Storytelling and the MEAH within rehabilitation 

Storytelling is an essential part of rehabilitation for patients who are coming to terms with the impact and loss from chronic illness. One reason for this is because stories allow social comparisons to take place which, if positive, are a central mechanism through which physical and mental health can benefit [1]. By sharing positive stories of illness individuals are able to consider how change and living with illness is possible. Sharing stories is an effective non-confrontational approach to changing attitudes and behaviour.  Stories don’t imply a judgement of another person, rather they empower the listener to make a choice to change and are important for establishing trust in the therapeutic encounter.  

The reason why sharing stories can be so beneficial can be understood by considering the story plot. Common story plots contain different representations of psycho-emotional adaptation and hope in relationship to the illness. Therefore, sharing stories can provide a powerful illustration of how adaptation, coping and management of the condition is possible. Research has used the model of emotion, adaptation and hope (MEAH) to illustrate this [2]. Understanding how each plot maps onto the MEAH can provide an insight to how sharing stories can offer hope, changes in emotions and psychological adaptation. This is important because clinical experience may introduce a judgement of what the story plot represents in the context of rehabilitation. For instance, around a half of final year physiotherapy students described a story told by an individual with a spinal cord injury as ‘unrealistic’ and around quarter as either ‘not accepted’ or ‘in denial’ when it focused on being completely restored [3]. The danger is that single words like realistic or denial can focus on what is perceived as wrong or right, or what works or doesn’t work within the process of rehabilitation. Such words may represent understanding of adaptation in terms of stage or phase models of psychological adaptation (e.g. denial, acceptance, anger, bargaining) and of hope in relationship to goals (e.g. pathways and agency). This is contrast to the complexity of responses to illness identified by the MEAH. Healthcare professionals need to understanding what common story plots are told by individuals with chronic illness in the settings they work. There should be an emphasis on the need to listen to them rather than to fix them. This would likely improve the therapeutic encounter, create trusted therapeutic relationships and encourage behaviour change.   

 

References 

  1. Thoits, P. (2011).  Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behaviour, 52: 145-461.

  2. Soundy, A. (2018). The psycho-emotional content of illness narrative master plots for people with chronic illness: Implications for assessment. World Journal of psychiatry, 8: 79-82. 

  3. Soundy, A., Smith, B., Cressy, F., Webb, L. (2010). The experience of spinal cord injury: using Frank’s narrative types to enhance physiotherapy undergraduates’ understanding. Physiotherapy, 96: 52-58.

© Andy Soundy Site Version 1.7 updated 22/01/2020