Stories can conquer fear: using storytelling for patient engagement

patient engagement Jan 17, 2019

Don’t forget to download the free guide that accompanies this month’s articles. In it, I show you three simple steps to help your patients choose to live well with cancer. You can grab your free copy here.

 

A couple of summers ago, we holidayed in the beautiful Scottish Isles of Orkney with my whole family. We were staying on the Mainland just outside Kirkwall in a quaint little converted church, and to say the landscape on the Orkney Isles is captivating is an understatement. There is a very rich history dating right back to prehistoric times, with standing stone circles and neolithic settlements, and more recent wartime history with the Churchill barriers and the Italian chapel that was built by prisoners of war. It’s plain to see this history is owned proudly by the people on this little archipelago.

On the last night of our stay, we took a drive out to a remote cottage, seemingly in the middle of nowhere, for a local storytelling of Orcadian folklore*. Once inside, I fell in love with the place! Original old flagstone flooring, low-beamed ceilings, walls lined with bookshelves with Scottish literature spilling out from within. Views across a green meadow out the back, complete with cows! But the best was yet to come. Inside the storytelling room was a large inglenook fireplace which housed a roaring peat fire. The smell and the smoke was overpowering! But the atmosphere was set, and the storytelling began.

In came the storyteller, in full Orcadian-style fish wife costume and told us stories about Selkies - mythical finfolk creatures that could transform into seals - and kelpies - giant, water horses that can lure onlookers to their death.

Her skill in weaving these tales was nothing short of mesmerizing: she held the entire room captive with her narrative, and wheeched our imaginations away to another time and place.

On the front of her business card, there’s an evocative picture of a wooden chair next to a large stone fireplace with a burning fire, and a quote from the poet and novelist, Ben Okri:

“Stories can conquer fear…

...they can make the heart bigger.”

This card sits on my desk, propped up against the wall as a reminder of that time, and it has led me on some very interesting research journeys. The odd Google here and there as thoughts popped into my head eventually led me to the field of therapeutic storytelling, which is often used in psychotherapy to help patients by shedding light on the nature of their problem and the direction in which change might take place.

“Our species thinks in metaphors and learns through stories.” - Mary Catherine Bateson, 1990

Stories help us remember lessons

One of my favorite Disney films is Brave - partly because it’s Scottish and partly because it has a strong female lead character - two things I identify strongly with! In one scene, the main character, Merida, quotes her mother when trying to get the attention of all the clans in the dining hall:

“Legends are lessons, they ring with truths!”

And she’s right! Legends and stories are great tools to speak truths into the hearts and minds of our listeners.

I’ll bet you can all recount (probably even recite!) the story of the boy who cried wolf? Of course you can - because a story is infinitely memorable. But what’s interesting is the speed with which that story conveys the message (that lying is wrong and will land you in trouble one day because people will stop believing you). If you were to tell a child, factually, that lying is wrong and the more you tell lies the less likely it will be people will listen to you, they might understand the concept, and they might even remember it, but it won’t have nearly the same emphasis and meaning as it has when it’s told using a story.

For this reason, stories can be extremely useful ways of conveying a message or a truth to our patients. Maybe that message is to remind them to practice mindfulness and gratitude daily, or maybe it’s to remind them to focus their attention on the things they can enjoy, despite what’s going on inside them. Whatever that message, look out for stories and narratives you see - in everyday life, in films, in books, even in children’s stories - that could help you convey your message in a way that is more memorable for your patient.

Stories help us accept truths

Just as stories can help us communicate truths to our listeners, because of their nature as external to the listener - i.e. the story is not about them - they are great tools to help our patients accept truths. In many cases, we human beings don’t like to face the facts because they’re too painful, or too raw to accept. Using stories can help highlight a key take home message without risking the defensive strategies our minds often present in response.

Stories help us organize our thoughts

I’ve heard our brains likened to computers with various storage files, all categorized neatly and compartmentalised into different areas, but my own personal belief is our brains are more like an interconnected web of thoughts and memories - more like the internet, with links and backlinks and archived articles, rather than neatly organised files and folders.

Mine looks more like this…!

For this very reason, we struggle to process information that is confusing or seemingly unconnected. Or perhaps that which we see as irrelevant to us. Stories, therefore, can be useful tools to help us organize and process this information because they follow a familiar structure. This also helps with recalling lessons and insights later.

Stories help us make faster progress on subsequent visits

Once you’ve used a story once, you then have the convenient tool of key words or phrases that can instantly bring that message back into your patient’s mind. For instance, going back to the story of the boy who cried wolf, we instinctively know what someone means if they say to us, “Well, I don’t want to become the boy who cried wolf, so…” There is no need to explain the story again, but instead we can simply use a keyword or phrase (in this case, “the boy who cried wolf”) to convey a point. In psychology, this is called the code of communication.

Stories as diagnoses of a patient’s problems

Just as a mechanic can diagnose a problem with your car (“it’s a faulty fuel injector”), patients receive a diagnosis about their medical problem (e.g. “it’s bowel cancer”). But with a cancer diagnosis, it’s more than just the cancer that’s the problem. There’s a whole complex, interconnected tangle of issues that comes with a cancer diagnosis - from family issues (changes in roles and responsibilities, relational problems) to financial issues (inadequate health insurance, unpaid sick leave, unemployment) - and this can lead to problems with how individuals behave (e.g. frustration manifesting as anger and rage directed at loved ones) as well as with the way they are on an ongoing basis (e.g. low confidence, or negative thinking).

Stories can be used to help identify and communicate with patients regarding the nature of their problems because they are clear and familiar to patients, and therefore represents something they can use without having to learn something new. Stories can also help identify possible paths to change that might help the patient overcome their difficulties, and are therefore empowering.

How two lions may help your patients

As I’ve mentioned before, one of the common side effects of a cancer diagnosis is anxiety and depression, for which many patients take anti-depressants to help them cope. Consider this remarkably simple story of two lions**, which can be used to convey several important points to a patient about what they need to do to get proper treatment for their emotional suffering:

#1: A lion walks into a room...Pat feels scared...Pat takes a happy pill...Pat doesn’t feel scared anymore...the lion eats Pat.

#2: A lion walks into a room...Mike freezes in panic...Mike takes a happy pill...Mike unfreezes...Mike runs out the back door and escapes the lion.

In the first story, where Pat resorts to taking a “happy pill” as her sole response to a painful emotion (fear), it shows that by not addressing the root cause of her emotion (the lion), she remains in danger, and indeed, gets eaten by the lion! This can be used to illustrate the importance of identifying and doing something about the real world circumstances or unhelpful thinking patterns that give rise to these emotions, not just treating the symptoms.

In the second story with Mike, whose response after taking the “happy pill” is to get out of dodge, it makes the point that emotional states such as anxiety, depression and grief can be paralyzing, and medication can often help reduce the immobilizing effects of the emotional state in order to help the individual do what they need to do to deal with the root cause of their emotions. This can be helpful for patients who need medication but are reluctant to take it.

Therapeutic storytelling by cancer patients

As well as being useful for helping cancer patients understand and accept the truths around their diagnosis, therapeutic storytelling can also be used by cancer patients to help other patients and at the same time boost their own wellbeing.

In a recent study of 160 stories told by cancer patients, those stories that were rich in emotional words and metaphors, self-talk and meaning-for-life themes, were indicative of enhanced wellbeing.

As one medical student said:

“Words nurse the wounds medicine cannot describe.” - Christopher Salib

Stories are powerful devices for assisting patients

When chosen well, stories that are carefully tailored to our patients’ situations can reap many benefits. They are more easily remembered. They can reduce defensiveness and help patients to hear and accept truths about their situation. They can reduce confusion by helping organize their thinking. They can help you make faster progress on subsequent visits and build rapport with your patients by bringing keywords and phrases into the mix. And they can also help identify and diagnose a patient’s issues beyond their cancer that reveals potential paths to change.  

Try it out and let me know how you get on!

Why not keep an eye out for a possible story to use in your next encounter with a patient and try this tool of therapeutic storytelling? I’d love to hear all about it: drop me an email at [email protected] 

In the free guide that accompanies this month’s articles, I show you three simple steps to help your patients choose to live well with cancer. You can grab your free copy here.

And don’t forget, I’m going to be delivering some FREE live workshops VERY soon. If you want to be among the first to hear about these, sign up here.

*If ever you’re visiting Orkney and wish to visit the Orkney Folklore & Storytelling Centre, you can find more information on their website here: www.orkneystorytelling.com. (This is not an affiliate link - I just loved it so much I wanted to share it with you!)

**The story of the two lions is adapted from Ossorio, 1997; inspiration taken from Bergner, 2007.

 

© Essential Cancer Education

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