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Victoria Brattström

Exclusion/inclusion in health care meetings

Abstract: Exclusion/inclusion in health care meetings

This on-going multidisciplinary research project investigates how exclusion operates as well as the possibilities for inclusion in health care meetings. The project addresses the questions: how does exclusion operate within the context of today’s health care? Is it possible for the patient to imagine her/him-self anew, with the help of another? What are the possibilities and difficulties in the meeting between patient and health care professional, given that the first just entered the building, and the second has an assigned place and role in the highly professionalized, specialized and authoritative milieu of the medical establishment? How can the patient enter this institution, and how does s/he get access to care?

The question of getting access to health care can in fact be put more bluntly, with far more radical implications: how can we avoid shutting the patient out from him/her-self? The objectification and alienation of one’s body resulting from illness or injury is often intensified in concrete care situations, when the body is examined and understood as a malfunctioning biological thing, and furthermore diagnosed and explained in medical language. Falling ill and being in need of care can thus imply a loss of access to one’s own body and self.

The project is part of a PhD study investigating the concept of partnership between patients and care providers. This study is a collaborative project between the Academy of Music and Drama and The University of Gothenburg Centre for Person-centred Care – GPCC. Methods from theatre and film practice are employed to interpret and analyze interaction between patients and professionals in clinical healthcare encounters. The aim is to develop a multi-facetted understanding of the healthcare encounter as a complex and challenging arena for processes enacting partnership.

Exclusion/inclusion in health care meetings

Exclusion/inclusion in health care meetings

Playing oneself as if another – Acting and directing strategies as practical approaches in person-centred health and care

Contact: victoria.brattstrom@hsm.gu.se
Publications by Victoria Brattström

Photograph Lars Kroon. Montage Victoria Brattström
Photograph Lars Kroon. Montage Victoria Brattström

The PhD study at the University of Gothenburg in Sweden is performed as a collaborative project between the Academy of Music and Drama and University of Gothenburg Centre for Person-centred Care. The study holds the dual aim of exploring: (1) how particular techniques of acting and directing can contribute to person-centred health and care practice and (2) what implications ideas underpinning person-centred health and care practices can have on theatre-based thinking and the field of performing arts more generally.

The PhD is within the field of artistic research and can also be framed as part of a new, but growing, field of Artistic Interventions in Organisations where artist-led initiatives help organisations to develop their activities or competencies. Artistic Interventions in Organisations is within the thesis work regarded as a strand within the field of artistic research. See for example (Lehikoinen 2013).

The playing field of the project

The field of person-centred health and care and the field of theatre are, within the project, acknowledged as two discursive realms where particular values, theories, ideas, rules and so on underpin procedures, practices and techniques. The project could be articulated as an artistic research project were the artist-researcher finds herself in an intervention process on the interface between these two realms. The idea is to tease out and expose specific practical knowledge and skills of the theatre artist as this knowledge is exposed in new ways in the encounter with another field of knowledge. By instigating a dialogue between, on the one hand acting and directing practices within the field of theatre and on the other hand person-centred philosophy and person-centred health and care practices, the artistic intervention process opens up a third space for co-reflection and co-creation. The concept of performance operates within the thesis work as a metaphor, and also as a tool for critical scrutiny, as it provides a means to frame and interpret social phenomena.

GPCC and Person-centred care

The University of Gothenburg Centre for Person-centred Care (GPCC) is an interdisciplinary research centre with the overall aim of implementing and providing support for person-centred health and care research. Person-centred care (PCC) sees patients as capable persons who are more than their illness. PCC is a partnership between patients/carers and professional caregivers encompassing all forms of health and care, illness, rehabilitation and welfare. PCC takes its theoretical starting point in existential philosophy and emanates from the patient’s experience of his/her situation and his/her individual conditions, resources and restraints. The patient’s narrative is recorded in a structured manner and a mutual care plan is created during the health care encounter. This care plan is based on the patient's narrative, together with physical examinations and test results, and incorporates goals and strategies for implementation and follow-up. The caregivers’ professional responsibility during the health care encounter includes creating suitable conditions for a conversation, which makes space for the patient’s narrative as a fundamental condition of partnership.

Exploring co-creative partnerships within theatre and person-centred health and care practices

The theatre has developed techniques for establishing partnership and handling interaction in collaborative work on the stage. Interplay in a practical theatrical context builds on the actors ability to make her-/himself receptive to her/his fellow actors onstage. The actor needs to understand how s/he is affected by the onstage action, as well as how s/he is affecting the onstage action, when acting within the framework of the scripted role and/or the dramatic situation. This ability, or skill, which is trained during the actor’s education, can also be used by a director as an asset in her/his preparatory work with analysing and interpreting a play-script. During theatrical rehearsals this ability can also be an essential part of the actors and director’s collaborative work with creating the performance. (Brattström 2015)

The PhD study develops the process of re-enactment as a method for interpreting and analysing interaction between patients and professionals in clinical healthcare encounters. Central to the study are the concepts of the ‘Magic if’ and the ‘Given Circumstances’ which are part of the system of acting techniques developed by Russian actor and theatre director Konstantin Stanislavski (1863–1938). The Stanislavski Method of Physical Action is elaborated in the context of person-centred health and care practice as a means to shed light on the phenomena of partnership, and partnership-creation.

Main study; questions, empirical data/material and analyses

In the main study audio recordings taken during observation of clinical health care encounters are transcribed. Recorded encounters were conducted as part of a larger GPCC study, in an intervention group were patients were randomly chosen to receive a person-centred health care process. These transcripts are then taken through 3 steps of analysis that include:

(1) Interpretation of the transcripts as if they were scenes in a play, based on a director’s way of analysing and preparing a play script for a theatrical production.

(2) Investigation into the concept of partnership and partnership-creation between patients and care providers. Participants (patients and health care professionals) are observed in a workshop using the camera as a tool to generate images and discussions on partnership. To use the camera and the methods of filmmaking is applied as a way to bring forward another quality of data than if using interviews. When shooting images, participants need to discuss, interact and pose. Participants use body and mind in action, in a way that could be described as “brainstorming in practice”.

(3) Re-enactments of extracts from the transcribed encounters. In “rehearsal laboratories” the transcribed encounters are re-enacted together with actors. The actors and director explore the “role characters” possible motives, and use of interactional strategies (physical, verbal and mental actions) in a co-creative process similar to a theatrical rehearsal. The aim here is to analyse preconditions to a partnership relation between the patient and the professional care provider in the transcribed encounters.
Specific questions explored within the main study are:

  1. How do the patient and caregiver co-create the role of the patient when both are considered an active expert and partner in a healthcare encounter?
    1. By what means (physical, verbal and mental actions) is the patient trying to position her/himself as an equal partner and expert in the healthcare process?
    2. By what means is the professional caregiver supporting the patient to position her/himself as an equal partner and expert in the healthcare process?
  2. In what ways are the parties searching to overcome the obstacles or difficulties that arise in the situation and hamper the creation of a partnership-relation?
  3. How is a "play-based approach" manifested, based on an exploration of the partnership process, in the interaction between patient and healthcare provider in the care meeting and in the person-centred conversation?

Photograph Lars Kroon. Montage Victoria BrattströmPhotograph: Lars Kroon. Montage: Victoria Brattström

Read more about The Centre for Person-Centred Care at the University of Gothenburg

Playing the 'Magic If' A theatre director's perspective on intervening

Teater bidrar till praxis inom personcentrerad vård (in Swedish)

Read about how research questions within the thesis work were explored in the creation of a directorial concept for the musical Passion (in Swedish)


Brattström, Victoria. 2015. "Playing the ‘Magic If’ A theatre director’s perspective on intervening." In Artistic Interventions in Organizations: Research, Theory and Practice, edited by J Woodilla UJ Sköldberg, AB Antal - 2015, 184-162. Routledge.

Lehikoinen, Kai. 2013. "Artistic Interventions as a Strand of Artistic Research." The Impact of Performance as Research: CARPA3 Proceedings.

Page Manager: Tobias Egle|Last update: 3/12/2019

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