Exploring Triangulation as the Foundation for Family System Thinking in the Balint Group Process

Contemporary family medicine has recognized and made explicit that the dyad of physician and patient is an illusion. The most elemental unit of analysis has become the triangle, involving doctor, patient and family. Sometimes the third element is not a family, but a consultant or even a pharmacological prescription, some system equivalent. A triangle may manifest a dynamic quality of its own that often induces its players into the roles of victim, rescuer and persecutor. Balint case presentations and group process are analyzed to illustrate how physicians get caught in the drama of triangulation and induced into family systems. Residents learn in the Balint process that they do not have to defeat illness, restructure families or rescue patients from distressing medical, life threatening situations in order to be therapeutic. This is avoiding triangulation and pursuing a more efficient, therapeutic doctor-patient relationship.