Experiences from a Balint group intervention with urban public school teachers

Abstract

Background: U.S. teacher shortages have more than tripled since the 2012-2013 school year, to over 110 000 teachers needed in 2016. At the conclusion of the 2011-12 school year, 13.8% of public-school teachers left their position. Approximately 50% of the public-school teachers cited the inability to manage their roles as the primary factor for leaving. Purpose: The purpose of this study was to examine the influence of participation in a 6-month Balint group experience on a novice teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. Research Design: A converged mixed-methods approach was used. Each question was explored with a corresponding qualitative and a quantitative dataset. Data Collection: Qualitative data included (a) a semi-structured focus group; (b) field notes shared from the co-facilitator and Balint group leader; (c) semi-structured debriefs with the Balint group leaders; (d) open-ended questions on the pre and post-test reflection forms, and (e) semi-structured interviews with 3 participants that served as a form of member checking. Quantitative data included pre and post-test and monthly reflection forms that were collected at the conclusion of each meeting. Teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. Study Sample: Eight teachers volunteered for the group after an email solicitation to all the teacher development program’s members. Results: This article examines sources of stress for new teachers, themes that came up in the Balint group that reflect the stress and its impact, and changes in felt burnout, self-efficacy, an intent to persist in teaching. Teachers faced similar stressors to professionals in the medical field. Conclusion: Balint offers an opportunity to addres the social and emotional needs teachers face.

Keywords

Balint groups public school teachers teacher development

Background/Introduction

U.S. teacher shortages have more than tripled since the 2012-2013 school year, to over 110 000 teachers needed in 2016.¹ At the conclusion of the 2011-12 school year, 13.8% of public-school teachers left their position.² Approximately 50% of the public-school teachers cited the inability to manage their roles as the primary factor for leaving.²

Open positions are largely filled with novice teachers, or those with less than 5 years teaching experience.³ Such teachers enter the profession with limited resources and support in addition to lacking experience.⁴ They face the challenge of meeting high-performance standards and performing instructional or managerial tasks at the level of their veteran peers while learning their new roles.⁵ An exploration of the experiences of first year teachers identified 10 themes.⁶ All themes align with occupational stress, or the accumulation of work-related stressors over time.⁷ Occupational stressors can lead to burnout or total emotional exhaustion.⁸ Forty percent (40%) of teachers experience burnout at some point in their career.⁸ Forty one percent (41%) of teachers left their roles within the first 5 years of employment.⁹ Ingersoll called this cycle of attrition the “revolving door effect”.¹⁰ This study sought to explore the effectiveness of Balint groups in addressing the factors that lead to burnout and attrition among school teachers.

Prior to this study, the researcher sought to determine if these findings were true to her sample population, which consisted of 100 teachers recruited through a program training those new to the profession. In turn, they commit to teaching two years in a low-income community.

The researcher conducted an initial needs assessment of the 100 teachers in the cohort using a Google Form. The needs assessment was designed as a quantitative study that utilized a series of Likert-scaled questions to collect information about members. All of the measurements were existing questionnaires that were compiled together to create the needs assessment. The instruments measured the sources of pressure in the work of educators using the Stress in the Teaching Profession survey,¹¹ teacher burnout using Maslach Burnout Inventory,¹² teacher self-efficacy using Tschannen-Moran and Hoy's Teacher efficacy short-from,¹³ the resilience of teachers using the brief resilience scale,¹⁴ perfectionism within participants us the Frost Multidimensional Perfectionism Scale,¹⁵ and any coping strategies that members are currently using to manage stress using the brief cope survey.¹⁶ The needs assessment revealed sources of stress similar to those indicated in the analysis of previous research on teacher attrition:

• long work hours completing administrative tasks

• poor working conditions

• job role ambiguity

• burnout

• individual personality characteristics, including a tendency towards perfectionism

• challenges to self-efficacy

The results of the needs assignment aligned to the experience of general practitioners. Through analysis of literature on burnout and retention in medicine, there was evidence to support the use of Balint groups in the medical field to combat similar challenges with self-efficacy, burnout, and retention.

Psychoanalysts Michael and Enid Balint developed Balint groups to enhance the general practitioner’s understanding and management of the doctor-patient relationship. The goal of Balint is to enhance participant’s ability to recognize and promote intrapsychic and interpersonal skills needed for robust doctor-patient relationships.¹⁷ Balint groups are currently used in a wide variety of medical settings, including residency/fellowship programs across specialties, faculty groups, and among other mental health practitioners.^17-21 However, no published studies exist about the use of Balint groups among school-teachers.

Balint groups have between 4 and 10 members. The group meets according to a regular schedule, typically for 60-90 mins. The Balint group is led by 1 or 2 people who have experience and/or certification in the method. During a group, a member presents a case from memory. Cases typically center around a patient who has elicited a difficult, memorable, or otherwise salient response from the presenting group member. The other group members attempt to understand the case from the patient and doctor’s perspective but avoid offering specific solutions or diagnoses. The case presenter meanwhile listens but does not participate in the discussion. This allows the presenter to reflect upon the discussion. Previous research indicates that participation in a Balint group can correlate with improved self-concept and relationships with patients.^22-25

Method

The purpose of this study was to examine the influence of participation in a 6-month Balint group experience on a novice teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. The study centered on a teacher preparation program located in the Houston metropolitan area. The program itself recruits individuals to commit to teaching in low-income communities for 2 years. The questions guiding the study were:

• How did participants perceive their experience engaging in a 6-month Balint group?

• How did the study implementation adhere to or differ from the proposed implementation procedures?

• How did participation in the experience change novice teacher self-efficacy along 3 domains: (a) efficacy in classroom management, (b) efficacy in instructional strategies, and (c) efficacy in student engagement?

• How did participation in the experience change participants’ level of burnout across 3 domains: (a) emotional exhaustion; (b) depersonalization; (c) low personal accomplishment?

• What was the difference in teacher self-expressed intent to persist in the classroom before and after participating in the Balint group intervention?

A converged mixed-methods approach was used. Each question was explored with a corresponding qualitative and a quantitative dataset. Qualitative data included (a) a semi-structured focus group; (b) field notes shared from the co-facilitator and Balint group leader; (c) semi-structured debriefs with the Balint group leaders; (d) open-ended questions on the pre and post-test reflection forms, and (e) semi-structured interviews with 3 participants that served as a form of member checking. Quantitative data included pre and post-test that included the 12 question short form of the Teacher Self-Efficacy Scale¹³ to access self-efficacy, the Maslach Burnout Inventory: Dutch Educator Survey¹² to access burnout, and closed-ended questions regarding the participant's intent to persist that were developed by the researchers. They included:

• Do you intend to complete your two-year commitment?

• Do you see yourself teaching beyond your 2-year commitment?

• Do you see yourself teaching for 5 or more years?

• Currently, what are your long-term plans?

• <Open Ended> Looking at the answers above, what factors contributed to your decisions around persisting in the classroom?

Additionally, participants completed monthly reflection forms that were collected at the conclusion of each meeting. All forms used 5-point Likert scale questions. A descriptive approach was used due to small sample size. T-tests were used to analyze the significance of change in outcome constructs.

Table 1 below provides a description of the data collected.

Table 1.

Data Collection Timeline.

Intervention Activity	Description	Timeline, Duration, and Location
Pre-test	12 question short form of the Teacher Self-Efficacy Scale¹³	November 2020 20-minute survey in an online Google Forms

	Maslach Burnout Inventory: Dutch Educator Survey¹²

	Intent to Persist and demographic questions
Balint Group Sessions with Reflection Form	In-person and Virtual Balint Group meetings with 7-question reflection survey	Monthly from December 2020-May 202190-minute Balint group meetings online using Zoom5-minute survey in online Google Form
Field Notes	Notes taken during the Balint Group meetings by the co-facilitator.	Monthly from December 2020-May 202190-minute Balint group meetings online using Zoom
Semi-Structured Debriefs	Meetings with psychoanalyst and co-facilitator to discuss any discrepancies in the field notes in regard to adherence to Balint group structure and any changes that should be implemented	Monthly from December 2020 - May 20211-hour collaborative online meeting following each Balint group meeting using Zoom
Post-Test	Same as Pre-Test	May 202120-minute survey in online Google Forms
Focus Group	Focus group with participants.	May 20211-hour virtual focus group using Zoom
Semi-Structured Interviews	Interviews with three selected participants that served as member checking post data analysis	June 20211-hour virtual meetings using Zoom

Eight teachers volunteered for the group after an email solicitation to all the teacher development program’s members (numbering about 100) (Table 2).

Table 2.

Demographic Information by Participant.

	Gender	Race/Ethnicity	Age Range	Years of Teaching Experience	School-Type	Subject	Teaches State Standardized-Tested Subject
Participant 1	Female	AAPI	<25	2	Elementary	Science	Yes
Participant 2	Female	Black	<25	1	Elementary	Math	Yes
Participant 3	Female	White	25-29	2	Elementary	English	No
Participant 4	Male	Black	<25	1	Middle	English	Yes
Participant 5	Female	LatinX	25-29	2	Elementary	English	Yes
Participant 6	Female	White	30+	2	Elementary	General Education	Yes
Participant 7	Female	LatinX	<25	2	Elementary	Math	No
Participant 8	Female	White	<25	1	Elementary	General Education	No

The group was scheduled to meet once a month, online, for 90 mins on a Sunday from December 2020-May 2021 (6 meetings), but due to Winter Storm Uri in February 2021, the group met 5 times. Two cases were presented each month. Practical elements of meeting online were addressed: joining in a confidential space, multitasking, and making sure video was turned on.

Results

An initial needs assessment of the 100 teachers in the cohort revealed sources of stress similar to those experienced in medicine, where Balint groups had previously been conducted:

• Long work hours completing administrative tasks

• Poor working conditions

• Job role ambiguity

• Burnout

• Individual personality characteristics, including a tendency towards perfectionism

• Challenges to self-efficacy

Participant perception

The quantitative data from the reflection forms illustrated that participants’ trust in 1 another increased throughout the intervention along with their perception of the meeting being a non-judgmental climate. Qualitative data from the focus group aligned with these findings. Participants shared that they felt understood, affirmed, and like a part of a community (Table 3).

Table 3.

Participant Responsiveness to Balint Group Meetings Overtime.

		Meeting 1	Meeting 2	Meeting 3	Meeting 4	Meeting 5
		(n = 7)	(n = 8)	(n = 6)	(n = 6)	(n = 8)
“The group had a nonjudgmental trusting climate”	Average	4.43	4.63	4.67	4.83	4.87
	Mode	5	5	5	5	5
“I felt safe in making comments or presenting a case”	Average	4.43	4.358	4.33	4.83	4.75
	Mode	5	5	5	5	5
“I felt I had an opportunity to speak when I wanted to”	Average	4.71	4.63	4.67	4.83	4.75
	Mode	5	5	5	5	5
“The group was able to understand the case from the standpoint of being the teacher”	Average	4.43	4.38	4.50	4.83	4.88
	Mode	4	5	5	5	5
“The group was able to understand the case from the standpoint of students and colleagues”	Average	4.29	4.25	4.50	4.83	4.75
	Mode	4	5	5	5	5

Adherence

The field notes and semi-structured debriefs with the Balint group leaders revealed that the structure of the Balint Group meetings was consistent. The reflection forms revealed that over time, teachers’ abilities to provide suggestions or identify areas where they could take action to influence change increased. The focus group data aligned with these findings. Participants revealed that they initially believed the Balint Group meetings would be about receiving suggestions for action they could take in the classroom that would improve their students’ performances; however, they realized it was about understanding the perspectives of others.

Change in self-efficacy

The quantitative data from the pre- and post-test indicated that the participants’ self-efficacy decreased overtime in 2 of the domains: class management and student engagement. However, their perceptions of their efficacy in instructional strategies increased. During the focus group, participants believed their relationships with students and their understanding of their locus of control also improved because of the intervention.

Change in burnout

Based on the analysis of data from the pre- and post-test, participants’ experiences with burnout increased across all 3 domains during the 6-month experience. During the semi-structured focus group, teachers felt more stressed throughout the school year and identified several factors that contributed to their feelings of burnout. These factors included administrative pressures, systematic pressures, social perceptions of education, a desire for recognition, need for additional support, limited time restraints, and lack of work-life balance.

Change in intent to persist

The data on the post-test aligned with that of the pre-test for all 3 of the closed-ended questions around intentions to persist for 2 years, 3 to 5 years, and 5 years or more. During the focus group, most participants shared a desire to pursue a role in education outside of the classroom except for 1 participant who expressed a desire to be a lifetime teacher. This participant attributed the change from her desire to leave the classroom at the beginning of the intervention to her participation in the intervention (Table 4).

Table 4.

Focus Group Codebook.

Participant Perception
Descriptive Code	Emergent Theme	Example
Community	Participants felt a part of a community. A desire to be a part of a community was also a primary motivator for participants to participate in the intervention.	“One reason why I joined this study was mostly because I was really struggling with finding community, especially with several educators. And so, I was hoping that this experience would remind me that I'm not alone in my relationship with my students.”
Various Perspectives	Participants were able to deepen their understanding of other’s perspectives	“The biggest reason [the Balint group] was helpful is just the fact that we were able to look at it through different perspectives. So, even if it wasn't a case that I spoke about at one of the Balint groups, it was something that I still was able to, you know, change my thinking and think about oh, what's the perspective of my student and what's the perspective of the family….So just looking at it from all different angles was really helpful and definitely helped me kind of have more of a clear head moving forward and dealing with that problem that came about.”
Relatable	Participants believed that the case studies that were shared were relatable.	“I feel that each case that was presented, in some way shape or form, the group was able to relate to it.”
Adherence
Descriptive Code	Emergent Theme	Examples
Experience vs. Expectations	Participants believed that the Balint Group experience was different than what participants initially expected because it centered on understanding other perspective over problem-solving and solutions	“I initially thought this would be kind of like a problem solving group where I would present a case, and then fellow educators would help me, like figure out my next step. But, in reality it was more of, ‘this is what I'm experiencing with a student,’ and then I got to sit and listen to the different perspectives of the situation. It was eye opening in that we talked about like the parent perspective and the student perspective. So, although the focus wasn't on problem solving itself, it was still a really valuable experience because it reminded me. I'm not the only person involved in this relationship.”
Self-Efficacy
Descriptive Code	Emergent Theme	Examples
Student Relationships	Participants believed the intervention improved relationships with students.	“I would say that the biggest thing that changed was the relationship with the student that I presented a case on. Before I presented the case I had a really negative relationship with them. We were always butting heads and things like that. Then, once I listened to the Balint group talk from the student perspective and the parent perspective, it has shifted my mindset about what I could do as the educator, and how I can change my own mindset in relation to the students.”
Locus of Control	Participants believed the intervention helped the to identify what was in their locus of control.	“During the Balint groups, it made me realize that I can let go of some things I'm trying to control, because in reality I don't have any control over it anyway. So, I would say it helped me, let go of, like, what my students do and don't do. You know, I can't really control their behavior. I can help them, and I can give them the skills they need to become, you know, more emotionally regulated and things like that. But at the end of the day, they are little people and they can make their own choices.”
Burnout
Descriptive Code	Emergent Theme	Examples
Administrative Pressure	Participants believe that the expectations of administrators influence their experience with stress in their roles	“Many of the stresses of this job, don't come from my students. They come from your administration or from expectations or a myriad of other sources. And so, while I think that presenting cases about students would be helpful for those students. The stress of administrative expectations and other aspects of the job, I don't know if that would be relieved, just by talking about my relationship with my kids.”
Systemic Pressures	Participants shared factors intrinsic to the educational system that contributes to stress.	“Some of the things that I thought were definitely outside of our control, some times it felt as if the school leadership or district would make it seem as if it was within a teacher's control. And so that's why I was kind of also experiencing like some conflict because in my head I'm thinking this is outside my control but it's being displayed as if it's something I can control….and that's just extra burden extra stress. It’s like hey let's look at it from the standpoint of this is a collaborative effort from the federal government, the state government to policy makers to the researchers to scholars, educators, parents, students. It's not fair to put all of that on solely the educators”
Desire for Recognition	Participants desire recognition	“Pay needs to go up. Like if you got paid more, I would feel more valued. Just because I put a lot more than 40 hours and everybody knows teachers do. Everybody knows teachers use their own money for their classrooms so I would, that would make me feel more valued. But I would also think that there needs to be a little more recognition from district from administrators from lawmakers from policymakers, because a lot of it is lip service. And in reality, I know that people who appreciate me or my parents and my kids, but they're not the ones who pay me and they're not the ones who evaluate me”
Additional Supports	Participants believe teachers are required to fulfill competing duties and increasing counseling support in schools could reduce stress for teachers	“I think a new additional in-house support will be good to have in schools”
Additional Supports		“taking away the hats that we have to wear, like, having more counselors, having more activities that they could do that they're in, like it just different people in the schools that are also, you know, lifting some of the weight that we have to carry it.”
Persistence
Descriptive Code	Emergent Theme	Examples
Desire for Career Shift	Most participants shared a desire to shift to educational roles outside of the classroom	“Just my experience throughout the first year, I started thinking about what was there a different role within education that will be better for you than being inside the classroom. Where you don’t experience all of this burnout and this stress that affects your health but at the same time you're working in the capacity of your long term goals, to really have an impact in this field”
Desire for Career Shift		“If you were to ask me that question that last year, I'd be like, I don't know what I'm doing but now I'm like, I feel a little bit more confident knowing that I love teaching, and knowing that I love being with kids and making some type of impact. I'm actually feeling more confident knowing, I could say like, I want to apply for a Master of Education. It was through processing it with the Balint group that really helped me get to that decision.”

Discussion

In this pilot study, Balint groups were employed among a novel population, public school teachers. The results indicate that this sample experiences stressors similar to professionals in the medical field, historically the target audience for Balint groups, and that Balint offers an opportunity to address social and emotional needs they face.

Specifically, one of the recurring themes of case presentations related to the concept of self-efficacy, with regards to both locus of control and perceptions around building relationships with students in a manner that promotes learning. Interestingly, experiences with burnout increased over the 6 month experience. It is not possible to attribute this trend to the Balint group itself, as the meetings occurred infrequently compared to the day to day work of being a teacher, but the goal of the group is to improve self-awareness and develop insights into the relationship the individual has with others. The post-test scores indicate an improvement in understanding in locus of control and perceptions in efficacy in instructional strategies; it is possible that teachers were able to better appreciate the nuances in their ability to relate to particular students, and in turn, tailor pedagogical styles to better meet their needs. Nevertheless, it appears that the Balint group itself did not help to have teachers feel more comfortable in their role as it pertains to the larger educational system.

Another key component of the Balint process is being part of a group. These teachers transitioned from a traditional in-person classroom environment, to a fully virtual 1 abruptly as the pandemic associated lock-downs began. The isolation of being at home and away from a group of colleagues and students prevented a previously essential part of teaching: direct human connection. This Balint group, even itself conducted virtually, provided an opportunity for teachers to validate the emotions that come from the work and its intersections with the changing world around them, and this was reflected in themes that came up of feeling part of a community.

One teacher noted that Balint group participation changed the perception this individual had about the desire to commit to the teaching profession. It is difficult to extrapolate information beyond the individual, but it does speak to the force a collective effort such as Balint can have in individuals to reaffirm their goals, and in a profession with attrition as high as it is, this is an important point to highlight.

This is a pilot study, and by its nature, it had many limitations. The group itself was small and self-selected. It was not possible to randomize and run a control group. As such, it is better suited to consider additional research questions than to form conclusions. Further research would benefit from a controlled group where teachers undergo more curriculum driven psychosocial support practices. Additionally, while fidelity to the Balint method was strong, the group itself met relatively infrequently due to external circumstances, and as such, further experiments benefit from more frequent, regular meetings.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for the pilot study was partially supported by Sarat Munjuluri’s American Psychiatry Association’s Minority Fellowship.

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