The Narrative Exercise: Introduction to Therapeutic Communication in the Psychiatry Clerkship
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Introduction: In medical school, much time is devoted to teaching students to elicit disease-centered histories from their patients. The narrative exercise supplements this traditional focus by requiring students to develop a person-centered narrative for one patient under their care. While the ultimate test of a diagnosis is the verification of the diagnosis by tests or treatment outcome, the ultimate test of a patient-centered narrative is whether the patient accepts it as a legitimate characterization of his or her experience. Methods: The psychiatry clerkship directors at the University of Rochester School of Medicine and George Washington University School of Medicine have developed parallel clerkship activities that teach the skill of constructing narratives in doctor patient communication. These exercises structure student/patient interactions according to the principles of narrative medicine, narrative therapy, and psychotherapy. Each school required the students first to elicit a patient's life story, then to write it out, present it to a preceptor, and finally to present it directly to the patient for comment. Results: Of 18 students surveyed using a five-point Likert scale (5 = Strongly Agree) the statement “The narrative exercise is a useful way to learn psychotherapy skills” received an average score of 3.94. The statement “The narrative exercise should be required in the psychiatry clerkship” received an average score of 3.88. Discussion: Patients' stories, the ways in which they describe illness and the meaning of illness in the context of their lives, form the core of both the contemporary discipline of narrative medicine and the traditional practice of psychotherapy. The ability to elicit and shape patients' narratives requires specific skills essential to the implementation of humanistic values in medicine. Students need guidance in cultivating the capacity to communicate in ways that make patients feel accepted, cared for, empowered, and hopeful within the constraints of their medical conditions. This resource presents the basic elements of the narrative exercise jointly developed at the University of Rochester and the George Washington University, along with the specific modifications each school made to integrate the exercise into its overall curriculum.
Garrison D, Frank J. The narrative exercise: introduction to therapeutic communication in the psychiatry clerkship. MedEdPORTAL Publications. 2010;6:7765. http://doi.org/10.15766/mep_2374-8265.7765
Contains Information Suitable for Patient Education
At the end of this session learners will be able to:
- Describe the elements of therapeutic communication, including the common factors of psychotherapy.
- Conduct and document interviews that incorporate elements of the narrative approach.
- Describe the differences between diagnostic and narrative interviewing.
- Gain experience with an analog to a psychotherapeutic encounter by sharing with a patient an empathic narrative that highlights the patients' own values and concerns and fosters hope.
- Psychotherapy, Narrative
Prior Scholarly Dissemination
The UR Evaluation data was a part of a submission to Academic Psychiatry in the late summer of 2007. The submission was sent back with revisions, but was not resubmitted.
This information is made available under the Creative Commons license.
Both authors presented posters on their respective exercises at the annual ADMSEP meeting, the UR clerkship director in 2007 and the GWU clerkship director in 2008
Authors & Co-Authors
David Garrison, MD
University of Rochester School of Medicine and Dentistry
Julia Frank, MD
George Washington University Sch of Med and Health Sciences
Sponsorship or Funding Source
Time to develop the project was provided to the UR clerkship director through the Dean's Teaching Fellowship