Note the following is abstracted from a chapter titled “Leadership Dimensions of the Physician’s Role: A Transitional Approach to Training in Pediatric Hematology/Oncology.” 15

Michael Balint was a Hungarian analyst and general physician. Freud saw instincts as the main motivating force in human development. Michael Balint radically departed from Freud. He saw behavior from the start as an interpersonal overture or demand reflecting a basic need for closeness to others. He also rejected Freud’s view of love as sublimated sexuality, and instead saw affectionate tenderness as a primary quality. Most importantly, he saw development as a reflection of the reality of the culturally conditioned interactions between infant and mother rather than a product of fantasized interactions. Balint viewed transference and counter-transference as the product of a unique interaction between a particular patient and a particular therapist. Further, the form of this interaction was interpreted as a reflection of the actual, not fantasized circumstances of both participants. This framework seems very compatible with social learning, social constructivist, and general systems perspectives.

Balint moved to England and began work at the Tavistock Institute. In the 1950’s he and his wife Enid Balint began offering seminars to general practitioners that drew on his object-relations perspective and the Hungarian model of psychoanalytic supervision. The seminars were designed as an opportunity for physicians to learn how to enhance the “therapeutic effect” of their doctor-patient relationships. In the Hungarian model of psychoanalytic training the training analyst supervised cases in the context of the trainee’s own analysis. Physicians participating in classical Balint groups are invited to discuss “difficult cases” without preparation or reference to case notes – relatively free associations. The group then reflected on the transference and counter-transference issues of each case as a means of increasing the physicians’ insight and empathic connection to their patients.

The Balint Group design has a long and illustrious history in medical education – particularly for the education of primary care physicians for their clinical role.5, 6, 16-20 Balint groups place emphasis on personal awareness and insight into personal style, character, preferences, values, etc. These dimensions come into play in the RP&L method but the physician’s personal style is viewed as one among many systemic factors and is not the primary focus. The primary focus of the RP&L method is observing patterns of interaction, articulating hypotheses to account for the patterns and testing the hypotheses through action. RP&L methods also emphasize the organizational dimension of analysis and not only the patient-physician dyad.

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Image credit: Boats and Waterfalls by Marc Horowitz