Abstract
As Mark Twain once said, “Prediction is difficult—particularly when it involves the future.” This statement was borne out by our own attempts to predict the course of the Covid 19 pandemic to hold the 2022 National Meeting of the American Balint Society. Originally scheduled for May of 2020, cancelled due to the Covid pandemic, rescheduled for January 2022, and changed at the last minute from an in-person to a virtual meeting with all the complications entailed in such a change, the result was a successful and gratifying meeting for all who attended. Because we pivoted to a virtual meeting to avoid becoming a super-spreader event, many more participants than usual could attend.
The current volume of the International Journal of Psychiatry in Medicine (IJPM) continues its publishing partnership with the American Balint Society (ABS). The papers published in this issue were presented at the 2022 Annual Meeting of the ABS. They are representative of the richness and scholarship that emerges when a suitable frame is established, and a protected space is provided. The reader is invited to enter this space and at the same time be prepared for the many ways one’s understanding of the impact of a Balint group experience may be challenged and the ways one’s perspective of the power of relationships may be stirred up.
Two groups of ABS members deserve acknowledgment for helping bring this issue to press: John Freedy organized reviewers of the many papers submitted to the Enid Balint student paper contest, selecting three winning essays and three honorable mention submissions, all of which highlight the emotionally gut-wrenching experience of patient care; and Laurel Milberg led another group of colleagues who reviewed scientific papers submitted as bridges of diverse experiences in clinical relationships and selected papers with impact in multiple arenas. The result of these efforts follows.
Each one of the six student papers alerts us to a challenge in medical culture when the clinician’s humanity is recognized. In “On a Tale of Two Caregivers,” Eugene Kim describes what happens when we put aside a primarily medical agenda and insert the human values of a patient from a different culture. In “Mija” TlalliAztlan Moya-Smith invites us to experience the impact of medical care conducted in the native language of a recent immigrant. In “For, Not To,” Christy Lucas helps us to feel the humanizing impact when the physician’s intent is communicated using a shift in focus that is represented by using a different preposition. In “A New Routine,” Rebecca Speer reminds us of both the value of our routines, as well as the power of a new routine to see our patient and ourselves differently. Madeline Maras, the writer of “Hidden in Plain Sight,” exposes her own humanity, sharing her vulnerability, and describing how that made all the difference in patient care. Finally, in “What Doctors Take,” Sarah Calvert points out for us that having a name makes loss personal, and that can be an entry to a relationship.
The first three peer reviewed scientific papers each provide a unique guide to how the Balint trained eye and ear see and hear the patient. In “Now showing: The presentation,” Eran Metzger and Clive Brock remind us of Osler’s observation that if we listen carefully to the patient, they will tell us the diagnosis. In parallel fashion, if the group listens carefully to the case presentation, the presenter will tell us the problem. The next paper, “Research cum training: Assumptions, questions, and future directions,” encourages us to look more closely to the research part of Balint groups. Jeff Sternlieb points out how the groups themselves are the research method of choice; they reveal patient narratives and physician management struggles with some of their patients. He further suggests and encourages the establishment of a new Balint study group. Finally, Radha Nandagopal and Janet Walker describe their initial efforts to use Balint groups in the creation of a medical training culture informed by reflective practice in a new medical school.
The next three papers share pilot projects designed to incorporate Balint groups in the training or continuing education of three groups, some of which are not customarily using reflective practices. Prathiksha Nalan and Alexandra Manning describe the process of introducing Balint groups to psychiatry residents. In the cleverly named “The Juice is Worth the Squeeze,” we are reminded that the measure of Balint work and the rewards for persistence are often only experienced at the end of a process and not immediately. In like fashion, Shana O’Mara and Jillian Romm‘s efforts to introduce Balint groups to struggling veterinarian professionals required patience and persistence due to challenges in schedules, Covid interruptions, and a culture that does not emphasize emotional self-care. Even with small numbers of participants, there have been very encouraging signs of the value of this process. A third group of professionals who are not typically focused on directly addressing the emotional impact of their work situation are teachers, and especially teachers with less experience who work in urban, underserved public-school communities. In their paper, “Experiences from a Balint group intervention with Urban public-school teachers,” TaQuana Williams, Sarat Munjuluri, and Albert Lichtenstein describe a six-month pilot project designed to support less experienced teachers working in less than desirable conditions in the hope that a Balint-type group experience might encourage teachers to stay in the profession. The support alone that participants experienced has encouraged a continuation of this project.
Readers can take a deeper dive into some of the complexities one faces in exploring DEI issues in Balint groups. Alexandra Manning’s “The Goldilocks of Social Justice Education: Balint Groups as a Curricular Intervention to Support Equitable Health Care,” addresses subtleties in the group leader’s role and presenter’s vulnerability in presenting cases with DEI issues. The next paper, “Addressing Implicit Bias to Acknowledge the Experience of Under-represented in Medicine Colleagues and Improve Patient Care,” is a riveting first-person description by Khama Ennis, who, daily, juggles her role and responsibility as a medical professional with what seems like relentless questioning by patients who act incredulous that their emergency physician could possibly be a black Caribbean American woman.
Sometimes and under some conditions, it becomes necessary to modify the Balint method. It is particularly notable when the essence of the group process is modified due to unique circumstances. “Virtual Balint Groups During COVID-19: Exploring Race and Equity in a CHC-Based Family Medicine Residency Program” is such a report. Kathryn De La Rosa, Jennifer Somers, and Anthony Valdini detail a situation made more complicated by the compounding of trauma, deep crevices in cases and institutional factors which all together led to Balint-informed topic discussion groups.
Given the history of this meeting itself, it seems appropriate that the final paper is a look back and a look forward documenting a brief but fortuitous history of Balint on the Zoom platform. Albert Lichtenstein, Don Nease and Lisa Buck share their evolving knowledge of the unique considerations and guidelines which seem like required reading for all leaders using this or other similar platforms. These observations not only remind leaders of relevant cautions, but they also remind us of the value of in-person meetings that have their own set of caveats.
These papers of the 2022 National Meeting of the American Balint Society reflect not only increasing registration, interest, and satisfaction, but also the overall success of a virtual meeting. The ABS looks forward to continued collaboration with IJPM, and continued bridge-building in applications of and reflections on Balint processes and methods.
Jeffrey L. Sternlieb, PhD
Ritch Addison, PhD
Chairs, 2022 National Meeting of the American Balint Society