The hardest days in the clinic do not usually involve the complexity of medicine. They more likely involve euthanasia, the inability to save the life of a patient due to financial restrictions of the pet owner, and when clinicians and clinic staff are targeted by an emotional pet owner in distress.
Exposure to trauma and moral conflict are common in veterinary practice,1,2 and secondary trauma and burnout are closely associated among healthcare workers.3 Emotionally challenging episodes can accumulate and have lasting negative effects when left unattended.
Reflective practice is the deliberate examination of personal actions and experiences, with the goal of gaining deeper awareness, and it can help clinicians recognize relationship dynamics with owners and nurture healthy boundaries. Although individual reflection can help focus and refine personal thoughts, understanding the perspective of others can help reveal hidden assumptions, expand one’s comfort zone, and achieve new understanding.
The Balint Method
The Balint method was first introduced by Michael Balint, a psychoanalyst, and his wife, Enid, a clinical social worker.4 They worked with general physicians in England who treated World War II veterans and developed a group method that focused on the therapeutic effects of the physician–patient relationship.4 The goal was to improve understanding of the patient’s psychology and develop awareness of how the physician’s emotional response affected the treatment relationship. Balint groups were used to train physicians to be more conscious in their work and, thus, become better at practicing medicine.
Balint Groups
A Balint group is a small group of care providers that examine the clinician–owner–patient relationship. During a Balint session, a member presents a case to the group, and the possibilities contained within the relationships of the case are discussed.
In practice, clinicians often see patients with diseases that evolve or do not follow expectations. Constraints often make definitive diagnosis impossible, and the inability to form a clear answer can be disappointing and possibly even feel like failure. The ability to thrive in the face of uncertainty may be the most important skill veterinary medical professionals learn. Balint groups offer exploration without definitive conclusion, allowing participants to gain comfort with ambiguity.
American Balint Society National Meeting
January 26-28, 2022
In Practice
In addition to allowing examination of the professional self, the Balint method encourages curiosity about what clinicians and owners bring to interactions. It is important this is accomplished among colleagues in a safe space separated from clinical practice. This method provides engagement of the often underused cognitive muscles (eg, via expansive vs reductive thinking patterns).
Although skills learned through the Balint method can improve medical practice, there are many benefits beyond professional skills. Exercising divergent, creative thinking can be a relief to those who feel trapped in the clinic. Hearing colleagues echo and explore similar experiences can provide important validation that is more meaningful than sympathy and support offered in a less-structured environment.
With Balint groups, the richness and complexity of veterinary medicine is acknowledged in a way that is often missing from conversations about professional lives. Research in human medicine supports the Balint method as a training tool and a way to combat isolation and loss of connection with purpose in medical providers. Participants report decreased feelings of isolation and guilt, as well as feeling “understood and cared for.”4 One study found an increased sense of self-efficacy and decreased burnout in nurses who participated in Balint sessions for 10 months.5
Personal Experience
The author has co-led a veterinary-specific Balint group for 2 years along with a credentialed Balint leader, who is a retired human medicine nurse and licensed social worker, and the benefits have translated well to veterinary medicine. Participants reported feeling understood by their peers and a sense of relief similar to that experienced in human medical groups.