Neil Gibson reflects on therapeutic photography and self-esteem as part of a workshop delivered at the June 2023 Scottish Medical Humanities Conference
Photography can be a catalyst for communication. When we engage with our own photographs, we are reminded of times gone by, significant moments, fleeting experiences, or the routine of everyday existence. Drill deeper, and we get a sense of who we are, what is important to us, and we can use the power of creativity to express ourselves. Such was the premise for my workshop at the June 2023 Scottish Medical Humanities Conference in Aberdeen, Scotland.
Therapeutic photography is the “structured [and] guided engagement with the creative intervention of photography in order to produce images for exploration with clearly defined outcomes for the participant” (Gibson 2018, 33). It is a method that can be used to enhance self-esteem, self-efficacy, and empowerment. Therapeutic photography can be a useful intervention to employ with patients who are going through significant change and coming to terms with a shift in their identity.
At the workshop, one of the participants appeared to be struggling with the concept of “therapeutic” photography. When asked to find a photograph on their phone which they love and then say something about it, they felt that it was impossible to find an image that defined their identity. Upon reflection, I understand and agree – one photograph may not be able to define our identity. But the purpose of this exercise, I believe, is to provide insight into an identity. Indeed, identity is not a fixed concept, and we are many things to many people. Our identity might be as a partner, a parent, an employee, a sports enthusiast, or even a patient, for example. It is fluid and changeable. Therefore, to view a photo taken by someone, and listen to why it is important to them, gives that person a chance to assert a part of themselves, take control of their narrative, and share something of their self with another person.
As participants settled into the experience of talking about their photographs, much information was shared, along with some artistic expression. Within the hour-long timescale of the workshop, I wanted to build on the artistic skills and link this with the exploration of emotions to emphasise the applicability of photography as a tool to explore well-being and mental health (Decoster & Dickerson 2014). I then asked participants to choose one emotion from a choice of six, including joy, sadness, anger, love, surprise, and fear. Once decided, they took a 15-minute walk and tried to capture an image to represent that emotion. To respect confidentiality and privacy, the only additional rule was not to photograph any other people.
The choice of exercise was deliberate and aimed to combine several factors to enhance the “therapeutic” value for each participant. First, by naming emotions there is an immediate connection with how each one makes us feel (Lench, 2018). We can consider previous experiences of these emotions, then take control of the creative processes to visually (and abstractly) represent each one. The exercise sets a task which is immediately achievable as there is no “right” answer. Participation will result in a picture which can be used to further explore what that emotion means for the photographer. Added to this, the process of “finding” an image connects the participant to the environment. They explore with their whole body, searching the environment for something, perhaps noticing the presence of objects they may never have paid much heed to before, and being in the moment which is akin to mindfulness.
Once an image has been captured, the participants are encouraged to sit in small groups, share their image, and explain what it represents and why. Having the experience of talking about emotions with other interested participants is novel for many, and what it does is it normalises the experience of having emotions. We all have them, we all experience them, but some are deemed to be more negative than others. Many times, I’ve heard someone say: “I don’t get angry”. My response is normally: “Why not?” Anger is just one of many normal emotions that we all experience. Exploring emotions with others helps us realise that it is human to be affected by our existence, and experience can affect us all in different ways… and that’s okay.
This particular exercise can work on a deeper level too. Coming from a background of working in social work, it was not unusual to encounter people who use services who found emotions to be alien. As babies grow and develop, their carer should help them identify how they are feeling and during this process will name emotions so that the developing child learns to associate emotions with a label. For some, this process does not happen. They might grow up where emotional expression is suppressed or absent, where a carer is unavailable, or worse, punitive. This can result in someone struggling to make sense of their feelings as they grow and develop, so emotions can be confusing and alienating. Encouraging exploration of emotions at an early stage can assist in the development of neural pathways, emotional intelligence, and brain development, therefore this exercise makes links with these developmental experiences (Van Der Kolk 2015; Gerhardt 2014).
The workshop aimed to give a flavour of the potential that therapeutic photography can bring to medical humanities. The areas for exploration using this technique can be mapped onto a socio-ecological model and give insight into self-perception, relationships, narratives, and wider interactions with society (Bronfenbrenner 1992). It can be used by an individual to help ground a person and recognise how situations and circumstances might be making them feel. For staff and students working in medicine, this technique can be used as a form of self-care. It can be used to help come to terms with a sudden change in life which can impact on our perception of the world around us, and consequently, our identity. For patients and clients, it can be used in a peer support situation where people can share experiences and learn from others about coping strategies and wider support structures.
Towards the end of the hour I moved into giving examples of groups where these techniques have proved to be useful. One such group was run by a local charity who supported people with a cancer diagnosis, as well as those caring for a loved one with the disease. The therapeutic photography group ran for six weeks with men from the northeast of Scotland. Typically, males are viewed as harder to reach when it comes to setting up peer support groups (Oliffe & Bottorff 2007). In this instance, the dynamic of using photographs to explore circumstances introduced them to a technique where things could be externalised and (literally) objectified to hold at arms length and talk about. In feedback, they stated that they could have formed a support group, met in a café, and chatted, but inevitably the conversation would have turned to football! Using the photographs, they spoke about relationships, emotions, and hopes for the future. When asked if they would like to display their photographs they responded with a resounding “No!” The photographs were personal to them. They did not feel the need to share the visuals with others. They were in control of their information and their photographs.
As the workshop drew to a close we summarised the intended outcomes of experiencing control whilst exploring identity.. I was left wondering if my critical participant had any more insight and understanding of the many facets of identity and how we can celebrate different aspects of this through slowing down, exploring our environment, and using the creative tool of photography to express our relationship with what is important to us. Given the intended outcomes aim to enhance self-esteem, self-efficacy and empowerment, the experience will be different for everyone and even if the seeds were planted to further ponder on the potential of these techniques, then that participant controlled their identity within the experience and had an appropriate outcome.
About the Author
Neil Gibson is an Associate Dean at Robert Gordon University, Aberdeen. He has a professional background in social work, including hospital based social work and palliative care. He has been researching the therapeutic use of photography since 2015 and is author of Therapeutic Photography: Enhancing Self Esteem, Self-Efficacy and Resilience (Jessica Kingsley Publishers, 2018). Neil has created the only online course to teach these techniques at a Post Graduate Certificate level.
Follow Neil on Instagram @gibson_therapeuticphotography
References
Bronfenbrenner, U. 1992. Ecological Systems Theory. London: Jessica Kingsley Publishers.
Decoster, V.A. and Dickerson, J. 2014. The Therapeutic Use of Photography in Clinical Social Work: Evidence-based best practices. Social Work in Mental Health 12(1), pp. 1-19.
Gerhardt, S. 2006. Why love matters: How affection shapes a baby’s brain. London: Routledge.
Gibson, N. 2018. Therapeutic Photography: Enhancing Self-Esteem, Self-Efficacy and Resilience. London: Jessica Kingsley Publishers.
Lench, H. (ed) 2018. The Function of Emotions, New York: Springer.
Oliffe, J.L. and Bottorff, J.L. 2007. Further than the eye can see? Photo elicitation and research with men. Qualitative Health Research 17(6), pp. 850-858.
Van Der Kolk, B. 2015. The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. London: Penguin.
