IBF Congress Report – An Introduction to Balint – by Beth Hamilton

The 2017 International Balint Conference was held in Oxford at Keble College from 6 -10 September 2017. I had the privilege of attending the Conference as a first year Doctor, and one of the recipients of the Ascona Prize- a reflective essay competition open to medical students around the world. After a long journey from Australia I pulled in at Oxford train station, and made my way down the cobbled streets in light rain to Keble College. It was in sharp contrast from the town in regional Queensland that I had travelled from, where it exceeds 30 degrees most days and rain was a precious scarcity! On arriving at Keble College, I was met with smiles from various strangers, and my nerves were immediately calmed. I quickly learnt in the opening plenary session that these strangers heralded from 29 countries around the world, spoke many different languages, and would soon become my Balint colleagues.

The Introductory Lecture was titled “Where there is silence, let there be story”, presented by Padraig O Tauma, an Irish Poet. He talked about his work at Corrymeela, Ireland’s oldest peace and reconciliation organization, which was founded to facilitate people of different religions, national and political identities in friendship and understanding, argument and civility with each other. He eloquently drew parallels between poetry, storytelling, and the doctor-patient relationship and started to explore the theme of the Conference, “Exploring Diversity”. He talked about the idea of “otherness” and of “sameness and strangeness”, discussing identity, territory, religion, conflict and how he uses storytelling to explore these ideas.  Poetry was spattered throughout the address, the audience were invited to participate at various stages, and by the end, the room felt united in embracing the theme diversity. Indeed, this thought provoking Introductory Lecture, combined with the setting that is Oxford, inspired a sense of being part of history, of learning and knowledge, of asking those questions and having conversation that supersedes oneself.

One of the most rewarding parts of the conference were the daily Balint Sessions- five in total were held over the duration of the Conference. This was my first Balint experience. I was rather nervous, unsure of what to expect and if I’d be able to contribute satisfactorily to the group. I found it fascinating listening to the insight and intellect demonstrated by my group members, and was witness to a level of emotional and social intelligence I have rarely encountered. This was only enriched by having people from such a diverse range of backgrounds, experience and skills. I eventually worked up the courage to share one of my own doctor-patient experiences and was overwhelmed by the support I received, and found myself approaching the scenario I had outlined to them in a different way. I had initially been disappointed in the way I had handled in the situation, and felt as though I had let the patient down. By listening to my colleagues input in a removed, safe sense, I was able to see the scenario from the patient’s perspective, and begin to appreciate the complex factors at play, far beyond the scope of our single encounter.

I also had the opportunity to be a part of the parallel “Student day” on the Saturday of the Conference, where we completed two Balint sessions. It was interesting to compare this to wider group Balint sessions. I noticed there were many additional factors relating to the medical student’s role in scenarios discussed, where they are often the “third person” in the room, serving roles as an advocate, as an observer, as a moderator, as a pupil. We also discussed the challenge that arises in identifying your role is in each scenario and the impact it has on the medical student-patient relationship and the doctor-patient relationship. I found this very interesting to dissect, considering my medical student experiences were still very fresh from a few months earlier, and I was transitioning into learning my role as a junior doctor.

There were plenary sessions held each day, where key papers were presented in Lecture form, on the theme of Diversity. Among many presenters, we heard from Nina Arzberger from Pakistan, who described the first Balint group in Pakistan. She discussed the challenges they faced in establishing a relatively liberal group that is Balint, in a highly conservative society, and the role of socio-cultural variables in Balint. Associate Professor Jeffrey Sternlieb delivered an insightful presentation about his paper “Discovering my white male privilege: becoming an ally- continuing my education”, where he described his own personal white privilege awareness journey, including examples and challenges for Balint leaders to consider in their own personal explorations.

In addition to engaging in these Lectures, we also had the opportunity to participate in Workshop breakout sessions. There were 8 workshops centred around the theme of diversity, providing an opportunity to learn and engage in an area of your interest, in a smaller group.  I attended the second Workshop called “Balint Theory and Practice: Exploring the Introduction of Balint Groups for Health Practitioners with People from different cultural and ethnic minority groups”, hosted by two fellow Australians, Dr Bambi Ward and Richard Fejo, an Aboriginal Cultural Educator from the Northern Territory. They discussed their Australian experience of Balint groups with Aboriginal cultural educators for doctors working in Australian remote communities, the challenges they faced (such as cultural safety and vicarious trauma) and benefits of the program. We learnt from each other, as people from across the world contributed their experiences working with different cultural and ethnic minority groups in their region.

On the final evening, I had the opportunity to present a condensed version of my first prize essay “Meeting Margery”. I was truly a world away from the small town of Warwick in rural Australia, where I had perused the email from my medical school advertising the “Ascona Prize” and first put pen to paper. What made this evening particularly special was listening to the two other students present their essays before me, and reflecting on the similarities between our diverse experiences literally across the world- Israel, America and Australia. It was such a special opportunity to share my story, and Margery’s story with a group of people I had the privilege of getting to know over the Conference, and I left having this final sense of validation. In addition to the academic schedule, there were also social events every night, which ranged from watching films to listening to a wind quartet in Keble College Chapel, and of course, the final night where we came together for a night full of singing and laughter in the Dining Hall.

I found myself reflecting on the Conference experience while sitting in a coffee shop in the Undercover Markets before making my way to the departing train. I was surprised by one of the major concepts that stood out to me, perhaps planted in my mind by Patrick the Poet. Silence. There was a lot of sound at the conference- discussion, questions, laughter, singing, musical instruments, the list goes on. However, there were also periods of silence. I found myself initially very uncomfortable with this. Sitting in silence for minutes at a time in Balint Groups, only interrupted by the distant sound of traffic. I found myself deeply analyzing it, often being the one to break it for I felt it needed breaking. By the end of the conference, however, I found myself observing the silence. The powerful form of communication silence facilitates, uniting people across their differences and language barriers.

Fast forwarding to the present- I have recently completed my Internship at Townsville Hospital. The Balint experience is always close to me and has an impact on the way I interact with patients on a daily basis. I try to remain cognisant of the experience of the patient and their family, and take the time to reflect on my own practice and factors that impact it.

Elizabeth Hamilton
Griffith University Graduate 2016
Current Resident, Townsville Hospital, Queensland.
Report published in the Newsletter of the Faculty of Medical Psychotherapy,
Royal College of Psychiatrists
See Medical Psychotherapy Faculty Newsletter – Winter Spring 2018