经济人,再加上舆论的推波助澜,社会保障体系不健全,以及医疗需求的刚性,医患间的信息不对称,患者对医疗预期值超越了当今的科技水平,导致医患矛盾越演越烈。     

Group Wrongs and Guilt Feelings

Can it ever be appropriate to feel guilt just because one's group has acted badly? Some say no, citing supposed features of guilt feelings as such. If one understands group action according to my plural subject account of groups, however, one can argue for the appropriateness of feeling guilt just because one's group has acted badly - a feeling that often occurs. In so arguing I sketch the plural subject account of groups, group intentions and group actions: for a group to intend (in the relevant sense) is for its members to be jointly committed to intend that such-and-such as a body. Individual group members need not be directly involved in the formation of the intention in order to participate in such a joint commitment. The core concept of joint commitment is in an important way holistic, not being reducible to a set of personal commitments over which each party holds sway. Parties to a group intention so understood can reasonably see the resulting action as "ours" as opposed to "theirs" and thus appropriately respond to the action's badness with a feeling of guilt, even when they themselves are morally innocent in the matter. I label the feeling in question a feeling of "membership guilt." A number of standard philosophical claims about the nature of guilt feelings are thrown into question by my argument.     

One Parent-Child Activity Group

Abstract

The framework that the author developed for parent-child activity groups is described. This is followed by “snapshots” of a group session to enhance the readers' understanding of the framework. Excerpts of the author's logs from her participant observation of the parent-child activity group that she studied are organized sequentially to provide examples of each part of a parent-child activity group session.