You are right that I should tell more about the photo-instrument and about myself.
Let me introduce then first. I'm a nurse researcher in a mental health institute in the eastern provinces of the Netherlands. Besides a nurse specialist in mental health I'm a historian as well. I do my research in the therapeutic effects of the photo-instrument as part of a PhD-trajectory.
To answer some of your questions:
-yes, I have submitted an abstract (on the photo-instrument) for the Turku phototherapy-congress.
-Patients follow a photo-group as a part of an integrated treatment day-program or as an element in a rehabilitation support program.
-participants in the photo-group are stimulated to respond to each other's story and help each other with suggestions how to visualize for instance future wishes. Although basically an individual project for every participant there is also sharing of stories that creates a bond among them and with the therapists/nurses conducting the group.
I would like to introduce to the annual meeting a non-verbal nursing intervention, the photo-instrument and present first findings of my PhD research into the therapeutical effects of the instrument, just as I did at the APA-congress last october in New Orleans.
Psychiatric patients often are inhibited to express their feelings and thoughts. They sometimes experience their surroundings as threatening. They can feel alienated from their surroundings because of derealisation and depersonalisation. Negative experiences and anxiety about the future can destabilise their confidence and self-appraisal.
In the case that patients have been dependent on psychiatric services for a long time this also will have effects on the way they look upon their selfs. Moreover patients and clients run the risc of their individuality only being acknowledged as being ill and needing help. The communication between the patient and his environment tend to be continously coloured by symptoms and problems. Looking for a nursing intervention to offset the disadvantages of these communicationpatterns centring upon a discours of disease and disorder we found in the medium of photography a suitable aid to apply in health settings.
The Photo-instrument is a manual or protocol for implementing a set of interventions with the medium of photography. It describes the stages that are needed to have patients or clients make photos of their lifeworld. There are 2x 8 sessions (groupmeetings). At the start the participating patients get a disposable camera and an assignment that tells them what to photograph. After 8 sessions the first round of sessions is completed with an exhibition of a selection of the photographs and a new round of 8 sessions starts. Whereas in the first round the focus is on what patients see as important (or dear to them) in their lives: people, spots, hobbies, etc in the here-and-now, the second round focuses on what wishes one has and how to realize these wishes in the near future. In both rounds, but especially in the first round there is room for the contrast between what one values in life on the one hand and what one has lost because of mental health problems on the other hand. The suffering must first be recognized and heard before one can go in life from there. The focus is however a positive one: it’s about what one values in life.
After the participants have taken their pictures they are invited to express their feelings and thoughts relating to the pictures. This is done in a very structured way and is extended over a number of sessions. In the end the participants select a small number of photos for an exposition. Photo and text are then combined.
In this way photography is a means to orient and direct our care more to patients demands and attune/tune in to their experiencing their lifeworld. At the same time it fulfills the need for developing activities in the field of leisure and provides opportunities for taking up new roles.
The Photo-instrument responds to the call for more ethics in care. There is a need for ‘narrative practices’. Renowned nurses and nursing scientists stress the importance of the patient narrative and the significance of the lifeworld paradigm.
Nursing is about activating and stimulating health and healthy behaviour. It also aims at minimalizing or reducing and taking away the negative consequences of illnesses and disorders. This supposes that nurses help patients to deal with the meaning of being ill, recovering or remaining handicapped. Taking pictures can assist the nurse in this task. Photos have one unique quality, that is they freeze time and place in an image. To get a hold on their existence and be able to cope patients need to halt their lives for one moment, to suspend the daily routine in order to have an opportunity to reflect. Offering this opportunity the photo-instrument helps integrating crises, illnesses and other life-events in the wider context of the patients’lifeworld. Moreover, making Photos implies certain awareness of the surroundings and settings you live in. The choices you have to make when selecting the places and people you want to make pictures of , highten your self-awareness. The interview questions in the sessions of the photo-instrument help people to verbalize their choices and reflect on them where they have to decide what to communicatie to spectators who come to the exhibition.
A such the photo-instrument fits in with rehabilitation nursing, but also concur with Parse’s theory of Human Becoming and Margaret Newman’s theoryn of health as expanding consciousness (or other humanistic-based nursing theories).
The stories patients tell with their photos are the result of a dialogue of participants with the interviewing nurse. Important to notice is that the participants are owners of their photos and decide for themselves which photos are selected for further discussion. Their expressed opinions and feelings may well be elicited by the nurse but are not subject to any modification for explicit therapeutic purposes. The expressed opinions and feelings are validated in their own right, that is their sayings are accepted and acknowledged as valuable per se. And that strengthens the participants confidence.
In taking upon them to photograph their world and showing us the results in an exhibition patients become providers and producers of information, amusement and tangible results. The photo-instrument realizes an active involvement in the project. There are many new roles the participants can involve themselves in: writing texts for brochures and announcements, deliver a speech at the opening of the exposition, taking care of the catering of visitors, etc.
There is still another contribution to nursing and that’s its capacity to train social skills. Making pictures stimulates communication among people. Someone making a picture always attracts attention and is an invitation for conversation. Sharing photos you can show connects people. Organising an photo-exhibition offers opportunities to practice social skills and does an appeal to latent talents while limitations and handicaps can be reckoned with and compensated.
The photo-instrument has been developed in a multi-centred trial with different patientgroups, in different settings, elderly patients as well as young people, institutionalised patients as well as ambulatory treated patients. There is a printed (dutch) version now, available with Publishers Kavanah and a shortened English version of the manual.