The Balint Group: The Arc of the Enduring Bridge Between Psychoanalysis and Medicine
by Randall H. Paulsen, MD and Don R. Lipsitt, MD
Michael Balint wrote in the Journal of the International Psychoanalysis in 1966 that there had been three great watershed occasions in the history of psychoanalysis: in the first, Freud’s daughter, Anna, and others opened the door to working psychoanalytically with children. Child analysis was integrated into the fold of psychoanalytic theory and practice to the great enhancement of both; developmental theory and practice grew from this synergy. The second, catalyzed by Wilfred Bion and others, applied psychoanalytic understanding to the study of groups through observation of group dynamics. Balint felt this was not welcomed into the mainstream of psychoanalytic practice, and the result had been a loss for both, as they went their separate ways. A third watershed, of which Balint was a major proponent, launched the integration of psychoanalysis with the practice of medicine, particularly medicine that centered on the relationships between patient and doctor in pediatrics, family practice, general medicine and primary care. The challenge of general practice called up Balint’s legendary metaphor stating that for 60 years psychoanalysis had existed as a foreign body within the corpus of medicine. He felt this unfortunate history was largely due to the insistence on interpreting unconscious meaning in clinical relationships. When Michael Balint immigrated to England from war-torn Hungary, he began consulting to the Tavistock Clinic where he observed mother-infant groups run by his future wife, Enid. Here was a model that he could imagine being a generative and enlightening offer to make to the overburdened general practitioners of post-war England. The analyst was not to function as an expert on relational difficulties but rather a co-explorer, a presence who invited physicians to listen carefully to each other describe and then respond to clinical dilemmas. With this model of careful, non-expert listening and associating, he began the Balint group method. Up until that point both unconscious interpretation and free associations were two hallmarks of the psychoanalytic method. By removing the former and highlighting the latter, Michael Balint had found a way for psychoanalytic practitioners to no longer be experienced as “foreign bodies.”
Schwartz, H. (Ed.), Applying Psychoanalysis in Medical Care (pp. 161-189). Routledge, 2021.
About the Authors:
Randall H. Paulsen, MD, is a psychiatrist, Training and Supervising Psychoanalyst, and past President of BPSI. He is an Assistant Professor of Psychiatry at Harvard Medical School and currently supervises and consults at Brigham and Women’s Hospital. His career has been focused on applied psychoanalysis, in directing inpatient and day hospitals at Tufts NEMC and Mt. Auburn Hospital (1981–1987), in developing primary care psychiatry as a component of Health Care Associates at BIDMC (1987–2000), and in facilitating a long-term Balint group for physicians. He was the mind-body consultant at The Osher Clinical Center at BWH where he also led Mindfulness-Based Stress Reduction courses (2002–2018). He views psychoanalysis as a subjective science in health-care, human development, and relationships—both individual, group and institutional. He has a private practice of psychoanalysis in Lexington.
Don R. Lipsitt, MD, is a member of the Boston Psychoanalytic Society and Institute, a professor of clinical psychiatry at Harvard Medical School and a past president of the International College of Psychosomatic Medicine. The founder of two journals on consultation-liaison psychiatry, he is the recipient of several lifetime achievement awards for contributions to the field and the author of Foundations of Consultation-Liaison Psychiatry: The Bumpy Road to Specialization (Routledge, 2016). The Academy of Psychosomatic Medicine has inaugurated the “Don R. Lipsitt Award for Achievement in Integrated and Collaborative Care.”
About the Book:
Applying Psychoanalysis in Medical Care describes the many ways that analysts interact with the medical world and make meaningful contributions to the care of a variety of patients. Clinicians with a deep psychoanalytic understanding of our vulnerabilities, fears and hopes are well suited to participate in the care of our body. This book brings together contributions from caregivers who have dedicated themselves to deeply knowing their patients, from prenatal care, pediatrics, oncology, and palliative care. The chapters are rich with moving clinical vignettes that demonstrate both the power and gracefulness of dynamic listening and insight. Members and partners can borrow the book from the BPSI library.
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