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For
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1999
CHURCHILL FELLOWSHIPS The Six-Part Story Method: Report of a four week Fellowship to Israel
KIM DENT-BROWN
Report
presented to: The Winston
Churchill Memorial Trust
INTRODUCTION
My application to the Winston Churchill Memorial Trust (WCMT) was for a 1999 Churchill Fellowship under the category "Workers in Community Health". I proposed to travel to Israel for four weeks to learn more about the 6-Part Story Method (6PSM). This is a method used in psychotherapy and counselling settings to help clients discover more about themselves by helping them to make and tell a new story. My plan for the Fellowship was to spend time with the originators of the method in Israel and also to travel more widely and observe Israeli approaches to mental health, psychiatry and work with personality disorder. I hoped that this would help me in my work as a Drama-therapist working in an NHS Community Trust with clients with personality disorders. Applications closed in October 1998. Approximately 1,600 proposals were shortlisted to 160, and I was interviewed in February 1999 by Sir Henry Beverley, Director-General of WCMT, and three members of the WCMT Council: Sir Roger Bannister, Baroness Masham of Ilton and Sir Terence English. I was one of 100 people awarded a 1999 Churchill Fellowship. The WCMT provided very generous funding covering air fare, car hire, hotel bills, living expenses etc, but not domestic expenses ongoing during my absence. To cover this, my employers, Hull and East Riding Community Health NHS Trust (HERCH) granted me paid study leave for my month away. We were able to recoup much of my salary for the period by applying to our local training consortium for service replacement funding.
The Fellowship
was undertaken for four weeks from 2nd-30th November 1999. During
that time I visited 25 individuals and institutions throughout the
length and breadth of the country - a summary of the timetable is
attached as an appendix. The body of this report will not be a
day-by-day diary of each visit, but will concentrate on those areas
that produced new information, opened avenues for further exploration
or led to recommendations for action. These are brought together in a
summary below. SUMMARY OF ACTION AND RECOMMENDATIONS (The number following each recommendation refers to the paragraph of the main body of the report that follows here.) Following my Fellowship visit I have set myself the following goals for action:
And I make the following recommendations/suggestions:
1. THE 6-PART STORY METHOD. The main aim of the Fellowship was to meet and work with the originators of the 6PSM, Prof. Mooli Lahad and Dr Ofra Ayalon, and to spend time with other workers who are now using the 6PSM in a variety of settings. Ofra Ayalon described how the 6PSM had come out of her familiarity with the work of Marie Louise von Franz, the Jungian analyst and author. Von Franz had suggested that all stories could be reduced down to a basic six-part structure of
2. Mooli Lahad told me how in the early 1980s he had taken this structure and applied it to an assessment he was already using, known as BASIC Ph. He was working as an educational psychologist in northern Israel in an area subjected to frequent random rocket and shelling attacks. His task was to try and help communities (in particular schools) become more resilient to these unavoidable, unpredictable attacks. BASIC Ph is the acronym for six different ways of coping which he identified people were using - coping based either on Belief, Affect (emotion), Social, Imagination, Cognition or Physical modes. 3. The 6PSM gave Mooli Lahad a vehicle to assess people's preferred method of coping. By asking an individual to make a new 6-part story and then analysing the story for BASIC Ph elements, he hoped to be able to make a quick assessment of that person's preferred coping style. This would then help them and their worker to mobilise the right resources to help them. For example, a person whose 6-part story revealed a high preference for C (Cognitive) but a low preference for S (Social) might be referred to explanatory self-help literature rather than a social support group. 4. I was able to get a fuller understanding of the BASIC Ph method of assessment and I recommend that in our work with clients with personality disorders, my team could make use of this (given that we already apply the 6PSM.) Analysing preferred coping strategies would help us in our work with individuals, as well as beginning to build up some normative data about the coping styles of people suffering from personality disorders. 5. I met Naomi Hadary, a Dramatherapist and former student of Mooli Lahad's. She is a nurse trainer who is preparing nursing students for their first clinical practice on the wards. She developed a short-term group format for working with the 6PSM in order to help a group of students prepare. Each student produced a story and these were then enacted week by week until everyone's story had been processed. At the end, group members' co`ping styles (measured by BASIC Ph) were measured and all had increased their range of coping styles. This format has the benefit of being focused and time limited; it could easily be transferred to our work with personality disorders, perhaps as an ending group for clients who have finished our long-term psychotherapy group. I will propose this to my team. 6. A further Dramatherapist using the 6PSM was EIsa Segev-Shoham, who works in the Paediatric Oncology unit at the Ha'Emek Hospital in Afula. This is a day unit for children undergoing chemotherapy, and EIsa showed me some of the story work she has done with them. She uses the 6PSM as her fundamental tool for helping the children communicate, and most of her contact with the children revolves around them making, illustrating, telling or acting out the stories. Adult carers (staff and family) found it very difficult to find a way of communicating with children about illness, pain and the possibility of death. The 6PSM was an acceptable way of communicating because the metaphorical language, although very direct and easily understood, gives a protective distance. 7 For example, one boy of 14 had not been told by his family that he had cancer, nor that his life was in danger. This was difficult culturally because of the stigma associated with cancer and because openness about the diagnosis would have made both him and his siblings unattractive as marriage partners in the future. Nevertheless he was able to communicate his understanding through a story about a dying tree being saved by a painful process of tree surgery. This allowed him to talk about his feelings and have them acknowledged, while not pressuring him or his family for unacceptable levels of openness. 8. After meeting these practitioners, and discussing our use of the 6PSM with them, I am even more convinced of its usefulness in a range of settings. I have already started to write articles about the GPSM which have attracted interest; I will continue to do so with my Fellowship experiences as extra material. I will also offer training in the 6PSM and the range of uses (including the BASIC Ph analysis.) This could be publicised through the journals where my articles appear and might well attract participants from all over the country. I will aim to do this through my work in the NHS. 9. I am now much clearer about what has and has not been the subject of formal research into the 6PSM. There is wide anecdotal agreement that the method is useful but there has been no validation study to test how meaningful its results are scientifically. Nor is there any data about its reliability - for example, would two skilled raters come up with the same interpretation of a given 6-part story (in which case we can say the 6PSM is reliably giving us information about the storyteller. Or do they come up with two very different interpretations (in which case the projections that are being revealed are those of the raters, not the storyteller.) I will submit a proposal to the Northern and Yorkshire Regional Health Authority for a Research Fellowship to enable me to undertake this validation and reliability study.
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