Balint autobiography—Laurel C. Milberg

Trained in a very 1960’s counseling psychology program at the University of Pittsburgh, my PhD concentrations were in group work and clinical supervision. My doctoral dissertation was a phenomenological study of impasses in therapy, focused on the therapist’s experience of being “stuck.” This was a perfect recipe for Balint work I, as yet, knew nothing about. When I returned to Pittsburgh in 1977, looking for a job where I could apply my training in therapeutic relationships to a profession other than traditional counseling, I wondered if physicians might be interested in learning these skills. Naively, I approached Obstetrics and Gynecology, Surgery, and Internal Medicine residency training programs, which were not interested at the time.

Then an internist friend introduced me to Dr Nicholas Toronto, a family physician, who was charged with starting a Family Medicine Residency Program at Forbes Regional Hospital in a suburb of Pittsburgh. Dr Toronto had practiced for many years in Meadville, Pennsylvania, north of Pittsburgh and participated there in a Balint group led by Dr Rex Pittenger. Dr Toronto needed a behavioral science faculty person and an in-house educational consultant to help structure the soon to be born program and gave me the position, his only directive being, “you will lead Balint groups for the residents.” Thus, Balint work became an inauguration into my new role as a psychologist teaching family medicine. It became the single most potent tool I had for creating a safe but challenging environment where trainees could learn and grow to be competent personal physicians.

I was fortunate to have been introduced to Balint seminars and taught to lead them by Rex Pittenger who worked and mingled ideas directly with Michael and Enid Balint. He gave the seminars his own style, yet helped me to see the sometimes hidden essential elements that constitute the Balint group process. Even at 7:00 a.m. Friday mornings, which is when our Balint groups were held, I found Balint work created a place where what a psychologist knew and what young doctors could benefit from learning, came together and made sense. Best of all, Balint work transformed at least an hour and a half a week into something more positive, affirming, divergent, creative, supportive, verbal, thoughtful, emotional, intuitive, and humanistic than medical education in general appeared to be. ¹

From 1982 to 1989, Rex and I led weekly resident Balint groups at Forbes and after he retired I co-led Balint groups with faculty members from the Forbes Program, several of whom later trained to be credentialed Balint group leaders. We also held a monthly faculty Balint group for many years focused on doctor–patient as well as teacher–learner relationships. One of our faculty co-leaders, Dr John Nemec, had been a resident in the very first Balint group held at St Margaret’s Family Practice Residency. Thanks to Rex’s invitation, I even got to dine with him and Enid Balint on perhaps her last trip to Pittsburgh.

During the 1980s, Rex and I presented some demonstration groups and workshops on the Balint method, often at a recurring event sponsored by the Penn State, Continuing Education Department, called the Family Practice Behavioral Science Education Conference. This group later became the Northeast Regional Society of Teachers of Family Medicine where Balint group workshops led by Dr Paul Scott, myself, and others continued to be a regular offering throughout the next decade. Paul has aptly described the feelings of excitement, challenge, and competition with which he and I responded to the Balint Theme Day organized by Dr Clive Brock, Alan Johnson, PhD, and Dr Frank Dornfest.

When the American Balint Society (ABS) first formed in 1990, I was appointed, and later elected Secretary/Treasurer. I worked with others on the ABS Council to produce three successive day-long pre-conference workshops on Balint Group Leadership which preceded the annual Society of Teachers of Family Medicine Conference in 1991, 1992, and 1993. In 1993, Drs Geoffrey and Katie Margo, Megeen Parker, and I designed a multi-session Balint offering for the annual Behavioral Science Forum meeting in Chicago, which has been continued by others to this day and earned one of the first Forum Impact Awards.

In 1995, I was elected ABS President, serving for four years, an unusually long tenure. (In 1998, the ABS Council met to restructure the Society’s operating procedures that changed the vice president role to that of president-elect and capped the president’s term at two years, starting in 2001.) During my time as president, I concentrated on creating policies, procedures, and revising the bylaws for operating the new Society, as well as researching the “Essential Characteristics of Effective Balint Group Leadership” ² with Dr Don Nease, Alan Johnson and Ritch Addison, PhD. I then turned my attention to structuring the process by which the ABS trains and credentials leaders^3,4 and became the first chair of the Credentialing Coordinating Committee, created in 2000.

I had the pleasure of co-hosting, with Paul, three Intensives in Pittsburgh and in 2003, the first Balint Weekend. Paul has described the Pittsburgh Balint community that he, Dr Bill Cohen, and I tried to build, reaching out to (or trying to infiltrate) the University of Pittsburgh Medical Center and their constellation of residency training programs in the Pittsburgh area.

Retiring from my posts at the Family Medicine Residency at Forbes and the University of Pittsburgh School of Medicine in 2010, but not from Balint work, I continue to lead Balint groups. One is a faculty Balint for the University of Connecticut Family Medicine Residency Program and one for their second-year residents.

For the first National Meeting of the ABS in 2014, on behalf of the History and Continuity Committee, I created and continue to maintain, a Timeline of the History of the ABS.

With Drs Ellen Barnett, Lisa Buck, Arnold Goldberg, Katie Margo, Albert Lichtenstien, PhD, and Jeffrey Sternlieb, PhD, I created the structure and curriculum for the Balint Leader Education Fellowship ⁵ in 2016, producing “Balint Basics” as a teaching and learning guide for ABS training offerings.

Like others, I blush at this compendium of Balint experiences because it sounds like, “look what I did.” However, what lies beneath is gratitude for the opportunity to build and teach and share the creation with a wonderful group of passionate colleagues and friends.