Clair Jacobs is the PPA Education Officer and the Lead Physiotherapist at INPUT Pain Management Centre, Guys and Thomas’ NHS Trust.
As Education Officer for the PPA, I am keen to develop a wide variety of learning for our members and others that supports, builds skills, informs and enhances our clinical practice. The PPA are delighted to offer opportunities to people working in health and social care to learn more about narrative approaches. Narrative practice has transformed my interactions with others - professionally and personally.
What is a narrative approach?
When we look at a picture, hear a story, watch a film, we bear witness to another person’s story. Often, our own experiences, emotions or biases consciously or unconsciously influence what we hear or choose to hear. If we can really listen, read or look closely, we may hear or see something very different, sometimes unexpected.
If we choose to share our own story, how often does the narrative become sidetracked by opinion or suggestions? If another person listens to us with curiosity and really hears our story, a space may be created in which the meaning could change for us. We may hear the space between the words. When another person is genuinely curious about our story, we feel that our story matters.
Being skillfully questioned is not being told what to do, given opinions, or other’s ideas or judgements. With questions that open up new insights, words and reflections can have space to percolate. Options may come back to us when we have room and we can act in a different way, if we choose.
We make meaning through stories and stories are never static, they change. I’ve heard Dr John Launer speak many times ‘...by telling a story you automatically will tell it differently the next time... you can’t put yourself in the same river twice…’
CIC arises from the simple idea that everyone – whether as a patient, client, learner or colleague – can benefit from telling stories about their experiences, and being skillfully questioned about these. CIC explores three core practices - short open questions , circulatory questions (building on the words spoken) and listening with neutrality withholding advice and interpretations. These practices create space. Listening to another’s words as a work of art, to the words, the rhythm, the phrases and the unsaid.
They feel hard to explain, seem intuitive but they are skills that can help our practice and have helped my practice.
Experience of Conversations Inviting Change
I delved into the world of narrative approaches, completing the Conversations Inviting Change (CIC) course pre-pandemic. This was a time when there were issues of conflict arising in my work as a clinician and as a manager. I was getting stuck really hearing the lived experiences of those struggling and in pain, and unsure about the direction my career was taking. I feel the skills and practice I developed during the CIC course allowed space to grow, personally and professionally.
The CIC course, developed by Dr John Launer, focused on the 7 C’s; including curiosity, context, challenge and care www.conversationsinvitingchange.com.
Within the course we experienced, used and developed the skills of CIC, within a safe place. Deeper exploration of the skills and practice is achieved by leading the conversation, being in the conversation or listening and observing the interaction. It may sound easy, but when we are on the receiving end of skilled CIC questioning it can be very enlightening and powerful.
Since completing the course, I have been involved in the PPA Peer Support and Reflection Session team using the CIC model, studied narrative medicine and practiced the skills learned in my role as manager, team leader, clinician, friend and human.
Following this, I coordinated writing workshops ‘Your story matters’ for the Footsteps Festival with a wonderful team of therapists and people living with pain. This was an amazing, privileged space to explore narrative approaches, writing practices and the sharing of stories. We treated one another’s stories as a work of art, to really hear, listen and be curious.
I have always been interested in stories. ‘Narrative medicine builds on the ability to acknowledge, absorb, interpret and act on the story and plight of others’ ... ‘and offers opportunities for respectful, empathetic and nourishing medical care’ (Rita Charon 2001).
I found the CIC course a very practical way to learn the principles and practice of narrative healthcare and integrate them into my daily practice. The listening skills, humility and ethics underpinning narrative approaches are aspects I am now keen to explore further.
Offering people a space to tell their stories and really feel heard is the part of the job I love. We all know how it feels when we have a conversation that connects, that goes deeper. When we offer the space to step back, people often find the way forward for themselves.
It takes confidence to ask the strategic questions, the exploratory questions, the slightly provocative questions and to just listen and plant a seed. It can be normal for us to avoid difficulties and to stay on safer ground. There is a sense of surprise when a small question asked with curiosity and care creates such a change in others.
“Which of these would you like to explore?
Where would you like to be?
…what would be a good outcome?”
We all know open questions allow space but we can get caught in our need to find things out. The musts… red flags. The normative information that our assessment and treatment demands can at times feel more fact finding, gathering of information rather than a space to listen and share a story.
Might the story take too long? What can we learn in the space between the words?
As therapists we can try hard all the time. I often hear “it is out of my scope of practice” and “I should have” ….it can be helpful to recognise through listening and sharing our stories that others are also struggling, “I’m not alone, it's ok to just listen and take time”.
Sometimes short questions asked of us stop us in our tracks…
“What is driving the other?”
“What other avenues might open?”
“Has this happened before?”
“Who has the power?”
What is it really like to work as a therapist, a manager, a patient? What is our motivation for choosing a speciality, a role? I often use the phrase ‘navigating my way through my job’... I didn’t realise I used this framing until I was skilfully questioned about this.
A deeper connection doesn’t always happen. Physiotherapists know the importance of building therapeutic rapport. Kindness, care, trust - are all values we are likely to bring to our practice.
Every story is important. Every story matters.
The Conversations Inviting Change introductory course is an opportunity to explore this approach to conversation skills.
The CIC introductory course
On behalf of the PPA, I invite you to learn, and more importantly, have an opportunity to practice the narrative approach.
Following a CIC course, many have formed small support groups, joined the Association of Narrative Practice in Healthcare www.anph.org for supervision and support, or became facilitators in CIC.
This introductory course is an opportunity to experiment and experience the space a narrative approach can give. We encourage you to bring your own stories as this will bring it to life for you.
Numbers are kept deliberately small to allow small group work. Places are limited. Don’t miss this opportunity to find out if this way of practicing can enrich your work.
I would like to mention a few people who have helped me on this journey -
- Dr John Launer, Diana Kelly and Sue Elliot at CIC.
- Sanja Maretic, Deb Penman and Jenny Zaremba, the remarkable team from ‘Your Story Matters’ Footstep workshop.
- Julia Schneider from Narrative Medicine and Pain Care workshops.
- The PPA executive committee.
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