Group processes in forensic psychiatry Balint work

Working in forensic psychiatry can lead to complex feelings, including countertransference reactions, in professionals who are attempting to provide care and containment for offenders. If these feelings go unrecognised and unexplored, then they may interfere with therapeutic care. In this paper, we describe case reflections which could be discussed in a Balint style reflective practice group, for clinicians caring for people within the forensic psychiatry system. Group processes are described, to demonstrate the essence of the work that occurred, via case vignettes. We describe seven fictionalised cases, considering a selection of factors that may be reflected on, demonstrating the process of the group. We highlight a general theme of each group, including intense feelings of loss and grief, contrary views leading to chaos, denial of reality, loss in suicidal ideation, psychosis as an escape from reality, therapeutic nihilism and complex moral dilemmas. In forensic psychiatry, professionals are dealing with some of the most traumatised people in society, which can be very emotionally triggering. Use of Balint groups and other forms of reflective practice invite clinicians to process such trauma and avoid burnout.