8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.9 Reflective practice, Balint groups and clinician care
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Reflection in clinical work
Reflective practice means looking back at a clinical encounter, at how you responded and at what it might mean. The aim is to understand and act better next time.
Countertransference (the clinician's emotional responses to the patient) can tell you something about the relationship.
Reflection also looks at the clinician's own circumstances, assumptions and previous experiences. Not every feeling comes from the patient.
Supervision gives support and challenge within an agreed professional frame. It covers competence, boundaries and clinical responsibility.
Balint groups
Balint groups grew out of the work of Michael and Enid Balint. They focus on the relationship between clinician and patient, not on producing a detailed diagnosis or management plan.
The presenter describes an encounter that was memorable or troubling, usually from memory. The group explores the feelings it stirs up and the different ways the relationship could be understood.
The leader keeps the space respectful, discourages advice offered too early and encourages curiosity about more than one point of view.
The group agrees how it will keep confidentiality and handle information about patients and colleagues respectfully.
Choosing a reflective space
Setting | Main purpose |
|---|---|
Balint group | Understanding the clinician-patient relationship |
Case supervision | Developing formulation, treatment skills and clinical judgement |
Team reflection | Exploring shared emotional responses and patterns in care |
Incident review | Understanding what happened and improving systems |
Personal therapy | Meeting the clinician's own therapeutic needs |
Caring for clinicians and teams
Self-care means rest, boundaries, supervision, contact with peers and seeking help when distress or illness affects how you function.
The organisation is responsible for manageable demands, psychological safety and access to support. Reflective practice cannot make up for unsafe working conditions.
Team consultation helps staff hold different perspectives and agree a coherent response without labelling one colleague or one patient as the problem.
Reflection needs protected time and skilled leadership. Attending should not require staff to disclose personal material beyond the group's agreed purpose.