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MODEL OF INTERVENTION WITH PHOTOTHERAPY      TECHNIQUES IN A HOSPITAL ENVIRONMENT
 

MODEL OF INTERVENTION WITH PHOTOTHERAPY TECHNIQUES IN A HOSPITAL ENVIRONMENT

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    MODEL OF INTERVENTION WITH PHOTOTHERAPY      TECHNIQUES IN A HOSPITAL ENVIRONMENT MODEL OF INTERVENTION WITH PHOTOTHERAPY TECHNIQUES IN A HOSPITAL ENVIRONMENT Document Transcript

    • 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
    • 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
    • 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
    • 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
    • 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:
    • 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
    • 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.
    • 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
    • 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
    • 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.
    • 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.
    • . 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?
    • • 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.
    • 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
    • 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.
    • 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
    • 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
    • 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:
    • 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,
    • 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.
    • 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
    • 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
    • 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
    • • 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
    • • 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.
    • 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 » Proponer una traducción mejor Traducir una página web » Página principal de Google - Acerca del Traductor de Google ©2008 Google