Art & science | first person

Once upon a time there was an

angry lion: using stories to aid
therapeutic care with children
Building a relationship with a child or young person is vital
to gain their trust. Dean-David Holyoake investigates how
storytelling can be a useful tool for the busy children's nurse
Correspondence
d.holyoake@wlv.ac.uk
Dean-David Holyoake is senior
lecturer/nurse consultant.
University of Wolverhampton,
Walsall campus
Date of submission
October 10 2012
Date of acceptance
March 7 2013
Peer review
This articie has been subject
to open peer review and
has been checked using
antiplagiarism software

Abstract
storytelling is a useful relationship-building tool to
use with children, as demonstrated by the work
of 'Johnny' and the author, his nurse. Five stages
of narration - purpose, backstory, pivotal events,
evaluation of effects and summary - encourage
children to recognise and accept feelings such as
anger, grief, shame and guilt in a safe way and make
small steps towards change. It is feasible fo sfarf
engaging children with simple everyday stories, and
then go on to develop fhe tale so that the nurse and
the child make additions as required.
Keywords

Author guidelines
www.nursingchildrenand
youngpeople.co.uk

Children's nursing, storytelling, therapeutic interaction

IT IS PROBABLE that some of the first things you

ever heard were stories. When you were a child your
guardians might have taken great dehght in teUing
you stories to help you nod off to sleep, entertain
you or impart valuable morals to keep you safe. Some
parenting traditions drift in and out of fasfiion, but
among primary school teachers, nursery staff and in
early years' centres, storytelling is still considered of
crucial importance, if not the highlight of the day.
So can storytelling be a skill put into practice
by nurses? The answer, of course, relates to the
pressures under wfiich most children's nurses find
themselves when confronted dauy with busy wards
and the other priorities for their patients' welfare
that seem to demote the importance of stories. Tfiis
article offers some ideas for nurses about storytelling
through a description of the trust-building
September 2013 | Volume 25 | Number 7

relationship that developed between nine-year-old

patient 'Johnny' and me (DH) as the nurse.
I used a five-stage model known as the 'points
of a story', developed by Duvall and Beres (2007)
from the work of Vygotsky (1978) and White (2005).
The five stages are: purpose, backstory, pivotal
events, evaluation of effects, and summary. The
stages encourage isolated children such as Johnny to
recognise and validate feelings such as mger, grief,
shame and guut in a safe way, and to address smaU
steps towards change.

Purpose
Johnny, whose name has been changed to protect
his identity, was six years old when he was scalded.
He had been watching fus mother cook and reached
up and tipped boiling pasta on himself. His mother
rushed fiim to hospital, but he had extensive burns
to the right side of his face, neck and arm. The
shock and trauma, both physical and psychological,
had affected his appearance and self-esteem. Back at
school he felt odd, and even though he was bright,
he found fiimself becoming increasingly isolated,
aggressive and achieving unsatisfactory grades.
It was decided that Johnny would have surgery to
correct some of his facial scarring and a plarmed
admission to the children's ward. Jofmny was
beginning to reason that he was different from most
children because of his scars.

Backstory
During a two-week period, Johnny and I developed a
relationship and a story to help him re-think his
self-esteem. I was on a post-registration placement
NURSING CHILDREN AND YOUNG PEOPLE

with a backgroimd in child and adolescent mental

health nursing, and was a novice to the physical
chedlenges faced by many of the young people in my
care. Therefore, storytelling was my initial reaction
to not knowing what to say. It was a spontaneous
response to engage opportunisticaUy, rather than
being part of a planned strategy to develop a
therapeutic relationship. The fact that Johnny was
quiet, isolated and not the most popular boy meant
that a persistent approach was called for. A creative
approach might arouse his curiosity, and it was with
this in mind that, after seeing Johnny struggling to
pull the head off a plastic zebra, I took the chance
and spoke to him about jimgles.
'I was really scared once,' I said. Johrmy did not
look up. He was in his bed waiting to go into surgery.
He was pretending not to listen. I too pretended I
had not noticed that he was ignoring me.
Tt was when I had to go into the jungle on safari.
I can tell you it was frightening,' I said, but he
scowled and tugged more at the zebra's head.
'I'll come back later and tell you what happened,
if you like.' I left his bed area and walked off
towards the nursing station. I wondered what I had
started by likening my story with what he was just
about to embark on.
Having spent some years attempting to
understcmd the principles of psychotherapy,
I wondered about the nature of creative storytelling.
According to Ong (2002) and Tambling (1991),
the storyteller represents conditions for his or her
own benefit and for the benefit of those hearing
or reading. This emphasises that stories are not
necessary 'truth' and that they can be altered,
adapted and changed. Considering that I had
never been in a jungle, seen a zebra or been to a
zoo in more than 30 years, Johnny had much room
for manoeuvre.
The emotions of fear, anger, sadness and
frustration being exhibited by Johnny were not
going to be addressed merely by the plastic surgery
because, put simply, some of his scars were inside
his head. This, it was explained to me by children's
nurses, is not uncommon for children in hospital,
who experience a wide range of emotions. Finkeihor
(1984) showed how damaged children may have
difficulty trusting others and/or themselves. The
chud asks: 'Why me?', 'What did I do wrong?' and,
as I noted in my work with Johnny, 'How am I going
to cope with the fact that no one hkes me?'. These
questions and key stages make up the pivotal events.

Pivotal events
Nurses have to find story purposes and pivotal
events quickly. The luxury of pre-preparing is
NURSING CHILDREN AND YOUNG PEOPLE

rarely an option in a busy children's ward. Yet, it

is possible to develop two or three pivotal events
from which to develop any story. Therefore, the
initial purpose for Johrmy was about increasing
his self-esteem and the pivotal events were about
'acknowledging his anger', the present feehng, and
'increasing a positive self-image through notions
of bravery', future change, by being less 'scary
to others'.
It seemed that the emotional effect of Johnny's
accident had taken second place to his feelings
about the visible physical trauma. His mother did
not hke to mention the scars in the hope that they
might disappear. There was no mention of any
psychological investment in his notes, yet it was
obvious to all the nurses and staff that Johimy's
outbursts of anger affected his popularity' and
educational abihty. Peers were scared of upsetting
him and this reduced his social interaction.
Johnny was feeling more aware that he was
different as a result of his scars, but did not know
about anger, sadness or making friends. Axline
(1971) used a free style of play to engage with
trauma-surviving children. I also noticed how his
use of metaphor - the anger of the strong and
capable hon - as described by Cazeaux (2007) and
Erik Erikson (1958), mirrored Milton Erickson's
techniques (Erickson etal 1976, Zeig 1980),
particularly the production of curiosity. Yet, unlike
other settings, I also knew I did not have much time
or the luxury of a settled envirormient, so would
have to teU stories on the hoof and in between other
duties. O'Hanlon and Beadle (1997) suggest that
brief therapeutic interventions sometimes work
best and increase busy practitioners' opportunities
to develop points of the story that mirror the
immediate feelings, expectations md outcomes for
the teller and the hstener.

Points of the story

'I put a lonely zebra on the locker, but he seems to
have lost his head,' I said, 'I wonder what happened
to him? Perhaps it was a Uon or something that felt
angry.' I indicated the plastic zebra torso on Johnny's
locker. He took a peek and then quickly looked away.
He was in pain from the surgery and the bandages
helped us both to remember this. I left him. What
remained was my uncertainty about what to say
next, but I was determined to find a good reason for
developing these emotionally Uaked points of the
story. I decided that they would include him being a
strong yet scary uon, with a pivotal point being that
he was allowed to address his anger.
Lawton and Edwards (1997) and Geldard and
Geldard (2002, 2005) show that therapeutic joint
September 2013 | Volume 25 | Number 7

Art & science | first person

storyteUing supports the right of the chud to
be heard, presents opportimities for the child
to share feelings, demonstrates acceptance and
recognises the privilege it is to be able to share a
story. Likewise, Gomez (1997) eind Duvall and Beres
(2007) suggest that the role of the therapist (nurse)
includes providing a map and 'the scaffolding
ciround a building while it is being buut or repaired'.
Repairs may make it possible for the nurse to
re-author a preferred way for the child of being in
the world (White and Epston 1990).
'It is a shame that the zebra can't see things
happening around him,' I said, 'When I was in the
jungle one day I accidentally bumped into a lion.'
I paused to check Johnny was listening. To my
surprise he actually looked me in the eye. I knew I
had to think of something quick.
'Do you know what lions sound like?' I asked.
He nodded to indicate yes. I knew that I had just
made contact and then to my surprise he said: 'They
go roooooooarh.' He put his hands up in a claw
movement, but the bandages hid his expression.
'Have you ever seen one?' I asked.
He shook his head to indicate no and looked at
me with his wide eyes.
'Well I have and they are very scary, that's why
people stay away from them because they are
frightened of being eaten.'
'Well how come you never got eaten?'
said Johnny.
This was actually a good question to which I did
not have an answer, so I said: 'I am going to finish
doing this laimdry and then I'm going to come back
and tell you.'
Kaduson (2004) noted a common problem
in doing work with young children - they have
an 'inability to verbalise their feelings'. In my
experience, coUaboratively developing stories as a
continuing engagement allowed for the creation of
mystiques to motivate the young person.
The use of mystery, quirky characters, magic,
miracles, pretending and plot twists helps with
this. Having established the main points of the story
- no matter how long it takes - the aim is to then
develop personal change (pivotal events) in
the young person.
'Because I learned the secret,' I said. I waited
for Johnny to ask because I knew he would. 'What
secret?' I now had his full attention.
'The fact that this lion wanted to play "let's
pretend",' I said, and Johnny screwed up his
half-hidden face. 'But why?', he asked. 'Well,
because the angry hon liked to pretend that a
miracle had happened and that people were no
longer scared of him.'
September 2013 | Volume 25 | Number 7

Stories appear to be relatively stable because they

have plot, script, characters, scenery and dynamism,
and they have a beginning, middle and end. We
all take something different from these elements
of a story. Eor some children it is the excitement,
for others it is trying to work out the end before it
happens and for some it is locating the villain or
discovering the twist. At the simplest, it may be the
enjoyment of the adventure, the rhyme and rhythm,
relating to the qualities of the hero and heroine,
or simply the distraction from other tasks and
connecting with the author or reader.
Street ef al (2012) explored how common
narratives validate overcoming adversity by
exploring the themes in these characteristic pivotal
events. In my experience, an awareness of such
matters may be an advantage, but they should not
deter the would-be nurse storyteller from simply
formulating pivotal events and points usually
based on a feeling - for Johnny it was anger - and
then developing characters symbolic of the desired
outcome, such as a nice, brave lion.
The story is the vehicle through which the nurse
can buud a trusting relationship (O'Hanlon and
Beadle 1997). Therefore, the use of what Brown and
Augusta-Scott (2007) called 'alternative preferred
stories' is a process of developing a joint story that
can make use of what Anderson and Goohshian
(1992) termed 'not knowing'. This allows space and
gives permission to validate feelings and open up
metaphorical spaces, free from the technological
advances of medicine, to appreciate 'different voices
or stories' (Smith and Nylund 1997).
'I don't care about your stupid hon, why should
I?' Johnny scowled. It was getting late and he had
just been told that his family were not visiting
because of unforeseen circumstances. 'I wish I could
have said the same,' I said, 'But there he was roaring
at me and I can tell you I was very scared indeed.
I did not know what to do.' I paused and let Johnny
sit with his anger.
'So I simply thought to myself, what would I
do if I didn't want to scare people off, because as
I later learned from the hon, he was lonely and had
to spend a lot of time on his own.' I was, of course,
using direct metaphor and sowing the seed for
Johnny to reflect on his own situation.

Evaluation of effects
The notion of opening up the therapeutic space
(Barragar-Dunne 1997), guided the direction in which
the story of the angry lion progressed. The use
of 'Let us pretend that the lion feels really scared
too' and 'What should happen next?', combined
with the curiosity language of wonderment and
NURSING CHILDREN AND YOUNG PEOPLE

wow, encouraged a metaphorical space for Johnny

and myself to bund and drive the story. Epston
(1997) and Holyoake (1997, 2001) show that
creating mystery and intrigue to snare the child is
a wonderful, yet so often neglected, skiU. Epston
(1997) describes how emphasising the meaning of
a child's name is a simple way of doing this. For
instance, my work with Johnny linked the initial use
of the plastic zebra with the idea of the lion.
'Where did that come from?' I said pointing
at the zebra with a head. 'It must be magic, the
lion must have helped the zebra feel better about
himself because now he has a head.' Johnny
beamed a smile because sometime during the
previous evening he had replaced the zebra's head
and waited excitedly for me to come on duty.
Like the metaphor, this symbolic act represented,
I hoped this would just be the beginning of our lion
and zebra story. 'I wonder how the lion and the
zebra will stay friends? I wonder what the other
animals will see them doing?'

Summary
From the ordinary world to the innermost cave and
back again with the ehxir in hand is, according to
Vogler (1998), the task of the hero in most stories.
And so it was with Johnny. During his two-week stay
he taught me a lot about interacting with ill young
people. Stories can be so universal, yet so personal,
so potent, but so neglected.

Conclusion
Engaging children with fictional stories can help
deed with the so often neglected psychological
connections to which nursing sometimes gives
low priority. The story of the angry hon allowed
Johnny to gain insight, skills and hope for his future
in the jungle we know as life. The symbohsm of
the missing zebra head, like the sceirs he so badly
wanted to disappear, would have to wait for another
day, for another story.
As for me I have still never spoken to a real hon
and am not intending to.

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Acknowledgements
Thanks are due to Jackie
Shakespeare, psychodynamic
nurse specialist, Priory Healthcare,
for her creativity, support and
dynamics
Conflict of interest
None declared

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