This is a weekly On-Line HIPAA compliant (private and secure) Zoom group covered
by OHIP. The participants will be MDs working in Ontario with a minority of
members being Psychotherapists connected to TS Medical Centre. The participants
are expected to commit to attending no less than one third of the sessions.
A referral from your GP is needed to join this virtual group. Prior to entering the
group, you will be meeting with me via Zoom for one or more sessions to get
acquainted. We will discuss your goals and assess if this group is suitable for your
purposes.
Description, On-Line Balint Group
This On-Line Balint Group is for MDs of all specialties across Ontario. The goal is to
focus on the relationship between the MD and their patients. The facilitator’s
analytical attitude (the relationship between two people is partially driven by the
unconscious patterns and motivations of both participants) allows the group to look
at the MD-patient relationship so to reflect on how both parties contribute to
challenges in the relationship.
What is the structure of the group?
1) The leader has Psychoanalytic and Group psychotherapeutic expertise.
2) The Group meets weekly. The group membership will vary session to session as
members are allowed to miss up to 2/3 of the meetings.
3) Meetings are 1.75 hours. With an optional additional fifteen-minute post group
reflection for members interested in leading their own Balint Groups.
4) The method is that of case presentation without notes.
What happens in the group?
1) Group starts with a ten-minute guided meditation, that helps to ground all
members and model an attitude of non-judgmental, open minded, curious kind and
compassionate acceptance of whatever may be expressed in the group.
2) The leader asks, “Who has a case?”
3) A member volunteers to tell the story of a challenging case. This is not a standard
case presentation, but rather a description of what happened between the MD and
their Patient. It need not be long, complicated or exciting but something that is
continuing to occupy the presenter’s mind. It may be puzzling, or has left the
presenter feeling angry, frustrated, aroused, irritated, sad…
4) After the presenter has finished, the group members will ask factual questions to
fill in the gaps of the story shared
5) After the group has finished asking questions, the presenter will turn their video
off and mute themselves on the Zoom platform. As if the presenter has moved
behind a one-way mirror if we were meeting in person. The intent for this is to free
up the group members to be less influenced or directed by the presenters. We are
attempting to reduce the nonverbal unconscious rapid implicit communication
between the presenter and the group, in the first portion of case discussion.
6) In the visual absence of the presenter the group discusses the relationship
between the MD and the Patient and tries to understand what is happening that
evokes these feelings. Group members are also encouraged to share whatever
comes to their mind even if not logically connected to the material shared. The
intent is to tap into the unconscious of each member and the group as a whole so to
bring to awareness possible novel perspectives.
7) In the last part of the discussion the presenter is invited back to join the
conversation after having witnessed the multiple expressions and perspectives that
were shared in the group as a consequence of their story.
8) Depending on the complexity of each case we may cover one or two cases in each
group
9) in the optional 15 min, post group section we reflect on the group process and
facilitators interventions and its effectiveness. At times and as needed there maybe
a five-minute didactic teaching of psychological and neuroscientific topics relevant
to interpersonal communications. Topic such as Empathy, Transference, Attachment
theory, right brain to right brain communication and therapeutic aspects of groups
etc. The hope is that covering those topics in addition to reflecting on the group
process will help train members to run similar groups themselves.
What can this group do?
1) It provides an opportunity for MDs to reflect on their work
2) It can provide an outlet for anxieties and frustrations generated by their work
3) It can reawaken the MDs interest in patients whom they are experiencing as
upsetting, annoying or “difficult”
4) It can open minds to other possibilities, both of diagnosis and day-to-day
management.
5) The group provides support and improves communication skills with patients
and other professionals
6) It can improve job satisfaction and resilience and help to prevent burnout.
7) Help train members to run similar groups
What does this group not do?
1) It does not tell MDs “how to do” their work
2) It does not provide easy answers
3) It will not solve all of the MDs’ problems with patients
4) It is not a psychotherapy group for the MDs. But therapeutic elements are active.
It is calming and affirming when the MDs share their stories and feel heard in a nonjudgemental and compassionate manner by peers in the group. In addition to those
therapeutic factors, they may also gain insights into their own patterns and reflect
on what they may be bringing to their MD-patient relationships.
CONFIDENTIALITY:
All participants in the group expect and can be assured that what they talk about
will be treated with respect and confidentiality. It is an essential aspect of ethical
professional conduct. The more public nature of group therapy does make it a less
private form of therapy, and hence these confidentiality guidelines are important to
keep in mind at all times.
a) Therapist Confidentiality:
For continuity, I will be recording brief confidential notes on each group member
and group as a whole. Each person can have access to his or her personal notes
though not to the group summary notes.
b) Group Members Confidentiality:
Strict confidentiality is expected of all group members.
That includes who is in the group and all participants’ ‘stories. This degree of
confidentiality is absolutely necessary for group participants to feel safe and for the
development of trust within the group.
You may know another group participant from your personal or professional
activities. Please do not discuss group issues outside of the group.
As this group is not a psychotherapy group, but more of a supportive group, outside
of group socialization with other group members is not discouraged.
Please feel free to discuss the group with your own therapist as that relationship is
bound by the same professional confidentiality codes. If you find yourself in
discussion with friends or family, be certain not to attach names to what you are
saying and avoid saying anything that might identify a person specifically. Talk
about your own story and not other members’ stories.
c) Video Conferencing Platform, Zoom
Virtual “face-to-face” sessions or VC (Videoconferencing) are real-time interactive audio
and visual technologies that enable a clinician to provide mental health services remotely.
Treatment delivery via VC may be a preferred method due to convenience, distance, or
other special circumstances. The VC system used in my practice is a professional version
of Zoom which meets HIPAA standards of encryption and privacy protection. You will
NOT have to purchase a plan when you “join” an online meeting. When you reach the
“Join a Meeting – enter meeting id” screen, please EDIT your name so that only your first
name shows in order to protect your privacy in group sessions.
Here is a link that is helpful if you are not familiar with Zoom. I recommend that you
experiment with it ahead of your sessions; it will show you how to join a meeting, and
how to check your audio and video.
https://support.zoom.us/hc/en-us/articles/201362193-How-Do-I-Join-A-Meeting
Please read and note that:
• There are many benefits and some risks of videoconferencing that differ from inperson sessions.
• Confidentiality agreements that are always integral to your care, are the same for
telepsychology services.
• Recording of sessions is NOT permitted.
• A webcam needs to be used during the session.
• It is important to be in a quiet, private space that is free of distractions (including
cell phone or other devices) during the session.
• It is imperative that no family member or friend is in hearing or visual proximity to
you or to your electronic device during the session.
• It is important to have a secure internet connection rather than public/free Wi-Fi.
• In order to be punctual please set up for the appointment at least 5 minutes before it is due to begin. You will be admitted to a virtual waiting room.
• A back up plan in the event of technical problems may include restarting the
session, or more likely supplementing with a phone for audio.
• Our safety plan includes at least one emergency contact and your location during
the call.
ANTICIPATED LENGTH OF THERAPY AND INITIAL LENGTH OF TRIAL
PERIOD/COMMITMENT:
The group is offered in three closed modules each lasting between 10-13 sessions.
Modules start on September, January, and April of each calendar year. There are no
sessions over July and August.
The participants have the option of continuing with subsequent modules for as long
as they find the sessions useful and can attend at least one out of three sessions on
an ongoing basis.
Participants are asked to make responsible use of their opportunity to be involved
in this type of group. The availability of this group is quite limited, so I ask that the
participants be responsible about their involvement and attendance while in this
group. If a member is missing more sessions that contracted for, I will contact the
member and the member and myself together will decide if the member should
continue with the group.
COST:
The cost of the group is covered by OHIP. You will not be charged for missed
sessions.
ATTENDANCE/LATENESS/GROUP PARTICIPANTS VACATIONS/THERAPISTS
VACATIONS:
Arrival on time to each session is expected. Please try to attend at least five minutes
before the On-Line session to make sure the technology is functioning well. The
platform will be open 15 min before each group to allow for some social time
between the members. If you are late you may have to wait in the Zoom waiting
room till the initial guided meditation segment is finished.
Its best to let me know if you are going to be late or if you can’t attend a session
I ask that you text me at:
416 627 4590
Or email me at:
kasra.khorasani@utoronto.ca
I ask that you let the group know your vacation plans well ahead of time. I will do
the same. The group works most effectively if it is cohesive, reliable and predictable.
PS:
Document updated August 2023