What I Learnt from Sitting in on a Balint Group as an Intern

Heartscape Psychology
3 days ago
6 min read

By Heartscape Intern, Tan Hong Ting

When I first attended a Balint group at the National Cancer Centre Singapore (NCCS), I expected something similar to a clinical case discussion — perhaps focused on treatment planning, problem-solving, or patient management.

Instead, I found myself sitting in a room where healthcare workers spoke honestly about something we often do not talk enough about: what it feels like to care for patients.

As an intern, it was one of the first times I witnessed healthcare not only as a science, but also as an emotional relationship.

So, what is a Balint Group?

A Balint group is a reflective discussion space where healthcare professionals explore the emotional side of patient care and the clinician–patient relationship. Developed in the 1950s by psychoanalyst Michael Balint, the concept emerged from his observation that difficult consultations are often shaped not only by medical concerns, but also by emotions, communication, and the relational dynamics between clinician and patient (Balint, 1957).

In a Balint group, a clinician presents a challenging patient interaction, and the group reflects on the feelings and perspectives involved — not to “solve” the case, but to better understand the human dynamics behind it (Otten, 2017). Today, Balint groups are used across many healthcare professions worldwide as a way to support reflective and compassionate care.

Inside a Balint Group Session

What stood out to me was how differently the cases were approached.

The discussion did not begin with “What should we do next?” Instead, it began with questions like:

How do you think the clinician felt?
What emotions came up while approaching the patient?
If this were your case, what would you secretly wish for?
If you were the patient, how might you feel seeing the clinician walk in?

The conversation moved beyond symptoms and logistics into something more human: helplessness, frustration, hope, and even guilt.

The Emotional Weight Behind Patient Care

What stood out to me during the session was not necessarily the details of the cases themselves, but the emotional weight clinicians carried while talking about them.

As different healthcare professionals shared difficult patient encounters, I noticed how often emotions such as helplessness, frustration, hope, and even guilt surfaced beneath the clinical discussions. Some spoke about feeling anxious before approaching certain conversations, while others reflected on the quiet pressure of wanting to emotionally connect with patients who seemed withdrawn or distressed.

What struck me most was that the group did not respond by immediately trying to problem-solve or “fix” the situation. Instead, participants slowed down to explore what these interactions felt like emotionally — both for the clinician and, imaginatively, for the patient as well.

Rather than viewing patients solely through a clinical lens, the conversations seemed to re-humanise the emotional complexity within these relationships. I began to realise that many difficult healthcare interactions are not about a lack of care, but about two people carrying very different fears, vulnerabilities, and expectations into the same space.

As an observer, it was powerful to witness how simply having room for reflection could subtly shift the way clinicians related to their patients — moving from frustration or emotional difficulty toward greater curiosity, empathy, and understanding.

The Unexpected Heart of the Discussion

What surprised me most was how imaginative and reflective the discussion became.

Participants used metaphors, imagery, and even fictional references to describe the emotional atmosphere of the cases. Some described feelings through places or environments — from the cold isolation of the Swiss Alps to the emotional distance portrayed in Frozen, both reflecting the loneliness when a patient emotionally shuts them out.

At first, this seemed unusual to me. But over time, I realized these metaphors helped people express emotions that are often difficult to put into direct clinical language. Rather than describing distress in abstract psychological terms, images, stories, or symbolic comparisons can be used to communicate feelings that felt too overwhelming, confusing, or vulnerable to state plainly (Fainsilber & Ortony, 1987).

In many cases, the metaphor created enough emotional distance for difficult experiences to become discussable (Salih, 2025). It also allowed the group to explore underlying fears, frustrations, or hopes in a way that felt less confrontational and more emotionally accessible.

Shi Min also gently guided the group back toward noticing their own physical and emotional responses by prompting questions like:

How do you physically feel at that moment?
What urge came up?
What fantasy or hope were you holding onto?

It was less about analyzing the patient from a distance, and more about understanding the emotional experience of caring for them.

Finding the Spark Again

Healthcare workers are often expected to continue showing compassion no matter how emotionally difficult a case becomes. Over time, repeated exposure to emotionally demanding encounters can contribute to burnout, compassion fatigue, or even avoidance behaviours toward certain patients. Studies on clinician wellbeing have increasingly shown that emotional exhaustion does not arise solely from workload, but also from the relational strain of caring for patients in distress without adequate opportunities for reflection or support (Adams et al., 2006; Figley, 1995).

What I think Balint groups offer is a structured space to pause and reconnect with the “why” behind patient care. They can be seen less as teaching sessions and more as opportunities for clinicians to slow down and examine how patient encounters affect them personally and emotionally.

The discussions often move beyond clinical facts, creating room to explore uncertainty, frustration, empathy, and the subtle relational dynamics that can easily go unnoticed in day-to-day practice.

Not every difficult patient interaction can be resolved immediately. But when clinicians are given room to reflect, process emotions, and hear perspectives from others, it can help shift the way they see the patient — from a “difficult case” back to a person carrying pain, fear, vulnerability, or unmet needs. Research on Balint groups has suggested benefits such as improved empathy, greater tolerance for clinical uncertainty, enhanced reflective capacity, and reduced feelings of professional isolation (Monk et al., 2017). Some studies have also found that reflective group spaces may support resilience and reduce burnout by helping clinicians feel emotionally supported within their work (Kjeldmand & Holmstrom, 2008; Yazdankhahfard et al., 2019).

At the same time, Balint groups remind clinicians that their own emotional reactions matter too. Feelings such as helplessness, irritation, anxiety, or sadness are often treated as something to suppress in healthcare settings, yet these emotions can contain important information about the therapeutic relationship and the pressures clinicians carry internally. Having a safe environment to explore these reactions can help clinicians better understand both themselves and their patients.

As an intern, I left the session realizing that healthcare is not only about treating illness. It is also about sustaining the human capacity to keep showing up for people, even when the work feels emotionally heavy. In many ways, reflective spaces like Balint groups acknowledge that caring for patients also requires caring for the emotional wellbeing of healthcare workers themselves.

And sometimes, finding that spark again starts with simply having a space where healthcare workers themselves feel heard.

References

Adams, R. E., Boscarino, J. A., & Figley, C. R. (2006a). Compassion fatigue and psychological distress among social workers: A validation study. American Journal of Orthopsychiatry, 76(1), 103–108. https://doi.org/10.1037/0002-9432.76.1.103

Ahead App. (n.d.). How healthcare teams build self-awareness through daily reflection rituals. https://ahead-app.com/blog/Mindfulness/how-healthcare-teams-build-self-awareness-through-daily-reflection-rituals

Balint, M. (1957). The doctor, his patient, and the illness. Postgraduate Medical Journal, 33(382), 417–418. https://doi.org/10.1136/pgmj.33.382.417-a

Balint Group Greece. (n.d.). What is a Balint group? https://www.balintgroupgreece.com/en/what-is-a-balint-group/

Fainsilber, L., & Ortony, A. (1987). Metaphorical uses of language in the expression of emotions. Metaphor and Symbolic Activity, 2(4), 239–250. https://doi.org/10.1207/s15327868ms0204_2

Figley, C. R. (1995). Compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized. https://api.taylorfrancis.com/content/books/mono/download?identifierName=doi&identifierValue=10.4324/9780203777381&type=googlepdf

Kjeldmand, D., & Holmstrom, I. (2008). Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. The Annals of Family Medicine, 6(2), 138–145. https://doi.org/10.1370/afm.813

Monk, A., Hind, D., & Crimlisk, H. (2017). Balint groups in undergraduate medical education: a systematic review. Psychoanalytic Psychotherapy, 32(1), 61–86. https://doi.org/10.1080/02668734.2017.1405361

Otten, H. (2017). The theory and practice of Balint group work. https://doi.org/10.4324/9781315147055

Salih, A. A. (2025). The power of metaphors in psychotherapy: enhancing therapeutic communication, emotional expression, and transformative change. Journal of Humanities and Education Development, 7(2), 80–84. https://doi.org/10.22161/jhed.7.2.9

Yazdankhahfard, M., Haghani, F., & Omid, A. (2019). The Balint group and its application in medical education: A systematic review. Journal of Education and Health Promotion, 8(1), 124. https://doi.org/10.4103/jehp.jehp_423_18