Program setting and participants
Session stage (approximate duration)
Specific examples from observation notes
Stage 1: Engaging with a creative work (7 min)
The facilitator leads a discussion of a creative text. The text can be any creative medium including poetry, prose, visual art, music, spoken word, graphic novels, etc.
The painting, ‘The Harvesters’ by Pieter Bruegel (1565), was displayed on a large monitor.
The session started with the invitation to observe: ‘Please take a minute to observe the painting in silence.’ During the group discussion of the work, staff noticed the work of harvesting crops in the middle ground and the sharing of a meal in the foreground. They shared their ideas of the likely time and place of the scene. They talked about the tension or balance between work and rest, community and self, men and women. They discussed the idea of teamwork and how the painting related to their own work in the clinic.
The function of this section of the workshop is to engage in close looking. If a written text is used, the activity is of close reading. Through the act of close looking or reading, we aim to strengthen participants’ skills of attention to their world and to themselves.
The facilitator aims to create an open and supportive environment that encourages an exploration of many perspectives. In an attempt to encourage close observation and skills of description, the facilitator asks staff members to find evidence for interpretations offered. For instance, in response to a comment such as ‘The workers in the painting look tired.’ the facilitator might ask, ‘What do you see in the image that makes you say that?’
Stage 2: Writing to a prompt (3–5 min)
The writing prompt is crafted ahead of time and draws from an element (a word, image, metaphor, theme, etc.) used in the creative text.
‘Now we’re going to do some brief writing. Don’t worry about how good a writer you think you are. Just go where the pen takes you. We are mainly interested in what comes up for you in the process of writing. Please write for 5 min to the prompt: write about the seeds that you are planting. I will let you know when you have a minute left.’
Prompts are crafted in order to encourage reflective writing about one’s own life. Brief and unplanned writing allows spontaneous expression that explores associations, memories, and emotions that is not analytical or essay writing.
During this stage, the facilitator seeks to create a safe environment of openness, acceptance, and discovery. The facilitator seeks to lessen anxiety that often occurs in such situations of creativity and encourages participants to take risks with one another.
Particularly for groups that are not familiar with narrative medicine sessions, the facilitator explicitly invites participants to write with the knowledge that they will share their writing with one another.
Stage 3: Sharing writings in pairs (7–10 min)
Staff are asked to form a pair with someone from a different profession and read their writings to one another.
‘Now pair up with someone who is not in your profession and read your writing to one another. You may need to get up and move to a different part of the room. Listen closely to the reading and pay attention to both what the story is telling and how it is being told. After you listen, tell your partner what you heard.’
Staff sat closely in pairs so as to hear their partner over a room full of people reading to one another. Leaning in, good eye contact, and nodding seemed to convey careful, attentive listening.
This activity allows for courageous telling and attentive listening. Sharing of one’s writing is an act of risk taking, and when the listener is respectful and attentive there is an opportunity for the building of trust.
The facilitator asks persons to read the text they have written to one another, and not just talk about what they have written. This is intended to allow attention to the text that was produced by the participants. During the reading, the facilitator quietly observes the pairs to make sure all are participating but does not interrupt the sharing. At half-way point, the facilitator reminds the pairs to switch.
Stage 4: Sharing writing in large group (7–10 min)
The large group is reconstituted and the facilitator asks for 2–3 volunteers to share their writing with the group.
‘Ok. Let’s come back to the big group. I want to invite a couple of you to read your writing with the group. Who would like to get us started?’
After each telling, the listeners commented on what they heard.
The content of what is shared is often sensitive in nature, exploring topics like one’s hopes, fears, and personal situation that sometimes results in the expression of emotion. This allows persons in the room to gain new understandings of their colleagues, and to more fully witness their humanity.
The facilitator asks for volunteers to read their text to the whole group. The facilitator allows silence after such an invitation in order to allow participants the time that might be needed to gather up the courage to volunteer to read.
The facilitator encourages close listening for form and content of what was written while also listening very closely to what is read.
At the close of the session, facilitator may identify themes that came up during the session. In closing, the facilitator might thank the group for their close listening and for trusting of one another with their stories.