The Balint Method(Care of the Dying)

Abstract

According to the recent investigation about terminal care, the educational curriculum of terminal care is set up only by 21.2% of Japanese large hospitals (Miyamoto, et al.). This demonstrates the lack of educational methodology for terminal care in Japan.We have been practicing terminal care education by the Baliant Method for more than two years. The Balint Method is developed by Michael Balint M.D. (1896-1970), who was born in Hungary and opened his clinic in London as a general practitioner. He developed his way of medical interview by "listening" to the patient. He tried to understand his patient biologically, psychologically and sociologically. He began his group-work in order to educate general practitioners so that they can understad their patients as whole persons. Ikemi, Y. has theorized essentially that the Balint Method makes it possible to understand the doctor-patient relationship (interpersonal communication) objectively, which hepls intrapersonal communication in the patient which covers his own bio-psycho-social levels. According to this mechanism, the patient will become aware of himself as a whole person, and then he will try to solve his problems for himself.Recently, especially in the U.S.A., behavioral medicine ahs developed its methodology, whose medical model is a bio-psycho-social one (Day, S.). Ikemi has added the psychoecological (or bioethical) point of view to this model.We began our "Fukuoka Balint Group" to study terminal care since July 1980,which includes medical doctors, nurses, psychologists and citizens concerned. We discuss freely, from a bio-psycho-socio-ecological (or ethical) standpoint about dying cases with difficult problems. A leader and a moderator helps participants expose their feelings to the case and the others accept them positively. The TPEG (Terminal Patient Evaluation Grid) has been made use of effectively as a learning strategy. According to the TPEG, we analyze the case bio-psycho-socio-ethically. In experience of 2 year-group-work, 93% of the participants have changed their view of patients' dying, and 44% of them have improved their own view of living and dying, and 31% of them have evaluated that their therapeutic selves have improved.Ikemi points out the merits of the Balint Method in terminal care as follows : 1) Through free discussion, the therapist can learn objectively how he himself treats his patients. 2) In the Balint Group, the participant can expose his feelings about the patient freely, and the others accept them positively. 3) In the process of dying, the patient shows various psychological reactions. The therapist can control his subjective impressions (subjectivity) and come to understand the patients' reactins objectively through the Balint Work. 4) Reactions of the dying patients are rich in variety. It is impossible for a therapist to understand all of them. In the Balint Group, many participants have various experiences. To hold them in common helps to solve this difficulty. 5) These experiences in the Balint Group will deepen the view point of living and dying and will be the base of the therapeutic self.