Storytelling and Narrative Techniques: Research findings support their implication in any healthcare setting

Abstract

Introduction: Narrative therapy is a technique that was first introduced in the 1970s by an Australian social worker. Yet, its impact has been a major influence in various scientific domains, including: preventive medicine, health psychology and sociology amongst others. Alongside storytelling, the narrative therapist aids people to create stories about themselves, their identities and their overall situation they face in a way that may be self-healing for them. By 'co-authoring' a new story about one's self, the therapist and patient are creating therapeutic environment. Aim: The aim of this position paper is to elaborate on the context, within which a therapist seeks to help the patient co-author a new narrative about themselves by investigating the background core of his/her values. Discussion: Storytelling and narrative therapy techniques can form the basis for therapeutic conversations which seek to challenge dominant discourses in viewing disease and hardship in destructive ways. The biomedical model sets the framework for a holistic approach narrative therapy adds an appropriate patient and family centered addition to it. Although narrative work is considered to be part of family therapy, many authors claim that by employing these techniques in any healthcare setting by nurses, can be beneficial for the patients since engage them to cope with their illness-related challenges and assist healthcare professionals to better meet the needs of patients and families. . Conclusions: Storytelling within the context of Narrative Practice is a mode of therapy that seeks to help patients identify their values and skills associated with them. Under this light, nurses need to provide their patients with the knowledge of their ability to live these values so they can effectively deal with the complexities of current or future disease. Narrative techniques and storytelling seem to be useful in all ages, but there is an increased evidence for their implications in the care of children and young adults. Their implication is simple and there is increased evidence that they can be effective and feasible to any health setting.

Headnote

Abstract

Introduction: Narrative therapy is a technique that was first introduced in the 1970s by an Australian social worker. Yet, its impact has been a major influence in various scientific domains, including: preventive medicine, health psychology and sociology amongst others. Alongside storytelling, the narrative therapist aids people to create stories about themselves, their identities and their overall situation they face in a way that may be self-healing for them. By 'co-authoring' a new story about one's self, the therapist and patient are creating therapeutic environment. Aim: The aim of this position paper is to elaborate on the context, within which a therapist seeks to help the patient co-author a new narrative about themselves by investigating the background core of his/her values. Discussion: Storytelling and narrative therapy techniques can form the basis for therapeutic conversations which seek to challenge dominant discourses in viewing disease and hardship in destructive ways. The biomedical model sets the framework for a holistic approach narrative therapy adds an appropriate patient and family centered addition to it. Although narrative work is considered to be part of family therapy, many authors claim that by employing these techniques in any healthcare setting by nurses, can be beneficial for the patients since engage them to cope with their illness-related challenges and assist healthcare professionals to better meet the needs of patients and families. . Conclusions: Storytelling within the context of Narrative Practice is a mode of therapy that seeks to help patients identify their values and skills associated with them. Under this light, nurses need to provide their patients with the knowledge of their ability to live these values so they can effectively deal with the complexities of current or future disease. Narrative techniques and storytelling seem to be useful in all ages, but there is an increased evidence for their implications in the care of children and young adults. Their implication is simple and there is increased evidence that they can be effective and feasible to any health setting.

Key words: Storytelling, narrative therapy, techniques, nursing, self-therapy

Introduction

Storytelling and fairy tales recounting arc an integral part of daily human life, from ancient times in all civilisations. From the beginning of the lives of humans, who started gathering in groups, man has learned to communicate with the members of his/her group, and he started telling about events which he/she witnessed and stories that he had heard by his/her ancestors (Meyerhofer-Parra & Gonzalez-Martinez, 2023).

Narrative therapy was a technique that was first initiated in the 1970s by an Australian social worker (White, 1990). Since then, it has been a major influence on various scientific domains, including health psychology, sociology and philosophy. In a combination of the two techniques, the narrative therapist aids people to create stories about themselves, their identities and the overall situation they face in a way that may be self-healing for them. By 'co-authoring' a new story about one's self, the therapist and client arc creating a therapeutic environment. Whereby the person can identify his/her values and recognize the skills and knowledge needed in order to live with the confidence of disease and hardship.

Therefore, re-valuing and re-prioritizing becomes the key process of facing the challenges of deteriorated health status (Payne, 2015). The principle behind narrative therapy techniques is that people arc made up of interacting stories that comprise the very sense of who they are. Hence, narrative therapeutic interventions incorporate re-storying a client's narrative as a mean to 're-authoring' his/her preferred live. In addition, narrative therapy techniques stand as a useful tool to navigate patients facing a serious illness or at the end-of-life; through their therapeutic journey and help them cope with a number of problems. Moreover, this approach can be particularly valuable in considering health injustice in minoritized individuals and in marginalized communities (Blinderman, 2023).

From the first wall paintings of cavemen to social networks and the present day, man's need to communicate his desires and concerns has become timeless. In the first chapter of Poetics, Aristotle argues that the performing arts in general, is an imitation of human action, therefore the representation of events and actions, to disseminate and communicate them to the public, are common in humans' lives.

Theoretical Framework & Research Findings

Even the trend of 'Storytellers', reminded to people of the necessity of storytelling as a communication tool. Folktales, myths and fairy talcs have contributed and continue to contribute to the construction of meaning, acting as a communication tool from generation to generation, between societies and, more importantly, between people (White, 2004).

Bakhtin (2007), referring to the art of storytelling, characterized it as a "'bridge to an open dialogue, an encounter of our inner experience that meets another at the threshold, and creates an interactive condition at the boundary between consciousnesses, setting the fundamental social assumption that no human event evolves or is resolved within the confines of a single consciousness."

The aim of this special paper is to elaborate on the context, within which a therapist seeks to help the patient co-author a new narrative about themselves by investigating the background core of his/her values. Thus, storytelling and narrative therapy techniques can form the basis for therapeutic conversations which seek to challenge dominant discourses in viewing disease and hardship in destructive ways (Theofanidis & Fountouki, 2008).

Therefore, the narrative process cultivates a dialectical relationship between the narrator and the audience, offering the listener the possibility to construct new meaning structures influenced by his experiences. Dialogue is a part of human life, he participates in it completely, constantly seeking answers to the questions that torment him (Bakhtin, 1984: 293).

The dialogue that is developing between the narrator and the listener, is an act of interaction between two human beings (Prousalis, 2009b :360), as each meaning, which is inherent in the speech or text, is constructed according to the social context in which it is located. The ideas and positions developed within the text and discourse are challenged and negotiated by the subject/listener, who is called upon to reshape the meaning constructions (Bavelas, 2000).

The dialogue between the listener and the narrator offers to the listener the possibility to develop a deeper understanding of the Self, but also of its social environment, as well as gives him an opportunity for an examination and revision of his/her ideas. The meaning of each narrative differs between subjects, as each person concludes according to their psyche and personal quests (Prousalis, 2009a). Symbolism found in fairy tales is used by the subject for the meaningful construction of the world and personal reflection (Bruner, 1997).

As mentioned above, storytelling is the meeting point for the transfer of ideas and thoughts, a means of connecting the communicating subjects. Through this type of communication, it becomes possible to develop their ethics and to raise the individual's awareness of specific issues (Pourkos, 2009b:438).

Personal stories constitute the channel of communication between individuals, offering the possibility of reflection and the development of a dialogue on issues concerning moral dilemmas. In this way, the subject, comes into contact with different ideas, opinions and arguments, examines and revises his own attitude towards the dilemmas under discussion. Telling a personal story activates the individual to a greater extent, both imaginatively and emotionally, enhancing mutual understanding of others. By putting oneself in the place of another, the individual cultivates his empathy, solidarity, while at the same time he/she knows himself better and in depth, thus developing his personal ethics. At the same time, by examining moral dilemmas through narrative stories of third parties, the subject sometimes feels threatened and exposed to a lesser extent, resulting in a more distanced treatment of them (Pourkos, 2009a:426).

Moreover, each narrative is in a dialogic relationship with its context in terms of its historical, cultural and political context. The approach to a text or narrative becomes different each time, as the conditions under which the examination takes place have changed. The elements of the narrative interact not only with the subject, but with all the individual elements that constitute the subject - its social, cultural characteristics. The way in which the subject acquires the linguistic meaning constructions of the narrative differs according to the social context in which it interacts with the narrative product (Pourkos, 2009a:421).

In short, it can be said that the narrative work is a channel of communication and transfer of ideas between the time in which it was created, and the time in which it is read/told. Through the narratives of folk tales, today's reality opens a dialogue with the past and the history of the place, keeping alive the folk tradition and folklore in general. Being cultural products, fairy tales and legends express past attitudes, they transfer attitudes and past customs to the present day (Kanatsouli, 2014:120), seeking their place in today's society.

Internationally, there is an increasing use of narrative therapy and storytelling with diverse populations. For example, the use of these techniques in paediatric patients and their families is limited. However, they are used in order to better understand experiences of children and their families. In a recent qualitative study, Baldiwala & Kanakia (2022) concluded that narrative therapy can stand as a collaborative process that help children and their families became visible through counseling, enhance communication skills, make them more resilient and experience a sense of control over their own lives and an interest in advocating for others with similar lived experiences. The study has brought to light how narrative therapy can make possible change in lives of children and their families and wider society (Baldiwala & Kanakia, 2022). In literature there is evidence that story telling can be effective in reducing anxiety, post-traumatic disorders and behavioral disorders in children after trauma or surgery. Hospitalization places children in conditions that may nurture fears due to the unfamiliar environment, painful procedures, interaction with strangers and disruption of family cohesion. Narrative techniques and storytelling can be used as a creative way to distract children and provide supportive care (Sekhavatpour et ah, 2019; Dewi et al., 2021).

The art of storytelling also functions as an intcrgenerational tool of communication and dialogue, "carrying" stories, feelings and experiences from one generation to another, perpetuating the feeling of "belonging" and collective identity. Narratives are a common point of reference, both for people with a common tradition and value system, and for later generations, who are interested in their roots, the everyday life of their ancestors, and other cultures. Through the stories, the person knows and acquires knowledge concerning other cultures, looks for similarities and differences between his familiar and the rest, and in the end acquires a better sense of belonging and understands more globally his relationship with others (Tsilimeni, 2011:140).

For instance, in Greece, the term "storyteller" is intertwined with the country's tradition and culture, while folk tales are told to this day, preserving their language and moralistic character. The storyteller does not simply transmit the tradition and old knowledge of the tale, on the contrary, he adapts and modifies the narrative so that it responds to the community he addresses and its history (Kaplanoglou, 2002:30). The narratives of the refugees from Asia Minor, both their personal experiences and fictional stories derived from the local tradition, reinforce the oral tradition and localism.

The narrator is the means of initiating the dialectical relationship between the narrative and the subject. He himself needs to meet certain criteria so that the narrative can be used to the best of its ability and respond to an ever-growing audience. His role is not simply to convey information through the narrative. He himself is inside the story, being a part of it, and at the same time narrating it, therefore he is considered the executive organ of the narration, mediating between it and the listener (Thcofanidis & Fountouki, 2019). The art of storytelling makes the storyteller exposed to the public, so he needs to be possessed by the need to expose himself, without feeling shy, but instead be open, communicative, projecting and developing his personal style and the uniqueness of his "art".

Furthermore, the relationship with the narrative process imposes ingenuity, both in terms of differentiating the narrative itself and the narrator's psyche and personality (Prousalis, 2009c:472). The reinterpretation of the narrative by him, depending on the subjects he addresses, contributes to the success of the narrative. The storyteller needs to keep intact his vitality and his will to tell stories, which must come from within, as his imperative.

Another important skill that the storyteller needs to possess is the art of adapting stories according to the audience he is dealing with. This is in fact the reason why the art of storytelling requires the existence of storytellers ready to accept diversity and opposing views, without the existence of prejudices and stereotypical perceptions (Prousalis, 2009a:463). The purpose of the narrative is not to censor the public and the individual subjects that make it up, but on the contrary, to protect free speech and freedom of expression. Storytelling, as a means of reflection, relief, but also emotional release, has the corresponding effect on the people who need it.

The role of the narrator, in addition to the above characteristics/skills, needs to be reassuring and encouraging towards the audience. Acting as an ally, rather than an enemy, to the audience's beliefs, showing understanding and helping them, through the development of narrative dialogue, to seek the Truth within themselves, constitutes the most important of the storyteller's characteristics. The art of storytelling is undoubtedly a pedagogic and educational tool, as it focuses on issues that cannot concern the educational community through simple teaching. In fact, through storytelling, students treat the learning process as an exciting, fun and participatory way to learn (Hadjipanteli, 2020:203).

Narrative therapy and storytelling have been implemented in different healthcare settings and different populations in order to assist them during their illness trajectory and to overcome stigma. Research findings support that narrative therapy effectively assists patients overwhelm a sense of shame, reduces overall stigma and significantly improves self-esteem and social relationships (Sun et al., 2022). For instance, storytelling has a strong influence on children and has been used as an effective tool for communication, is universally comprehensible and adapts to cultures easily (Ramamurthy et al, 2023).

The narrated story told refers to a person's personal worth, and its confirmation by the social environment. The main character does not receive the expected acceptance from his environment, as a result of which he doubts himself and his capabilities. Through a test given to him by the Wise Elder, he discovers that the true affirmation of personal worth comes from the individual himself, and not from others. Therefore, one reading of the story could be that support and encouragement, coming from one's social environment, demonstrate the truly built friendships (Madigan, 2019; Velic et al., 2023).

The space where the specific narrative can take place can be a school classroom, a hospital ward or a camp where desks or chairs are moved to create the appropriate space for the implementation of the activity that has been planned. At the beginning there is an effort to raise awareness and the audience is asked to make guesses about the content of the story for example "The True Value of the Ring", based solely on its title. The act of raising awareness is completed by the narrator telling the story while the audience rccnacts/dramatizes the events of the story. After reading the text, the audience is invited to discuss the method the Sage used. Do they think it had an effect on the subsequent development of the hero? Then, guided by the narrator, they proceed to implement the theatrical game "The Interrogation Chair", in which one of the audience takes the role of a character in the story and the rest ask him questions about feelings and thoughts (Chau et al., 2024).

Through this specific activity, the audience uses narration to communicate imaginary events, which are, however, influenced by their personal life and everyday life, thus self-evaluating their experiences. The audience, with the support of the narrator, proceeds with the dramaturgical processing of the text, dividing the story into individual scenes and recording the elements of each scene (persons, place, time). With the guidance of the narrator, the audience is divided into groups, and each group member is then assigned the roles of the Sage, the Boy, the Merchant, the Jeweler, and the Storyteller. Attendees arc asked to work together to write an alternate twist and ending to the story and then present the result to the plenary. The role of the narrator during the activity is guiding and encouraging, helping students with any enabling situation (Langthorne et al., 2023).

The narrator encourages the students to discuss the content and course of the action. Specifically, it asks the following indicative questions:

1. "Did you feel exposed at all during the activities?"

2. "Tell me some things/situations that make you feel confident and good about yourself."

3. "What changed for you after the lesson?"

Storytelling-based interventions in children and young adults, with participatory approaches using cultural stories, and positive psychology-based interventions can be effective and feasible. Health professionals can provide timely and consistent support to children while helping them explore support systems, mechanisms and coping strategies helping build resilience (Ramamurthy et al., 2023).

This stands as well in health professionals' education. More recent research confirms that we learn best when we are emotionally engaged with the subject (Taylor, 2020). For example, personal stories of medical error can stand as an effective and engaging means of learning about patient safety for medical students (Cooper, Hatfield & Yeomans, 2019).

Conclusions: Storytelling within the context of Narrative Practice is a mode of therapy that seeks to help patients identify their values and skills associated with them. In this light, nurses need to provide their patients with the knowledge of their ability to live these values so they can effectively deal with the complications of current or future diseases. In paediatric patients, they can stand as a distraction method as well as a technique to reveal fears and beliefs from the side of both children and their families. There is an increased amount of evidence that supports their use in different healthcare settings and in a wide spectrum of patients. Nurses can be at the front fore of delivering collaborative as well as person-centred therapy. Narrative techniques and storytelling are methods that are simple, effective and feasible to any health setting.

References

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