July 2022

Positive Assessment: Storytelling as a Method to ‘Open the Door’

by Alan Schlechter, MD, Jennie Byrne, MD, PhD, Natasha VanWright, RN, MBA, MS, Ramon Jacobs-Shaw, MD, MPA 

Since medical professionals are often characterized as left-brained, clinical thinkers, you may be surprised to learn there is a strong creative element to our work. A doctor’s abilities to collaborate, to problem-solve, to clearly articulate solutions, and to form empathetic emotional bonds with each of our patients and partners are all central to our professional development and, ultimately, to the success and survival of those we serve. 

At its heart, then, medicine is both a scientific enterprise and a storytelling exercise — and a growing field known as narrative medicine has lately been shining a valuable spotlight on how this blend of right- and left-brained care can empower patient health in accessible and energizing ways. At Belong Health, we recognize narrative medicine isn’t just a boon to patients and providers — it helps address systemic challenges across the fields and communities in which we work. 

In an earlier blog post, we introduced readers to Positive Assessment, a new style of client engagement that has unlocked wonderful storytelling opportunities across the medical profession. Its holistic approach to care, built around the PERMA model of well-being that was developed by University of Pennsylvania’s Dr. Martin Seligman, reframes the process of medical treatment to more fully encompass five of the creative components of the human experience. 

PERMA Model includes positive emotions, engagement, relationships, meaning, and accomplishments.

Those five components are outlined in the acronym PERMA, itself: Positive Emotions, Engagement, Relationships, Meaning, and Accomplishments. Together, their impact on the medical practice continues to be immeasurable. Just ask clinical social worker Tracy Posniak. 

Over the past 13 years at Four Winds Hospital in Westchester County, NY, Tracy has held a number of significant patient-facing roles. Early on, Tracy discovered that, although she quickly became well-versed in working with teams and with very challenging patients, a hybridization of clinical and creative tools would likely be essential for her own personal and professional health. 

Positive Assessment offered just the right resource for Tracy. She immediately found herself deeply connected to the idea of meaning, one of Positive Assessment’s five components, which is explicitly defined as what matters to us and provides the springboard for our purpose in life. As someone who offers so much of her own heart, talent, and time in an effort to help others, Tracy knew she lived a life rich with meaning and was eager to help others find their meaning and purpose, too. 

It didn’t take long for Tracy to put this passion into practice. Soon, she met “Susan,” an elderly resident of a supportive living program, who had struggled with a deep history of mental health challenges. Upon their first interaction, and drawing from the Positive Assessment approach, Tracy implored Susan not to discuss only her challenges but rather to reveal “the whole Susan.” Given Tracy’s own personal interest in meaning, Susan was routinely encouraged, in their sessions together, to share what was personally meaningful to her. 

The result of this empathetic approach to care was transformative. With little prompting, Susan, a peer group co-leader herself, began to talk about her work supporting others with mental health challenges. Where Tracy noted Susan had once begun their interaction as a bit “stand-offish,” the invitation to share her personal purpose freed Susan to be more conversational and trusting. With time, Susan even began their phone calls with an enthusiastic, “Can I tell you something?” 

As Tracy found herself more and more inspired by Susan’s dynamic history of peer group facilitation, both women recognized they regularly looked forward to those shared phone calls.  

Over time, Susan slowly let Tracy come even further into her life, and the two of them discussed not just meaning but each of the other elements of PERMA. Susan eventually shared her love of water coloring with Tracy, noting that the artistic practice was a way to preserve creative independence while clearing her mind of stress. This cathartic personal activity, Tracy noted, represented the “E” in Susan’s PERMA: engagement.  

Relationships, the “R” of PERMA, were also central to Susan’s life. Tracy soon learned just how much strength and insight Susan had gained from working with others with mental health challenges. Her peer group facilitation, Susan shared, made this complex woman feel like a leader — and even a role model — within her own community. That recognition of her own social significance, in turn, ultimately pushed Susan to take better care of herself.   

In a more recent phone call with Tracy, Susan bared her soul and confided a personal concern: the co-leader of her peer group was leaving, and now Susan found herself fighting to secure more her stability in own life. Her peer group, Susan had come to recognize, had long provided a key part of her own social scaffolding. Now she couldn’t help but worry for its future — and, consequently, for her own. 

Like many Belong Health providers, Tracy did have experience as a personal therapist. She did not, however, have experience as a therapist in this unique context. Nevertheless, by relying on Positive Assessment, and on the valued relationship she and Susan had gradually built, Tracy found she was ultimately able to be a source of comfort and insight — especially as the two women reflected on Susan’s remarkable process, both with her peer group and outside of it.  

If not for the trusting and interpersonal relationship Susan and Tracy had built, brick by brick and with the help of Positive Assessment, it’s unlikely Susan would have shared such personal fear and uncertainty with a social worker. Had Susan not felt that Tracy cared about all of her stories, she may not have revealed this difficult one.   

Thankfully, however, Tracy and Susan’s relationship was forged with an awareness of both women as full and complex and emotionally intuitive people. To this day, Tracy is confident the Positive Assessment approach to care guided Susan and Tracy to a place of shared safety — one where they could fully hear each other in their own voices, and at their own pace. After all, once someone has told you of their fullest self, their fullest story, your own story has changed forever.