Social Dreaming

by Franca Fubini

social dreamingSocial Dreaming was discovered by G.Lawrence in the 1980’s when he directed Tavistock Institute of Human Relations in London.
Lawrence, recovering a historical and anthropological knowledge, hypothesized that it is possible to dream socially (i.e., to consider the dream as a manifestation of the social dimension in which we live) and that dreams can shed some light on the shared social context (just as Freud hypothesized that dreams, in the course of analysis, can shed some light on the unconscious life of the dreamer).

Social Dreaming is a methodology to transform the dream-thought using free association, amplification and systemic thinking, so as to create links, find connections and reliese or generate new thoughts.

The basic event is the Social Dreaming Matrix, where some basic concepts of social dreaming have developed: matrix, free association, amplification, working hypothesis, systemic thinking.

The matrix is the "locus" where waking conscious life mirrors the unconscious/infinite world of the dream-work that occurs in the sleep. The matrix is a place where 'something can grow’.
The matrix is a group of people (from six to sixty persons with one or more ‘hosts’ – who act as facilitators) assemble to share dreams and, through free associations and amplification of some themes, find links and create connections to explore the dream-thought.
Lawrence hypothesized the need for a dream container – the matrix – different from the group – which is a word saturated with meanings, a too well-known tool that had been explored for decades in the history of reasearch at the Tavistock Institute and in many other contexts –, as the latter would stir already explored dynamics and observation verteces that would mainly lead to the psyche of the individual in the group.
The matrix constitutes a new container to unveal new context of dreaming. The matrix is at the same time a form and a process. As a form, it is represented by a group of people that together create a container to think the dreams, their contents and their potential meanings. As a process, the matrix is the system, the network of the thoughts, the emotions and the connections in each relationship, but it is not always recognised or taken into consideration.

The free associations were discovered by Freud as he invited his patients to say whatever came to their minds without censorship.
To explain this concept Freud used the metaphor of a journey by train. When we look out the window, every aspect of the landscape stirs impressions, images and thoughts that are free associations.
In the process of yielding to free associations elicited in the account of the dreams, we find out paths that escape the rational linear thinking. Without needing to judge what emerges in the mind, we can associate to the images of a dream and other images may connect and further more images, striving together to make sense of the dreams.

Amplification means to expand a thought, an image, a sentence.
The participants use their imagination to explore the dream, to frame it in the cultural context in which it was produced, to understand its symbolism. Without thinking that there are right or wrong answers, an idea will lead to another idea, a dream to another dream in the process of transforming the thought, which is the primary task of a matrix. Amplification respects the integrity of the dream.

The systemic thinking of dreaming looks for configurations that interconnect dreams, and similar dream elements group up and identify common themes. The systemic thinking does not look for the best and successful option, as the analytic thinking would do, but considers all the options to let then emerge a synthesis, the product of all the elements and something different from the sum of the elements themselves. A sum that becomes the key to reveal an unexpected reality and possibly a new vertex of observation.
In the SD matrix the chair of the members are arranged as a snowflake or a hive, that is, an initial geometrical module of 4, 5, 6 chairs that develop a pattern made up of multiples of the original module. As if the first hive cell is the building block that is then duplicated to create the whole arrangement.
The arrangement in space somehow takes up the development of the dream thought. Very often, if not always, the first dream that is told in the matrix becomes the fractal around which the entire ensuing thinking of dreaming builds or unwinds.
In Social Dreaming dreams are not interpreted and no reference to the dreamer’s life is made; dreams are rather used to put forward some working hypotheses, some approximations to reality as it is perceived. The working hypotheses can match the evidence or become redundant, in which case new working hypotheses need to be formulated.
It is the scientific method whereby we learn from experience.
It occurs as we reach the limit of our own understanding of the reality in which we live and we acknowledge the need to formulate new hypotheses to work with.
This is particularly helpful within the business contexts, where one is periodically forced to verify the limits of planning and those of understanding the market.
Times of change might require faster responses than the ones an enterprise can give. At these times it is necessary to access what the unconscious/infinite of the system has already picked up and its potential creativity to put forward new hypotheses that respond more promptly to the market’s requests.

In Italy SD programmes have been applied within consultancy to business and training projects: in public insitutions, hospitals, universities, intercultural workshops and within the context of research, in profit and non-profit organisations, in many associations dealing with immigrants and refugees, etc.
It is taught in Psychology faculties in three Italian universities (Rome, L’Aquila, Turin).
Intensive research seminars are regularly held in Rome and Turin, where G.Lawrence used to participate in running them.
However extremely versatile and very interesting, SD has more or less appropriate contexts in which to be applied. It is necessary to evaluate when and how to use it, in relation to a specific analysis of the clients’ demands and being aware about its potential results.

- Social Dreaming is very accurate for the climate analysis. It reveals clearly what are the thoughts and the concerns of the system to which the group participating in the matrix belong.
- It favors a fluid, non-hyerarchical interaction among the members: ‘meaningful’ connections and conversations develop.
- It favors a non-dependence culture, in which the capacity to exert one’s own authority and to work in a group of people develops.
- It fosters the capacity to tolerate not knowing, so as to really access new thoughts.
- It promotes the development of systemic and complex thinking.
- When it is used with continuity, it leads to change that sometimes, by its nature, appears in an unexpected and surprising way.

Tavistock Method

tavistockThe Tavistock Method is essentially:

a) a method of analysis of institutions, aiming at action-research or organisational diagnosis;
b) a training tool for managers, technicians and professionals;
c) a consultancy technique for organisations that are going through some difficulty and their members.

It has its roots in the theoretical corpus and the applicational experiences carried out by the Tavistock Institute of Human Relations and the Tavistock Clinic in London in the field of social research and group and organisational psychodynamics.

Over the last 50 years the Tavistock Institute and the Tavistock Clinic have developed, both in cooperation and separately, an intense activity focusing on group relations, the analysis of institutional processes and consultancy to public and private organisations, applying its results to an understanding of the work team functioning, the analysis of socio-health services, the exploration of helping professions, to organisational diagnosisi and business consultancy, and paying close attention to authority and leadership issues.

From this research path, among other things, stemmed:

•  the notion of group emotional functioning developed by Bion with his theory of "basic assumptions" (fight/flight, dependence and pairing);
•  the notion of social systems as defenses against anxiety, developed by Elliott Jaques and Isabel Menzies;
•  a large body of studies on authority, leadership, roles and institutional boundaries, chiefly informed by Eric Miller and Kenneth Rice’s work;
•  the discovery of the social meaning of the dream by Gordon Lawrence ("Social Dreaming");
•  the notion of the organisation-in-the-mind formulated by David Armstrong;
and more generally the studies on the importance of emotions in human work and in the life of organisations.

This complex of ideas and concepts gave rise to what has been called the Tavistock Method, an eclectic conceptual paradigm, originated from the encounter of two different theoretical matrices that, over time, have found an excellent mutual integration:

1. Group psychoanalysis that W.Bion initiated in the 1950’s and his followers developed (E.Jaques, I.E.P.Menzies, H.Bridger, P.Turquet, R.Gosling, etc.)The latter re-founded it as socio-analysis and also exported to larger institutional contexts.
2. Systemic theory, formulated in the USA and in Great Britain, it had its roots in the systems general theory and K.Lewin’s studies and later developed as a socio-technical theory in the field of groups and organisations by A.K.Rice, E.Trist, E.Miller, W.G. Lawrence and others.
Along these matrices, after which it was named as "systemic-psychodynamic approach" (or "Group relations"), there are important contributions from other disciplines, such as economics, political science, social psychology, business and administrational science.

In this sense, the Tavistock Method is not a closed and exhaustive theoretical system. It does not aim at a complete explanation of the institutional processes and does not contrast or want to replace the more known and proven notions on business management or work psycho-sociology. However, unlike the latter, it is based on a "clinical theory of organisations" that is in fact conceived as a complex human system with its life cycles, its health and illness cycles, a "body" that can experience suffering and vulnerability but can also activate generative or destructive and self-destructive behaviours, a "mind" that can learn and think, but also an organisational unconscious working below the surface and full of fantasies, myths, prejudice and powerful primitive emotions.  That is why the method explores, in particular, the blind areas of the organisational life and the unconscious components of individual and group behavious within an institution, with the conviction that they can affect deeply the functioning of the institution itself and its ability to pursue its primary task, the quality of the relations among its members and between the institution and the external environment, the people’s capacity to think, work creatively and manage themselves in their roles.

The general assumption is that in any organisation plans and strategies – although designed rationally, competently and accurately, using the necessary resources and being largely supported – are often defective or remain more or less unapplied.  The consequent working hypothesis is that the reasons of the problems and the failures or of strong resistance to change may depend at least in part on unexpressed psychological factors and unexpectable emotional processes that can affect the behaviour of the leadership, the management and the staff. As these factors and processes, unconscious in nature, go rationally unnoticed, the psychodynamic-systemic approach of the Tavistock Method seems to be better equipped than other approaches not only to identify and modify those processe but also to use this experience for organisational learning.
In this light, the applications of this method seem to prove clearly that the idea of rationality of organisations is essentially a myth.
Having originated in the Anglosaxon area and having developed in the Middle-European culture, the Tavistock Method was gradually processed and adjusted for a more suitable application to the socio-cultural specificity of our country and the Mediterrenean area. The need to promote exchanges and synergy between the world of human services and the world of commercial business has been particularly emphasized, trying to overcome the mutual communication difficulties between the considerations of wellbeing and the considerations of profit, between the culture of thinking and the culture of acting, as we are convinced that each part has a lot to earn from a dialogue and an exchange with the other one.

Institutional Observation

osservazione istituzionaleInstitutional Observation is a method conceived to understand  the relational processes and the institutional cultures in their less visible aspects, as these are moslty unconscious, overlooked or simply hidden. It is a method that comes from the one originally created by the British psychoanalyst Esther Bick for the mother-infant observation, the so-called "infant observation" (Bick, 1964), adapted to the analysis of organisations by researchers working at the Tavistock Clinic (Obholzer) and at the Cassel Hospital (see Hinshelwood & Skogstad, "Observing the Organisations", 2000). In fact, the “Tavistock-Cassel” method of Institutional observation integrates the use of the psychodynamic lens and a systemic and/or ethnographic understanding of the context, placing at its core the evidence of individual behaviours that can be observed through the emotional resonances of the observer and interpreting the individual behaviours as "functions" of the group or the system and as derivatives of the implicit assumptions of the institution and its hidden culture.
Several years ago our Association developed, under Anton Obholzer and Robert Hinshelwood’s guidance, some study and training programmes on the method of Institutional observation and, in the last years we have started to use observational techniques as part of our training offers, as an organisational consultancy tool and in chief executive coaching. We have organized a Conference about Institutional Observation and some of its applications in Turin in 2012.

To observe the surrounding reality is an innate capacity as well as a need. We need it to orient ourselves in the world and to decipher the relationships and the emotions of the others. It also gives us valuable information  about ourselves. We ceaselessly observe things and people, events and speech, the details and the larger picture, but we are rarely told that we can use what we have observed or how to use it, so much so that most observational data remain unconscious and unseen or are available just to regulate our automatic behaviours. Except some rare exceptions, such as in infant observation or the study of behaviour in school and the anthropological enquiries, this “natural” process is not considered as a tool that could be used by those who work in groups and organisations,  as managers, staff members or consultants.

The supporters of the "digital" approach will object, with some good arguments, that a camera or a scanner see much better than the human eyes and that when you are looking for detailed, reliable and complete information an observer provides too few garantees, as he sees and does not see, distorts, forgets, tones down, interprets, shortly, his vision is too subjective. That does not occur – or it does to a much lesser extent – with objective observational systems, such as journals, photographs, scales, questionnaires, audio and video recording, etc.

However, to our ends – i.e. a deep understanding  of relational dynamics and institutional cultures – the superiority of subjective observation lies in the very fact that it is not a  “recording” but a non-saturated and incomplete process of understanding. What might look as a flaw – that is, too many missing elements, in terms of content and sometimes also in terms of context – often turns out to be advantageous, as it forces us to draw on more sensory, intuitive, empathic kinds of experience and mostly on self-observation, largely based on the emotions that are elicited in the observer by the observed field, which is what is called "countertransference" in psychoanalysis.

The goals of Institutional observation can be summed up as follows:
1.    to observe without preconception and to formulate hypotheses on the functioning of an organisation;
2.    to maintain the observer role, despite pressures to leave or change it;
3.    to stay in contact with one’s own feelings and emotions and try to understand  to what extent these are the observer’s (countertransference) responses to the institutional processes he/she has been exposed to.

The above three points, that are crucial in consultancy, are just as important for those who work in an organisation as professionals, managers, chief executives or trainers.

Using this kind of observation is very helpful, not only in the research projects but also in advanced forms of organisational diagnosis and consultancy or deep coaching and in the analysis of organisational roles, in counselling for structural or strategic issues, in negotiations, in conflict resolution and crisis management. Institutional observation can also be part of many training programmes, particularly in group work training, where it can be carried out individually (when a group works in the presence of an observer) or collectively (like in the fishbowl setting, where a group work re-enact a problem in the middle of a larger circle of observing participants), enhancing the degree of involvement and the capacity to learn from experience in the attendees.


Balint Groups

by Mario Perini

gruppi BalintBalint Groups is a well-established method to train medical doctors that aims to help them deeply understand the nature and the vicissitudes of their relationship with the patient and to improve their communication with the patient and his environment, using it therapeutically, and to decrease conflicts and professional stress.
The inventor of this method, Michael Balint, was born in Budapest in 1896, his father was a general practitioner, and he became a doctor himself. After his psychoanalytic training in Berlin and Budapest, he emigrated to Great Britain in 1939 and, after World War II, he was part of the staff group at the Tavistock Clinic in London. Here he and his second wife Enid began holding training seminars for “general practitioners”; Balint groups were later named after him.
Today the training in the Balint method is spread across the world and the experiences in different countries have led to the creation of Balint Associations nationally (in Switzerland, Germany, France, the Nederlands, Great Britain, the USA, Italy, etc.). Most of them are part of the International Balint Federation. Even though attending a Balint training is mostly an individual choice made by the physicians, participation in a Balint group is part of the official medical student curriculum and GP trainees and, in Germany, physicians with this background have the right to get higher fees in their out-patient clinical practice (Ransom 1995).

Fundamental lines

The Balint Groups began at the end of 1940’s when the British Ministry for Health, as it launched the National Health System, asked the Tavistock Clinic and in particular Michael and Enid Balint to hold a psychiatric training to GPs so as to compensate the severe lack of mental health specialists. The original idea was to train general practitioners and manage the so-called “small psychiatry”, but the scheme was soon proved to be unfeasable.

However, from this attempt some important concepts arose. The Balints realized that an understanding of the therapeutic (or iatrogenic) potential in the doctor-patient relationship met much more the needs of the GPs than an extra psychiatric training. The physician’s personality – as it was discovered in the seminars at the Tavistock Clinic – was by far the most important medication in the treatment, but the GPs knew very little about this medication (its dynamic and kinetics, its posology and toxicity, its therapeutic action and side effects), as their approach was traditionally based rather on the symptoms and the illness than on the person, and even less on the relationship between the doctor and his/her patient. Balint developed this notion thouroughly in The Doctor, his Patient and the Illness (Balint 1957), a book that apparently changed the features of British medicine (Sutherland 1971).

The assumptions in the Balint Groups approach are four main points, that are currently as important as they were at the end of the 1940’s:
•    Psychological problems manifest themselves often through physical phenomana and, on the other hand, physical illness has psychological consequences.
•    The doctor is not a neutral observer and the patient in not an “isolated fish in a fishbowl”.
•    General medicine offers a fertile ground for the application of psychological thinking.
•    To understand the patient as a person and to show empathy towards him/her has in itself a therapeutic value.

Traditional medical training, focused on a nosological, objective and fragmented clinical practice and on technical and impersonal aspects of treatment, does not provide the doctor with any instrument that enable him/her to use his/her own subjectivity or a relational perspective, despite the evidence showing that a great deal of the phamily physician’s work is devoted to psychological cases and problems. How do the vicissitudes of the doctor-patient relationship lead often to dissatisfaction and anxiety for both of them, as well as being a source of diagnostical and therapeutic mistakes? How come that having technical competence, common sense and good will ultimately is not enough to be a good physician?

But then, what are the Balint Groups? What kind of training do they offer?
The Balint Group is not a didactical workshop or group therapy for doctors, but a “learning environment”, that is, a training institution that gives the physicians a chance:
•    to explore and check continuously their perception of emotional and personality factors– their own and their patients’– that play a role in the illness or interfere with the treatment or affect the therapeutic relationship;
•    to re-define their own role as GPs (without any need to become psychiatrist or psychologist), also in the broader relation with the network of services and social institutions involved in the treament process.

The main goals of this approach are:
•    greater sensitivity about the clients’ needs and an enhanced ability to understand and deal with the anxieties and difficulties implicit in a care-giving relationship, avoinding counterproductive defensive systems
•    an increase in the degree of satisfaction about one’s own work and the quality of relationships and of professional services
•    an understanding of the organisational processes and network relations that affect the work and the institutional climate, with a subsequent improvement of the clinical governement  and decrease in the risks of mistake and professional burnout.

More in details, the expected results are:
-    the ability to manage more easily – that is, with less anxiety, pain, anger or frustration – the patients that were felt as intolerable earlier;
-    the creation of a broader repertoire of strategies and personal styles that can be adapted to different patients, instead of a defensive use of rigid patterns that cannot be changed (in the anamnestic interview or the clinical examination);
-    the possibility to take the proper distance from the pressure exerted by the patients, so as  to examine the meaning before responding and to avoid “reactive”, impulsive, short-circuiting answers or acting-out;
-    an opportunity to critically analyze “in retrospect” the the medical examination process, paying attention to one’s own emotional responses to the patient’s behaviour;
-    the development of a state of mind involving a “non-judgemental curiosity” about the irrational behaviours of the patients;
-    being aware that the emotions stirred during the meeting with the patient reflect his/her state of mind, processes and unconscious conflicts about his/her self-image, life and illness (use of transference and countertransference);
-     enhanced ability to manage the relationships with one’s colleagues, the interprofessional relationships and those with bodies, istitutions and agencies with which the doctor has to interact for the treament;
-    an experience of relief and support for the doctors (both for the one presenting the case and for those who discuss it), although the goal of the group is the professional development and the role maintenance rather than personal therapy.  

Structure, atmosphere and evolution

In Balint Groups a number of doctors meet regularly with one (or two) experienced group leaders to discuss the doctor-patient relationship. In turns each participant reports about one of his/her current clinical cases – preferably a problem patient – and the other members intervene with comments, emotional responses and working hypotheses. Problems related to the patient’s psychology or personality, the interactions occurring in the therapeutic relationship, the family’s role,  the doctor’s relationships with his/her colleagues and the institutions involved in the process – such as the hospital or the local health services, will tend to emerge in the discussion.

The group meetings are not a platform for the discussion of the types of patients or the treatment techniques of “abstract” illnesses. Unlike the biomedical model, which is based on generalization, this approach mainly attends to individual differences that make the encounter between a given doctor and a given patient “unique”. The assumption underlying the Balint Groups process is that all the doctors have their habitual models of response to particular types of patients and problems and in their clinical practice they are periodically confronted with questions, dilemmas and contradictions that depend on environmental factors, such as the work context, and on personal elements, such as their age, gender and emotional life.

In the Balint Group the discussion prompts the participants to examine their individual approaches to different circumstances and to explore alternative ways of responding. The leader’s role is not to teach “contents” or to give advice, but to help the group think creatively and enrich their repertoire personal repertoire to manage difficult situations. The leader stimulates the participants to deepen their understanding of the therapeutic relationship, draws their attenton onto details that can be important clues about the relational processes and monitors the group climate to prevent it from becoming too aggressive or shifting into small-talk.

The atmosphere in Balint Groups is based on listening, acnowledging the emotions as a compass to understand the doctor-patient relationship, a climate of freedom of “giving-and-taking”, where everyone can bring a problem in the hope of learning from the group. This approach does not deal with abstract concepts – in fact it considers theoretical discussions as intellectualized defences that hampers the group’s task – and it has to fight the temptation to idealize the patient, the illness or medicine (or the Balint group itself). The discussion focuses on the feelings, the fantasies and the vicissitudes of interpersonal relationships, not on “medical issues”. Its central axis is the emotional response of the doctor to the patient.

Among the typical difficult situations brought to the Balint Groups there might be:
-    the dying patient
-    the patient to which a bad piece of news has to be told
-    the patient with a thick clinical folder (a “stuck” of medical examinations)
-    the seductive patient
-    the angry patient
-    the demanding patient
-    the dependent patient and the regressed patient
-    the hyper-anxious patient
-    the chronic patient
-    the patient “playing his own game”
-    the non-compliant patient
-    the depressed patient and the suicidal or potentially suicidal patient
-    the manipulative patient
-    the “psychosomatic” patient or the patient with marked somatizations
-    the “crazy” patient
-    the alcoholic or addicted patient
-    the patient who goes to all the consultants
-    the “scapegoat” patient who hides all the other family pathologies behind his/her illness
-    the patient who is also your neighbour, acquaintance, relative, friend, shopkeeper, clerk in your bank, your child’s teacher, etc.
-    the patient who is also one of your colleagues

How does a Balint Group work?

The Balint Group is a natural task-oriented group and, as such, it has its own life with its aging and renewal cycles. Its duration has no set time limit, but the experience shows that one gets the best results when its members participate for about two years. Until the group is working, there can be some participants leaving and other joining in or replacing them. Ideally the groups include between 6 to 12-15 members who meet for  2-3 years. Depending on the circumstances and the time limits, the duration of the meetings range between one and two hours once a week or every two weeks.

Even though the basic approach – that inspired Michael and Enid Balint’s experiences in the 1950’s and 60’s – was maintained, the Balint Groups underwent a remarkable evolution over time, as they came to deal with huge changes in medicine, the social structure, the health culture and the therapeutic relationships. As the traditional paternalistic medical roles have disappeared, the greater and more spread health knowledge, the increase in autonomy and negotiation power of the patient, along with the break-in of technology, “managed care”, and a variety of different institutional agencies at the very heart of the therapeutic alliance have introduced new models and experiences in the Balint method and practice (J. Balint 1996).

In the course of the years the method expanded and later was adapted to an increasing number of medical professionals other than the GPs, such as hospital doctors, nursing staff, psychologists, social workers, medical students, Therapeutic Community workers, educational and teaching staff, judges and lawyers working with minors and famiglie as well as interprofessional groups. The flexibility of the method chiefly depends on it being centered on:

•    the inquiry of the (therapeutic, educational, helping) relationship
•    the group action as a facilitating instrument for thinking
•    ways of experience-based learning not only based on intellectual knowledge

All these elements are not specific of the medical practice but belong to all the “helping professions”.
Compared to the original model, that implied the participation of people coming from the same work environment, in interprofessional Balint Groups a relative heterogeneity among the members in terms of professional disciplines, cultures and working languages is justified
-    as it mirrors the contemporary working models based on multidisciplinary teams and the network of services;
-    for its value in prompting the learning process and a confrontation among different perspectives, as training experiences across the world within the so-called “Tavistock model” of group relations show (Perini 2007).

The focus has not changed: it still emphasizes not the illness or the clinical picture but the patient or, rather, the relationship between the latter and his/her doctor. However, this relationship is more and more complex, as it has to deal with the patient’s family or with a therapeutic staff group that is in charge of the patient in some specific situations (hospital, Therapeutic Community, home care, hospice, ambulance), it has become part of a “case management” in a network of services, it is confronted with group processes among several therapeutic teams, it may be dealt with in the context of group medicine, or it interacts, negotiates and sometimes gets into conflict with the hospitals and their managers. Therefore, the focus of the Balint Group cannot only be on the doctor-patient dyad, but it needs to expand across a network, a relational plexus that includes the following relationships:
-    doctor-patient
-    doctor-doctor
-    general practitioner-consultant-patient
-    doctor-patient’s family
-    doctor-patient-nurse or care-giving staff
-    doctor-clinical team or colleagues
-    doctor-patient-institution (hospital, local health service, insurance, justice, social services, etc.)

As well as
-     doctor introduces the case-Balint Group members
-     Balint Group members-Balint Group leader

Faced with this scenario, which is not so reassuring, doctors often wonder (and ask to the organizers of Balint Groups) why they should engage in this further task, as their job is already so demanding. Consistently with the complexity of the picture, the answer is not as simple. We could talk about supporting the care-giving role, explain how the Balint method helps manage the group relationships and, ultimately, the organisational climate and the work relationships with the patient and all his/her environment, although this may sometimes look like an extra burden than a relief.

We could list all the development and progress indicators occurring in the Balint Groups:
-    doctors capable of “listening” to their patients (letting them talk, seizing the critical points, etc.);
-     enhanced attention paid to details that mirrors the state of the medical-patient relationship;
-    fewer “blind areas” (“unseen” aspects despite their clarity or “overlooked” though important aspects)
-    fewer purely technical or intellectualized discussions about medical or psychological aspects in favour of an action-oriented understanding;
-    fewer diagnostic and therapeutic mistakes;
-    greater and more useful participation in group discussions, greater courage to expose oneself without fearing of loosing one’s face, greater availability to offer one’s own contributions to the group without exibitionism, greater freedom of criticism without manifestations of contempt or destructiveness;
-    higher quality of observations and case reports (more complete, more detailed and more “personal” descriptions);
-    less tension with the patient  and fewer non-compliance cases;
-    less intense “detective-like” approach or interpretative inflation;
-    greater capacity to recognize the emotions at play and the recruited defences (including “role defences” connected with the physician or the patient’s status);
-     talking is less oriented towards the symptoms and more towards the relationship;
-    temporary increase in the duration of the consultancy (including the so-called “psychotherapeutic” phase) followed by greater satisfaction in one’s work;
-    greater tolerance of “uncertain” and “unknown” situations as inevitabile experiences in the medical practice (and recognition of the defensive nature of omniscient certainties)

But these advantages are true mostly for those who are living this experience. What about the others, those who do not know what it is about? What can we say that is convincing?
Maybe just this: the exploration of the therapeutic relationship tends to activate in the group a network of “support among peers”. Sometimes, when being a doctor or taking care of the patients is becoming an increasingly complicated, anxiety-provoking, disavowed and exhausting task, Balint Groups can help decrease the emotional load of the care-giving function, prevent professional burn-out and alienation and make the doctor feel a little less alone.

Work Method

metodo di lavoroThe theoretical-scientific frame in our work draws on the studies about groups and the ensuing application models from the research and experimentation activity at the Tavistock Institute, known as the Tavistock Method and is based, primarily, on psychoanalytic theory applied to groups and institutional analysis (socio-analysis) as well as the open systems theory.

In the analysis of and the interventions on social processes and organisational dynamics we share the need for an inter-disciplinary approach that strives to open a dialogue – both in theory and practice – with a variety of disciplines that help understand institutions and human work, such as psychoanalysis, social, anthropological and economic sciences, psychology, educational sciences and the theories on business organisation.

In our training, consultancy and research programmes we use different tools and ways that we adjust to different contexts or to the specific needs of our clients but are mainly based on learning from experience. Some of these tools, such as Group Relations Conferences, Listening Post, Social Dreaming, Institutional Observation, Balint Group, Role Consultancy, particularly inform our approach.

Our work method has also, as one of its essential foundations, the group functioning.
To design and implement our programmes we mostly invest in the creation and the maintenance of interprofessional work team, attending in particular to clarity, suitability and sustainability of roles and tasks and paying close attention to the quality of our services and the achievement of sought-after objectives. At the same time we strive to protect the relational climate against the detrimental effects of a criticising and blaming culture and to preserve the willingness to learn from experience and the defence of organisational wellbeing.

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