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09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Different narratives in different doctor-patient relationships
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Family practice
Carachterized by:
All sorts of problems Great part of workload is made up of mental
disorder Long-extended knowledge of patients Knowledge of illness story and family story
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Aim of study
To explore which narratives family physicians told about patients with psychological problems or mental disorder
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Narratives Increasing interest in narratives across many
disciplines since the 1980s The ’narrative turn’
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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The ’narrative turn’ In psychology
Bruner, J. (1986). Actual Minds, Possible Worlds. Cambridge, Mass.: Harvard University Press.
Bruner, J. (1990). Acts of Meaning. Cambridge, Mass.: Harvard University Press.
Sarbin, T. R. (1986). Narrative psychology, the storied nature of human conduct. New York: Praeger.
Polkinghorne, D. E. (1988). Narrative Knowing and the Human Sciences. Albany, N.Y.: State University of New York Press.
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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The ’narrative turn’ In psychotherapy
Schafer, R. (1980). Narration in the Psychoanalytic Dialog. Critical Inquiry, 7, 29-53.
Spence, D. P. (1982). Narrative Truth and Theoretical Truth. Psychoanalytic Quarterly, 51, 43-69.
Angus, L. & Kagan, F. (2007). Empathic Relational Bonds and Personal Agency in Psychotherapy: Implications for Psychotherapy Supervision, Practice, and Research. Psychotherapy:Theory, Research, Practice and Training, 44, 371-377.
McLeod, J. (1999). A narrative social constructionist approach to therapeutic empathy. Counselling Psychotherapy Quarterly, 12, 377-394.
Schafer, R. (1992). Retelling a life: Narration and Dialogue in Psychoanalysis. New York: Basic Books.
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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The therapist is never a neutral mirror The story is always created in an interplay
between therapist and patient
In psychotherapy and In family practice
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Consultations in family practice contain many psychotherapeutic elements
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Method
In-depth semi-structured interviews with 14 family physicians
Invited to tell patient stories Narrative analysis of interviews
Descriptive Interpretive
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Results Different participants told completely different
stories Different themes Different narrative styles
Four types Stories with detailed description of patients’
situation Stories about emotions and relationships Stories about irritation Stories about categorization and biomedical
perspectives
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Each participant told the same type of narrative
– the same narrative style – through the entire interview
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Stories with detailed description of patients’ situation
Easy and natural to tell stories Detailed stories Deep knowledge Own reflections Engagement
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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I think it’s fantastic, to deal with different life stories, and to relate them to the their present lives, well, also the broadness you have as a family physician, children, wives and husbands and – well it’s a fantastic approach. And it’s a fantastic knowledge you possess.
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Stories about emotions and relationships Patient’s emotional reaction and the
relationship had a creative influence on the story
And I think, then she experiences a relation between two human beings. That I think is important. This is the way we work in the dialogue, to get some, what could I call it, some feelings on the table which the patient has to tackle, and I have to tackle, and then we must see how we manage. The relation between, really, what happens just between us.
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Stories about irritation Tired of patients Stories created by irritation Not interested in hearing incoherent stories
To be honest I had actually become somewhat tired of her, so I simply could not stand it any more
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Family physician: Some can be enormously irritating. She made me – well, she was really irritating, unctuous, and would tell of all these horrible things she had – and how it hurt here and there. Interviewer: but was that someone you could ask to tell her life story to get another view of her?Family physician: no, she was too irritating, too peculiar. I’m damned if I think so. It must be some who – who you are somewhat interested in hearing about. I was not interested in hearing about her.
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Stories about categorization and biomedical perspectives Much shorter About
Biomedical diagnoses Prescription Sick leave Medical certificates
Reluctant to tell patient stories Did not know details
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Interpretation of results
Family physicians have different theoretical frames of reference for understanding patients
Different consultation styles Different discourses of understanding Different professional positioning Manifests itself through the style of narratives
they tell about their patients The style is global and consistent
09-04-2023Annette Sofie Davidsen, MD, PhD [email protected]
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Implications Training a narrative understanding could
increase family physicians’ psychological understanding of patients.
The conditions in family practice are suitable for this approach
