Tatiana Tishkova

Psychoanalytic Psychotherapist and Accredited Balint Leader,
Vice-president of Russian Balint Society (Russia, Moscow)

Based on an article by Alfred Drees (Germany)

Prismatic Balint groups have developed from the classic Balint groups in the form of mood oriented sensitive-metaphorical process. The group method allows to resolve chaotic, panic, psychotic and traumatic experiences, which as the source of the conflict blocked the communication between doctors, members of the group. Prismatic mood oriented Balint group fully functions within an organization and includes participants from various fields of activity and levels of hierarchy, since role conflicts and relationship conflicts prismatically defocus due to orientation on the mood.

Mood oriented work method may be expressed in the following way: after the relationship conflict or the patient’s problem is presented to the group, the group members are requested to prepare for describing their mood and their own physical and mental state. They should not analyze or interpret the presented Problem, but instead provide metaphorical fantasies, in which their mood, physical and mental states seek expression.

We call such group prismatic, because we comprehend different descriptions of the experiences of individual group members as the unfolding of various aspects of the patient in the group members. We compare this process with rainbow colors in white light, which become visible only in prismatic deflection. Thanks to mood oriented prismatic sensitive-metaphorical group method it becomes possible to make conscious and unconscious components of a patient or a client visible in a group, comparable with Winnicott’s transient space (1971).

All those various health and mood states of individual group members are not interpreted and are not understood as part of a relationship. Unpleasant feelings, chaotic deathly fears, aggressive, erotic as well as depressive afflictive aspects of a patient’s experiences may unfold freely in the individual group members. With the help of those multicolor events, one may find a way out of paralyzing relationships and transference fixations.

Group members learn to accept their sensitive experience and their ideas as a creative achievement, as a resonating and creative ability as well as a desire and ability to bear the strain between the content of a conflict and various processes of the mood and fantasy in a group … As compared to the classic process of a Balint group, where the emphasis is made on the relationship patterns, in the communication of a prismatic group the reflections, desires of self-comprehension and blockade, caused by them, may considerably get less. Therefore, the prismatic group remains fully functioning within an organization with participants from various fields of activity and levels of hierarchy, since role conflicts and relationship conflicts prismatically defocus due to orientation on the mood (Drees, 1982).

During twenty years, Drees have been trying to understand and overcome professional complexities and group conflicts, based on emotions, through the practice of a certain Balint group work. The prevailing paradigm in this work was the psychoanalytic idea that the conflicts along with learning difficulties and professional difficulties in an organization may be found in the interaction patterns, which block the creativity between colleagues. These interaction patterns may be further understood as renewed patterns of infantile relations and may be explained as aspects of desire, longing or resistance in the processes of transference and countertransference. Soon Drees became aware that the development of various transference patterns turned out very useful in considering various possibilities of transference towards a patient.

The mood soon became the core and the sphere of new orientation of our prismatic group work.

This term includes the atmosphere and the climate, physical sensations and feelings. The mood became the basis, the framework, the variable means and finally the content of a whole group process, on which the attention can be focused. Mood orientation allows to develop the awareness of the mood and turn emotions from interaction into the mood feelings. 

W.Loch (1969), the psychoanalyst, has created “prismatic” as a technical term for group processes. He Balint groups with a prism, which helps to divide the doctor-patient relations into the shades of monochrome light without the necessity to involve genetic or resistance work. Drees has taken this comparison from W. Loch and has developed it into the mood processes.

One may understand the expressed shades of mood as a necessary tonal chromatic phase, in which the following tones and moods may unfold. Through those experiences and expressions of each group member, prismatically differentiated feelings lose their logical and semantic connection. Emotional patterns and conflict totalities defocus, transform and thus minimize themselves. This approach raises sensitive awareness and creative ability to cope with complex material in the transient space as described by Winnicott. The term “prismatic” was used for over 15 years, then Drees proposed the term “defocus”.

Fantasies and memories, based on imagination or fantasy elements, are understood as a mood process-experience formed by the images. Such linguistic imagery may be described as “open fantasies” to underline that its metaphorical content should not be limited to symbolic expression of a certain behavior in the relationship configuration. This means that individual metaphorical elements primarily serve as elaboration and further development of each mood process.

It’s important to become aware that metaphorical poetic and rhetoric language is not an inferior, esthetic deviation in search of truth, but through it the complexity of the language, archaism, history, future and multidimension of vital processes find their adequate expression, which we postulate here as free from subject-object transient space as per Winnicott (1971).

We may aptly adopt the elements of group methodic, such as sensitive experience, creative work and metaphorical forms of communication, but still experience problems with the theoretical conceptualization of the mood and defocus in prismatic Balint groups. Drees wrote: “Since then we found a few explanations, allowing at least approximately comprehend this occurrence, which in its kaleidoscopic forms of expression encompasses our whole being. We cannot free ourselves from the mood.

We all know and sense the dependence of our decision and motivation on our mood feelings, which are influenced by the inner and outer factors. Advertising industry has realized the importance of mood feelings in developing the sales strategies. The politicians see its influence as crucial at the elections. However, the mood still remains out of the framework of psychological research. Taking into account the number of psychotherapeutic schools and methods, it’s surprising that the mood has practically not been considered”. 

Thure von Uexkull (1963) considers the mood as the central psychosomatic term. His mood concept as pre-reality may be collated with Winnicott’s views on transient space and with objects in Michael Balint’s theory about “primary love” and the “flash” and with some other theoretical approaches, which describe the absence of subject-object dimension as an unstructured transient space where the main therapeutic, creative and productive processes occur.

In prismatic group process there is an attempt to develop the complex of unstructured information into the mood dynamic. This dynamic may only develop when the group members manage to transform the teleological “complexes of questions why-that’s why” and the object-centered emotional processes into the physically sensitive experience. These very processes of experience and transformation we understand as the expression of the mood dynamic.

Working together with the students in Balint groups, Thure von Uexkull (1982) described how students expressed the growing ability to perceive and discuss physical and sensitive experiences in the group, because they were not yet familiar with the language of psychological medicine. The behavior, the symptoms and the mood change, when the mood and the feelings are described by figurative language.

It was especially valuable for our work to realize how the individual types of communication may be transformed. Thus, we were able to study how the chaotic, unconnected, unconscious feelings and above all the fears of psychotic disintegration and fears of death in the patients could increase the emotional strain in the personnel and have the opposite effect on the organization dynamic.

We understood that unassociated feelings may be transformed and, therefore, attached to interaction patterns. On the other hand, emotionally fixed experiences of the conflict may be transformed into the mood feelings by means of prismatic mood orientation.

In the therapy of neurotic and psychosomatic patients Drees and colleagues studied physically-mental processes of mood awareness along with figurative metaphorical forms of communication. Thanks to mood orientation, even the psychotic patients to the surprise of the therapists learned to understand their experiences and fantasies in the process of mood communication as playing a creative role in the group.

They realized that their mood feelings were their individual expressions of the given problem of the other patient or the group conflict. It opens a new door in understanding and transforming egocentric feelings and interaction feelings into the mood processing feelings. By these means it is possible to liberate a person from incorrect perception of the outer world as well as what one feels in oneself. Mood oriented therapeutic fields open new possibilities to help the growing group of patients with posttraumatic stress or borderline symptoms as well as the patients with cancer or dying patients.

Death and dying are difficult experiences for the patients ’families. The grief, the despair, the depression crises and infantile protests confuse family members as well as medical personnel, leaving the dying patient alone in silent isolation under the burden of unhuman conditions.

Family members try to cope with their grief and guilt feelings by means of carefully thought through and expensive funerals. Nurses and doctors, working in the wards with high death levels, express their psychological crises and personal strain in the tendency to seek refuge in technology and objectivity of self-distancing. Sometimes somebody resorts to black humor. However, the discomfort due to the situation continues to grow and the medical personnel has to cope with this problem and their certain situation without any help.

They experience the feelings of doubt in the self and their role, the loss of professional competence and guilt feelings in the face of death. In this problematic field, there is a very strong need for psychotherapeutic help, for relief, for professional training. In such moment a Balint group is the best and the most effective tool. 

Drees gives an example of defocus of fixation on grief in prismatic Balint group during the role play:

During half an hour, one of the participants takes on the role of a patient according to his choice. The other participant plays the role of the therapist. The other group participants are obliged to mark the transference positions of those two speakers, while at the same time develop their own intuitive associations. It allows to not only get insights related to such transference, but also simultaneously unfold the detailed metaphorical descriptions of personal experiences.

Here the discussions of the doctor-patient are tested, but at the same time, there occurs an understanding of the function of the intuitive conversation parts. It’s astonishing how the barriers of transference and countertransference may be displaced by such intuitive ideas.

Drees’s description of the group:

The doctor, practicing in the rural area, tells the group about a patient who seemed “paralyzed” after the death of her son of leukemia two years before. Even her husband was no longer able to have an adequate conversation with her. At that time, she was an in-ward patient of a psychosomatic clinic and then had a course of psychotherapy. However, nothing brought results. The rural doctor describes that he also feels quite helpless.

In the following role play he takes on the role of the patient and has an interview with a woman, a family doctor. At the beginning of the conversation his colleague describes her image of a large red flag at the top of the mountain. To everyone’s surprise, the doctor, undergoing the interview and playing the patient’s role, very emotionally tells about a white flag with a bat, which her son made when he was sick and which he after the illness attack regularly raised in the garden with a view to the nearest mountain. The flag was put on top of his coffin and buried together with him. The daily newspaper published this photograph.

The doctor, treating the patient, now describes his growing feeling of sorrow. He hardly restrains tears. During many months he was “paralyzed” by this feeling of sorrow each time the patient was in his office. He reports that during seven years he has been treating her son, suffering from leukemia, up to his death at the age of eleven. He was present at his deathbed.

After the interview one female participant of the group reports that her sorrow and the physical strain flowing out of it, give a picture of a frantic waterfall dropping down on a valley. She also vividly describes a strange mountain scenery. The mood of the doctor, treating the mother, now changes and he tells how her little son stayed active and creative up to his death and always consoled his mother until the very end.

After the description of the following images of endless spaces, “warming coldness”, consoling and humorous scenes, autumn moods and graciously presented fruits, the colleague reports that he can now speak freer with his patient. In the conclusion, the group discusses the astonishing intuition regarding the flag, arising in the very beginning of the group process and associated with the expressed grief fixation of the doctor, treating the patient.

For the first time in practice, I got acquainted with such groups during my leader’s training in Potsdam. Doctor Wolfgang Loesch conducted the groups using the method of symboldrama — the imaginative-sensitive therapy. After the case presentation, all the group members were offered to envisage an image regarding the presented case.

It was a bang of emotions and images — bright, deep and very accurately reflecting the situation. Such images enriched the work a lot. Then at the leader seminars of the Polish Balint Society I observed how often the metaphors, scenarios, where one of the group members was the therapist and the other, for instance, the patient, were used. It brilliantly illustrated what the presenter told and opened new facets.

In my practice I offer the group members to envisage any image regarding the presented case and these plots considerably help to grasp the essence of the told case and catch the mood.

For example, at one of the latest groups one female participant remembered a fairy-tale about the Bremen musicians and this association changed the flow of discussion. There is plenty of such examples. 

Thus, mood orientation allows us to understand and integrate the new non-verbal bodily and sensitive-oriented methodics into our work. Prismatic mood oriented training groups lower the emotional strain and by so doing minimize the burnout syndromes. Such groups provoke mood awareness in the therapist as well as in the patients, which enlarges the psychotherapeutic possibilities and integrates non-verbal methodics into the all-inclusive mood concept.

The experience of prismatic Balint group with its key terms — orientation on the mood process, prismatic expansion, transformation of the interaction patterns, sensitive resonance, metaphorical imaginative language and poetic communication — is used beyond the Balint structure in psychotherapy.