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Photography and art therapy: An easy partnershipAlexander KopytinPublished online: 02 Jan 2008.

To cite this article: Alexander Kopytin (2004) Photography and art therapy: An easy partnership, Inscape: FormerlyInscape, 9:2, 49-58, DOI: 10.1080/02647140408405677

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PHOTOGRAPHY AND ART THERAPY An easy partnership

by Alexander Kopytin

Abstract

Photography is a visual medium. It would seem natural for art therapists to consider its therapeutic use and potential. Paradoxically, however, there are only rare instances where art therapists have explored the use of photography. The aim of this article, therefore, is to stimulate thinking about photography from an art therapeutic stance that involves its use in clinical practice. A wide range of therapeutic factors implied in the taking and perceiving of photographs are presented. Additionally, a variety

of creative activities based on photography are described. Case illustrations demonstrate different forms of thematic group activities and contexts where photographic pictures may be used. K~~ words: art therapy, groups, photography, phototherapy

In tro duc tio n Due to our own personal experience and from the pracbce of phototherapy (Cook, 1997; Krauss and Fryrear, 1983; Spence, 1986) we all know that healing and self-discovery often takes place when people are involved in either taking pictures or just looking at and discussing them with others. We could not imagne our life nowadays without photography, whch accompanies us from birth. For most people, photographic pictures serve as a valuable documentary of their personal histories. Photographs can biing people together and speak much more eloquently and convincingly than words. They can also serve as vivid and concentrated fragments of external reality as well as the objectified repre5entation of our inner worlds. This can lead to personal discoveries by providing a cohesion and contiriuity to experience.

Taking: photos and later arranging and rearranging them in albums can be playful as well as develop a sense of order. Through photographs we can pose and ( ontrol objects and even create a new reality. We can also try to stop the flow of time and make various instances of our life last forever. Through photography we can also pose ourselves - our fantasies, sensations and feelings as well as our body and relationships, because we can create the context and take what we need for ourselves. And sometimes with the help of photography, we can restore the forgotten or thngs that we have lost. ALl thrl possible health-promoting effects of photopphy are fairly obvious within the therapeutic context. It IS surprising, therefore, that it remains a somewhat exotic medium for most therapists and still poorl!. represented in contemporary literature. Since photography implies making and perceiving visual images it would be natural for art therapists to take the lead in the exploration of its therapeutic potential,

using the ideas and principles that characterise their profession. There are some examples where art therapists have used photography with individuals and groups and applied different theoretical approaches to support their practice. Judy Weiser (1993) encourages the use of phototherapy techniques alongside other skills, in particular for family therapy. She started as an art therapist and extended the scope of phototherapy through the use of other visual media. She indicates that certain qualities of photography such as the mechanical production of images make it easier for some clients than most other visual arts techniques. Looking at photos is less intrusive, in her opinion, than looking at a painting. Fryrear and Corbit (1992) attempt to integrate Jungian psychology and photographic techniques within an art therapeutic context. Central to their work with active imagination is the process of graphic elaboration, where the subject of the photo is cut out from the background and glued to a piece of drawing paper. The client is then encouraged to elaborate on the image in various ways. These authors demonstrate how photo art therapy can be used in dealing with specific short-term treatment challenges such as relieving fears and depression and resolving intrapsychic conflicts. They have also applied photography in group therapy situations and give suggestions of how to work with the stuck group by integrating aspects of psychodrama, photography, meditation and videotaping. Michael Barbee (2002) presents a visual-narrative approach, which he used with a small group of transgender clients in San Francisco. Partiupants were asked to photograph their gender story. Photographs later became the basis for open-ended interviews, leading to a narrative portrayal of

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participants experiences. In Barbees study, photographs proved a valuable stimulus for eliciting individual meanings of transsexual experience.

Wadeson (2002) refers to the art therapy work of Bettina Thorn (1998), who combined writing with photography and art in a phototherapy group she established at a psychosocial rehabilitation facility. The group visited locations around the city and took photographs. Through photography, art and writing, members of the group learned new skills that improved their self-esteem and confidence.

Phillips (1986) found photography useful as a metaphor for self in her clinical work with people with schizophrenia. It helped her to enter the visual field of her clients and experience their sense of reality, as well as allowing her clients to come to a more realistic view of themselves.

A similar approach to the use of photography is developed by Mark Boorno (1989), in his therapy through creative self-expression. He claims that photography enables a client to achieve a sense of individuality and thus understand his/her specific creative way of life. In her pioneering work with photographic images, Landgarten (1993,1994) used photo collage as a quick and economical way to evoke descriptive accounts and explore cross-cultural themes.

All these studies indicate that photography has vast possibilities for art therapy practice and some have indeed been successfully realised by our colleagues. It seems, however, that many such possibilities are not sufficiently used. The specific qualities of photography as a visual medium and the effects it can have on clients, depending on the different formats and procedures of its use, remain subjects for further investigation in our profession.

Photography as a visual a r t medium The art of photography is multifaceted, but it cannot exist without making and perceiving photographic images. Unlike painting, drawing or clay-work, it needs special technical equipment. This provides additional possibilities for creative self-expression, in particular the possibility of copying pictures, exploring different formats and colours, using special visual effects, etc.

The conscious control needed to use the camera can, however, lead people away from spontaneity and thus inhibit emotional expression. It seems more natural for photography to provide a more structured way of expressing ideas and emotions and to be a means of projective-symbolic communication rather than a means of their direct expression. The mechanical nature of photography and the possibility

of producing visual images when a client has no ability or is too anxious to draw may be two of its advantages in the art therapy process.

The physical density of a camera and photographs can evoke a feeling of safety, which can be especially important with regard to anxious clients or those who are fearful of strong or difficult emotions. Through this quality, and by the fact that it enables representation of the external world, photography provides grounding in reality and helps a client to cope with internal chaos. When a client makes pictures, a sense of power and possession of objects or feelings may be important, especially if the client feels powerless.

Due to the social nature of photography, that is its ability to link people together and stimulate communication, it can be used to structure relationships and provide a sense of order and cohesion in individual or group situations, especially when the situation is perceived as not safe enough. Photography is environmental, in the sense that it reflects relationships between objects. Searching for objects and arranging them in some or another way in order to make a photographic picture of them, or choosing a certain position and posture while making photographs, helps to include oneself in the space and develop a sense of physical presence in the environment.

Photography stimulates visual thinkmg. Through photography, clients can think through images and compensate for a deficiency of verbal ability. The art of photography is akin to play, because it gives vast possibilities to play with reality and its representations. Conscious and unconscious, fantasy and reality can come together through picture- making. We can consider photography as a means of active dialoguing with the world and ourselves. Due to its play quality, picture-making may bring a feeling of joy and freedom. Making and showing pictures often involves self- representation, by demonstrating oneself in one or another appearance or role to a real or imapned audience. Photography often implies fixing ones own or other peoples appearance, activities or interactions. We can see various postures and mimic expressions that reflect different emotions and reactions to persons and objects as well as how we feel in certain environments. This enables us to use photography as a means of exploring our body image and our ability to express feelings. Showing photographs to others is often accompanied by stories. Telling stories helps render our attitude to what is represented in photos and clarify what is hidden behind them. This also helps to explore the meaning of events by connecting them together.

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Stories accompanying pictures are often complex and vivid, which makes them even more powerful, by being ible to express thoughts and feelings more fully. Ths makes the narrative element of photography significant in its therapeutic effect.

Thus photography can be regarded as a complex visual medium with many unique qualities absent in most art materials. It also integrates various creative activities and art forms such as play, drama, movement, story-telling, etc. that can be used in different combinations throughout the therapeutic process.

Some therapeut ic f unc t ions of photography t h a t m a y be relevant in ar t therapy Specific qualities of photography as a visual art medium provide therapeutic functions, which are outlined in this section. As far as the art therapy process is concerned, these functions can be sufficiently realised and understood in the context of therapeutic relationships. This draws on fundamental principles of art therapy. These are: that visual image (or object-) making is an important aspect of the human learning process; that the image.making . . . in the presence of a therapist may enable a client to get in touch with early, repressed feelings as well as with feelrngs related to the here-and-now; that the ensuiirg art object may act as a container for powerful emuticins that cannot be easily expressed; and that fhe object provides a means of communication between therapist and patient. It can also serve to illuminate the transkrence (that is, feelingsfiom the past which are brought into the here-and-now and influence the way we experience others) between the therapist and patient. (Waller, 1993, p. 3)

Photographs provoke memories and feelings, both positive and negative. Though memories may be traumatic and negative, feelings are sometimes overwheIming; when psychological safety is established and containment of feelings is provided h s c m lead to catharsis and resolution. This focusinglactualisingfunction is also connected with expression of latent, previously hidden characteristics of a client. Perceiving a photo, a client may discover, for instance, that she or he is presented in a new and unusual way or does something she or he never imagined they would do.

Photography stimulates diferent sensory systems inchding vision, tactile and kinaesthetic sensations. When a person is taking photographs or showing them to others she or he takes an active stance in the world. In this way, photography promotes initiative and zntentzonality. It stimulates fantasy and thinking,

evokes different emotions and often physical activity. By creating an image, a person taps into her or his creativity. Photography is inseparable from ones ability to choose and include a perceived object or feeling into a system of personal meanings and relate them to ones experience and needs. This can be an important factor of bringing the unconscious into consciousness. Another therapeutic function of photography is reflecting the dynamics of external and in tonal changes. Photography enables us to see and recognise changes in our appearance and environment and often understand changes and our identity and way of life as well. Photography can help a client to observe changes as a result of certain events or influences and to see a meaning in the clients own and other peoples actions and feelings. Combining certain photographic images taken from different sources may lead to a discovery of new, meaningful connections between them. There is therefore the possibility for self-reflection and reframing. Keeping pictures in an album may be an additional factor of containing. It is interesting to speculate about associations to the camera and its containing function. It may also represent a kind of hermetic vessel. When the film is inserted into the camera it is as if it goes through stages of an alchemical process. Our actions and feelings can be safely kept on the film inside the camera and later assume a new quality, when the film is taken out of the camera and processed.

Photography has a cathartic and communicative function in helping the expression of feelings and ideas. There is also a protective function by enabling some distance from traumatic experiences.

Different f o r m s o# using photography with ar t therapy groups Various photographic techniques may be used periodically during the art therapy process depending on clients needs. There may be a wish to capture some moments of their artworks or to create a new experience. Sometimes photography helps to establish a more direct contact with reality and a distance from powerful feelings. In certain cases, clients may want to use photography in order to objecw changes that take place within them or around them.

Though clients and groups can spontaneously come to using photography, in some cases a therapist may stimulate them to use it by introducing certain themes, games or exercises. Client or group activity may be structured differently depending on the situation. Sometimes, for instance when a group lacks self-organisation or anxiety is high, a therapist can

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use such a thematic approach. I choose from a number of different themes, games and exercises that can be separated into several categories such as Thinkmg, dexterity, memory, General themes, Self-perceptions (Liebmann, 1986). To give an example: the Polarities theme may represent the Leneral themes category. Working on this theme, group members are asked to make a series of pictures representing objects with opposite or complementary characteristics, or those that evoke opposite feelings. Some of the particular polarities may be The big and the small, Beautiful and ugly, Pleasant and unpleasant and so on. It is possible for group members to formulate or choose a theme themselves. Photographs can be made either during or between sessions.

When the photographs are ready, group members are invited to arrange them in certain ways making a composition, installation, album or poster. Texts, including those created by members themselves or borrowed, can accompany the visual material. Later, presentation and discussion takes place.

The polarities theme may allow symbolic expression of different feelings, including difficult or negative ones and their recognition and conscious integration. It can also improve self-control and facilitate safe self- disclosure, in particular with regard to clients latent needs. An example of the Self-perceptions category might be the theme Life-line, when a client or group members are asked to bring photos from their homes, in which they are represented in different periods of their life. Some pictures may reflect important biographic events, such as weddings or graduating from college or university. People choose any pictures they find significant. Sometimes, if a group is mature enough, members can concentrate on most difficult or dramatic events. During the session, group members show their photos to one another, accompanwg them with their commentary. Sometimes I might invite people to concentrate on particular periods of their life or relationships. In some cases, the role dynamics, professional career, hobbies, family relationships, etc. can become a subject of discussion. The first case example presented below illustrates clients responses while they work on this theme. Sometimes my approach is less directive and open projects can be introduced to the group, giving participants more space to choose from a number of perspectives (Waller, 1993). Group members may also be asked to arrange pictures in certain ways, making a composition, an album or a poster. A long sheet of paper, such as wallpaper, can provide a suitable format for this task.

~~

They may use texts and different art materials to draw between pictures to provide additional visual and narrative material.

Beside personal photos, which clients bring in by invitation or on their own initiative, they may also be asked to make photos either during or between sessions and later use them in different ways (to produce a thematic album, a book or a poster, or include them in a collage or an installation). Combinations of visual media with different art forms may satisfy the changing needs of clients at different stages of the art therapy process and provide additional avenues for self-expression.

Using the exercise Expressive gestures and postures, group members form pairs. One person expresses different feelings and emotional states, particularly those that are most typical of or signhcant to her or him, through a series of movements or postures. In doing so, the group member should not say what concrete states or feelings are being expressed. Meanwhile the second member of the pair observes the others movements and postures and periodically takes snapshots. She or he should also pay attention to what feelings and fantasies of their own are being evoked by the partners movements. Later, partners share their impressions. One describes what states or feelings she or he expressed, while the other describes what states or feehgs she or he observed. They then exchange roles. When the photos are developed, the partners discuss the movements and gestures shown in the pictures. They might pay special attention to the degree to which their experience of particular states or feelings is expressed in movement and postures. Sometimes, they might be asked to make a composition of several photos reflecting the dynamics of their movements and gestures. Their personal meanings may also be conveyed by arranging photos and inserting drawings and/ or texts. This exercise helps to express different feelings and develop interpersonal skills and the ability to be engaged in collaborative activities. It also helps to improve self-regulation and ones ability to experiment with new roles and experiences, to reveal and make conscious ones latent needs, to develop empathy and give emotional support to others. When mutual trust between group members is established, using this exercise may provide safe self-disclosure and facilitate closeness.

I realise, however, that the effects of clients activities, and the particular photographic technique or theme they may use, depend on the context and such factors as the stage of the individual or group art therapy process, the quality of therapeutic and group relationships, the time limits, individual

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characteristics of a client or group, overall goals of therapy, etc. I also understand that some techniques may be used to achieve certain immediate goals (better understanding of the clients situation, establishing rapport, emotional release, stimulating interaction between group members, etc.) in one case and serve as an instrumental basis to achieve long- term goals in other cases.

Examples of using photography in the context of interactive art therapy groups In h s section some examples of using photography in an interactive art therapy group are presented. Examples 1,2 and 3 reflect my work with short-term training groups. Participants were asked to bring in personal photographs and later include them in their artwork. Example 4 reflects work with a long-term therapeutic group of psychiatric patients resident in a specialised unit.

Example 1: finding meaning and cohesion in life stories through individual art-making w i th photographs During a session, members of a thematic group were asked to make a two- or three-dimensional composition reflecting their life story and various past and present roles. Compositions could be made using personal photographs and any art materials. Group members had different cultural and professional backgrounds. Most of them were Latvians, a few members had a Russian background and one member came from the Czech Republic. One member of the group, Mara, made three paper cones and placed her personal pictures onto them. These also symbolised her past, present and future. Presenting her composition to the group, she said that her family had experienced deportation and been sent to Siberia when Stalin occupied Latvia. She had been born in Magadan, in the far east of the USSR, and lived there for some years. Though she had later returned to Latvia many years ago, personal pictures from her childhood stirred up strong feelings as she recalled her past.

Mara 1 made the three cones. I understand that my inner lfe must be represented in such a form. Thefirst cone is my pas t - my family, my childhood. The second cone is my present and the third one is myfuture. I placed pictures represtwting the life of my family in Siberia on thefirst cone. 1 dont remember who took these photographs, but the past eiiokes strong feelings in me . . . My parents were in hell. We lived in Magadan, but 1 didnt sufir. Our home was vt7y small. 1 saw the sea and its presence was v e y positive. I remember how I tried to imagine what Latvia looks iike while 1 was a child. . . 1 am iiow showing these pictures to other people for the

first time in my life. At school I was ashamed to show them to anyone. When we came back to Latvia I was uncomfortable, because children in my school were very suspicious of me. . . Here is my present. 1 like to be alive, to feel, to meet diferent people, to create, to be a woman. There are my children here as well . . . I dont like to be in the Fumes. Im lucky to be an artist, because it gives me an opportunity to go out of the 'frames'. I put the two photos which represenf me together with my brother on this cone as well. He now lives in America. He also doesnt like to be in Fumes. Our relationship is very important to me. I placed the cone which sign$es thefuture on the paper with diferent colours and glued a blue paper onto the top of it, because I perceive myfuture in this colour. This colour signifies something that is very dificult to render in words, but which can be perceived intuitively. 1 want to see the world and travel in the future and keep my connection with arts - my art and that of others. The commentary presented indicates that arranging personal photos and creating three-dimensional images that incorporated the photos enabled distancing from difficult feelings; it helped Mara to feel in control of her memories and to find a meaning in her past, present and future. This also facilitated verbal expression of feelings and provided structure and cohesion to her life story. She found the group space safe enough to present those photos and memories, which she had never presented outside her family before.

Example 2: art-making w i th photographs and creating stories in pairs The group was instructed to form pairs and then make an art object together (a collage, a drawing, a painting, a composition in plasticine, etc.) that would contain personal photographs of the group members, and then create a story. It was suggested that the stories be imaginary and not necessarily reflecting biographic events of the participants.

There were six pairs in the group. The first pair cut two windows in the form of hearts in the centre of a sheet of pink paper and placed their childhood pictures in the windows. After that they put five pieces of dark blue paper around the windows and placed pictures that they had cut from magazines on the blue pieces.

The second pair started their work together with a discussion, that lasted for about fifteen minutes. During this time they approached the piano, but then placed their photos, portraying themselves in different periods of their lives, in several rows on the floor and began to carefully select pictures. Later they asked the leader to let them leave the room for a whde in order to prepare their performance. The third pair took a big sheet of paper; one started to

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Figure 1. The Sea and the Maiden: artwork incorporating personal photographs.

draw, while the other person was writing. They drew a stormy sea on the left and a figure of a maiden standing on the rock in front of the sea on the right. Below the maidens figure there was a tree with leaves and blossom (Figure 1). The fourth pair also started their work silently drawing together. They later began to select and cut pictures from magazines and exchange ideas from time to time. The fifth pair took wax crayons and started to draw on a sheet of paper. Then they placed two photos in the centre of their drawing, one portraying a man, woman and child and another portraying a child. The sixth pair took longer to decide what to do. At last, they glued two sheets of paper together and started to draw what looked like a film. When the art objects and stories were created and the discussion had begun, the first pair read their story to the group. Their composition consisted of their two centrally placed childhood photos and ten pictures taken from magazines placed around them numbered one to ten. The second pair titled their performance Talking in between and throughout. They put on their coats and approached the piano. Both had their latest personal photos attached to their backs. They started to improvise. After a minute, they took off their coats and there was another selection of pictures on their backs, this time portraying them when they were

students. Finally, after a couple of minutes they took their shirts off to reveal their childhood pictures fixed to their bare backs with sellotape. One of them said that the pictures on his and his partners backs signhed something in the past. While performing he felt a warmth in his back. He explained that his and his partners childhood pictures were shown only for a few seconds, because they could only make contact with their early memories for a short while and these photos were very intimate. He also said that it was important to feel mutual trust while he and his partner worked together. They selected pictures to be placed on their backs without being able to see how the pictures looked. This meant seeing oneself through the eyes of another person, because each had selected photos that reflected the most characteristic personal features of the partner.

Presenting their artwork and story, the third pair switched off the light and lit a candle. One person put the drawing of the sea and woman on the chair, sat down by it on her knees and started to read the story while her partner played the piano. The story was as follows: The sea was stormy and presaged changes. The maiden wanted to make a new beginning, but was afraid of this. She looked at the sea and held an old mirror. The stars were bright and the moon was shining. Everything was mysterious. The sea and the sky were herfiiends and she shared her feelings with them. She wanted to get to the core

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of hrr being. She believed that the mirror must help her and 1ookt.d at the sea and in the mirror. And soon she discovered her new face. The storm changcd me ything and it changed her as well. Then the maiden asked the mirror, Tell me, who am I? Show me my future! I want to know what to expect. And the mirror answered, You are a queen, you are everything in the world, the tree, the storm, the strength, the sand, the sea and all the elements, if YOU want to be. All these things are imde you and around you.

The maiden looked in the mirror and understood that she already knew this, but she needed strength to believe in it. Soon her anxiety disappeared and there was no mirror in her hand anymore. There were no waves on the sea. The sky was calm and the world was at peace. She looked below and iioticed that spring had already come and the tree was blossi>ming. The fourth pair just showed their drawing to the group. As they were very engaged in the drawing they chose not to create a story. The fifth pair expldined that they had drawn spontaneously. Only when they had stopped did they start to think about what their drawing might represent and how their photographs might be included in the drawing. One of the partners said that the blue line she had drawn was

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Figure 2. The Ciw. a group painting incorporating personal photographs.

not to include their photos in the group painting at all. I observed that most group members were very emotionally involved in their work, searching for wavs to settle their photographic selves in the houses they had created or to find another place (such as a park). This contributed to a feeling of safety and containment in the group. The discussion helped to reveal members roles and express feelings with regard to the group as a whole. Inclusion of members photographic self-images in the group painting stimulated identification with its space and intensified projections. On the other hand, vast possibihties for exploring hidden meanings and experimenting with roles existed due to creating and inhabiting the imaginary environment.

Example 4: working w i t h psychiatric patients in a s p e d unit This example describes my work with patients who have committed severe offences due to psychiatric illnesses such as schizophrenia or personality disorder. As well as medication, verbal psychotherapy and art therapy are offered to some patients. Throughout the course of art therapy, patients sometimes took photographs and later used

them to produce thematic artwork. Sometimes photos were given to patients as stimuli. The group that I worked with met once a week. The sessions lasted one-and-a-half hours; and sometimes in summer patients took photos in an enclosed yard. The group consisted of six men. Their ages ranged from twenty-two to thirty-eight years. All of them had a diagnosis of schizophrenia. None of them had previously attended individual or group psycho- therapy.

Before beginning to use photographic techniques, the patients had worked for about three months, mostly with paints, crayons and pencils. Sometimes I took photos of them and their artwork and noticed that they were always pleased to be photographed and even asked me to give them some of the pictures. This led me to introduce some special themes and exercises using photography. I describe below some of these themes and exercises and present my observations on patients responses.

Self-portraits: The session started with a discussion, about the word self-portrait and what this might mean to them. The group members were then invited to paint a background for their own self-portraits on a big sheet of paper. When the backgrounds were

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completed, the patients were asked to stick them to the wall. Then they 'tried on' their 'backgrounds' by standing in front of them and loolung in a mirror. The therapist photographed each of them. The session finished with patients sharing their feelings about this process.

Making stories with photographs: In the following session, I brought in photos that I had previously taken (landscapes, objects, street scenes, etc.) and asked each group member to select one photo. Then I invited them to create a story around the selected photo, whch were then read out and responses sharcd.

During one session, a patient selected a photo of the psychiatric hospital. The hospital had solid brick walls and bars on the windows. His story was as follows:

The world is a crude thing and due to a relentless law you can lose everything . . . Cells, walls, bars, all this takes everything that was beautifulfrom a woman. Only when she sometimes looks at the sky she comes back to the world of sun and pleasure for a moment . . . He related that his girlfriend was being treated in the same hospital. He said that he felt sad and wanted to select another photo in order to create a different stoq . This time he chose a photo with a window through which the sun was shining, and said: The window. Sometimes the v im that opensfiom it is very eloquenf as lfyou are looking for a moment into another world, into something beautiful, which you ignore most of the time being in the ordinary world. But you can see and feel anofher world through your soul and your fantasy . . . At the end of the session the patient was more relaxed and satisfied with what he had done. Another patient in the same session selected a photo featuring a cesspit and created the following story: Life I S overburdened with old and useless things. W e are surrounded hy them and cannot escape from them. W e spend our life among garbage. As if he were continuing this story, the third patient wrote a poem as a response to a photo portraying a toy bear that had been put in a dustbin. Hello' My name is Bear. M y llfe is a garbage bin. I am/orgotten forever, But there's a taste herein. Then are new friends in garbage And ;'m not alone. People call me 'son of a bitch', But I don't care at all. This patient asked me to give him the photo and later

he wrote another poem and a song. Several patients asked me whether they could keep the photos as powerful feelings were invoked.

Making photos in the hospital yard: One of the following sessions was spent in the hospital yard. It was spring and I explained that participants could try taking photos of different objects. I said that though the yard was well known to the patients they could hopefully see it with fresh eyes. I invited them to find an object or scene that evoked positive or negative feelings or seemed meaningful for them. Since there was only one camera in the group, the patients walked around the yard in search of an object. When an object was found, I gave the camera to the patient so he could take a snapshot. When the pictures were printed they were shown to the group and discussed. Sometimes strong emotions were expressed, both positive and negative. As a positive object, one of the patients (twenty-two years old) had chosen the black cat that lived in the hospital. An object that evoked very negative feelings in him was a concrete slab that resembled a tombstone. He took two sticks and made a cross and then put it at the 'head of 'the tomb'. Doing this he looked agitated. When his 'installation' was photographed he was able to explore some intense ambivalent feelings: he felt pity and sadness, on the one hand, and satisfaction, on the other hand, since he had made his own creation.

Enacting stories evoked by photographs: The patients were asked to select a whole series from a pile of photos (previously taken by me) and create a scenario of a drama, a farce or a comedy that could later be enacted.

One of the patients made a sequence of the following pictures: (1) an exterior view of the psychiatric unit; (2) a view of the Finnish Gulf shore; (3) a mop; (4) vegetables (potato, onions) on the floor; and (5) an open oven. During the discussion he imagined his release from the hospital. He went to the Finnish Gulf shore to relax, then he came back home and cleaned it to get ready for his guests. He then peeled vegetables and prepared a meal for his guests, who had come to celebrate his release from the hospital. He added that he would like to invite the group to such party when he eventually left the hospital. He then enacted the story by moving furniture as if it were on a stage. Patients showed increased activity and interest in various objects around them, as though they were discovering them anew. They also became more attentive to their own and other people's appearance. Some of them expressed an interest in learning more about 'body language' and how others perceive them.

When photography was used, the interaction

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between the patients stimulated their emotional support of each other. Photographic techniques together with other art therapeutic activities helped to restore many functions that were damaged or lost as a result of illness and social isolation in such patients,

c 0 12 c I u s i 0 n Mv intention in this article has been to consider photography used within the art therapy context as distinct from other applications of photography that may be characteristic for occupational therapy or verbal therapies. A wide range of therapeutic factors implied in taking and perceiving photographic pictures as well as various possibilities of including photographic techniques in the art therapy process ha\re been presented with illustrated case examples. I bt3lievr that photography has very much to offer to art therapists. They can be leaders in the therapeutic use of photography, because their practice is rooted in 1-isual arts. This does not exclude, however, conibina tions of various therapeutic approaches and art forms with the vast range of photographic practices, because photography is universal and integrative by its nature.

Refuences Barhee, M. (2002) A Visual-Narrative Approach to Understanding Transsexual Identity, Art Therapy: Journal of the American Art Therapy Association 19(2): 53-62. Boorno, M.E. (1989) Therapy through Creative Self-Expression. Moscow: Nauka (in Russian). Coo&., J.A. (1997) The Disposable Camera Technique, in Kaduson, 3. and Schaefer, C. (eds) 101 Favorite Play Therapy Techniques, pp. 388-390. Northvale, NJ: Jason Aronson. Fryrc