Bohdan Wasilewski,

Ireneusz Kaflik, Jan Łazowski

Abstract:

This paper describes the fundamental organizational framework of intensive training for those who wish to obtain the qualifications authorizing them to lead BGT on their own. The current training for leadership is limited to a brief description of the requirements to obtain the desired qualifications.

These can be found in the statutes of organization of the Polish Balint Association and in a curriculum approved by the Management Board of the Association.

The training consists of replicating the behavioral patterns of “masters” and orally transmitted instructions. In discussing supervisory procedures, our intention is to close the gap (if only partially) between qualification requirements and practical training activities.

Michael Balint introduced group training for physicians 60 years ago in Great Britain. The groups were subsequently named — Balint groups (BGs). In Europe, the Balint movement has a history of over half a century and in Poland for over 30 years.

Balint group trainers were invited to Poland from Germany, England and Switzerland and they helped to introduce international standards. Their first goal was to prepare local BG leaders. The future leaders of the Balint groups played active roles in the first international Balint training sessions.

The Polish Balint Association (PBA) was established on 18th May 1991 and promotes the ideas of the Balint movement, conducts training for many groups, organizes conferences and training and it educates candidates to become independent BG leaders. Interest in the Balint movement has increased, but a shortage of people qualified to lead the training has become evident.

The need for leadership training became a pressing issue in 2008, when Ukrainian physicians and psychologists applied for participation in BGs in Poland. They wanted to start the Balint movement in their country and needed leaders with the required qualifications. In order to address this deficit, intensive multi-day training for leaders was organized by the PBA in Warsaw, Czestochowa and Kraków. In other centers, the enthusiasts of BGs organized training on an occasional basis; e.g. in Wrocław, Węgorzewo, Zakroczym, Struga, Przemyśl and Poznań. In principle, almost all of them serve as a means to develop and improve the therapist-patient (client) relationship.

In Poland, the training for leaders consists of 100 hours of participation in a BG, which consists of 80 hours of independently leading a group and 20 hours of working under an experienced leader’s supervision.

A leadership candidate is required to have a university education and several dozen hours training in psychology, psychotherapy and psychosomatics, as is the case for BG leaders in Western Europe including Poland. This model of requirements is one, which could be usefully replicated elsewhere.

A commission composed of experienced leaders decides on how the candidates should be prepared and indeed on whether they are ready to sit the exam. They assess the candidates’ qualifications by comparing their work to that of the experienced leaders and exams are held under the supervision of the president of the PBA and an Examinations Commission.

We have been fortunate in that outstanding teachers have led our long-term participation in Balint training. Our own practice as leaders and the standard of education in psychology and psychoanalysis in small groups has enabled us to develop an insight into the fundamental processes of Balint training.

The purpose of the training that we propose, addresses the competences required of a BG leader and his or her expectations. In so doing, we have adapted the educational program, including the methodology and process of supervision. Formal requirements for admission to the exam are described in a curriculum approved by the PBA.

The professional requirements, which to date were only verbally communicated are described in the present paper and are largely based on work published by Balint and his disciples. We also use oral information, publications and manuscripts by our colleagues, in addition to our own experiences of practicing psychotherapy.

The circumstances and requirements of this project have forced us to explore further and deepen our knowledge about what happens during Balint training. Our conclusions and reflections are included in this proposal, which we believe to be both innovative and to a certain degree, original. We have introduced an additional session in the leadership-training program that we term “the support session” (SUS) in which we distinguish three levels of leadership education.

Moreover, we include a proposal for more accessible training conditions. The preparation, verification and gradual improvement of the present proposals are based on observation and analysis of the training programs, led or supervised by the authors in 2009-2014 and they resonate in the version we now present.

Significant contribution to the development of the Balint training methodology for group leaders, derives from the training center of Czestochowa, led by I. Kaflik (Kaflik I. at all., 2013, 2015), as well as other centers (Wasilewski B., 2008, 2014). It can be used both in intensive training and single training sessions. The presentation of the program starts with a description of Balint group training (BGT) rules. Supervision methodology consistent with the standards set by Sackin, P., Salinsky J et al is also described.

Rules for the organization of Balint training

The Balint Method requires certain skills to be demonstrated by participants and they are divided according to the competences demonstrated. …

In order to streamline the course organization we need to differentiate three levels of skills related to the Balint method.

1.The elementary level is of individuals who start their adventure with Balint groups, who attended 50 hours of BGT. This group is composed of psychologists, doctors, psychotherapists, lawyers, managers, priests, nurses, educators and helpline consultants — people involved in assisting others in the broadest sense of the word.

2.The next is the “improvement level” group which consists of individuals who have already had 50 hours of training and still wish to take part in BGT. Their objectives are as follows: improve the understanding of the method, develop the ability to communicate effectively and in their own practice, to increasingly use the skills acquired during the training. These people were offered new tasks in the BGT.

3. The last or advanced group is designated the “supervision level” and is for those who have attended at least 100 hours of training led by certified BG leaders and who have begun to lead groups as leaders or co-leaders under supervision. In addition, in order to verify their skills of leading BGT independently, they are already prepared for the relevant examination.

In the three-day leadership course, the composition of the training group is best composed of participants from the 3 levels mentioned above. We suggest that for a minimum sized group (14 members) the training is most effectively conducted when the 3 levels are represented by 5 persons at elementary, 5 at improvement and 4 at supervision. These proportions will enable 6-8 supervising training and 4 support sessions to be conducted.

Venue requirements: At least one room which accommodates all the participants is needed, i.e. a room for at least 50 people together with the audiovisual equipment for lectures, seminars and training of the large group. Two rooms, each of which must accommodate 15 people for small group training and 1 small room for 6 people suitable for support sessions.

Duration and Schedules: We organize 3-day and 5-day courses. The 3-day course has a total of 30-32 hours of training (so called school hours of 45 minutes) and consists of 24 hours of training (12 sessions per 90 minutes) and 8 hours of lectures and seminars. The 5-day course includes proportionally more hours.

Training Staff: The best use of time is achieved by working with 3 leaders, two of whom should be experienced supervisors.

Leadership Course Schedule: The example below indicates how we structure a 32-hour training course for a minimum of 14 participants. This is the number of participants for leadership training below which the costs of fewer participants outweigh the benefits. The first day of training begins with a presentation of the organizational assumptions and an introductory lecture.

After that a certified leader starts working with a demonstration group after which small group training sessions are held. The number of members within each group depends on the overall number and level of the participants. The degree to which the participants are familiar with the methodology determines the way in which the groups are led.

Certified leaders lead the elementary and improvement groups and the advanced group is led by candidates for BG leadership, under the supervision of an experienced and certified leader called the “supervisor”. On the first day, two advanced training and support sessions together with an elementary session can be carried out with 14 participants.

The day concludes with a 2-hour lecture followed by a seminar in which all trainees and trainers participate. On the second day, 5 group trainings are held out of which — two advanced in two groups and two support sessions. The day ends with a one-hour lecture and a one-hour seminar.

On the third day, 4 training sessions take place in two groups, two of which are advanced and two support sessions. There is a 2-hour lecture and a seminar to conclude the course.

Organization of supervision:

Part 1

The first part of the supervision is a training session led by two candidates for BG leadership, in which they assume the roles of leader and co-leader. In this part, the supervisor locates outside the group and does not participate in the group-work at all, leaving the leader and co-leader to lead the session.

His role consists in observing and collecting material to be used in the first assessment of candidates ’work according to standard rules. These are set out in that section which deals with the role of the leader in the first part of the present work.

The work collected and his observations will inform his comments which are critical for the support session .. The following suggestions facilitate more objective assessments: Make a record of the problem, analyze and record relationships, note the number, timing, content and results of interventions at particular stages of the training.

A positive assessment of the group process depends on it having credibility for the participants and an effective explanation of the process.

Part 2

The support session is the second part of the supervision and takes place directly after the training. The supervisor arranges a session and then leads it. This can be held either with or without the group depending in part on the number of supervisors.

The main purpose of this session is to help candidates improve their skills of leading the training sessions. This is done through a constructive assessment of their work, addressing their shortcomings, noting their progress and correcting any mistakes in all training aspects. In the support sessions the group is composed of the candidates for leadership who lead the training, a person selected by the candidates and a person selected by the group.

The 2 people selected by the candidates and the group are called delegates and they help recall particular details of the training. As a result the candidates learn how their own statements were received and what remarks were made regarding their performance. The delegates improve their BT-related skills thanks to their participation in the support session.

Stages of the Support Session: The work in the support session can be presented in 5 stages. This division is not a rigid construct but rather a tool to prompt discussion of the how the course was conducted and to assist in recalling the core training problems. Such reflection is necessary in order to usefully discuss the candidates’ behavior and responsibility for this remains with the delegates in stages 1 and 2.

Stage 1. This involves a description of main problems noted in the reported narrative and should consider why the patient came for the visit and why at that particular moment. Further, what were the patient’s expectations, how were these signaled and then described by the reporter, and how was this described (by the reporter) and finally his / her expectations of the training program. 

Stage 2. In this stage the main relationships, which are evident from the story and the group, should be identified: therapist — patient, story-teller — group, leader — group, leader — co-leader, group — patient.

Stage 3. This involves a discussion of the leader’s activity and his / her performance of the required tasks.

• Did the leader identify the training problems and the main relationships?

• Did the explanation of the problem emerge spontaneously during the group’s activity or did the leader direct it?

• What were the number, quality and accuracy of the leader’s interventions?

• What determined the timing and substance of the interventions?

• What were the overall results?

Stage 4. This stage concerns the subject of co-operation with the co-leader.

• What was the division of tasks while planning the training?

• Were those tasked able to co-operate?

• How effective was their communication?

• What emotions and feelings were revealed?

• How did this influence the group process?

The supervisor links the delegates’ contributions to the questions posed by all members of the session. The candidate who assumes the role of leader explains his interventions, analyzes their results, explains their reasons and reports his moments of certainty and doubt.

The co-leader does the same and all participants of the session are then invited to take part in the discussion. In his position of authority, the supervisor usually decides on the conclusions emerging from the session. He should however take into account the opinions of other participants. He should aim at understanding and be capable of judging the credibility and objectivity of opinions, even when these differ and / or are ambiguous.

Stage 5. This last stage lists the strong and weak points of candidates’ skills revealed before, during and after the training sessions. It is important to emphasize successes, to analyze results and reflect on what could have been done differently and perhaps better. The supervisor finally brings the session to a close and proposes future directions for further development.

The role and responsibilities of the Supervisor

The objective of the candidates is to achieve the requisite qualification; this will enable them to independently lead a supervised BGT. The supervisor mentors and guides them toward this goal. He observes the training outlined above, but plays a largely passive role, remaining for the most part uninvolved.

This means that he does not intervene in the training process, but collects the relevant information in order to discuss and evaluate the candidate’s work. The support sessions are organized and managed by him in a planned and structured way, according to the rules set out in the present paper.

He formulates the conclusions and recommendations (derived from the support sessions) to generate further development of the leadership candidates knowledge and competences ..

Literature:

1. Kaflik I. (2013). The experiences of the doctor and the patient in psychotherapeutic contact. Existential tradition: philosophy, psychology, psychotherapy, 1.22.105-116.

2. Kaflik I., Łazowski J. (2015). Training for candidates for Balint Group Leaders according to Częstochowa model. In: Wasilewski B., Engel L. (Ed.) Balint Group Training. Theory and Application. IPS Editions, Warsaw, 2015, in preparation for printing.

3. Sackin, P., Salinsky J. (2012). The Balint group as a form of supervision. In: Owen D., Shohet R. (Ed.). Clinical Supervision in the Medical Profession. Open University Press, Berkshire, 34-47.

4. Wasilewski B. (2008). Training of communication skills of medical doctors in Poland. Veröffentlichung des Kongresses: 59. Jahrestagung des Deutschen Kollegiums für Psychosomatische Medizin (DKPM) und 16. Jahrestagung der Deutschen Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM) 12.-15. März 2008. Freiburg im Breisgau, p. 58

5. Wasilewski B. (2014). Supervision of the Balint groups leaders and use of Balint groups as a tool for psychotherapy training. J. Psychosom. Res., 76, 6, 519.

Authors:

Bohdan Wasilewski, MD, PhD, Professor at Psychosomatic Institute, Poleczki str. 40A, 02-822 Warsaw, Poland, e-mail: b.wasilewski@ips.pl

Ireneusz Kaflik, PhD, Ośrodek Usług Psychologicznych, Jana III Sobieskieskiego Str. 19/12, 42-217 Częstochowa, Poland, e-mail: psyche45@op.pl

Jan Łazowski, MD, PhD, Emeritus Professor of Medicine, Łużycka str. 44 m. 12, 30-658 Kraków, Poland, e-mail: jan.lazowski@gmail.com