Petra Makela
5 May 2016 0 comments
Topic: Self-management

The role of listening to people’s stories in supporting self-management

“Small, but massive” - the stories that make me ‘me’

Sometimes, when listening, a small fragment of an unfolding narrative will stand out, bringing a moment of clarity which then sticks – those are the ‘gems’. I remember during one of the early focus groups for co-designing Bridges in Brain Injury there had been some discussion about what to call the book section where people describe how they keep on going, despite challenges, beyond simply carrying out physical activities. One of the project contributors, John, suddenly had the idea that the section could be called “This is me”.  Everyone nodded, smiled, agreed, and that was decided. Within this section of the Bridges Brain Injury book, contributors share stories of their personal, everyday ways in which they incorporate the things that “make me feel like me” – which are, as John says, “small, but massive” (another gem).

I consider the telling of and listening to stories - people talking about what they do, have done, want to do, and what it means to them, to be central in supporting self-management through the Bridges way of interacting.  Starting from co-production of the resources, people’s own stories of their experiences are the essential drivers, told in their own words and including their own choice of subjects.  Someone recently made a general comment that, “Stories can’t just be told any old way” – but why not, when that is what makes them unique, meaningful and contextualised. Supporting people in this way requires us to listen to stories, respond flexibly and without contamination from our own imposed structures and categorisations.

 

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Stories help us to understand patients as people and place them in the context of their long, messy, beautiful lives.

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I have just returned from a conference called Broken Narratives and the Lived Body.  Depending on whom I share this experience with, the responses range between a confused, “Huh?” to an enthusiastic, “Ooh”.  One fellow conference attendee told me a story about when she described her ethnographic research (on interactions of acute healthcare staff with patients) to a medical consultant, who had stopped to express momentary interest in her purpose on the ward: he responded, “Sounds like watching paint dry.” No, not at all, it’s fascinating, we both agreed.

The theme of the Broken Narratives conference portrayed the idea that when people become ill, the narrative structure and stability of their life stories are disrupted.  If we are to offer meaningful support as healthcare professionals, then really listening to people’s stories is essential.  The importance of making time for this sort of listening, even in a busy acute setting, is powerfully captured in this blog called letting patients tell their stories to understand patients as people and 'placing them in the context of their long, messy, beautiful lives'.

‘Broken narrative’ research illustrates ways that narrative disruption does not simply relate to a personal narrative that is no longer continuing into the future according to an expected, or hoped for, plot. As listeners, we become aware of other ways in which narratives can be broken. Someone who is not able to convey their story in a conventionally linear way - perhaps confusing events across time, perhaps missing parts or details - may be considered to be giving a ‘fragmented narrative’, or to be telling their story incompletely.  A person’s stories do not exist in isolation though, but rather as ‘entangled stories’ that have been built on common ground between friends, partners, family members and others. Meaningful interactions and support from healthcare professionals require us to listen out for the shared social resources in these relationships, and the harmonies and tensions in people’s entangled stories.

As listeners who are healthcare professionals, we also actively influence what is told to us, and can support the telling by providing ‘scaffolding’ when we hear ‘fragmented’ stories. What do we bring to this co-construction, and whose priorities drive it? Do we support people to tell us their story of “This is me”?