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Reflections from the International Balint Conference Porto 2019

The bursary given to me by GAPS permitted me to attend the International Balint conference in Porto in September 2019.

I left my demanding workplace, difficult and complex work, an irritating manager who quibbled over my taking two days leave, a demanding and stressful organisation that allows little space for learning and reflection, to arrive in the beautiful city of Porto. Porto is perched on the edge of the Douro river. The conference itself was held in Porto university – a beautiful campus about six metro stops from the centre of town from where l was staying. l managed to find a delightfully small yet modern, guesthouse in the old part of town. Initially l was geographically and culturally disoriented alongside hearing voices speaking in an unfamiliar tongue. The absence of the familiar and the loss of my bearings, was a metaphor for my journey through the duration of the four-day conference. This sense of loss of the familiar seemed an important place to begin my intellectual and emotional journey – allowing a space for growth, creativity and curiosity similar to that of the experience of a Balint group.

I arrived at the conference venue where I was greeted with a smile and welcomed and handed a cloth bag with the conference symbol stamped on it, inside it contained the program including all the presentations and additionally some small mementos of the city of Porto – including a small bottle of port wine. I immediately felt welcomed and excited about the days ahead.

I was absolutely thrilled that GAPs had supported me to attend this conference the theme of which was ‘seeing through other eyes. The question of what is a window was explored at the beginning. What is a window? It is a bridge between worlds, an invitation to the circulation of the real, a bond between interior and exterior, a close threshold to infinity -and our eye knows it well. A window leads us to be curious, as we look through them, we look at the openness of life, through them we realise what initially seemed to us as only a sensory perception of what is outside, was after all a precious probe to travel inwardly. A window is a hermeneutic machine, a complex system of relationships, a model of knowledge. When we open a window it opens on what?

I was allocated to my small Balint group which was also a leadership training group. We began on the Thursday in our groups at 8.30am sharp. Our group was a very international one. It constituted of two Portuguese GP’s (female), me – Aust/British SW (female); an Australian psychiatrist- (male), a GP from Luxemburg- (female), an Israeli GP- (female), Serbian Psychiatrist- (male), Brazilian GP, (female) – living in France. Our leaders were Israeli (of Brazilian origin) (male) and a Danish (female). This group anchored us and gave space for us each to take a turn at leadership, practicing the art and skill of deftly leading or being a co-leader of an experienced Balint group. Our leaders were enormously skilled, and they would make observations and gently feed these back to us, enabling our learning through our own experience and that of others. Our group met four times ( for one and a half hours long) over the course of the conference and this provided us with a space to think on a deeper level about our leadership skills, but also gave me an opportunity to observe and learn by observing others, as well as by undertaking the role myself with my co-leader. We worked together, carefully tending to the group, listening to what was both said and not said, prodding and asking questions – such as, ‘are there any other emotions that people are feeling that have not yet been spoken’? I learnt the need to stand back from the group a little, to trust the group and allow the group to work the case – learning to make short but well-timed interventions through the art of posing a thoughtfully worded question.

This experience led me to reflect on my own group, and my interventions in the groups l lead. My group is an emergent group with individuals who have had little to no prior experience of a psychologically bounded group of this kind. My desire to teach and educate seeping through my interventions, at times finding it difficult to pull back and trust the group. This is double edged as my frustration about their lack of growth may be impacting on their ability to grow – to become a more mature ‘working’ group to use Bion’s term. It also led me to think about the importance of transparency and to think out loud with the group and invite the group to think about what might be missing. It was of course interesting in the light of different expectations and slightly different nuanced way in which each person (dependent on country) , applied the Balint model. These differences emerged through the course of each group. I learned of the importance of not making assumptions but instead transparently setting firm boundaries in a manner that everyone understood from the outset. To explore with the group what they are ready to digest and process about the case, not to persist further than where the group were at. These were all important insights for me for the groups l run and in my own research.

The emotional learning in the group was contrasted with the intellectual stimulation of the papers which were presented – three papers each twenty minutes in length, with plenty of time for discussion and questions about the ideas presented. Needless to say, some were more interesting and pertinent than others. Nevertheless, they were all stimulating and invited much thought and dialogue afterwards. Each group of papers would invariably be followed by a break where all conference participants were invited to have coffee in an outside courtyard, food was beautifully presented on white tablecloths under umbrellas to protect us from the hot sun. A long queue would quickly form for drinks, as we waited for the barista to make us our freshly brewed coffee. As someone who is a confirmed lover of good coffee and food, this attention to detail was my idea of bliss.

The conference was made even more special by the generous hosting of the entire event by the Portuguese Balint Society. On the first night there was a recital in a 16th century church located in the old town of Porto. This performance involved a single musician playing his lute and singing to create a glorious sound in one of the city’s oldest churches. Afterwards we were taken on a tour of the church and told a little of its history. On the Friday afternoon we went on a boat tour along the Douro river and afterwards a tour of port and wine making which was located in a warehouse along the river. On Saturday evening the gala event took place – an evening when everyone dressed in their finery, all gathered. We mostly arrived by bus and we entered this vast beautiful space and were offered an aperitif by a black suited waiter. Once we were all gathered and comfortably chatting, we were then ushered to our tables. It initially felt a little like a wedding reception – along with the associated rising fear of being stuck next to someone unknown and feeling socially awkward, lodged itself in the back of my mind. My fears were unrealised and l was seated next to one of the Australian contingent, with much to discuss about the conference thus far. As we chatted, more wine was poured and consumed, and a delicious three course meal was served. This chatter was interrupted by a call to national groupings to gather and take their turn to sing. Being a dual national, l was approached by both the Australians and the British, others with dual nationality did the same. It was great fun. The Brits made up a song to the tune of God Save The Queen, instead inserting text which spoke of our love of the EU and not wishing to leave. The Australians sang an old favorite, Waltzing Matilda – a song they had sung before. In the final plenary the issue of singing national songs was addressed and it was proposed that dancing may be a way of crossing and bridging national boundaries.

On the Saturday, there was a presentation by medical students who won the ASCONA award similar to our own Clare Winnicott award – the difference being that there were three joint winners. They each presented their paper in person at the conference. All three were very moving and thoughtful essays and they all seemed to relish the opportunity of presenting their work to this esteemed audience.

The conference was thoughtfully conceived and every last detail it seemed had been thought about, leaving every participant to feel that they were part of something very unique and special. The final day was one largely of reflection and farewells after having spent four intense days either in Balint groups, workshops or listening to a range of papers on the value of Balint groups within diverse clinical settings across the globe. I met a range of interesting people and made some connections with other scholars also working on Balint. There were social workers in attendance at the conference – one from Germany and one from the USA. They also found value in this model and were practicing the model in their own settings. We were few in number as a profession, but it was a reminder that despite medics being the predominant profession drawn to the Balints and their work – it also has enormous resonance and meaning for those of us from other disciplines working in the human services.

So, thank you GAPS for allowing me the privilege of attending this international Balint conference 2019.

Steve Marsden
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Steve Marsden