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2001 - 12th International Balint Congress - Portoroz - Slovenie

Categorie: IBF

The 12th International Balint Congress was held from 3-7 October 2001 in the Metropol Conference Centre, Portorož, Slovenia. Portorož is a seaside town which lies on the side of a small peninsula on Slovenia's brief stretch of Adriatic coastline. It is a popular holiday resort with plenty of large hotels but it retains a good deal of its natural beauty. The seafront and yacht marina are surrounded by green hills, thick with all sorts of trees including some lovely cypresses. Modest houses are scattered thinly over the treescape. In the town itself there are some elegant older buildings, most notably the old Palace Hotel which is awaiting restoration and looks like a grand old lady who has seen better days. The modem hotels are mostly inoffensive, rising to about 8 stores with cheerful red tiled roofs. The Metropol, sits on a little hill surrounded by its sister hotels. It is big, round and fat with a revolving Casino sign on the top. It has no architectural merit but at least it is easy to find your way back to. Its conference facilities are excellent, the bedrooms are comfortable and from the spacious balconies there are superb views of Portorož.

A few kilometres along the coast, at the tip of the peninsula is the gorgeous old Venetian town of Piran, an ideal place for an excursion or a meal of fresh seafood. Piran consists of a wedge shaped huddle of ancient houses with orange roof tiles. At  the top of the hill is the impressive basilica of St. George (dating from the 5th Century) with its campanile, modelled on the one in the Piazza San Marco in Venice. Down in the town centre, Piran has its own lovely oval piazza presided over by the statue of Giuseppe Tartini, the 18th Century composer who was born here and is portrayed carrying his violin and bow. Delicious little streets wander between the houses; each turning reveals a beguiling view, while appetising smells drift from the many restaurants. After a leisurely lunch, it is only a few steps down to the harbour where a little boat will take you back to Portoroû in 20 minutes.

As a result of the terrible disaster in the USA on September 11th and the subsequent suspension of services by Swissair, a substantial number of people were unable to travel to the Congress. Nevertheless, a total of 75 delegates managed to attend. There were 20 people from Slovenia, 10 from the UK, 7 from Israel, 5 each from Croatia, Germany, Romania and Sweden, 4 from Finland and one or two from Austria, Belgium, Czech Republic, Denmark, France, Holland, Hungary, Italy and Portugal. 17 countries were represented altogether.

This Congress was the International Balint Federation's first major event since the 11th Congress in Oxford, England in 1998. Many of the people who came to Portoroû had happy memories of Oxford and were looking forward to meeting their friends from other countries once again. The papers and discussion also formed a natural continuation of the ideas and reflections of three years ago. The theme of the 12th Congress was 'Balint after Balint' and the middle day (Thursday) was set aside for the 2nd Slovene Balint Day. On the other days the official language of the Congress was English. The morning session on each day consisted of papers followed by discussion in the lecture room. After a break for lunch and afternoon recreation, everyone had the opportunity to take part in a Balint group which met on each of the three days. On the last day (Saturday) there was also a final plenary session.

 
First evening: Wednesday

The Congress began with a welcome party in which delegates were invited to sample some unusual aperitifs, invented by champion cocktail mixer Aleö Ogrin. Then we assembled in the lecture room which was to be our academic base for the next three days to listen to the opening speeches. Dr Ziata Kralj, the organiser of the 12th Congress (Slovenia) formally welcomed everyone to the Congress and to Slovenia. Our new president, Dr Heide Otten (Germany) said some things about Balint and expressed her confidence that we would all do some good and enjoyable work together. Finally, Prof. Dr Vojka ätula, Mayor of the Community of Piran welcomed everybody and expressed her appreciation of the importance of doctors and patients talking together as human beings.

Thursday morning: first session

Dr Rubida from the Slovenian Ministry of Health gave a short speech of welcome and said that good doctor-patient communication led to good clinical outcomes. Zlata Kralj then read a paper by Prof Boris Luban-Plozza (Switzerland), the honorary president of the Congress, who had unfortunately been unable to come because of the grounding of all Swissair flights. In his paper, Boris recalled Michael Balint telling him: 'There is no need to know everything, but you must use your own mind.' The Balint method had enabled us to establish a very quick meeting of minds with the patient which eased formality and permitted greater openness.

 The next paper was given by Prof Ernst Petzold (Germany) who also chaired this first session of the morning. Ernst's paper was entitled 'Our Track to the Milky Way'. Using the idea of the Milky Way as a bridge ('not a chocolate bar) he described the ways in which Balint work could make links between psyche and soma, between general practice and psychoanalysis and between disease orientated and patient-centred research.

Next, Dr Kornelia Bobay (Hungary) spoke about 'The Balint group as an antidote to professional and human alienation'. She told us about two multidisciplinary Balint groups in which she had taken part. In one, a village priest was able to help the GP and the specialist to understand their relationships with the patient better. In the other group, a GP presented a patient who was recognised by two specialists in the group and the discussion led to the disappearance of all their stereotyped views of the patient and each other.

Dr John Salinsky (UK) described an unwilling home visit to an old lady who told him the story of her life. The story was better than he had expected; and listening to it transformed his attitude to the patient.

The next two papers were by doctors from Israel. Professor Benyamin Maoz gave an absorbing account of Balint work in his country. A number of factors were contributing to increased professional stress for doctors and many were feeling threatened by burnout and, sadly, counting the days to retirement.

Balint groups provided an atmosphere of listening and tolerance in which they could talk about their relationships with their patients and their colleagues and also about their personal emotional difficulties. He reminded us that patients and doctors both need to be allowed to tell their stories. In another paper from Beersheva, Dr Amir Mandel gave a progress report on his group's evaluation of the effectiveness of Balint groups for primary care physicians and for residents. Preliminary results showed no real change in the way they take care of their patients (perhaps they were unwilling to admit that they ever made mistakes). But 80% reported a change for the better in their feelings about their patients and their work as a result of their participation in the groups. Dr Mandel's final message was that you need at least two years in a group to achieve some change: and it's better to start early because some older doctors may be beyond help.

The papers were followed by some discussion in which the main themes were doctor-centred versus patient-centred groups, the training of leaders (by apprenticeship) and the specific problems of residents/trainees ('teenage doctors').

 
Thursday morning: second session

After a coffee break and a chat we returned to the lecture room for the second session of papers, chaired by Dr Igor Praznik (Slovenia). Professor G Martignoni (Switzerland) was unable to be present and so his lecture, 'Memories of the body' was read by Dr Uröa Mrevlje (Slovenia). He saw the body as 'a great book' in which everything about the person is written in a psychosomatic language. The difficulty we have today is in understanding the different voices and signs in which these messages reach us. He recalled the story of Rabbi Loew of Prague who breathed life into a clay man (the golem) which got out of control and became alarmingly destructive. Today we can prolong life and clone new lives in the laboratory but we still need a better understanding of the links between body, mind and environment.

The next presentation was by Dr Sanja Bilaûekovič-Milakovič (Croatia). Her paper was entitled- 'The psychosomatic approach in general/family practice'. She described a study which compared the outcome for two groups of patients: one treated by conventional medical methods and other with a psychosomatic approach. The psychosomatic treatment group showed a significant improvement in both somatic symptoms and emotional well being compared to the control group. Although patients with psychosomatic symptoms expect a specific organic diagnosis they also need help to understand the psychological origin of their illness.

Dr Michel Delbrouck (Belgium) gave a psychoanalytical account of the causes and ways of preventing child abuse, illustrated by computer slides of various paintings, including work from ancient Babylon and from the painter Klimt. When the child's internal world is attacked or even destroyed by abuse, especially from his father, he needs support from an alternative external father figure. This figure, who is often the doctor, has the task of providing another model of good child care; he must also be aware of the shame experienced by victims of child abuse. One of his tasks is, through his own sexual maturity, to reframe for the patient that adult sexuality is not necessarily directed towards the child. He needs to work with the parents and show that he appreciates the efforts toward good parenting that they have been able to make.

Polly Blacker (psychotherapist, UK) then gave an account of her proposal to provide a multidisciplinary Balint group for the staff of a hospital paediatric intensive care unit. She interviewed a large number of managers, nurses and doctors to explore their views about devoting a regular 'space' to talking in a Balint group about the emotional aspects of their work together. There was considerable resistance to the idea, mainly because each professional group tended to project their own needy feelings on to the others who were seen as unhelpful or demanding. She concluded that it might be more productive to work with the senior managers in the first instance, or, alternatively, to introduce the Balint at an earlier stage, during professional education.

Finally, Dr Stanislava Stojanovič-äpehar (Croatia) described a case in which a multidisciplinary team had great difficulty with a broken family and a physically abused 7 year old boy. She described a number of misunderstandings between family members and team members. Participation in a Balint group helped everyone to reach a better understanding in psychodynamic terms.

The session of papers was followed by a tasting of health food preparations, We also had the opportunity to look at the posters which were displayed in the foyer. These included presentations on 'Balint groups for trainees in psychiatry' (Drs Neilsen and Thorgaard, Denmark), 'The iatrogenic patient' ( Dr S. äupe and colleagues, Croatia) and 'Determinism and liberty in Balint groups' ( Dr Ante Gilič, Croatia).

 Friday: 2nd Slovene Balint Day (details not yet available)

 
Excursions

As an alternative, the non-Slovenian speakers were provided with opportunities to see more of the region's attractions. One group went on a coach to the spectacular caves of Skočan. Another party went on a guided tour of Piran followed by a visit to a winery where they were able to taste some of the excellent local produce.

 
Saturday morning: first session

The morning started with a talk on the Slovenian lace making school of Idrija. Ms Metka Tratnik gave a fascinating talk about how the lace is made, illustrated with some beautiful photographic illustrations. Later on, in the foyer we were able to examine the real lace for ourselves. Lace making involves application, the ability of people to work together and the weaving together of many different threads to form an interconnected and meaningful pattern of relationships. The comparison with Balint work comes readily to mind and this was the reason why the organisers had chosen a traditional Idrijan lace pattern as the symbol of the Congress.

Then the first morning session of papers began, with Dr John Salinsky (UK) as moderator. The research and evaluation theme was resumed by Dr Chris Mace (UK) who described the work of his team in examining the structure and process of current Balint groups in the UK. He noted that that groups for established practitioners tended to be more traditional, concentrating on the doctor-patient relationship and more often having a psychoanalytic psychotherapist as a leader. Groups for trainees, on the other hand were more likely to be led by GPs and to include discussion of other matters of professional concern to the members.

Next, Dr Ioan Bradu Iamandescu (Romania) spoke about patients with severe drug allergy syndrome. He told us that the fear of further exposure to the allergen could, in some patients, result in a psychosomatic syndrome very similar to the genuine immunological reaction. He suggested that the Balint group might be useful in helping these patients, their families and their physicians to understand the phenomenon better.

This was followed by a paper from Dr Dorte Kjelmand (Sweden) who returned to the question: 'Do GPs benefit from Balint group participation?' She told us about the continuation of the work which she first described in Oxford in 1998. She has now completed an evaluation of the attitudes of a group of 26 GPs who had been in a Balint group for more than a year, compared with a control group (also 26) who had never had this opportunity. She had used both quantitative and qualitative methods in the questionnaire On a number of outcome measures, including feeling in control of the work situation, awareness of feelings and a more positive attitude to somatising patients the Balint trained GPs scored significantly better. They were also more likely to be 'holistic' in their approach.

The next speaker was Dr Stanislava Stojanovič-äpehar (Croatia) who told us the story of a young female patient who was very socially withdrawn and unhappy. Over a period of years, and with the help of her Balint group, Stanislava was able to do therapeutic work with the patient which enabled her to overcome her difficulties and find fulfilment in a personal relationship.

Dr Ena Grbič (Croatia) described her personal experiences of participating in Balint groups. It was clear that the leadership and culture of the group were crucial in determining whether the members found it supportive and helpful. Ena had been put off by her first group which spent too much time analysing the doctors themselves. Later in her career, she sought the help of another group with a very difficult and frustrating patient. This group provided the space she needed in which to learn about her relationship with the patient without too much 'dissecting of the soul and probing of guilt'.

The final paper in this session was given by Dr Ari Lauden (Israel). He described a compulsory Balint orientated course for students called 'Emotional Processing'. The students had 8-10 sessions in small groups in which they discussed their emotional experiences in the wards under the guidance of one or more group leaders. The subjects raised included helplessness, levels of emotional connection with patients, anger and frustration, conflicts of loyalty and dealing with death and dying. There was evidence that the students appreciated the group experience and found it useful.

Saturday morning: second session

The second session was chaired by Dr Heide Otten (Germany). We began with Dr Anita H‰ggmark (Sweden) who presented a follow up of her report to the Oxford Congress on the Balint group leader training in Sweden. The program enables GPs, nurses, psychologists and psychotherapists to train together. The course runs one day a month for two years and it consists of lecture/seminars, group sessions and supervision. This year nine leaders have graduated and the evaluation has been very positive. The course will continue in 2002.

Next, Dr Jean Gillis (Belgium) told us about the Belgian 'Group Post-Balint' which has been running successfully for 20 years. All the participants are Balint veterans and some, but not all, are group leaders. In the group, members take turns at leading as often as they want to. The presence of at least one psychoanalysed member maintains 'psychoanalytical listening'. The group has been used for leader training and research as well as a forum for members to discuss their cases with old friends.

After hearing about the joys of senior Balint work we were treated to two excellent contributions from students. Monika Pixius from Aachen, Germany, told us about the anamnesis groups at her medical school through which students were able to get to know patients better and to see each patient as a whole person. Then Mojka Bˆhm (Ljubljana, Slovenia) described how she and her fellow students worked in groups of six with a mentor. Each student was asked to a patient to visit at home and report back to the group. She found the experience of the home visit rather daunting at first. However she was welcomed by the patient (who had suffered a stroke) and his wife and she soon began to appreciate the problems of both of them and to understand more about their relationship.

These words of appreciation form the students brought the final session of papers to a close on a very hopeful note.

 
The small group meetings

The Balint groups met each evening at 4.30 or 5.00 p.m. There were five groups at all and all were conducted in English as there proved to be insufficient numbers to support a group in any other language. This was fine for native English speakers but posed a considerable challenge to many of the delegates and I am full of admiration for their bravery and perseverance in overcoming the language barrier and making themselves understood. My group had members from at least nine different countries. Our first patient was an unhappy lady who had been summarily divorced by her husband. She seemed to have no life of her own except for her frequent visits to the surgery. She was very grateful for the doctors efforts to help her and embarrassed him by kissing his hand The second patient was a man who insisted on sprinkling the consulting room (and the doctor) with holy water before starting to describe his problem. Finally we had a patient tormented by psychosomatic digestive symptoms and depression who seemed impossible to understand and yet... through the magic of the Balint group, by the end of the session there seemed to be some hope for her too.

On Saturday, before the final small group session, there was a meeting of group leaders and representative members from each group. It emerged that there were some interesting differences in leadership style. (This was also noticed at the Oxford Congress in 1998). In some groups the leaders were more active in questioning the presenter about his feelings. In another group, it was observed that the leaders were happy to contribute accounts of patients of their own with whom they had had similar experiences to the presenter.

I am told by my reporters in the different groups that, in the final session after this meeting, there was a tendency for all the leaders to revert to a quieter, more conservative style.

 
Greek dancing

I must tell you about one other group activity of a totally different kind which we were able to enjoy. On Saturday afternoon, Dr Monika Voncina (Austria) took a band of enthusiastic pupils out on to a hotel terrace, overlooking the sea and taught them how to dance in a ring to traditional Greek music. Everyone who took part found this music and movement refreshing and exhilariating. And it was quite easy to get the hang of. Greek dancing reappeared later on at the Farewell Party (see below).

But first we had the Final plenary session on Saturday evening. The chairs in the lecture room were rearranged so that everyone could sit in one big circle. I chaired the proceedings and did my best to notice and respond to everyone who wanted to speak. Many people made recommendations for the next Congress in two years time (Berlin 2003). Here are a few of the comments that were made:

It was good to have one Slovenian leader and one leader from a guest country in each group.

There was a request for the next Congress organisers to provide a list of delegates with country of origin, address and contact numbers form the beginning. (The list for this Congress did appear about half way through).

It was suggested that people might have been able to mix with each other socially a little more if they could have eaten lunch together at the Congress.

The papers had been of great interest but it would be nice to have them presented so that papers on related themes were placed together. A short period of discussion after each presentation was preferred. Visual aids (pictures, graphs, electronic presentations etc) were appreciated and there was a call for all papers to include these if possible. It was probably better not to have papers read by other people in the author's absence as this was a very difficult task. English people were asked to try and speak more slowly!

Some people would welcome fewer papers and more discussion. The student forum was warmly approved. In future congresses the students could be asked to participate more fully and give papers. There was a proposal to create an international scientific board. Posters were encouraged and one-minute poster presentations suggested. There should be one session for evaluation and one for new Balint Societies to present themselves. It would be nice if presentations from the National (host) Society could be translated at least in summary. Everyone agreed that sitting with people of many different nationalities gives one a wonderful feeling.... But it's hard to think and speak in English in a big group.

There was a request for all the Proceedings of the Congress to be published. The Greek Dancing was wonderful and should be repeated.

Warm thanks were expressed to Zlata Krali and her colleagues for all their hard work in organising the Congress and bringing us all together for such a fruitful and happy few days.

 
The farewell party: dining, dancing - and singing

On Saturday evening, we gathered in the dining room of the Metropol for a celebration of our reunion and our achievements. There was an excellent buffet dinner and plenty of good Slovenian wine. There was dancing to the music of a versatile and tireless two-man orchestra (keyboards and guitar). After the meal our Greek dancing teacher, Monika Voncina led us all out onto the floor and proceeded to get us all moving and shaking, more or less rhythmically, with arms linked, sometimes in a circle, sometimes in a long snake winding in and out and round about  ... After that there was an outbreak of furious scribbling in all parts of the room. What was going on? The Swedish delegation had decided that we should compose the words of a Balint Anthem to be sung to the tune of 'Lili Marlene'. When the creative lyric writing was finished the words were copied for everyone, the band was taught the tune and the massed choir of the International Balint Federation cleared their throats and sang. The second performance was recorded by Michel Delbrouck (with the good singers nearest to the microphone). The CD will be available shortly, but meanwhile here are the words:

 
THE  BALINT  SONG  FOR 2001

 (Melody: 'Lili Marlene')

 
We are all together for a Balint week
Gathered in Slovenia, a place that's very 'chique'
Coming from Holland, I soon made friends
And in some lace I put some pins
Balint aprËs Balint - Balint aprËs Balint

Talking of our feelings makes me very glad
Along with my patients I can be so sad
With sexuality and incest-
and broken hearts, the talks are best

In groups with old Balint - in groups with old Balint
In Michel's heart a black hole will take place
It will be filled in golden Berlin days
When he shall meet the Balint girls
From Northern lands, he'll start to dance

Alors Balint Alors! - Alors Balint Alors!

Strolling by the seaside, wand'ring through Piran
Balint folk are gath'ring, according to our plan
Talking of patients - everywhere

We are so happy, they're not here
They're far away at home - they're far away at home!

Although Balint lovers, we must be aware
Not to build a tower pointing in the air
That, like a 'Babel', will fall down
In different language we may drown

Babel is not Balint -. Babel is not Berlin
And to follow that..
What more can I say? I'll see you all in Berlin.

John Salinsky