Listening to Life Stories
A New Approach to Stress Intervention in Health Care
Bruce Rybarczyk, Ph.D.
Albert Bellg, Ph.D.
Originally published by Springer Publishing Company, New York, 1997Copyright Bruce Rybarczyk, 2014
Our patients are continually trying to tell us stories about their lives. As health care professionals, our response typically runs the gamut from amusement to irritation, as we try to shift them to our clinical agenda. Yet the movement toward patient-centered and holistic approaches to health care has awakened in many of us an awareness that these personal stories are telling us something significant and that we ought to be paying attention to them. But we are not quite sure what to do when these moments come along. We don’t know what clinical purpose the process of telling and listening to stories can serve.
In writing this book, we believe we are bringing good news to our fellow health care professionals. The news is simple: stories are important, they should be encouraged, and they can be used to help patients cope with stress. The goal of this book is to equip the reader with the knowledge to recognize these therapeutic opportunities and the skills necessary to guide the storytelling process so that patients are strengthened by their own stories.
The premise of our life narrative interview is that during times of stress, we need to be reminded of the positive aspects of our life, especially our strengths and resources. Being reminded serves as a shortterm buffer against the feelings of vulnerability and helplessness that so often accompany medical illness and treatment. We have found that each individual, regardless of the misfortune in his or her life, has positive experiences that can be drawn upon for this purpose. We all have our high points, defining moments, and finest hours. This book emphasizes the skills necessary to keep the focus of the interview on these positive experiences.
The other key premise is that the listener has a key role in the storytelling process. In a very real sense, stories are “co-created” by teller and listener. The storyteller (the medical patient) constantly observes the listener (the medical caregiver) for subtle and not-so-subtle signs of interest and lack of interest, acceptance and nonacceptance. A responsive listener will inspire patients to tell meaningful stories and validate the personal attributes revealed in those stories.
An important agenda of this book is to empower health care professionals from all disciplines to be counselors to their stressed patients. Stress is a simple fact of the world of health care, whether that world is a hospital, an outpatient clinic, a nursing home, a hospice, or a dental office. Yet stress management is often viewed as the exclusive territory of mental health professionals, beyond the scope or training of other health professions. If other professionals do offer coping assistance to their patients, it is usually
in the form of words of encouragement or a referral to a support group. We hope to convince readers that any of us can be more directly involved in managing stress by using the life narrative approach. Indeed, with the current emphasis in health care on reducing costs while improving quality of care, “cross training” in stress management is a timely idea.
While our research has focused on life narrative interventions in a 45- minute interview format, fortunately there are many other ways to use these techniques in shorter time periods. They can be worked into the fabric of our day-to-day conversations with patients, whenever and wherever there is an opportunity to listen to a story—and there are abundant opportunities. Life narrative interviews can be conducted while administering chemotherapy or obtaining a medical history, and even during a psychological counseling session. A series of brief “snapshot” stories shared over a period of time will accomplish many of the same objectives as a single longer interview.
We also wish to impress on readers that life stories serve a vital function whatever the age of the storyteller. Even though our research was initially directed toward older adults, the idea of using life narratives for stress intervention has been broadened to include individuals of all ages. We changed the name of the intervention from “reminiscence interview” to “life narrative interview” to reflect this shift. We find that reminiscing is too often regarded as an activity in which only older adults participate. That view does not do justice to the enormous psychological and interpersonal potential storytelling has for all individuals, regardless of age. We all need someone to bear witness to our unique journey in life, whatever its length has been.
Finally, we would like to encourage other investigators to explore the power of stories to promote coping. As Dr. Brody points out in the Foreword, there has been a surge of scholarly interest in the role of the patient’s narrative in the illness experience. But this renewed interest has led to very little in the way of practical clinical research or guidelines on how to use stories in health care. We hope this book is a first step toward helping a wide variety of professionals apply this new understanding of narratives and storytelling to promote the well-being of patients.
The writer Elie Wiesel once quipped, “God created man because He loves a good story.” We love a good story too, and our patients have some of the best stories around. Listening to them not only helps our patients but enriches our own lives.
Bruce Rybarczyk, Ph.D.
Albert Bellg, Ph.D.
October 6, 1996