Behind what a Balint group adds to the clinical practice, different aspects are found participating to the success of this process.
The group as a support.
To be supported, comforted and validated by a group is often times necessary but can also be hazardous: Groucho Marx said that never would he be part of a group that would welcome him as a member!
We can hardly express better the paradox constantly existing between the very human desire of being comforted by a group and the inherently narcissistic, moral and superegotic linked to it and the lawful desire to stay oneself. Both aspects are at the same time dependent from each other and autonomous. It’s impossible for the human being to discover themselves without the others while not being able to be themselves without some form of conflict with the others.
That inevitable paradox, when it is understood and accepted by the leader, allows for tolerance and kindness within the group’s functioning without looking to repress too strictly what seems to not fit into the rules. Those also need to be in a state of dialogue with what pushes them instead of trying to impose themselves too violently. A decreed rule is often a rule that can’t be explained… The firmness can’t exclude dialogue which implies that the leader and the group expose themselves to hear things they haven’t considered and wouldn’t have listened to if too much firmness had been used. In some cases, firmness is also closure…
When it is heard this way, conflict seems less violent for everybody as it testifies of a helpful process of salutary differentiation and exchange of more meaningful and deeper stories.
Thereby, if the group has a motherly function of development and support the fact that it comes at the price of a consensus that can easily weigh on creativity, the risk that each one can take to stay themselves in opposition to the others and the group shouldn’t be forgotten.
A quick example of this contradictory process: in a short-lived group, a leader participant express a difficult they have with one of their groups, where one of the members sometimes takes an invasive place making the flowing functioning of the group hard. It happens that this member is also the one who invites the others as it happens on their workplace. It is undeniable that if the development of this short-lived group had stopped there, wholly invalidating the leader’s experiences who reported this case, this sequence’s conclusion would have been entirely superegotic, even authoritarian. Thankfully the group got through this rule’s stiffness to dig deeper into the historical specificities explain its functioning and the development could peacefully continue.
The work on guilt
The other aspect mustered by the group, far from being he least important, is linked to the question of guilt. This is the result of a fault involving a damage, be it imaginary or not, caused to someone else no matter the nature of this fault, had it been wanted, unconscious or unavoidable. As a choir in ancient Greek tragedies which function is to continuously bring back a character’s dilemma to the city’s justice, guilt sings us a melody that wants to close the debate on the other’s side, of moral, of said city.
A Balint group’s goal is here different, in a way comparable to psychoanalysis: it is, from this wall of guilt, impression of a fault or symptom in the analysis to allow the resumption of a story’s run, or stories’, that is to say the stories of who is exposing themselves, who is exposed and the participants. This beyond of guilt, as the beyond of the symptom in psychoanalysis when it is allowed to unravel without judgment often times allow to discovered really productive and fertile layers that otherwise would have stayed buried in the individual’s or group’s unconscious.
It is important to point out a parental link between this function of suspension of the judgment allowing the continuation of a development and the psychoanalysis’ free association rule that pushed to let thinking flow independently from any moral judgment on what has been said.
Allowing the development of a complex story instead of a moral judgment that would otherwise stop the process is what can also be part of a Balint leader’s formation for this group to function properly.
Of course superego, rules, moral judgments are ingredients that no society could let go off. But a lot of societies also suffer from a certain amount of difficulties caused by rules that don’t take what reality show them into account: rules themselves need to keep an open ear… It’s the only condition for guilt to be able to deliver its peculiar message which is then often to enrich a practice.
An example coming once again from a group: a member of the group wants to talk about a case that put her in an unstable position. In fact, this child she accepted to work with doesn’t correspond to her “official” competence, let’s say psycho-motor specialized speech therapist or something else… Furthermore, she doesn’t do anything with them as they carefully sabotage all her instructions. A somewhat strong guilt sprung from there that took her to talk about it during a Balint group. The proceedings of a Balint session on this case, far from any moral judgment on the fundamental moral goodness of such a practice allowed to show all the good that this specific practice of a lack of pressure, demands and this simple human presence exempt from expectations did to this child in reality overly requested for the performance that were expected from them by both family and school. This was only allowed by the flexibility of this person’s professional rules who learned that sometimes guilt can be a teacher when the depth of stories and instincts of one another are let to unravel.
Questions in question
As Michael Balint said, if we ask questions we’ll get answers and nothing else!! However, the use of questions as everyone knows and sees, is at the center of the balintian process. The development of a session is based at the same time on a story and the reactions caused by the questions offered by the participants. In fact, we can make an analogy between the story which would be the narrator’s conscious plane and the questions oscillating between pure projections of the participants or opening on the unconscious at play in the story. Between the two is located what we call the group dynamic, which is the more or less conscious feeling of the unconscious elements at play in the story. Then the leader, first withdrawn during this time of development through questions, can little by little enter in the depth of the case thanks to the story and remarks of the group, especially if he has a formation on the group dynamic to begin with. There is however that should never be forgotten: a question is always an intrusion of the thinking process and can in that case create as many good things as it can cause damages… We can never exactly know what the impact of a question can be. Only what the question causes gives it value, which is always uncertain.
In the previously quoted book by Michael Balint, countless are the reproaches he does to doctors who are too upfront with their patient, overly quick in their own reflections. The resistances created often block the therapeutic process.
Questions aren’t only informational, they also orientate in directions which belong mostly to the one who asks them.
Thereby, if they enrich the case’s story, if they help unveiling layers hidden until then, questions divert the aim, orienting the reflections in directions that makes us uncertain if they belong to the psycho-therapeutic that was brought up if there are too many of them or they’re too insistent. In this case, we only obtain answers and not the useful deepening of the story anymore.
Too many questions or a too important insistence can move the group dynamic in insidious ways from the case’s story to the problematic of those who question it without always realizing it on time. The object of the Balint itself changes and instead of being to any use to whoever decided to tell the case’s story, it becomes a place of reflection for those who ask the questions…
It is all a question of moderation, knowing that question can shine a light on a case as much as make it foggier! The leader’s art is to attempt to unravel this as best as they can, to save a group dynamic that still serves the therapeutic transfer brought to the group.
Let’s illustrate this: thus during this session the case, a paranoid closure in a rural isolation will remind a doctor of the group a similar experience still vivid in their memory bringing them to ask lots of really passionate questions and remarks. In fact, the questions they’re asking always bring back to their own experience instead of being relevant to the current case. The group would only get its dynamic back when the offer to go back to this story would have been made in a later session, which it will do, but this time in an appropriate mindset, the group clearly serving the doctor’s questioning in this later step.
In fact, every question asked is the witness of a projection in the story heard, projection that will always be only partially valid. In reality, this confusing aspect of the flow of question coming to enrich the developing story is inevitable. The only thing that could prevent too many drifts is in that case knowledge which allows to not take literally all those questions to simply witness their effect, enriching or confusing depending on the case.
The last point I wanna talk about is the one of advice. It is a subject often debated in balintian places. While some think that because of their formation they are legitimate in giving advice in a group or individual setting of the art of psychotherapy or psychoanalysis, others think it limits the precious risk-taking capacity in the run of a psychotherapy and therefor any advice restrains the therapist’s creativity, mandatory to their job. But what is an advice? In the most simple cases, it is a technical advice from someone who possesses a bit of knowledge that the other doesn’t have. But even in the most simple cases, it isn’t that simple… Let’s imagine that I am having a hard time with this gas pump with a vacuum valve that equips the carburetor of this Solex that I am renovating for my own enjoyment. It’s been a week that I am on it and it does work for me. A friend to whom I have not asked anything comes and explains to me that it is the membrane’s flexibility that is flawed even if it is not pierced… He is certainly right but at the same time he takes away the enjoyment of searching by myself without me asking anything! Nothing really important you’ll tell me but even then… If this friend does this each time he comes with every problem in a house or in life, he will quick become insufferable! It is that the energy and passion we put to find a solution to our problems matter sometimes more than the solutions in themselves, which are are more priceless when they are ours.
It is truly that dynamic process of the psychic life, this research, those developments, those unresolved difficulties that make life worth living.
Thus can we differentiate two types of advice: those that are given and those that are asked for. In general, the first ones are really risky with the second ones are better received. It is that the advice, the technical competence can only work with a real desire to learn coming from who it applies to.
All of this stays quite simple in field with little complexity like mechanics. If we can easily be confused by it, it is far from a really complex field like the psyche… It is indeed something else!
During Balint are reported encounters between therapists and patients, meaning two psychic devices that dialogue to go forward through the paradoxes and hardship of life and thoughts.
We have to be really humble in front of this unfathomable complexity, far away from mechanics! In Balint, it will be twice filtered: on one side, the story we tell of ourselves is a part of our being that can be translated into words. It is then only a very small part! On the other side, the story the therapist tells to the group is also filtered by them, that only renders a really tiny part. To this double reduction is added what the group’s members can grasp from it, which makes it a third reduction.
It is truly because of those drastic reductions that Lacan could say of his supervised young students that they were doing anything but… that they were also always right! It is just simply that they were directly in contact with their patient’s hyper-complexity unlike their supervisor, would he be called Lacan, Freud or anybody!
Is it why the practice of the supervision of an analyst by another one is so widespread and yet little controlled? It circulates in the analytic field that the patient is a bit sacrificed to the good functioning of the supervision…
I think that this can in fact happen when advice are given in this setting! When this happen, the direction the psychotherapy takes escapes from both protagonists living it to get in the supervisor’s hands who lacks what represents the heart of every psychotherapy: the complex encounter between two psyches.
To get back more directly to our subject, this is exactly what happen when a guiding advice is thrown in a Balint group. The more the person giving the advice is invested, as the leader of an analytic school or as a reference of knowledge, the more risk there is for a massive deleterious effect by the reduction we described and that isn’t accounted for at all anymore.
Thus in this Balint session, a participant reacts to the story of another describing a situation where the patient is taken care of by a psychologist and a psychiatrist. Paradoxes created by this situation fed by the difference of speeches that the patient gives to one another is putting off the psychologist participating in the Balint group. Advice is giving by the other participant to call the psychiatrist to even out this complex situation. Thankfully, the group worked on this remark, finally showing that this advice would have broken the fragile balance the patient controlled by those “manipulations” that were also careful progress on both sides at their rhythm…
Thus, a Balint group that allows the emotional weight of our work as therapists to be collectively shared can be of great help, however under certain conditions.
The first is to see that what protects, supports, allows a development, that is to say the group when it is welcoming and kind doesn’t protect from a certain weight, from the risk that all group consensus can weight on each person’s individual creativity. It always exists between the two a certain form of paradox that might be better to accept than try to shrink.
The second is that the feeling of mistake, the weight of a certain guilt from the therapist confronted to the numerous difficulties of a psychotherapy can thanks to the Balint group change into a new knowledge, a fertile development.
In the third, the leader’s art and that of the group itself is to maintain a development thanks to and despite the amount of questions about the case in the group. Here again, remembering that all those clues can deepen as much as they can blur the way make accepting this paradox possible, even inevitable.
Finally, the use of advice being often the exact opposite of a psychotherapy’s goal which is that the patient find their way again and the enjoy to look for it, it seems useful to finish with this point.
Maybe then, without all those aspects being exhaustive, all of this allows for an enjoyable progression of a Balint group and participate to help the therapist in a comfortable practice, which is anyway the first ambition of the Balint practice.
Dr. Michel Levy, Saint-Sauveur, 29/01/2019