The Power of Stories for Patients and Providers
By Robyn Fivush, PhD
Stories are, fundamentally, the way in which human beings understand their experience.1,2 Stories carve the unremitting flow of experience into meaningful chunks – beginnings, middles, and ends that are dense with human intentions and motivations, thoughts, and feelings. They turn “what happened” into something meaningful that happened to specific individuals living in a complex physical and social world. Stories of self define who we are, how we have become this person, and who we want to be.3 Sharing our stories with others, and listening to their stories, is a powerful way of connecting, and, as I will argue in this article, of healing – for patients and medical providers alike.
Stories in Everyday Life
Sharing stories is ubiquitous in everyday social interaction. Whether speaking with colleagues over coffee, with family over the dinner table, or old friends across the miles, we talk about what happened to us and we listen to their stories of what happened to them. Stories about personal experiences emerge about every 5 minutes in everyday conversation.4 Across an average family dinner table, multiple kinds of stories are told: family members talk about their day and re-tell stories about their shared past, such as family holidays and outings. Stories about the more distant past, such as the parents’ experiences growing up, emerge as well.4,5 If an event is emotionally tinged, we are especially likely to share it with others. Ninety percent of everyday emotional experiences are told to someone else within 48 hours of their occurrence.6
And, of course, in sharing our stories with others, we also listen to their stories. Stories tell us how others see the world, and how we may be the same or different. Stories of others also provide us with vicarious experience,7 what could happen, what we might do, who we might be. Stories both embody and express human experience – the good, the bad, and the ugly. In this way, stories teach us about ourselves, about others, and about the world.
Sharing stories of difficult or stressful experiences may be particularly beneficial.8 Telling our own stories of stressful experiences helps us regulate our emotional reactions; through creating a more coherent narrative of what occurred, we are better able to manage difficult emotions, and place stressful experiences in a larger context that allows us to modulate our emotional reactions.9 And listeners matter. When we tell our stories to attentive listeners – those who help us hear ourselves and help provide interpretation and evaluation of our experience – we tell more coherent and emotionally regulated stories. When we tell stories to listeners who are distracted, or not really paying attention, our stories are incoherent and dysfluent, and our subsequent memories of these events are more fragmented.10 Hearing others’ stories helps us as well. Stories of others provide models for us of how to deal with difficult situations, and how to live a good life.11 For example, adolescents and young adults who know stories about their parents’ childhood experiences show higher levels of self-esteem and psychological well-being.12 Stories are part of the fabric of everyday interaction, and are a critical part of our identity and well-being. Stories empower us. So, how can we use the power of stories in everyday life to benefit ourselves and others?
Story Circles are semi-structured ways of bringing people together to share their stories in order to build meaningful connections, and use the power of stories to create community.13 When we share our stories with others, and they share their stories with us, we connect, sometimes in surprisingly deep ways. Story Circles work on a few basic principles.
First, small groups of individuals, no more than 8 or 10 people, sit in a circle. This can be a group that already works together or knows each other, or it can be a group of strangers. A story prompt is decided upon in advance – a prompt that helps elicit each person’s story around a shared topic, such as a time that one dealt successfully with a highly stressful event, or a time one faced a difficult challenge. A trained story facilitator helps each group with the simple instructions:
- Each person has 3 minutes to tell a specific personal story, a particular moment cued by the story prompt.
- No interruptions, no questions.
- Everyone simply tells their story.
- Discussion occurs only at the end.
This very simple process is surprisingly effective. The sense of community and commitment is palpable, and the sharing of stories and the subsequent discussion is deep and meaningful. Whatever the story prompt, Story Circles help participants understand something about themselves, about others, and about “self” in relation to others. Perhaps most importantly, Story Circles help participants learn how to listen – a key skill for individual development and community building.
Stories and Rehabilitative Medicine
So far, this article has told a very nice story. But so what? How might these concepts influence care, both for patients and medical providers, in a rehabilitative setting? Emerging research demonstrates the power of stories to build connections, to create identities, and to help individuals understand and empathize with others. In all of these ways, sharing stories in a care context is beneficial for patients and providers.
Turning first to how stories benefit patients, especially as they navigate new identities around illness and injury that might have longstanding effects on their health, there is a great deal of evidence that constructing more coherent and emotionally regulated narratives of experience leads to higher levels of psychological and physical well-being.14 More specifically, studies that ask patients to journal about their experiences – to simply write about daily stressors, for 10 to 15 minutes a day for as few as 3 or 4 days – indicate that engaging in this personal storytelling exercise has enormous benefits.15 For example, patients with rheumatoid arthritis who engaged in an expressive writing intervention, in which they were asked to write their deepest thoughts and feelings about an ongoing stressful experience for just 4 days in a row, showed lower levels of fatigue 3 months later than a non-writing control group.16 And patients with myocardial infarction who engaged in expressive writing subsequently showed higher compliance with medical plans, reported fewer symptoms, and attended significantly more rehabilitation sessions than patients who did not engage in expressive writing.17 The evidence suggests that having the opportunity to explore one’s story helps one to regulate emotions and cope with aversive and stressful experiences in positive ways.
Storytelling also benefits medical providers. Rita Charon18 has championed the idea that the practice of narrative medicine – the ability to understand, interpret, and engage with the stories of others – is critical for medical professionals, helping them provide higher levels of care for their patients, and for themselves as well, as they confront stressful situations on a regular basis. Learning techniques of humanistic inquiry, such as textual analysis and literary criticism, helps medical providers become better able to draw out their patients’ stories and listen to them more effectively, thus forging a deeper understanding of their plights. Through this process, the connection between patient and provider also becomes deeper; as patients feel heard and validated, they are better able to take advantage of more abstract medical information, advice, and action plans. In turn, through a deeper understanding of both their patients’ stories and their own, providers are better able to engage in self-compassion and care for the self.19
Today’s medical providers often are not operating alone; there is a growing emphasis on forming healthcare teams. Research suggests that a team-management approach to healthcare benefits patients and providers. Interestingly, Bennett et al20 found that sharing stories during provider group meetings facilitated better outcomes. The more the healthcare team shared stories about their patients, the more effectively the team performed. The authors argue that sharing stories builds supportive relationships, enhances compassion for patients, and increases trust. This sounds very much like Story Circles! In this case, the healthcare providers focused specifically on sharing stories about their patients, but the underlying idea is the same: through sharing stories on a mutually important theme, the group of story-tellers builds deeper connections and trust among its members, and this, not surprisingly, leads to the team being more effective.
What emerges from all these observations is that patients and medical providers engaging in telling the stories of their own experiences, providers engaging with patients around stories, and providers sharing stories among themselves, all create benefits for multiple health outcomes.
How to Leverage the Power of Stories
So, how can providers use this information effectively for themselves? I end with some suggestions for how you can leverage the power of stories.
- Keep a journal. Each day, write about your own difficult, stressful, or challenging experiences. In writing, explore your deepest thoughts and emotions, and reflect on what you think each experience means. This exercise does not have to take very long. Research shows that writing just 10 to 15 minutes a day can provide significant benefits to both physical health and a sense of psychological well-being.
- Learn to listen. Effective listeners ask open-ended questions and let others respond in their own ways. This can take time. Let the other person speak without interruption; simply remain positively engaged through eye contact and nodding, until the narrator finishes. Do not assume; let the other’s story unfold. Be in the moment with that person, reflecting back what they are telling you. But do not ask questions that might impose a particular answer or interpretation. Questions like “How did that make you feel?” allow the narrator free expression, but “Did that make you feel angry?” makes an assumption that may or may not be valid for the teller. An open-ended “Tell me more” expresses interest and encourages further participation, but asking for specific information, as in “Tell me about X,” constrains the narrative to what the questioner thinks is important.
- Apply your new insights. For further study, Baikie and Wilhelm14 provide a set of specific instructions that may help you employ the power of storytelling with your own patients.
- Bruner J. Life as narrative. Social Research. 1987;54(2):11-32.
- Gottschall J. The Storytelling Animal: How Stories Make Us Human. Boston, MA: Houghton Mifflin Harcourt; 2012.
- McAdams DP, McLean KC. Narrative identity. Cur Direct Psych Sci. 2013;22(3):233-238.
- Bohanek JG, Fivush R, Zaman W, Lepore CE, Merchant S, Duke MP. Narrative interaction in family dinnertime conversations. Merrill-Palmer Qtly (Wayne State U Press). 2009;55(4):488.
- Merrill N, Gallo E, Fivush R. Gender differences in family dinnertime conversation. Discourse Proc. 2014;52:533-558.
- Rimé B. Emotion elicits the social sharing of emotion: theory and empirical review. Emotion Review. 2009;1(1):60-85.
- Pillemer DB, Steiner KL, Kuwabara KJ, Thomsen DK, Svob C. Vicarious memories. Conscious Cogn. 2015;36:233-245.
- Pennebaker JW, Chung CK. Expressive writing, emotional upheavals, and health. Hndbk Health Psychol. 2007;263-284.
- Smyth JM, Pennebaker JW. Exploring the boundary conditions of expressive writing: in search of the right recipe. Br J Health Psychol. 2008;13(1):1-7.
- Pasupathi M. The social construction of the personal past and its implications for adult development. Psychol Bull. 2001;127(5):651.
- Freeman M. Rewriting the Self: History, Memory, Narrative (Vol. 2). Abingdon, UK: Routledge; 2015.
- Fivush R, Bohanek JG, Zaman W. Personal and intergenerational narratives in relation to adolescents’ well‐ New Dir Child Adolesc Dev. 2011;131:45-57.
- Curthoys L, Cuthbertson B, Clark J. Community story circles: an opportunity to rethink the epistemological approach to heritage interpretive planning. Canadian J Enviro Ed. 2012;17:173-187.
- Baikie KA, Wilhelm K. Emotional and physical health benefits of expressive writing. Advances Psych Treatment. 2005;11(5):338-346.
- Frattaroli J. Experimental disclosure and its moderators: a meta-analysis. Psychol Bull. 2006;132(6):823.
- Danoff-Burg S, Agee JD, Romanoff NR, Kremer JM, Strosberg JM. Benefit finding and expressive writing in adults with lupus or rheumatoid arthritis. Psychol Health. 2006;21(5):651-665.
- Willmott L, Harris P, Gellaitry G, Cooper V, Horne R. Effects of expressive writing following first myocardial infarction: a randomized controlled trial. Health Psychol. 2011;30(5):642.
- Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286(15):1897-1902.
- Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Educ Couns. 2004;54(3):251-253.