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

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Photographic self-concept of counsel. Journal of Counseling Psychology,

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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.

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Photography as therapy. Arts in

Psychotherapy, 9:1, 19-23.

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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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