Narrative medicine and counselling share in their practices the attention, acceptance and valorisation of the stories of people who go through the experience of illness directly as patients, professionally as health professionals or as relatives and caregivers.
They are two paths that can be integrated in a coherent and harmonious way, offering a space for reflection on one’s own experience in contact with pathology and physical discomfort, for awareness of one’s own emotions, and for explication of expectations and desires.
Both approaches make it possible to take care of people through their narratives with a focus that is not only on the pathology, but also includes the impact it has on the patient’s life, on their psychological well-being and on their multiple existential spheres. Narrative medicine and counselling also offer people caring or nursing a broader view of their experience and the opportunity to get in touch with their inner world by reworking feelings and thoughts.
The convergence between narrative medicine and counselling can be summarised in the following points:
- Patient-centricity: Both approaches place the patient at the centre of the process, recognising the importance of his/her experiences, emotions and needs.
- Active listening and empathy: both counselling and narrative medicine value active listening and empathy as fundamental tools for effective communication and personalised care.
- Reflection and awareness: Both approaches promote reflection and awareness, both on the part of the patient and the health professional. The patient is helped to understand and reframe his or her experience, while the physician, health professional or care-giver develops a greater sensitivity to the human dimension of illness.
When a person feels free to reconstruct his or her history, he or she may discover meanings, contextualisations, possibilities for understanding, acceptance or change.
Counselling in health care is a process of accompaniment and emotional support offered to help manage situations of stress, anxiety and difficulties related to illness. It can also be an answer for relatives and care-givers when they feel the need to deal in a more sustainable way with the sick person, the discomfort caused by the illness and the complex relational dynamics that may emerge.
Counselling techniques can facilitate the application of narrative medicine and in turn the methodology of narrative medicine offers counsellors additional tools to help people tell their stories and describe the development of the illness, the course of treatment, and their states of mind. Narrative traces in fact stimulate thoughts, create connections between phases that are sometimes difficult to remember, help to get in touch with the inner world. The parallel file broadens the physician’s observation, enriches clinical evidence by promoting a human vision of treatment, a personalisation of care and a more effective therapeutic alliance.
But that is not all, language analysis techniques and text classification enable a greater understanding of the processing of the experience of illness, whether lived directly or indirectly.
The integration of counselling and narrative medicine can bring numerous benefits in clinical practice. In particular, it makes it possible to:
- Reducing patient anxiety and stress: the patient feels listened to and understood, reducing the fear and feeling of uncertainty related to the disease.
- Improving therapeutic adherence: when patients understand their condition better and feel involved in the decision-making process, they are more likely to follow therapeutic indications.
- Prevent burnout in healthcare professionals: storytelling and reflection help doctors and nurses manage the emotional stress of their work, preventing the risk of burnout.
- Personalising care: understanding the patient’s history allows care to be tailored to the patient’s specific needs, improving the effectiveness of interventions.
Especially for the treatment of chronic illnesses, narrative medicine is essential to monitor positive and negative developments from a clinical and emotional point of view and to outline a care pathway that responds dynamically and positively to the patient’s needs. The helping relationship offered by counselling can maintain the motivation to follow the therapeutic indications, discovering new personal resources, reinterpreting personal beliefs and reorganising certain habits. Also the family system and the people who support the patient on a daily basis, through both practices, can alleviate their sense of helplessness and loneliness, reorganise their ways of caring, and seek emotional well-being for themselves.
In today’s world, the need for objectivity is answered by the great possibilities of data management and increasingly sophisticated therapeutic solutions give hope of successfully tackling very serious diseases. Despite the scientific advances we can count on and the effective treatments that are prescribed, the perceived quality of care and the patient’s confidence still depend on the attention received, the communicative experience established with the healthcare environment and the understanding of his or her needs as a person.
Illness and psycho-physical distress enter people’s lives unexpectedly and generate fear and suffering. Listening, cognitive and affective empathy, respectful and partitive relationships built with the patient can bring consolation and hope, safeguarding people’s dignity and sustaining the courage to face fatigue, physical pain and sometimes exhausting waiting. Narrative medicine can complement the professional level of health professionals as well as humanise and profoundly enrich communication in healthcare by also stimulating new discoveries on an individual and societal level.
“And when you find the courage to tell it, your story, everything changes. Because at the very moment when life becomes a story, the darkness becomes light and shows you a way’.
Ferzan Özpetek
Anna Cacopardo – Professional counsellor and trainer