This page provides information about the key concepts of CIC and a selection of published articles about the approach or related to it.
Key concepts: the seven C’s
CIC is based on ideas and skills from systemic family therapy, communication theory, narrative medicine and a range of other sources. For simplicity, we use seven core concepts to communicate the essentials of our approach. We call these the seven C’s. They are not meant as a toolkit but as signposts towards taking a narrative-based stance in professional conversations. The seven C’s are:
Conversations. Effective conversations don’t just describe reality, they create new understanding of it. Whatever the setting or the purpose of the encounter, conversations can be seen as interventions in their own right. Through the judicious use of questions, they create opportunities for people to rethink and redefine their realities. We believe that every narrative contains the momentum for change if allowed to breathe, rather than being nudged in the direction the listener wants.
Curiosity. This is the common factor that turns conversations from chatter into something more substantial. It should be friendly but not nosy. Curiosity invites people to reconsider their stories. An essential aspect of curiosity is neutrality (to people, to blame, to interpretations, to facts.) Curiosity should also extend to yourself. How can you stop being bored, critical, impatient, or possessed by the need to fix things for other people?
Contexts. This is what it is most effective to be curious about. Important contexts for patients and clients are their personal histories, families, belief systems and values. These are what people want to talk about and make their conversations come alive. Similarly, important contexts when talking with colleagues are their teams, networks and organisations. Curiosity into these contexts often leads to shifts in the narrative, which may be unexpected for both the narrator and listener. (“I never realised that until I heard myself say it.”)
Complexity. Life can be seen as an evolving dance of interactions in which each conversation plays a part. Introducing a sense of complexity into the conversation gets away from fixed ideas of cause and effect, unchangeable problems, and over-concrete solutions. We help people seek provisional resolutions of their stories rather than illusory permanent solutions.
Challenge. Any conversation is an opportunity for challenging someone to explore and create a better account of reality than the present one: a story (a narrative) that makes better sense of what they are going through.
Caution. You need to balance challenge with confirmation. Remember you’re not doing therapy – on colleagues or on patients! If people want straightforward advice, be prepared to give that too, while being aware of its limitations. And remember that reality exists, in manifestations such as broken bones, strokes and domestic abuse. There are times when your professional responsibility to take action must override your neutrality.
Care. None of the other ideas will work unless you are respectful, affectionate and attentive. Every professional encounter needs to be grounded in moral commitment.
These published articles describe different aspects of CIC
They all appeared originally in the “On reflection” column of the Postgraduate Medical Journal (PMJ). Some were republished in Reflective Practice in Medicine and Multiprofessional Healthcare by John Launer, a collection of his monthly essays from the PMJ and the international medical journal QJM, written between 2002 and 2022. A full list of these essays on reflective practice and medical humanities, and his columns in the BMJ since 2022 appears at johnlauner.com.
Effective clinical conversations: the art of curiosity
Digging holes and weaving tapestries
Is taking a history outmoded? Why we should listen to stories instead
The Yin and Yang of medical consultations
Why metaphors matter: the semantic determinants of disease
Below are three earlier articles from QJM. These also appear in John’s book How Not To Be A Doctor, And Other Essays.