规培科室巴林特小组简介PPT课件

巴林特小组简介朱丽娟*困惑 患者对低年资医生不信任；纠纷时，医师感觉孤立无援；被带教老师当着病人的面批评，继而病人又 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 示强烈不满；目睹同事被患者辱骂；熟人患者治疗效果不满意，面对朋友的抱怨；患者不合理的要求……挫败、烦恼、痛苦、委屈、愤怒、悲伤、迷惑……*主要内容 1、什么是巴林特小组 2、巴林特小组的目的 3、巴林特小组的特点 4、巴林特小组的工作程序 5、巴林特小组案例提供者和组员要做什么 6、参加我院巴林特小组前的评估和协议签订* 巴林特（Balint）小组工作是欧美医学教育和职业培训的必修课程，聚焦职业化医患关系，有助于促进沟通与医患和谐，由匈牙利精神分析师MichaelBalint于20世纪50年代在英国伦敦创建的针对医务人员职业压力的培训和研讨小组。我国已于2011年6月加入国际巴林特小组联盟，并作为职业化医患关系技术的推广。**创始人MichaelBalint1896-1970psychoanalystattheTavistockClinicinLondon**BrJGenPract.2005September1;55(518):724–725.MichaelBalint—anoutstandingmedicallifeEdinLakasingOneofthemostnotablenamesingeneralpractice,MichaelBalint'sanalysisofthedoctor–patientrelationshipanduseofgrouptherapymadehimaninternationallyacclaimedfigure.1MichaelBalintwasbornMihályMauriceBergmanninBudapest,Hungaryon3December1896,hewasthefirstoftwochildrenofaJewishGP.Heobservedhisfather'spracticeandfromayoungagebecameinterestedinthedoctor–patientrelationship.In1914hebeganstudyingmedicineattheSemmelweissUniversityofBudapest,butshortlyafterwascalledtothearmyintheFirstWorldWar.HeservedinRussiaandlaterItaly,wherein1916aninjurytohisleftthumbmeanthewasabletoreturnhome.Hismaininterestsasastudentwerebiochemistryandpsychoanalysis.OntherecommendationofhisgirlfriendAliceSzékely-Kovács,hereadSigmundFreud'sTotemandTabu,andbeganattendingthelecturesofSándorFerenczi,whoin1919becametheworld'sfirstProfessorofPsychoanalysis.Despitethewarinterruption,hequalifiedin1918attheearlyageof21,andofficiallychangedhisnameataroundthistime.MichaelmarriedAliceSzékely-Kovácsandin1920thecouplemovedtoBerlin.HesplithisworkingdaybetweenthebiochemicallaboratoryofOttoWarburg,thefutureNobelPrizerecipient,andtheBerlinInstituteofPsychoanalysis,workingwithHansSachs.Meanwhile,Alicealsotrainedinpsychoanalysisandsupplementedtheirmeagreincomebyworkinginafolkloremuseum.TheBalintsreturnedtoBudapestin1924,wherehecontinuedtoworkwithFerencziandstartedpublishinghisownwork,particularlyinpsychosomaticmedicine.HealsostartedhistrainingandsupportgroupsforGPs,whichhadtobecurtailedshortlyafteraradicalright-winggovernmenttookpowerinHungaryin1932.Theyviewedpsychoanalysiswithsuspicion,notleastbecauseitskeyfiguressuchasFerencziandBalintwereJews,andinsistedthatpoliceattendmeetingstomonitordiscussionsaboutpatients,thusrenderingmeetingsuseless.In1939theBalintsandtheirsonJohnmovedtoEngland,settlinginManchester.LaterthatyearAliceBalintdiedsuddenlyfromarupturedaorticaneurysm.BalintwasinvolvedmainlywithchildpsychologyduringhisstayinManchester,becomingdirectoroftheChildGuidanceClinic.Heremarriedin1944buttherelationshipwasnotasuccessandthecouplepartedsoon,thoughdivorcewasnotfinaliseduntil1952.In1945hesufferedanotherpersonaltragedywhenhisparents,abouttobearrestedbytheNazisinHungary,committedsuicide.1945wasalsotheyearBalintmovedtoLondon.HebecameaBritishcitizenin1947,andthefollowingyearjoinedthestaffoftheTavistockClinic.Itwasherethatin1949hemethisfuturewifeEnidEichholz,andinhisfiftieseventuallyfoundpersonalcontentment,thoughthecoupledidnotmarryuntil1958.Shewasasocialworkerwhoworkedwithpsychologistsinvestigatingmaritalproblems.Hebecameleaderofthis,thefirsteponymousBalintGroup,andin1950herestartedthesupportivegroupworkwithGPsthathehadbeguninHungary25yearspreviously.HeservedtheBritishPsychoanalyticalSocietyasscientificsecretaryfrom1951–1953,andasPresidentfrom1968untilhisdeath.Balint'smostfamousworkwasTheDoctor,HisPatientandTheIllness,whichwasbasedontheexperienceoftheTavistockGPsgroup.2Theconceptsexplored,suchastheuseofthedoctorasadrugandthecollusionofanonymity,arewellknowninthelexiconofmoderngeneralpractice.Whenhereachedtheageof65yearsin1961,Balinthadtoofficiallystopworkingasadoctor,althoughhecontinuedhisgroupworkandwasabletotravelabroadmorefrequentlyanddisseminatehisideas.Thesegrewinpopularityandin1969theGPsoftheseminalgroupsfoundedtheBalintSocietyforthediscussionandadvancementofhiswork.TheInternationalBalintFederationwasfoundedin1972.MichaelBalintdiedinLondonon31December1970,aged74yearsold.Untilherdeathin1994EnidBalintcontinuedandexpandedhisworktoincludenon-psychoanalystsasBalintgroupleaders.3MichaelBalint'slifeandworkhappenedrecentlyenoughtobearrelevancetoday,yetsufficientlyfarbacktomakeinterestingcomparisonswithtoday.Ishallofferacriticalappraisalofhismainlegacies,inexploringthedoctor–patientrelationshipandinformingtheBalintgroupsforprofessionalsupport.Balintdidnotinventthedoctor–patientrelationship;however,hewasthefirsttoexplorethisinthecontextofgeneralpractice,inwhichthatrelationshipremainscentraldespitethehugesocialandpoliticalchangesthathaveaffectedthedeliveryofhealthcareinthehalf-centuryorsothathaspassed.LikeFreud,Balintwrotefrompersonalexperienceinasubjectivewaythatnonethelesshasgreatvalue,andsuchcreativewritinghasbeenacasualtyoftheprimacythatmodernmedicineplacesontherandomisedcontrolledtrial.AninterestingsidetrackisthatBalintwroteinEnglishthroughouttheBritishphaseofhislife,aremarkableachievementconsideringhisEnglishwasrudimentaryuntilhewasinhisforties.Asgeneralpracticehasbecomemoretechnicallysophisticated,multidisciplinaryandbusier,thedoctor–patientrelationshiphasinevitablyaltered;thesedaysitislikelythatacounsellormaybeaskedtoassistwithsomeofthepsychosocialaspectsofillnessthatBalinturgedustoexplore.Acommerciallydriven,materialisticsocietyhasalsoservedtoalterourrelationshipwithpatients,withdefensivemedicalpracticethemostextremeexample.Yetforallthistheempathicawarenessofthedoctorremainsakeytenetofpractice.4ThefirstBalintgroupsintheUKcameatatimewhentheimpactofWorldWarIIwasstillfresh;patients,andnotafewdoctors,hadbeentraumatised.Fromthepatientviewpoint,talkingtherapywastheonlytherapeuticoptioninpsychologicaldistress,giventhatthefirstantidepressant,imipramine,didnotsurfaceuntil1957—theyearTheDoctor,HisPatientAndTheIllnesswaspublished.Fordoctors,thewarexperienceanditsaftermathwerealsodarkdays—itisamyththatstressinmedicineisamodernphenomenon.Manyhadservedinthearmedforcesandthosethatenteredorresumedgeneralpracticemetaset-upimmeasurablylesssophisticatedthantoday.Workingsingle-handedwasthenormratherthantheexception,andtherewaslittlesupportfromnurses,counsellorsordeputisingservices.ThesupportmechanismaffordedbyBalintgroupswasthereforetimely.Today,thesegroupsoftypicallybetweeneightand12peoplearefrequentlyusedinGPvocationaltrainingschemesandareincreasinglypopularinotherspecialtiesand,ofcourse,forongoingprofessionalsupport.TheInternationalBalintFederationhasprovedagreatsuccess,withover30affiliatedmemberstates,andholdsabiannualcongress.Atonceadoctor,psychotherapist,teacher,writerandhumanist,MichaelBalintsurelyranksamongthemostinfluentialmedicalfiguresofthe20thcentury.巴林特小组的历史 对于怎样让临床医生获得对病人和医生之间关系的无意识互动的理解，巴林特对此十分感兴趣。1930年，他在布达佩斯与全科医生进行了第一次尝试。第一个定期见面的小组成员是伦敦Tavistock诊所的社会工作者，他们想进一步学习顾客冲突的无意识动力，这些都是一些伴侣和家庭。从1950年起，巴林特与一组全科医生，一些“家庭医生”工作。他称这些小组是“附带研究的研讨会”。 1954年，迈克尔巴林特写了第一篇关于如何培训全科医生理解精神分析的 报告 软件系统测试报告下载sgs报告如何下载关于路面塌陷情况报告535n,sgs报告怎么下载竣工报告下载 ，发表在《英国医学期刊》上，题为对全科医生培训心理治疗”。三年后，巴林特发表了其经典著作《医生，病人及疾病》，随后几十年里，在欧洲乃至全世界，这种精神分析思考的训练方法被称为巴林特小组***巴林特小组的组成*********** 巴林特小组是“巴林特小组”不是医生的治疗小组，但也可对组员产生治疗性的影响，“巴林特小组”是专注于医患关系，是通过职业互动，来改善医生处理医患关系的能力、提高自我的意识和发展人格的专业人员训练小组。巴林特小组中无论是组员还是组长均不提供诊断或治疗方案。小组成员都是促进案例的呈现，各种情绪体验和评论让巴林特小组变得丰富，从而对案例提供者有所帮助。**谢谢**BrJGenPract.2005September1;55(518):724–725.MichaelBalint—anoutstandingmedicallifeEdinLakasingOneofthemostnotablenamesingeneralpractice,MichaelBalint'sanalysisofthedoctor–patientrelationshipanduseofgrouptherapymadehimaninternationallyacclaimedfigure.1MichaelBalintwasbornMihályMauriceBergmanninBudapest,Hungaryon3December1896,hewasthefirstoftwochildrenofaJewishGP.Heobservedhisfather'spracticeandfromayoungagebecameinterestedinthedoctor–patientrelationship.In1914hebeganstudyingmedicineattheSemmelweissUniversityofBudapest,butshortlyafterwascalledtothearmyintheFirstWorldWar.HeservedinRussiaandlaterItaly,wherein1916aninjurytohisleftthumbmeanthewasabletoreturnhome.Hismaininterestsasastudentwerebiochemistryandpsychoanalysis.OntherecommendationofhisgirlfriendAliceSzékely-Kovács,hereadSigmundFreud'sTotemandTabu,andbeganattendingthelecturesofSándorFerenczi,whoin1919becametheworld'sfirstProfessorofPsychoanalysis.Despitethewarinterruption,hequalifiedin1918attheearlyageof21,andofficiallychangedhisnameataroundthistime.MichaelmarriedAliceSzékely-Kovácsandin1920thecouplemovedtoBerlin.HesplithisworkingdaybetweenthebiochemicallaboratoryofOttoWarburg,thefutureNobelPrizerecipient,andtheBerlinInstituteofPsychoanalysis,workingwithHansSachs.Meanwhile,Alicealsotrainedinpsychoanalysisandsupplementedtheirmeagreincomebyworkinginafolkloremuseum.TheBalintsreturnedtoBudapestin1924,wherehecontinuedtoworkwithFerencziandstartedpublishinghisownwork,particularlyinpsychosomaticmedicine.HealsostartedhistrainingandsupportgroupsforGPs,whichhadtobecurtailedshortlyafteraradicalright-winggovernmenttookpowerinHungaryin1932.Theyviewedpsychoanalysiswithsuspicion,notleastbecauseitskeyfiguressuchasFerencziandBalintwereJews,andinsistedthatpoliceattendmeetingstomonitordiscussionsaboutpatients,thusrenderingmeetingsuseless.In1939theBalintsandtheirsonJohnmovedtoEngland,settlinginManchester.LaterthatyearAliceBalintdiedsuddenlyfromarupturedaorticaneurysm.BalintwasinvolvedmainlywithchildpsychologyduringhisstayinManchester,becomingdirectoroftheChildGuidanceClinic.Heremarriedin1944buttherelationshipwasnotasuccessandthecouplepartedsoon,thoughdivorcewasnotfinaliseduntil1952.In1945hesufferedanotherpersonaltragedywhenhisparents,abouttobearrestedbytheNazisinHungary,committedsuicide.1945wasalsotheyearBalintmovedtoLondon.HebecameaBritishcitizenin1947,andthefollowingyearjoinedthestaffoftheTavistockClinic.Itwasherethatin1949hemethisfuturewifeEnidEichholz,andinhisfiftieseventuallyfoundpersonalcontentment,thoughthecoupledidnotmarryuntil1958.Shewasasocialworkerwhoworkedwithpsychologistsinvestigatingmaritalproblems.Hebecameleaderofthis,thefirsteponymousBalintGroup,andin1950herestartedthesupportivegroupworkwithGPsthathehadbeguninHungary25yearspreviously.HeservedtheBritishPsychoanalyticalSocietyasscientificsecretaryfrom1951–1953,andasPresidentfrom1968untilhisdeath.Balint'smostfamousworkwasTheDoctor,HisPatientandTheIllness,whichwasbasedontheexperienceoftheTavistockGPsgroup.2Theconceptsexplored,suchastheuseofthedoctorasadrugandthecollusionofanonymity,arewellknowninthelexiconofmoderngeneralpractice.Whenhereachedtheageof65yearsin1961,Balinthadtoofficiallystopworkingasadoctor,althoughhecontinuedhisgroupworkandwasabletotravelabroadmorefrequentlyanddisseminatehisideas.Thesegrewinpopularityandin1969theGPsoftheseminalgroupsfoundedtheBalintSocietyforthediscussionandadvancementofhiswork.TheInternationalBalintFederationwasfoundedin1972.MichaelBalintdiedinLondonon31December1970,aged74yearsold.Untilherdeathin1994EnidBalintcontinuedandexpandedhisworktoincludenon-psychoanalystsasBalintgroupleaders.3MichaelBalint'slifeandworkhappenedrecentlyenoughtobearrelevancetoday,yetsufficientlyfarbacktomakeinterestingcomparisonswithtoday.Ishallofferacriticalappraisalofhismainlegacies,inexploringthedoctor–patientrelationshipandinformingtheBalintgroupsforprofessionalsupport.Balintdidnotinventthedoctor–patientrelationship;however,hewasthefirsttoexplorethisinthecontextofgeneralpractice,inwhichthatrelationshipremainscentraldespitethehugesocialandpoliticalchangesthathaveaffectedthedeliveryofhealthcareinthehalf-centuryorsothathaspassed.LikeFreud,Balintwrotefrompersonalexperienceinasubjectivewaythatnonethelesshasgreatvalue,andsuchcreativewritinghasbeenacasualtyoftheprimacythatmodernmedicineplacesontherandomisedcontrolledtrial.AninterestingsidetrackisthatBalintwroteinEnglishthroughouttheBritishphaseofhislife,aremarkableachievementconsideringhisEnglishwasrudimentaryuntilhewasinhisforties.Asgeneralpracticehasbecomemoretechnicallysophisticated,multidisciplinaryandbusier,thedoctor–patientrelationshiphasinevitablyaltered;thesedaysitislikelythatacounsellormaybeaskedtoassistwithsomeofthepsychosocialaspectsofillnessthatBalinturgedustoexplore.Acommerciallydriven,materialisticsocietyhasalsoservedtoalterourrelationshipwithpatients,withdefensivemedicalpracticethemostextremeexample.Yetforallthistheempathicawarenessofthedoctorremainsakeytenetofpractice.4ThefirstBalintgroupsintheUKcameatatimewhentheimpactofWorldWarIIwasstillfresh;patients,andnotafewdoctors,hadbeentraumatised.Fromthepatientviewpoint,talkingtherapywastheonlytherapeuticoptioninpsychologicaldistress,giventhatthefirstantidepressant,imipramine,didnotsurfaceuntil1957—theyearTheDoctor,HisPatientAndTheIllnesswaspublished.Fordoctors,thewarexperienceanditsaftermathwerealsodarkdays—itisamyththatstressinmedicineisamodernphenomenon.Manyhadservedinthearmedforcesandthosethatenteredorresumedgeneralpracticemetaset-upimmeasurablylesssophisticatedthantoday.Workingsingle-handedwasthenormratherthantheexception,andtherewaslittlesupportfromnurses,counsellorsordeputisingservices.ThesupportmechanismaffordedbyBalintgroupswasthereforetimely.Today,thesegroupsoftypicallybetweeneightand12peoplearefrequentlyusedinGPvocationaltrainingschemesandareincreasinglypopularinotherspecialtiesand,ofcourse,forongoingprofessionalsupport.TheInternationalBalintFederationhasprovedagreatsuccess,withover30affiliatedmemberstates,andholdsabiannualcongress.Atonceadoctor,psychotherapist,teacher,writerandhumanist,MichaelBalintsurelyranksamongthemostinfluentialmedicalfiguresofthe20thcentury.