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Storytelling: a way to build therapeutic relationships in mental health settings

Storytelling can have positive mental health benefits and be a useful de-escalation tool

Telling a story to a patient in a secure hospital proved to be a life-changing moment for Jess Wilson and storytelling is now being used more widely as a therapeutic aid

  • Hospital director Jess Wilson talks about how she discovered storytelling as a therapeutic aid while working at a medium secure hospital
  • Stories can be used to soothe patients, distract them and to instruct and inspire
  • Storytelling can facilitate discussion of difficult emotions and help build hope and resilience in times of fear and anxiety

I stumbled into storytelling a few years ago, but its something that has changed my nursing practice and I use the techniques in my daily work.

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Telling a story to a patient in a secure hospital proved to be a life-changing moment for Jess Wilson and storytelling is now being used more widely as a therapeutic aid

  • Hospital director Jess Wilson talks about how she discovered storytelling as a therapeutic aid while working at a medium secure hospital
  • Stories can be used to soothe patients, distract them and to instruct and inspire
  • Storytelling can facilitate discussion of difficult emotions and help build hope and resilience in times of fear and anxiety
Picture: iStock

I stumbled into storytelling a few years ago, but it’s something that has changed my nursing practice and I use the techniques in my daily work.

During the COVID-19 pandemic, it’s particularly important to have stories of hope, joy and resilience.

Storytelling began as a distraction

I’d worked as a community psychiatric nurse before moving to a medium secure hospital, which was a big change.

One of the patients had a learning disability, a background in trauma, self-harm and she could be violent towards staff and patients.

She was difficult to nurse, with staff spending 90 minutes with her before a colleague took over. Sometimes she would spend several hours a day in restraint.

One day I was looking after her when she sat on the floor and said: ‘I’m bored. What are you going to do about it?’

I knew I had to do something quickly or she may become aggressive.

Impromptu story had my patient transfixed

Everyone had tried different ways to keep her occupied, including reading and drawing, but she had used the pens to self-harm or assault people.

All I could think of was telling her a story. I’d never done this before and didn’t know how to do it.

As the words came out of my mouth, I remember thinking, this is a stupid idea – she’s not a child, she’s a woman and she’ll probably feel patronised.

But she said: ‘Okay, go on then.’ I just said the words: ‘Once upon a time’ and told her a story that my mum had read to me when I was little – a Russian fairy tale about a witch called Baba Yaga. I had loved it as a child.

Although I thought I told it quite badly, the patient was transfixed. Her shoulders relaxed and she had a smile on her face.

When I finished, she asked me to tell it again.

The second time around, I remembered the story more clearly and could add some elements.

I began to enjoy the experience and afterwards the patient remained relaxed and chatty for the rest of the time I spent with her. It felt like a remarkable difference.

Tips on using storytelling in your nursing practice

Find one of the UK’s many storytelling clubs. The Society for Storytelling has an events list, with several running online during the pandemic. The society also produces free factsheets on storytelling skills and telling stories to different audiences and in various settings, including health and therapy.

You can tell stories one to one, as appropriate, or consider setting up a storytelling group that meets regularly. Remember some patients will enjoy telling stories too.

Look out for storytelling festivals, including the Scottish International Storytelling Festival.

Don’t worry too much about grisly content. Some folk and fairy stories can be quite gruesome, but none of them are worse than what we see on EastEnders.

Find out more at jesswilsonstoryteller.co.uk

Folk tales helped convey lessons about bullying

That evening when I got back home, I looked up storytelling, mental health and therapy on the internet, but I couldn’t find anything.

Further research led me to discover weekend courses in storytelling, so I signed up.

At that point, I didn’t think it would lead to anything; I was just doing it for my own interest and enjoyment.

Back at work, one of the psychologists told me she was going to start a group on bullying awareness as it had become a problem among the patients.

She was looking for ideas to avoid it being boring and dry, and I suggested telling a story.

Over the next six weeks, I told a ten-minute folk or fairy story at the end of each session.

Stories helped reduce anxiety at bedtime

All of the patients enjoyed it, so I began incorporating telling stories into my own practice and set up a storytelling club.

Patients said it helped them to feel relaxed and distracted.

‘In a secure hospital, nurses walk a fine line between care and custody. Storytelling helps us feel we’re human beings together, rather than nurses and patients’

I remember one patient asking for a story in the evening rather than taking lorazepam to help her sleep. She had intrusive voices, which made it difficult for her to concentrate on television or audio books.

When I asked why she was able to focus on the stories I told, she said: ‘Because I can see your face and your eyes.’

Another patient with learning disabilities, who couldn’t read or write, said he could see the images in his head when I told him a story.

Another said that if people read to him, it made him feel stupid because he couldn’t read himself, but he enjoyed my storytelling.

Stories are fantasies, but the emotions are true

In a secure hospital, nurses walk a fine line between care and custody. Storytelling helps us feel we’re human beings together, rather than nurses and patients.

I take all the stories I use from the oral tradition.

The words, ‘Once upon a time’ are magical. Everyone understands what will happen next.

Although the stories are a fantasy, the emotions are true. They open a gate to be able to speak more honestly with patients about feelings that can be difficult to discuss – grief, jealousy, falling in and out of love.

We don’t usually talk about these issues in a secure hospital. A story makes it easier and it feels safe.

A tool to challenge prejudice

They can also help to break down prejudice. In one instance, a patient who was on one-to-one observation refused to be cared for by a nurse from Zimbabwe, because she said she didn’t like black people.

I told a story that evening to a group of patients including her, and the nurse from Zimbabwe talked about how storytelling was common practice in her culture.

She then told a fantastic story involving African animals.

The patient was so awe-inspired by it, she was fine about the nurse looking after her.

Picture: Stephen Shepherd

As there was no evidence about the impact of storytelling in healthcare settings, my employers agreed to fund an MSc in professional practice research, which I finished in 2015.

I’d taught 36 nurses how to use storytelling as part of their practice and I used their experiences in my dissertation.

Those who found it most useful were nursing in psychiatric intensive care with patients who were extremely distressed.

They felt it provided distraction and worked as a de-escalation tool.

Stories of hope, joy and resilience for the COVID era

Since then, I’ve spoken at conferences at home and abroad and I have also taught more healthcare professionals, including nurses, working with the University of South Wales, which has the first UK academic research centre devoted to the study of storytelling and its applications.

In 2017, I was nominated for the RCNi mental health nurse of the year and my work was highly commended.

I’ve since been promoted to a hospital director at Aberbeeg Hospital in south Wales, part of Elysium Healthcare, and now I use the techniques in staff meetings.

One of my favourite quotes about storytelling is from GK Chesterton, who said: ‘Fairy tales are more than true: not because they tell us that dragons exist, but because they tell us that dragons can be beaten.’


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