MODEL OF INTERVENTION WITH PHOTOTHERAPY TECHNIQUES IN A HOSPITAL ENVIRONMENT
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Transcript of MODEL OF INTERVENTION WITH PHOTOTHERAPY TECHNIQUES IN A HOSPITAL ENVIRONMENT
MODEL OF INTERVENTION WITH PHOTOTHERAPY TECHNIQUES IN A HOSPITAL ENVIRONMENT
Francisco Avilés, Maria Elena Bautista, Diana Cedeño, Diana Rico
Abstract
This contribution summarizes the family therapeutic work and
the research experience with patients at the National Institute of
Pediatrics in Mexico City INP, using Phototherapy techniques. The
process of integrating a therapeutic team from the Institute of the
Family (IFAC), is described, as well as the family therapy sessions
and the research outcomes. Among the problems we a have worked
with chronic renal disease with kidney transplant, development and
learning disorders, grief elaboration and dysfunctional family
dynamics associated with. Advantages of using these techniques in a
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Original text: Translation: Spanish 'English
Intervention models phototherapy
techniques in an environment hospitable
* Francisco Aviles, Maria Elena Bautista,
hospital environment are discussed. An Intervention model is also
described.
Key words: Phototherapy Techniques, Family Therapy
Introduction
It would be hard to imagine our world without photographic images.
Photography was born in the mid-nineteenth century and since then we
have included in our daily lives with many and varied purposes and various
forms. Photography, as we all know, is the procedure whereby an image is
captured and later fixed permanently on a sensitive surface and / or a
digital file. It is in essence the miracle to stop time and keep it for the
lifetime and beyond.
At first only a few privileged people had access to the photographic
processes and could afford to pay the high cost involving equipment,
chemicals and time to carry out photographs. Little by little, and gradually
Diana Cedeño, Diana Rico
Summary
This proposal summarizes the experience of
research and therapeutic work using
familiar techniques phototherapy patients
with the National Institute of Pediatrics in
Mexico City. It describes the process of
integrating a team of therapeutic and
research of the Institute of the Family
(IFAC), family therapy sessions with
patients of the institution, and the results
achieved in this first stage. Among the
problems are dealt with chronic renal
failure, kidney transplant, developmental
delay, learning problems, development of
taking pictures has becomed an accessible reality to most of us. In recent
years, with the digital photography this posibility is closer than ever, we
can show them, communicate with them, present and represent our
complex world.
We can say without doubt that we have created and that we live in a
world of images that represent us.
Pictures always contain information, stories to tell and share, evoking
thoughts, feelings and significant memories in people's lives. When
viewing an image, each person gets a different interpretation and associates
their own cognitive and emotional content. While the images contain
information, it is the observer who creates the meaning, so photographs can
be used as a powerful tools in therapeutic processes.
An important precedent in the history of photography applied to
mental health, is the photographic work of Diamond (1856), who
grief and associated dysfunctional family
dynamics.
It discusses the advantages of using these
techniques and proposes a model
intervention in a hospital environment
Keywords: Photodynamic therapy, family
therapy
Abstract
This contribution summarizes the family
therapeutic work and the research
experience with patients at the National
Institute of Pediatrics in Mexico City INP,
phototherapy using techniques. The process
of integrating a therapeutic team from the
Institute of the Family (IFAC), is described,
photographed his patients as an aid in the diagnosis and identification of
different types of mental illness; he discovered that the photographs had a
positive therapeutic effect when they are shown to patients. The findings
of their research were presented at the London's Royal Society of Medicine
in the same year. (Krauss 1983)
In the book Photoanalysis (1973), Dr. Akeret described methods for
the analysis of family photographs in order to obtain information from their
interpersonal dynamics.
Stewart (1978) defines phototherapy as the use of photographs or
photographic materials, under the guidance of a trained therapist, to reduce
or relieve painful, psychological symptoms, to facilitate growth,
psychological and therapeutic changes.
David Krauss (1980) holds phototherapy as the systematic application
of the photographic image and / or photographic processes to create
as well as the family therapy sessions and
the research outcomes. Among the
problems are worked chronic renal disease,
kidney transplant, development and
learning disorders, grief elaboration and
dysfunctional family dynamics associated
with. Advantages of using these techniques
in a hospital environment are discussed. An
Intervention model is also described.
Key words: phototherapy techniques,
family therapy
Introduction
It would be hard to imagine our world today
without photographic images. The
photograph was born in the mid-nineteenth
positive changes in thoughts, feelings and behaviors of clients.
Fryrear (1980) makes an analysis of the major applications that until
then had been documented in the literature on the subject, these being:
evoke emotional states, facilitate verbal behavior, model, develop skills,
provide socialization, foster expression and creativity, help diagnose,
promote verbal communication between therapist and client, document
therapeutic changes, prolong meaningful experiences and promote self-
confrontation.
In 1993 Judy Weiser publishes a classic book called Phototherapy
Techniques, she did a broad description of the main techniques used and
notes that the personal photos and family albums are visual metaphors of
experience; adds that the photographs can be a window to unconsciousness
and help people understand more themselves.
The five techniques described by Weiser phototherapy are based on:
century and since then the people we have
included in our daily lives with many and
varied purposes and various forms. The
photograph, as we all know, is the
procedure whereby captured and later set an
image permanently on a surface sensitive
and / or a digital file. It is in essence the
magic to stop time and keep it forever.
At first only had access to the photographic
processes a privileged few who could afford
to pay the high cost involving equipment,
chemicals and time to carry out
photographs. Over time, and gradually take
pictures se ha ido becoming a reality
accessible to most of us.
1. Photos that have been taken or created by the client
2. Photos that have been taken from the client by other people
3. Self-portraits, which are photos taken from clients
themselves.
4. Family albums and other biographical photo collections.
5. Photo-projectives
A variant of the earlier techniques is what Jo Spence (1986) called
Therapeutic Photography , which encourages the realization of self-
portraits to be used later as tools to study body image in order to work
physical appearance and consequently the self-acceptance.
It is noteworthy, according to Judy Weiser, that Phototherapy is not a
therapeutic model in itself, but a set of techniques based on photographic
images to support therapeutic processes, thus, it can be useful regardless of
In recent years, with digital photographs is
closer than ever and we can show them,
communicate, present and represent our
complex world. We can say without doubt
that we have created and live in a world of
images that represent us.
The pictures always contain information,
stories to tell and share, evoking thoughts,
feelings and memories significant in
people's lives. When viewing an image,
each person gets a different interpretation
and associated cognitive and emotional
content themselves. While the images
contain information which is the observer
creates the meaning, so good photographs
can be powerful tools used in therapeutic
the therapists theoretical framework.
It is incorrect to speak of Phototherapist as a professional identity.
The research
The overall objective was to determine in what way Photo Therapy
Techniques can contribute to the therapeutic work with families in public
health institutions.
Research was conducted at the National Institute of Pediatrics (INP)
from October 2007 to May 2008. We met four families and phototherapy
techniques were used during these sessions. The National Institute of
Pediatrics (INP) is an institution of public health, located in Mexico City.
Concentrates pediatric patients across the country at the third level of
attention, that is highly specialized.
processes.
An important precedent in the history of
photography applied to mental health, is the
photographic work of Diamond (1856) who
photographed their patients as an aid in the
diagnosis and identification of different
types of mental illness; discovered that the
photographs had an effect positive
therapeutic when they are shown to
patients. The findings of their research were
presented at London's Royal Society of
Medicine in the same year. (Krauss 1983)
In the book Photoanalysis (1973), Dr.
Akeret described methods for the analysis
of family photographs in order to obtain
Its purpose is to provide service to Mexican children, through medical
care, research and training of specialized human resources. The INP
serving daily more than 800 children and adolescents from 0 to 18 years in
various medical specialties. It achieves more than 20 surgeries and
endoscopies per working day.
Every two days an article is published in a high level scientific
journal. More than 700 undergraduate and graduate students are formed
annually. The child population of INP comes throughout all Mexico, so it
has a wide socio-cultural and socio-economic diversity, dominated by the
lower and middle levels.
Our model of intervention
The investigation team consists of family therapists with several years
of experience working in the institution on a voluntary basis. From our
experience we saw the possibility of conducting this investigation and
information from their interpersonal
dynamics.
Stewart (1978) defines phototherapy as the
use of photographs or photographic
materials, under the guidance of a trained
therapist, to reduce or relieve painful
psychological symptoms, facilitate growth
and psychological changes therapeutic.
David Krauss (1980) holds the
phototherapy as the systematic application
of the photographic image and / or
photographic processes to create positive
changes in thoughts, feelings and behaviors
of customers.
implementing an innovating a creative approach to help families in their
vital process within the institution.
We have a bio-psycho-social and spiritual approach. Our theoretical
framework is based on systems theory, social constructionism,
phenomenology and narrative therapy.
We do not make an interpretative work of the patients responses , we
accompany them through new questions to help and give a new meaning to
the experiences and put them into the right direction of the therapeutic
goals that we had stablish jointly. It works in the present, past and future
to build new narratives.
The model is under construction and is still being definied from the
direct experience of working with these families.
The ethical framework of our position mainly considers respect for
Fryrear (1980) makes an analysis of the
major applications that until then had been
documented in the literature on the subject,
these being: evoke emotional states,
facilitate verbal conduct, model, develop
skills, provide socialization, foster
expression and creativity, help diagnose ,
Promote verbal communication between
therapist and client, document changes
therapeutic prolong meaningful experiences
and promote self-confrontation.
In 1993 Judy Weiser publishes a book
called classic phototherapy Techniques in
making a broad description of the main
techniques used and notes that the personal
photos and family albums are visual
cultural diversity of ideas, values and beliefs, respect for the free
expression of emotions and acceptance of differences as an enriching
element of human experience.
Methodology
The method that was used for research was the qualitative
(exploratory - descriptive method). We work with what we have called a
Participative Team, which is a model in co-therapy with a mixed team
formed by several therapists for family and couples, interacting actively in
the sessions.
The model proposes a three stage work. : Pre-meeting (planning)
which includes only participative team, 20 minutes approximately to agree
and stablish the guidelines to be followed. The sessions, with the family
(conducting) will last approximately 50 minutes of efective work and the
post-meeting (thematic discussion and emotional elaboration) which only
meets again with the participative team.
metaphors of experience; adds that the
photographs can be a window to help
people understand and unconscious More
themselves.
The five techniques described by Weiser
phototherapy are based on:
1. Photos that have been taken or created by
the customer
2. Photos that have been taken from the
customer by other people
3. Self-portraits, which are any photos taken
from customers themselves.
4. Family photo albums and other
biographical collections.
5. Photo-projective
Characteristics of the sample
In regard to the sample, four families were studied, all of them of low
income, residents of Mexico City and metropolitan areas. The medical
diagnoses registered in the files of the identified patients were: chronic
renal desease with kidney transplant, goiter colloid, learning problems,
juvenile diabetes and mourning processes.
In the family dynamics we observed multiproblem families where
other members also present physical , mental and emotional health
problems.
Being middle and lower economic resources families they find it
very expensive to attend the sessions frecuently. It implies for supplying
members not to perceive the daily economic income, therefore we see to
give them appointments taking advantage that they are coming for other
medical services needed for the identified patients.
A variant of the earlier techniques is what
Jo Spence (1986) called Photo
Therapeutics, which is encouraging the
realization of self-portraits to be used later
as tools to study body image in order to
work physical appearance and consequently
the self-acceptance.
It is noteworthy, according to Judy Weiser,
that phototherapy is not a model therapeutic
in itself but a set of techniques based on
photographic images to support therapeutic
process, thus, can be useful regardless of
the theoretical framework used therapists. It
is incorrect to speak of professional identity
as fototerapeutas
.
This article is not present in detail the therapeutic processes of these
families, our main interest is to present the model with which we work and
share the general conclusions reached.
PhotoTherapy techniques used in this investigation were: self family
portrait by the identified patient, Family portrait decided by other family
members, photographs of family albums and photographs taken during the
sessions.
Working with photographs takes us to the following questions:
• What title would you put in this picture?
• What story does this image account for?
• What does it make you feel?
• What does it say about yourself or your family?
The Investigation
The overall objective was to determine in
what way the Therapy techniques can
contribute to the therapeutic work with
families in public health institutions.
The research was conducted at the National
Institute of Pediatrics (INP) from October
2007 to May 2008. They met four families
and phototherapy techniques were used
during the sessions.
The National Institute of Pediatrics (INP) is
an institution of public health, located in
• What would have to change in this image so that you would have a
differente thought and / or feeling ?
• Who took this photograph?
Procedure
Families are referred to us by the different medical services at the
institute.
First session
In the first session families come to talk freely about their individual,
and family problems and about their experience at the institut.
In this finitial meeting a family dynamics assessment is made as well
as a consideration of the identified patient clinical file. We explained to the
family that we will be working with photographs and ask them permission
to take pictures and to record the sessions.
Once we have the authorisation we clarify the doubts, if needed.
Mexico City. Concentra to pediatric patients
across the country at the third level of
attention, that is highly specialized. Its
purpose is to provide service to Mexican
children, through medical care, research and
training of specialized human resources.
The INP daily serving more than 800
children and adolescents from 0 to 18 years
in various medical specialties. It achieves
more than 20 surgeries and endoscopic per
working day. Every two days an article
published in scientific journals high level.
They are formed annually more than 700
undergraduate and graduate students.
The child population of INP comes from
Later on we ask the identified patient to take a photograph of the
family without him or her, who will decide how and where the members
of the family should be placed. Then he/she should decide his/her place for
a second photograph to be taken by a member of the participative team.
Next the therapeutic team with the family take a new photo
altogether. The photographs that have been taken are given to the family, as
gifts and a copy is saved for us to document our work.
We invite each family member to choose and bring a photo from the
family album, something that is meaningful in order to work with it for the
next sessions
After the first meeting we gather the participative team to exchange
ideas of the session contents and to propose the general and specific
therapeutic goals that will guide for our future interventions.
General therapeutic objectives
throughout Mexico, so it has a wide socio-
cultural and socio-economic diversity,
dominated the lower and middle levels.
Our model of intervention
The investigation team consists of family
therapists with several years' experience
working in the institution on a voluntary
basis. From our experience we saw the
possibility of conducting this investigation
and implement an innovative and creative
approach to help families in their vital
process within the institution.
We have a bio-psycho-social and spiritual.
Our theoretical framework is based on
systems theory, social constructionism,
For all the cases we propose the following therapeutic objectives:
• Stablish family working goals
• Clarifying doubts about the health condition and treatment of the
identified patient
• Exploring and re-orienting family beliefs concerning health
problems and medical treatments
• Stick to the medical treatments
• Improving communication among family members
• Handle family stress through the medical procedures and frecuent
hospitalizations
• Organizing family resources
• Exploring formal and informal support networks
• Negotiating feaseable agreements and individual responsibilities
• To Handle, contain and guide positively emotional expressions
• Create awareness concerning the importance of collaboration and
support among all the members.
phenomenology and narrative therapy. Do
not we interpretive work of the responses of
patients, we accompanied by new questions
to help re experiences and put them in the
service of therapeutic targets set jointly. It
works at present, past and future to build
new narratives.
The model is under construction and has ido
defining from the direct experience of
working with these families.
The ethical framework of our work as
fundamentally respect for cultural diversity
of ideas, values and beliefs, respect for the
free expression of emotions and acceptance
of differences as enriching elements of
Second Session
After the social phase of the interview, we ask them to show us the
photographs they bring and each member of the family shares the photo
chosen and the reason for the choice.
Then we ask to put a title to the picture and to talk about their own
story of the image. What is usually first done is to describe the content of
those who are present, the place where it was taken, the person who took
the photo and and afterwards what does the photo mean to the people
Stablishing connections with these memories leads to people in a
very deeply and fast way to the emotional content that the images evoke.
During the exercise photographs are taken showing emotional
interactions and nonverbal messages that occur spontaneously and make
visible other aspects of family dynamics and resources from which we will
work the relational diagnosis and then the specific aims, being these the
ones that are derived from the particular problems of the family, and from
human experience.
Methodology
The method that was used for research was
the qualitative (exploratory method-
descriptive).
We work with what we have called a
Participatory Team, which is a model in co-
therapy with a mixed team formed by
several family therapists and couples
intervening actively in the meetings.
The model poses a job in three stages. : Pre-
meeting (planning) which intervenes only
team participatory, approximately 20
the observed and referred material.
It is important to say that our relational diagnosis takes into account
the problems of families but we focuses primarily on the system resources,
because it is with these that we work particularly.
Given the emotional intensity that this exercise brings, it is advisable
to ensure a post-meeting for the therapeutic team to exchange ideas,
experiences and to elaborate emotions that arise in each of the therapists.
This post-meeting is also important to consider aims to work
associated with the specific family dynamics.
The team's preparation sessions take place after each session of family
therapy.
From the third to the seventh session
minutes to agree on guidelines to follow.
The sessions with the family (driving)
lasting approximately 50 minutes of actual
work and post-meeting (thematic discussion
and emotional development) which meets
again the only team participatory.
Characteristics of the sample
In regard to the sample, were studied four
families, all of them low income, residents
of Mexico City and metropolitan areas. The
medical diagnoses registered in the files of
the patients were identified: chronic renal
failure with kidney transplant, goiter
colloid, learning problems, juvenile diabetes
and processes of mourning.
From the third session, even though the team has some pre-defined
goals to work, the families will be the ones that based on their needs and
priorities will determine the item or items to be addressed.
It is part of our model to respect the priorities of the family reason
why we give some time for the expression of these needs at the beginning
of each session.
It is noteworthy that we dont work all the sessionss with photographs.
In situations that demanded it, we request from meeting to another, to
bring again photographs of the family album to facilitate contact between
members, promote communication, share information and emotional
relevant responses useful for the therapeutic process.
Eighth Session
We work based on the photographs that we have taken during the
sessions, we present them and formulating the following questions:
In the note that family dynamics are
multiproblemáticas families where other
members of civil society presents various
problems of physical health, mental and
emotional.
As families of middle and lower economic
resources find it very expensive to attend
sessions little spaced over time. It implies
for members suppliers fail to perceive the
income and therefore seek appointment
exploiting them coming to other medical
services necessary for the patient identified.
This article is not present in detail the
therapeutic processes of these families, our
What is the story that these pictures have?
What do they say about you and your family?
Ninth Session
In this session we make a review of the obtained achievements and
ask to each member of the family on an individual basis to express their
thoughts and feelings about the experience of having worked in the manner
proposed and the changes it has brought to his personal daily life, both
individually and for the family dynamics
Tenth Session
In the closing session we invite them to express “what follows for
their family life”, reinforcing the positive aspects and the obtained
achievements , we work in order to stablish new goals for the future life
and give them the botton line of a collaborative work in the family.
Each therapist makes a devolution of his/her personal experience,
main interest is to present the model with
which we work and share the general
conclusions reached.
Therapy techniques used in this
investigation were: self-portrait family
identified by the patient, self-portrait by
other family members, photographs of
family albums and photographs taken
during the sessions.
Working with photographs revolves around
the following questions:
• What title would put him in this picture?
• What history has this image?
• What makes you feel?
reinforcing individual and family resources. All together we make a ritual
farewell.
Up till now the presentation of the model.
Next we shall share the difficulties we have encountered, the
contributions of our work and the conclusions which we reached in this
early stage, outlining the projects that will continue over the next steps and
making recommendations for future research.
Difficulties encountered
Associated with the model: time agreed for the sessions:
Originally we thought it would be possible to work with
phototherapy techniques, in the same way as we do in family therapy
sessions excluding these techniques. Quickly we found out that the 50
minutes format was inadequate to the extent that this time does not allow us
to work deeper if we want that all family members can participate and
expressed themselves widely, which is not only desirable but essential.
• What you said and / or your family?
• What would have to change this image so
that had a thought and / or feeling different?
• Who took this picture?
Procedure
Families are referred to us by the various
medical services at the institute. At the first
meeting families come to talk freely about
their individual problems, family and his
experience in the institution.
First Meeting
In this initial meeting is an assessment of
family dynamics and the patient's clinical
records identified. We explained to the
Difficulties associated to the family dynamics
Eventhough these families are organized around the suffering
institutional identified patient, they experience as any other family system,
tensions, difficulties and failures both at individual and relational level.
This leads us to consider them as multiproblems families in which it
will be necessary to seek adaptive systemic changes for the entire family
and the individual needs of each member and not only focus isomophicaly
on the identified patient´s needs .
Even having previously established lines of work and aims to reach,
family needs have priorities and there is a need to address them at the
beginning of each session and to work as long as necessary. This implies to
changes the strategy and requires rethinking of the immediate objectives.
We consider important to be flexible and adapt to the demands of families.
Another difficulty encountered revolves around the availability of members
and economic problems associated, to the extent that members of the
family that we will work with photographs
and ask permission to take pictures and to
record the meetings. Already with your
permission we clarify the doubts, if
submitted.
Then we ask the patient identified to take a
photograph of the family without him or her
to decide where and how to place each
parcel and then to define its place alongside
the family for a second image that will be
taken this time by some of the Team
members. The therapeutic team after taking
a photo together with the family. The
photographs were taken gifts and a copy is
saved for us to document their work. We
invite each family member to choose and
families have to leave their daily responsibilities, work, schools and so on,
and that affects the economy functioning of the family; quite often the
main economic provider is unable to attend the meetings. The distance and
the time it takes to get to the hospital (on average more than two hours
round, time of meetings and two hours back) per trip, is also a factor to take
into account to set the frecuency and schedule for sessions.
Difficulties related to medical and institutional priorities.
At this early stage due to of refurbishment works and the scarse
availability of spaces in the hospital we did not have adequate facilities
according to the needs of our model. It is important to say that our
interventions are a support for medical services and that we are dependent
of their priorities. The health status of patients and last minutes medical
decisions obligued us to be flexible and respectful and often change the
direction and intensity of our work.
Contributions of our research
bring a family photo album, sometime it has
been significant, for working with them in
the following sessions
After the first meeting we met the
participatory team to exchange ideas on the
contents of it and propose the general and
specific therapeutic targets in principle that
will lead our future interventions.
Therapeutic targets general
In all cases we propose the following
therapeutic targets:
• Set goals working in the family
• Clarifying doubts about the condition and
treatment
It is our understanding that this research is a pioneer in the use of
phototherapy techniques applied to families in a hospital environment with
a bio-psycho-social and spiritual approach in our country. We have no
information that these techniques have been applied by a Participative co-
therapy team in any other study, nor in our country or outside it.
Conclusions
• Working with cameras and phototherapy techniques generates
acceptance and enthusiasm in families and therapists
• Working with cameras and voice recorders was useful for the purposes
of this investigation
• Phototherapy techniques help establish a good therapeutic hitch
• It is esear to approach the privacy of families
• There are clearly observed potential alliances, coalitions and family
physical and emotional closeness between family members.
• Is it possible to include symbolically absent members
• Facilitates the grief work
• Promotes more verbal and nonverbal exchanges
• Explore and re-orient the beliefs of the
family on the problems and medical
treatment
• Work adherence to medical treatment
• Improving communication among family
members
• Manage stress by family medical
procedures and hospitalizations continued
• Organize Family Resources
• Explore formal and informal support
networks
• Negotiate agreements viable and
individual responsibilities
• Handle, contain and guide positively
emotional expressions
• Create awareness about the importance of
collaboration and support among all
• Photographs provide information about the socio-cultural context of
families.
• Giving photographs of meetings with family members and the
therapeutic team, helps the creation of the emotional link and the
establishment of a collaborative work.
• Through photographs family members who no longer live are
symbolically present at these working sessions.
• Through photographic images, the participative team can get to
know the life stories of families and their contexts.
• It promotes greater awareness and attention to the needs of other
family members
• We note that in the hospital environment the families with one
chronically ill member join spontaneously and bring support to each
other in various ways, both from instrumental and emotional point of
view.
Recommendations
members.
Second Session
After the social stage we ask them to show
us the photographs they bring with them
and each member of the family shares the
photo you chose and why he made the
choice. Then we ask that you put a title to
the picture and we talk about their own
history of the image. It is generally done
first describes the contents, who are present,
in what took place, who took personal
history and what has that photo. Connecting
with these memories leads to people in a
very rapid and deep emotional content to
• Due to the intense emotional expression in the sessions, it is
imperative that the team should be made up by well-trained therapists
with expertise and knowledge of phototherapy techniques
• It is advisable to work in a space that allows movement,
comfortable and well ventilated
• We recommend working sessions from 90 to 100 minutes
• It is suggested to record, photographe and video film sessions as
teaching aids , if it is authorized by the family and the hospital.
• To promote an ongoing dialogue with medical specialists
responsible for the physical health of patients
• We propose a working model in which families work together with
their experience to help other families facing similar situations.
• It is proposed to design research projects to address specific
problems of each medical specialised service.
Bibliography
Akeret, R.V. (1973) Photoanalysis. New York: Peter H. Wyden, Inc.
the images they evoke.
During the exercise are taken photographs
showing emotional interactions and
nonverbal messages that occur
spontaneously and make visible other
aspects of family dynamics and resources
from which we will work relational
diagnosis and then the specific aims, these
being the arising from the particular
problems of the family, and referred
reported.
It is noteworthy that our relational diagnosis
takes into account the problems of families
but focuses primarily on system resources,
because it is the resources so that we work
All rights reserved. Amerikaner, M., Schauble, P., and Ziller, R.C.
(1980). Images: The use of photographs in personal counseling.
Personnel and Guidance Journal, 59, 68-73. Anderson, C.M., and
Malloy, E. (1976). Family photographs: In treatment and training. Family
Process, 15:2, 259-264. Bach, H. (2001). The place of the photograph in
visual narrative research. Afterimage: The Journal of Media Arts and
Cultural Criticism, 29:3 (Nov / Dec), 7. Coblenz, A.L. (1964). Use of
photographs in a family mental health clinic. American Journal of
Psychiatry, 121, 601-602. Combs, J.M., and Ziller, R.C. (1977).
Photographic self-concept of counsel. Journal of Counseling Psychology,
24:5, 452-455. Cosden, C., and Reynolds, D. (1982). Photography as
therapy. Arts in Psychotherapy, 9:1, 19-23. Démarré, L. (2001).
Phototherapy: Traveling beyond categories. Afterimage: The Journal of
Media Arts and Cultural Criticism, 29:3 (Nov / Dec), 6. Entin, Alan D.
(1983). The family as icon: Family photographs in psychotherapy. In:
D.A. Krauss and J.L. Fryrear (Eds.), phototherapy in mental health (pp.
117-134). Springfield, IL: Charles C. Entin, A.D. (1980). Family albums
primarily.
Given the emotional intensity that this
exercise brings, it is essential to ensure a
post-meeting for therapeutic equipment to
exchange ideas, experiences and develop
the emotions that arise in each of the
therapists. This post-meeting is also
important to consider aims to work
associated with the specific family
dynamics. The team's preparation sessions
take place after each session of family
therapy.
From the third to the seventh meeting
From the third session, even though the
and multigenerational portraits. Camera Lucida, 1:2, 39-51. Fryrear,
J.L. (1983). Photographic self-confrontation as therapy. In: D.A. Krauss
and J.L. Fryrear (Eds.), phototherapy in mental health (pp. 71-94).
Springfield, IL: Charles C. Thomas. Fryrear, J.L. (1982). Visual self-
confrontation as therapy. Phototherapy, 3:1, 11-12. Fryrear, J.L., and
Corbit, I.E. (1992). Photo Art therapy: A Jungian perspective.
Springfield, IL: Charles C. Thomas. Krauss, D.A. and Fryrear, J.L.
(1983). Phototherapy in mental health. Springfield Ill., USA: Charles C.
Thomas. Spence, J (1986). Putting myself in the picture: A political,
personal and photographic autobiography. London: Camden Press.
Weiser, J. (1993). Techniques phototherapy. Exploring the secrets of
personal snapshots and family albums. Vancouver, Canada:
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team has some pre-defined goals to work,
which are families with their needs and
priorities determined largely item or items
to be addressed. It is part of our model
respecting the priorities of the family by
what we give some time to the expression
of these needs at the beginning of each
session. It is noteworthy that not all
meetings are working with photographs. In
situations that warrant it, we request a
meeting to another, returning to bring
photographs of family album again to
facilitate contact between members,
promote communication, information
sharing and emotional responses relevant to
the therapeutic process.
Eighth Session
We work based on the photographs taken
during the meetings we were formulating
the present again the following questions:
What is the history that has these pictures?
What say you and the family?
Ninth Session
At this meeting we review the achievements
and ask each member of the family on an
individual basis to express their thoughts
and feelings about the experience of having
worked in the manner proposed and the
changes it has brought to his daily life both
individually and in family dynamics
Tenth Session
At the closing session invite them to
express what follows in family life,
reinforce the positive aspects and
achievements, work setting targets for the
future life and the importance of
collaborative work in the family. Each
therapist makes a return of his personal
experience, dedicating more resources
individual and family. Together we make a
farewell ritual.
So much for the presentation of the model.
We present below the difficulties we have
encountered, the contributions of our work
and the conclusions which we reached at
this early stage, outlined the projects that
will continue over the next steps and make
recommendations for future research.
Difficulties encountered
Associated with the model
Time agreed at the meetings: Originally we
thought it would be possible to work with
phototherapy techniques in the same way as
we do in family therapy sessions excluding
these techniques. Quickly realizing that we
went the format of 50 minutes was
inadequate to the extent that this time does
not allow us to work deeper if all family
members participate and are expressed
widely, which is not only desirable but
essential.
Associated with the Family Dynamics
Although these families aified and
institutional experience as any other system,
tensions, difficulties and failures
botindividual needs of each member and not
just focus on the patient isomórficas
identified.
Even having previously established lines of
work and aims to reach family needs have
priority and there is a need to address them
at the beginning of each session and to work
as long as nesary. This changes the strategy
and requires rethinking of the immediate
objectives. We consider it important to be
flexible and adapt to the demands of
famAnother difficulty encountered revolves
around the availability of members and
economic partners, to the extent that
members of the families have to leave their
daily responsibilities, work, schools and so
on. and that affects the functioning
economy and the family; quite often the
main economic provider is unable to attend
the meetings. The distance and the time it
takes to get to the hospital (on average more
than two hours round, time of meetings and
two hours back) per trip is also a factor to
take into account to set the timetable and
schedule for sessions.
Associated Medical and institutional
priorities
At this early stage because of refurbishment
works and the availability of spaces do not
have adequate facilities according to the
needs of the model.
It is important to note that our interventions
are a support for medical services and we
are dependent on their priorities. The health
status of patients and medical decisions last-
minute compel us to be flexible and
respectful and often change the direction
and intensity of our work.
Input from our research
It is our understanding that this research is a
pioneer in the use of phototherapy
techniques applied to families in a hospital
environment in our country and from a bio-
psycho-social and spiritual.
We have no information that these
techniques have been applied by a team
participatory co-therapy in any other study,
nor in our country or outside it.
Conclusions
• Working with cameras and techniques
phototherapy generates acceptance and
enthusiasm in families and therapists
• Working with cameras and voice recorders
was useful for the purposes of this
investigation
• phototherapy techniques help establish a
good therapeutic hitch
• It comes easily to privacy of families
• There are clearly potential alliances,
coalitions and family physical and
emotional closeness between family
members.
• Is it possible to include symbolically
absent members
• Facilitates the work of drafting duels
• Promotes more exchanges verbal and
nonverbal
• The photographs provide information on
the socio-cultural context of families.
• Regalar photographs of meetings with
family members with therapeutic
equipment, facilitates the creation of the
emotional link and the establishment of a
collaborative work.
• Through photographs are present at
meetings symbolically family members who
no longer live.
• Through photographic images,
participatory team can get to know the life
histories of families and their contexts.
• It promotes greater awareness and
attention to the needs of other family
members
• We note that the hospital environment for
families with one member chronically ill
join spontaneously and are supported in
various ways both in the instrumental as
well as emotional.
Recommendations
• Due to the intense emotional expression in
the sessions is imperative that the team is
made up of well-trained therapists with
expertise and knowledge of techniques
phototherapy
• It is advisable to work in a space that
allows movement, is comfortable and well
ventilated
• We recommend working sessions from 90
to 100 minutes
• It is suggested recording, photographing
and video filming sessions for use as
teaching aids and, if it is authorized.
• Promote an ongoing dialogue with
medical specialists responsible for the
physical health of patients
• We propose a working model in which
families work together with their experience
to help other families facing similar
situations.
• It is proposed to design research projects
to address specific problems of each
medical service specialist.
Bibliography
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reserved. All rights reserved.
Amerikaner, M., Schauble, P., and Ziller,
R.C. (1980). Images: The use of
photographs in personal counseling.
Personnel and Guidance Journal, 59, 68-73.
Anderson, C.M., and Malloy, E. (1976).
Family photographs: In treatment and
training. Family Process, 15:2, 259-264.
Bach, H. (2001). The place of the
photograph in visual narrative research.
Afterimage: The Journal of Media Arts and
Cultural Criticism, 29:3 (Nov / Dec), 7.
Coblenz, A.L. (1964). Use of photographs
in a family mental health clinic. American
Journal of Psychiatry, 121, 601-602.
Combs, J.M., and Ziller, R.C. (1977).
Photographic self-concept of counsel.
Journal of Counseling Psychology, 24:5,
452-455.
Cosden, C., and Reynolds, D. (1982).
Photography as therapy. Arts in
Psychotherapy, 9:1, 19-23.
Démarré, L. (2001). Phototherapy:
Traveling beyond categories. Afterimage:
The Journal of Media Arts and Cultural
Criticism, 29:3 (Nov / Dec), 6.
Entin, Alan D. (1983). The family as icon:
Family photographs in psychotherapy. In:
D.A. Krauss and J.L. Fryrear (Eds.),
phototherapy in mental health (pp. 117-
134). Springfield, IL: Charles C.
Entin, A.D. (1980). Family albums and
multigenerational portraits. Camera Lucida,
1:2, 39-51.
Fryrear, J.L. (1983). Photographic self-
confrontation as therapy. In: D.A. Krauss
and J.L.
Fryrear (Eds.), phototherapy in mental
health (pp. 71-94). Springfield, IL: Charles
C. Thomas. Fryrear, J.L. (1982). Visual
self-confrontation as therapy. Phototherapy,
3:1, 11-12.
Fryrear, J.L., and Corbit, I.E. (1992). Photo
Art therapy: A Jungian perspective.
Springfield, IL: Charles C. Thomas.
Krauss, D.A. and Fryrear, J.L. (1983).
Phototherapy in mental health. Springfield
Ill., USA: Charles C. Thomas.
Spence, J (1986). Putting myself in the
picture: A political, personal and
photographic autobiography. London:
Camden Press.
Weiser, J. (1993). Techniques phototherapy.
Exploring the secrets of personal snapshots
and family albums. Vancouver, Canada:
phototherapy-centre
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