Therapeutic Photography - PhotoVoice

“ When I look at these portraits, I realise that three weeks ago I wouldn't have dreamt of talking to anyone, I would have turned away.” John, 2009

       
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Therapeutic Photography
How is photography therapeutic? Outlining therapeutic photography


How is photography therapeutic?

The healing and transformative potential of the arts and their value in supporting mental wellbeing has long been recognised. There is now a growing evidence baseFor a review of evidence see the following reports and research projects:  Mental health, social inclusion and arts: developing the evidence base, Department for Culture, Media and Sports to support the claims for the impact of the arts on our mental health but still we need to ask; how is photography therapeutic? We think of photography in relation to our holiday snaps shots, to news reporting or celebrity doorstopping, but it is not often that we consider its potential in relation to therapeutic work.

When we dwell on how photographs accompany us throughout our lives- how they relate to our memories, how they link us to who we are and how we perceive ourselves and each other- then we can start to imagine its huge potential as a creative tool to explore the world we live in and our own relation to it. 

To pick up and use a camera, one does not need extensive training - it is immediate and accessible and requires no specific skills or knowledge.  Photography provides an open-ended invitation to play, explore and discover.  

Before considering the potential of photography as a therapeutic support tool we first need to broaden our understanding of what photography involves.  Whilst the focus in photography tends to fall on the decisive moment, the act of pressing the shutter and taking a picture, this is only a small part of the photographic process.  The key therapeutic power of photography lies in its ability to enable dialogue and communication about ourselves and with others, and this centres around a notion of the whole photographic process that involves:

•  taking pictures
•  looking at pictures
•  editing pictures
•  playing with photographs
•  using photos as points of discussion
•  talking about pictures
•  presenting your pictures to others
•  exhibiting pictures
•  writing alongside and captioning pictures
•  using photos in collages and journals
•  taking pictures with friends and family
•  making photo albums or books.

Photography involves endless decisions. It asks us to frame the world - decide what to include, what to leave out, what to emphasise and what to overlook. As such photography helps us to form a sense of our selves and our place. It requires we take an active stance and in this sense promotes initiative and purpose.

It is possible to highlight a number of qualities of the photographic process which make it valuable for therapeutic support work:

Exploring self, identity and memories
Photographs of ourselves, our family albums, images of places we have been to – all of these build a picture of whom we are as people.  For many of us, talking about the personal pictures that we keep can provide opportunities to explore, experiment and reflect on who we are, who we have been and who we want to become. For people who have no pictures of themselves or photos of family and friends, creating new photos provides similar opportunities. Aspects of mental health issues are closely tied to negative self-image.  Many people who have used or survived the mental health system, or who live with a label or diagnosis of mental ill health, experience considerable stigmatisation and discrimination, adding to negative self-perceptions.  Photography can offer opportunities to explore how you see yourself, how others see you and how you wish to be seen. 

“It’s another accessory, a part of you, nothing else around you matters, you know…it’s just you and that piece of equipment you’re using.” Workshop participant

 

Acting as a distraction

For others, photography can offer respite from distressing symptoms and an opportunity for distraction and to forget about your problems.  Within medical approaches to mental health individuals become patients or service-users, but within a photographic project people become photographers and remain in control of their own activities.

“It made me forget, every time I came here I forgot about all my worries, I seem to have left my worries at home.  I mean to come back to them but it’s given me a focus”.  Workshop participant

“Are the groups therapeutic?...My view is that they shouldn’t be, the therapy should be incidental to the whole endeavour. Some of these people will have been through everything, psychiatrist, doctors, the whole shooting match and this is really time out from all of this, trying to put your problems in perspective” Facilitator and former mental health service-user

A means of creating order

Some therapists have noted that the mechanical use of camera requires a conscious control that leads away from spontaneity and creates a more structured way of expressing ideas and emotionsp50;  Kopytin, Alexander, Photography and Art Therapy: An easy partnership  Inscape, Vol 9, no 2 2004. When taking pictures people have to think about what they want to photograph and why. In doing so the photographic process provides a contained framework and encourages us to create structure. It asks us to relate things - people, places, objects - to each other. When you are coping with internal chaos and a sense of powerlessness, photography can offer a way to take control and bring a sense of order.

These pictures are about re-learning to get on the bus and not getting impatient.  It is the kind of thing other people take for granted but I have found it very hard for a while. I want to learn to use the bus independently, without the help of my support worker.  I chose to photograph this because I wanted to show how difficult it is for me to be independent.  I feel so trapped on a bus.  I am trying to change my way of thinking to see a bus journey as a way of going from A to B rather than being trapped.  I wish I could be like the other people on the bus who seem relaxed and comfortable.  Following the journey in my photography project has actually taken away some of the difficulty factor as I was concentrating on taking the photos.  Time is a great healer and I believe I can get back to where I was and be independent again.Creates distance and containment

In photographing something we objectify it.  The resulting photograph is itself an object.  Through photography we can gain a sense of distance from the subject of our picture.  PhotoVoice’s experience of working with vulnerable people indicates that photography’s therapeutic benefits are linked to its potential for looking and discussing at an arm’s length, through pictures, issues which are difficult or sensitive creates distance, perspective and a sense of safety.  In this sense photography can play a protective function.  We can take pictures or talk about pictures that might reflect traumatic or distressing things but stay one step removed by focussing on the picture or the act of photographing rather than the direct emotions. Therapists have noted that ordering pictures, putting them in albums and journals may be a factor in containingp51, Kopytin, Alexander   Photography and Art Therapy  Inscape, Vol 9, no 2 2004. In addition participants in PhotoVoice projects have found the act of photographing can create a buffer zone that allows them to engage with the external world but from a safe distance. It occupies them in an activity that distracts
from other destabilising fears, concerns and preoccupations.


Encourages sharing, storytelling and dialogue

Sharing your photos with other people can help build bonds, friendships and networks, encouraging dialogue and communication. Evidence from one project showed that when photography was used at a residential unit the interaction between patients stimulated their emotional support of each otherSee research case study p.56, Kopytin, Alexander   Photography and Art Therapy  Inscape, Vol 9, no 2 2004.Central to all PhotoVoice projects is group discussion where people talk about photographs together – their own and other peoples- encouraging exchange, social networks and peer support.

Photography is a narrative medium - pictures tell stories and they can help us to tell our own stories and to share them with others.  Telling and sharing stories with pictures enables us to explore meanings, memories and significance, which can have a cathartic and healing effect.  Taking pictures of people you care about and sharing them with them can reflect and strengthen relationships.


Bridge between our conscious and unconscious, our internal and external worlds
The arts have been used as therapeutic tools for many years, with roots in Freudian analysis and the discovery of the unconscious. Creative expression can increase self-confidence and motivation, enabling the “expression of the otherwise inexpressible, and experience of cognitive, emotional and spiritual areas to which people otherwise have no access”Argyle and Bolton, 2005, as cited by Brandling, 2009 .Similarly, photographs can act as a bridge between our conscious and unconscious and our internal and external worlds. Photography is rooted in the external world. For people who have been struggling with internal confusion it can provide a 'grounding' in reality - a way of exploring internal concerns through an external register. Photography may provide an opportunity for accessing, exploring, and communicating about feelings and memories – many of which we may not be fully conscious of.

“It’s quite difficult taking photos when you are depressed, you know, getting organised…this course is a bit like art therapy…you can express what you want to express, saying this is how I feel” Workshop participant

It is not just the contents of the photographs themselves that can be important but the memories, feelings and thoughts that may emerge during the dialogue that happens as we look at and discuss pictures. Talking about pictures, asking questions about them, may reveal the layers of meaning we assign to photographs – values, attitudes and expectations that may be either or unconscious or consciousFor further information see Weiser, Judy  PhotoTherapy Techniques   PhotoTherapy Centre, 1999 . It should be noted that significant therapeutic work, that digs deeply into people’s emotions and memories, when there is the possibility of uncovering traumatic or distressing memories, should only be done with the support of trained mental health professionals.

Overcomes barriers to verbal expression
Images can compensate for a deficiency of verbal ability or help with communication with people who are speakers of other languages. Some people coping with mental distress find it hard to express all they are dealing with in terms of words. Photography provides an alternative visual language and playing with photographs and words together allows people to find new forms of expression.

Saint...or Sinner?! By Sean Steward
Provides opportunities for play
Photographs allow us to pose, play or pretend to be someone different. In pictures we can create new realities. We can be silly, serious or build a fantasy world. There is lots of fun to be had and photography can provide a sense of freedom and inventiveness, encouraging and nurturing people’s creativity.

 

 


Confidence and self-esteem

Participating in photographic workshops or other arts projects can boost the self-esteem of people living with mental distressHeenan, 2006 as cited by Brandling, 2009. The confidence, self-esteem and sense of pride in their achievement can enable people to feel more resilient and able to cope. The evaluation of the photographic workshops run jointly by PhotoVoice and United Response showed that participants gained self-esteem, and for some this lasted beyond the duration of the course. As well as the sense of achievement in learning a new skill or developing an existing one, participants took pride in their photographs and in sharing them with the group. For many participants, the workshops also gave them a sense of purpose and a boost to their self-confidence

Photography allows people to take ownership of a creative process and feel proud of the work they produce. Mastering a skill and knowing you have the ability to take good photographs is for many a rewarding experience. Learning something new in terms of mastering the functions of a digital camera and knowing you are capable of doing this is a boost to people’s self-esteem and sense of personal capacity. Many people find a new ‘voice’ though photography as it enables them to communicate about things they feel strongly about, issues that move or interest them in a different way. In PhotoVoice’s experience photography is accessible for people of all abilities, camera equipment can be adapted to enable people with mobility issues and physical impairments to enjoy taking pictures. Pictures are easily presented in exhibitions, digital presentations, printed in digital books or as postcards. When photographs are presented to an audience – of peers, family and friends or even public audiences – the experience can be affirming and validating for the photographers.

“Sometimes when the pictures go on the wall….and they sort of put you on the spot to describe what you were thinking or feeling then I have been able to say something….that’s quite good for me.” Workshop participant

“…When I took one person home he said, “I can’t remember the last time someone clapped and applauded something I have done”, he was so chuffed” Workshop facilitator

Provides opportunities to get out and overcome social isolation

This picture gave me a real sense of achievement.  I walked up a steep hill and I’m not good with heights and depths as well as not being as fit as I’d like to be.  But all the puffing and panting to get up the hill was worth it – to see this scene of the Devon coast.  I was out of the four walls of the house and I had done something that had made me feel good.Social exclusion greatly affects people living with mental distress who may feel unable to get about by themselves, may not have access to transport and may have had long periods of unemployment and/or in residential units – all factors contributing to isolation from their local communitiesSee Making Waves research into Mental Health and Social Inclusion for further details, report summary available for download here . Photography provides a focus and reason to get out and about. Arranging for outshoots to local areas – parks, beauty spots, high streets – can provide opportunities to explore the local community, explore new environments and reconnect with old places.

“I don’t stand out when I’m out and about and having a camera I just ignore everyone, there was one photo…I had to literally lie on the floor to take it, and people must have thought I was a complete nutcase (laughs) but I didn’t care particularly, it was just, I wanted the shot.” Workshop participant

Most of the participants of the PhotoVoice/ United Response workshops said they enjoyed the experience of meeting new people. Many had to overcome a degree of trepidation when entering the group for the first time. Some described a sense of belonging and felt encouraged to join other groups because this experience had proved so positive.

“I won’t be so frightened about joining a new group having joined this group. I was a bit frightened when I first come here because I knew nobody.” Workshop participant



A note of caution
While photography has numerous applications to support therapeutic work it should be not be taken as a given that all the qualities listed above are necessarily relevant or valuable to all people living with mental distress. People’s experiences of mental ill health are diverse and some aspects of therapeutic photography maybe of great value to some while having limited impact or, even potentially, a harmful affect on others. This is particularly important for those with complex mental health needs or those suffering extreme states of mental distress. Some caution needs to be taken and it is vital to involve experienced mental health professionals in both developing the project and supporting individuals.

For example:

Exploring self, identity and memories
Some people who have been through mental health services and have complex mental health needs have very deep-rooted negative self-images. Using photography to explore their identity can be tricky and needs to be used with caution. It may take some people weeks or months before they find a picture of themselves acceptable. Some might find using a camera troubling and thinking about how they see themselves might be a distressing process. Looking at old family pictures may bring up old recollections or uncover buried memories that could cause considerable upset.

A means of creating order
For some making decisions can be tormenting and it is difficult for them to create any sense of order. Being forced into making decisions can cause even more pressure.

Encourages sharing, storytelling and dialogue
In some cases sharing personal stories and experiences can open up old wounds which are more harmful than beneficial. People continually repeating personal stories can be reflective of unhealthy fixations and the facilitator needs to encourage different kinds of stories and dialogue. People’s responses to sharing stories in a group setting can be very different - one person can react in a negative way and this can have an effect on other members of the group.

Provides opportunities for play

Playing, particularly role playing for the camera might scare some people. Some find it hard to let go and pretend or may not want to participate in playful activities as it may raise issues or reminders of times when they may have felt excluded or intimidated. Some people do not feel that they can let themselves go in this way.

Taking Pride
Some people find it very difficult to acknowledge that they have made any achievement no matter how much encouragement or impressive comments are made. Others might find it incredibly hard to master the skills. The faciltiator’s expertise here is central in enabling people to realise their potential.

“People keep telling me how good I am….I find it hard to think they are meaning it.” Workshop participant

Provides opportunities to get out and explore
Some people may find it too intimidating to take pictures in public places.

Photography has numerous qualities that give it huge potential as a therapeutic tool but such examples demonstrate the delicate nature of the work. Practitioners need at all times to be sensitive to the needs and mental well being of the people they are working with.


For further info see: Responsible Practice section

Questions to consider:

  • How do you find photography therapeutic?
  • What kinds of images are most precious to you?
  • Thinking of the people you will be working with and their mental health needs, in what ways do you think photography can be of most value as a therapeutic tool?
  • Can you think of two or three instances in which you may need to take care with using photography as a therapeutic tool?

 

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