THE POWER OF STORYTELLING AT END OF LIFE WITH PATIENTS AND CAREGIVERS Christina Kulp, LCSW 1
PRESENTER BIOGRAPHY Christina Kulp, LCSW Medical Hospice Social Worker Christina is a graduate of Marywood University School of Social Work and has worked in the geriatric, non-profit and healthcare fields for over 15 years. She has an ongoing interest in quality/process improvement and program development. She is firm believer in the team approach to palliative and end of life care which provides the best possible services to patients and their loved ones. Christina enjoys providing supervision to student social workers as it provides a fresh view to the discipline through new eyes. 2
OBJECTIVES 1. Participant will be able to define benefits of storytelling at the end of life. 2. Participant will identify ways to facilitate life review and storytelling with patients and caregivers. 3. Participant will learn ways to utilize stories as a source of information to enhance assessments and individualize interventions. 3
OVERVIEW Storytelling has been used as a tool to communicate since humans were still living in caves. It has been a way to obtain information, avoid danger, learn societal rules and chronicle human life, amongst others. Stories provide information to help provide connection, education, and collaboration. The act of storytelling gives meaning to a series of events which happens in a person s lifetime. It can be told from a personal perspective or from an observer s point of view. A clinician can choose to focus on the story of a patient and/or caregiver instead of reviewing stark facts to enhance the assessment process and produce more individualized interventions. 4
ECLECTIC APPROACH MODELS AND THEORIES Psychotherapy - A variety of approaches using dialogue where an individual and a professional work to understand and hopefully improve an identified problem areas in the individuals life. (Sigmund Freud, Carl Jung, Alfred Adler) Narrative Views problems as separate from the person and takes away blame. It recognizes the individual has skills, abilities, values and beliefs which will assist in producing change. (Michael White, David Epson) Therapeutic Storytelling relating a series of events to bring connectedness, insight, educate, and express values, to name a few. (Carl Jung, Dan McAdams, Jerome Bruner) 5
ECLECTIC APPROACH MODELS/THEORIES (CONT) Gestalt Therapy Humanistic based therapy focusing emotions and behaviors in the present. Goal is self-awareness. The whole is other than the sum of the parts (Kurt Koffka, David Hume) Family Therapy A branch of psychotherapy that views change in relation to the interactions of family members. (Carl Whitaker, Theodore Lidz, John Bowlby) Social Constructivism how humans create meaning within social contexts and how that meaning influences the way humans author their own life. (Lev Vygotsky, Jerome Bruner) 6
FACILITATION Scottish traveler proverb a story is told eye to eye, mind to mind, heart to heart Provide a non-judgmental environment Maintain a stance of curiosity Be present Address feelings directly, don t avoid Show concern for the other person s wellbeing 7
FACILITATION (CONTINUED) Be supportive rather than evaluative Develop a conversation-style approach. Respect the silence Proceed at the storyteller s pace, not yours. Allow space for reflecting/reminiscing. 8
ASSESSMENT Know what you need to know and get the information from your facilitation of their story. Save quality time visit by preparing demographic information obtained in the medical record. Then briefly confirm during assessment and encourage expansion of their story. Identify areas of hesitation or discomfort to further explore when rapport is established (verbal and non-verbal). 9
ASSESSMENT (CONTINUED) 10
TAILORING INTERVENTIONS Talk about it - Don t forget.the act of verbalization itself is therapeutic and an intervention. Identify problem areas in the patient/caregiver story that may not have been present in a fact-based assessment. These areas will be emphasized by teller. Individualize interventions by adding part of the narrative to generalized interventions. Example: Change provide counseling related to anticipatory grief to provide counseling for daughter s anticipated loss of daily conversations and interactions with patient as identified in assessment. 11
EXAMPLE CASE 12
BENEFITS Creates a bridge between the teller and the listener Minimizes the impression of the healthcare worker as being in power Encourages the healing process to begin by exploring the meaning in the experience Provides and environment of intimacy allowing authentic communication 13
BENEFITS (CONTINUED) Ideal for brief treatment which is often the case in short hospice length of stay Focus is on what the teller feels has the most impact at the time (teller identifies the problem or challenge) Inspires hope and empowerment in a time of vulnerability Provide an opportunity to create meaning out of chaos 14
LIMITATIONS Can open the door for lay theories related to why the patient got ill. Only use in its particular context - The story is only one person s interpretation not the entire caregiving unit. Difficulty in assessing the effectiveness Potential to re-open old wounds which may require more work during at time which may be limited. 15
IT S ALL ABOUT COMMUNICATION 16
REFERENCES Bruner, Jerome. (1986). Actual minds, possible worlds. Cambridge MA: Harvard University Press. Freedman, J. & Combs, G. (1996). Narrative Therapy: The social construction of preferred realities. New York: Norton Paal, Piret. (2013). Therapeutic Uses of Storytelling. Chapter 10. Lund Sweden: Nordic Academic Press. Reisman, C. (1993). Narrative Analysis. Thousand Oaks CA: Sage. White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton. 17