Fam Proc 15:259-264, 1976

Family Photographs: in Treatment and TrainingCAROL M. ANDERSON, M.S.W.a

ELAINE S. MALLOY, M.S.W.b

aDirector of Family Therapy, Western Psychiatric Institute and Clinic; Assocate Professor of Clinical Psychiatry, Department ofPsychiatry, School of Medicine, University of Pittsburgh.bFamily Therapist, Family Therapy Clinic, Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine,University of Pittsburgh.

The universal appeal of nostalgia and reminiscence makes photographs a natural instrument for studying the impactof the past upon the present. This paper explores photography as a medium for facilitating reminiscence to discoverindividual roles, interpersonal relationships, and family dynamics. A method is described for using family photographsin treatment and training of clinicians at a Family Therapy Clinic.

Nearly everyone has family photographs in an album, in envelopes, or in a box which from time to time elicitnostalgia for past events. The ability of photographs to stimulate the memory and recapture times gone by is reminiscent ofMarcel Proust's "Petite Madeleine":1

When from a long distant past nothing subsists, after the people are dead, after the things are broken and scattered,still, alone, more fragile, but with more vitality, more unsubstantial, more persistent, more faithful, the smell andtaste of things remain poised a long time, like souls, ready to remind us, waiting and hoping for their moment, amidthe ruins of all the rest; and bear unfaltering in the tiny and almost impalpable drop of their essence, the vaststructure of recollection. (13, p. 65)

NOSTALGIA AND REMINISCENCEWhat is it that draws us to collect and become fascinated by pictorial records of our family history to become

nostalgic when reminiscing about our personal heritage? Some have said that nostalgia is common to human experienceand represents a wish to return to an idealized past (8). Other have connected this active urge "too keep in touch with ourroots" to the biological homing instincts of fish, birds, and animals (10). While there are therapists who may be wary ofdwelling on the past, nostalgia seldom becomes a clinical problem in itself; in fact, it has been described as a healthysurrender to the biological inclination to return to the past, to childhood, to sleep, and to the unconscious (8, 10).

Reminiscing is a way of fulfilling our nostalgic needs. Frequent thoughts and conversations about the past are usuallyassociated with old age. "The life review" is described as a universal occurrence in which older people experience a mentalprocess of reviewing life through increased reminiscence (3). The prevalence of reminiscing among the senior members ofsociety prompted a study (9) to clarify the adaptational significance of reminiscence in old age. Results positively correlatedreminiscing to freedom from depression and to personal survival. Through reminiscing, self-esteem is maintained and asense of identity reaffirmed. Past experiences progressively return to consciousness along with the resurgence of unresolvedconflicts. Further, it has been shown that "simultaneously and normally, these revived experiences and conflicts can besurveyed and reintegrated" (3, p. 66).

Although the life review is commonly observed among the old, contemplating the past seems to be a general response tomany types of crises and problems regardless of age. "People of all ages review their past at various times; they look backto comprehend the forces and experiences that have shaped their lives" (3). Since the themes of the past also exist in thepresent, and will carry into the future, an understanding of those themes can be useful in learning to cope with them moreeffectively.

IMAGES AND PHOTOGRAPHYThe ability to respond to images-and particularly to recognize one's own image occurs developmentally between 18 and

30 months of age (11). Seventy sources in three languages relating to photography since the turn of the century areidentified in Kiell's Psychiatry and Psychology in the Visual Arts and Aesthetics, A Bibliography (7). The appeal ofphotographs transcends the purely visual record; photos are akin to "dreams, body language, slips of the tongue, andhandwriting" for significant knowledge of what is beyond usual observation (1).

Robbins recommends the camera "as a great common denominator" among people of varied temperaments, interests, andbackgrounds. The development of photography as a serious hobby fits well with his practice. "My psychiatric interest in

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people can be expressed in portrait studies with special effort to bring out the personality of the subject by catching acertain expression, having the person doing something characteristic, or emphasizing some special facial feature by thearrangement of the lighting" (14). Since it has long been recognized that photographs effectively capture complexities ofindividuals and relationships, it is fitting that these lasting documents of personality and life are being acknowledged as avaluable resource for therapists and patients.

APPLICATIONS IN THERAPYRecognizing oneself in a mirror or a photograph can be a rewarding discovery. Positive responses to one's own image

are found even among the severely disturbed. Mirror-gazing, which has been identified as another manifestation of the lifereview, is one useful tool in treatment. Elkisch found that severely disturbed patients could reduce their tension level bylooking in a mirror. She hypothesized that this demonstrated their attempt to retrieve and restore losses of ego, self, andboundaries (5).

At the Central Louisiana State Hospital, a series of photographs of forty patients were taken and displayed on the ward.Patients' reactions to their pictures were observed. Although no dramatic cures were noted, it was found that "thepicture-taking did serve as a vehicle for increased socializing between personnel and patients and among the patient group"(11).

In therapeutic work with less disturbed patients, photographs have been used to arrive at individual and interpersonalinsight. Akeret's book documents the use of "photoanalysis" as a psychologically sound method of increasing self-awarenessin individual psychotherapy (1). Graham reports the use of photographs in a research project in 1964 in which a polaroidphotograph was taken of 37 patients at the close of each psychiatric interview "to assist the team in later discussion." Cuesabout behavior, manner, and mood were portrayed and provided interesting comparative data for the therapist during thecourse of individual treatment (6).

The policy of requesting a recent photograph of new families coming for treatment at a family mental health clinic isdescribed by Coblentz. As anticipated, this proved helpful to staff during case presentations in remembering familymembers and nuances of their interaction. However, the photographs appeared to have collateral advantages to thetherapists toward the understanding of individual and intra-familial dynamics (4).

The technique of enlarging a family photograph in marital therapy sessions is described in A Martial Puzzle (12). Pauluses this as one method of facilitating the resolution of unfinished mourning and working through family themes as they aretransmitted from one generation to another. Family therapists have used photographs to become more familiar with thefamily outside the office, to encourage openness and sharing by stimulating conversation, and, with polaroid photographstaken during the session, to provide instant feedback of spacing, postures, facial displays (2).

The assignment of a task to families to bring in photographs during family therapy sessions makes use of the therapeuticvalue of recounting the past in times of crisis. It is also an effective training tool for staff members of the clinic to gainawareness of their own family system. Following is a description of the procedure and some examples of its uses.

PROCEDURE

Assignment of the TaskEach individual is asked to bring to a session a specified number of family photographs that they feel say something

important about their family relationships. While no instructions are given regarding the composition of the pictures,limiting the number of photographs is particularly useful, since the process of selection, as well as the final choice, thenassumes more significance. The number and time span covered by the photos is best determined by the time available andthe goals of the exercise (assessment, training, therapy). Three photographs provide enough material to establish basicthemes and can usually be covered within a time allowance of fifteen minutes per person. On the other hand, examiningthree-generational themes may require more photographs and considerably more time. In training groups, it is generallypreferable to begin with childhood or family-of-origin photos, since these are as significant and usually less threatening thanthose of the current nuclear family. For some participants, several weeks notice is necessary to allow for correspondenceand/or visits to other cities to gain access to family albums.

The Photograph SessionSince the discussion of developmental stages and themes of family life may arouse strong and upsetting feelings, it is

very important to create a climate in which everyone feels comfortable dealing with intimate themes. A "warm-up" exercisethat requires some sort of sharing is recommended.

Sharing. The most natural warm-up is a discussion of the process of selecting and obtaining photos, since difficultiesoften occur. Common themes include suspicious reactions of other family members, inability to find any picture of the total

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family, inability to make a selection, surprise reactions to what does or does not exist. The process or problems encounteredare sometimes more significant than the photographs themselves. For instance, when a family album contains no picture ofthe father, his non-participation in the life of the family is a likely issue.

Rules. Structure is necessary to insure distribution of time. Since one person must not be allowed to dominate to theexclusion of others, the limits of time and numbers of photographs must be enforced. Some people, for instance, bringmany more photographs than suggested or explain theirs in great detail. If this occurs, the leader/therapist must limit theirparticipation or help the group or family to renegotiate the original contract.

Finally, since the technique often reveals very intimate material, sensitivity to the presenter's feelings is essential so thathe/she is not pushed into revealing more than is comfortable and to insure that the information is not misused.

The Presentation. Following the sharing process, the group or family is asked who would like to begin. Each person inturn then presents his/her chosen photographs, telling the group why they were chosen, the meaning they have, and hisfeelings about the pictures. The order and style of the presentation is usually significant. Of particular note are such thingsas which photo is presented first (or last), the speed with which the photos are shared, the level of interest or anxiety abouteach, and the amount of joking or seriousness of manner.

The content of each photo is also discussed, exploring the closeness and distance between family members, the degree offormality, as well as present or absent members to assess various aspects of the family system. Usually, alignments, splits,role behaviors, boundaries, communication processes, and family structures are thrown into sharp relief in this process.Sometimes even the care that has been taken of the snapshots can add to the understanding of these issues.

The Use of the Group/Family. As the individual presents his photographs, other family or group members areencouraged to respond to the photographs and the presentation with observations and questions. Themes, comparisons, andcomments are made spontaneously, leading to increased self-awareness on the part of the presenter and the observers, aswell as new perspectives of family patterns.

Treatment ExampleThe Kraft family provides us with an example of the use of family photographs to elicit information about family

interaction and facilitate the articulation of treatment goals.

Mr. and Mrs. Kraft came to the Family Therapy Clinic for help with their marital problems. Mrs. Kraft had beendiagnosed as "schizophrenic," with repeated hospitalizations on psychiatric units. With each successivehospitalization, their marriage seemed to deteriorate further. Though Mrs. K now was functioning reasonably well,the stigma of her craziness remained as the sole focus of the marital relationship he accusing, she bemoaning. Atthe time of the assessment, both partners were locked in a discouraging effort to define their life together as all bad.It became clear that their negative focus prevented the existence of hope for change and thus the formation ofreasonable goals. It was at this point that Mr. and Mrs. Kraft each were asked to select three family photographs tobring to the next session.

Both Mr. and Mrs. Kraft arrived at the next session with more animation and enthusiasm than ever before. Theirreport of the selection process revealed a degree of communication they had thought impossible. They hadunearthed an old family album and had their first "good time" together in years. Mrs. Kraft's previously defectivememory was resurrected in the process of reminiscing, as each of them recalled happier times. One of the snapshotsshe had chosen pictured her in an outfit she had sewn. As she described the photo, her pride swelled. Rememberedcompetence further chiseled away at the negative patient image she now carried. Mr. Kraft chose a picture of hiswife in a strapless evening gown emphasizing her sexuality. She was embarrassed by his choice and unable torespond positively to the complimentary statements he made. This interchange and the discussion that followedgraphically demonstrated conflict and confusion in their sexual expectations and communications. Both wererelieved that the issues were in the open and readily agreed to make this area the business of future sessions.

In the process of the photograph assignment, they had remembered happier times, had experienced a positivecommunication, and had begun to improve Mrs. Kraft's dysfunctional image. These positive experiences helped tomitigate the impact of the negative events and feelings of recent years and to move them toward the task ofrenegotiating a more satisfactory marital contract.

Training Example

A group of experienced family therapists working together in an outpatient clinic for some time, reserved one anda half hours a week to devote to their own continued professional development. This time had been used to watchone another's tapes, bring in guest speakers, to review recent developments in the family therapy literature, and to

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practice new techniques. Over a period of several months it became obvious that each therapist had strengths aswell as blind spots that tended to be repetitive.

The use of family photographs was suggested as one way to explore and hopefully modify some of the negativepractice issues, since cognitive awareness of the right way to proceed with any given family seemed insufficient.Therefore, each therapist was to bring photos of his nuclear and/or families of origin that he felt said somethingimportant about family relationships.2

Despite the fact that the date for the exercise was scheduled several weeks in advance, it was necessary topostpone the session twice when the participants had not accomplished the task. This and other demonstrations ofanxiety about sharing this information continued into the day of the presentation when one person had to returnhome to pick up the "forgotten" photos, another began her presentation with a "self" photograph of a gorilla, andanother began to go through the photos so fast, the presentation was impossible to follow. The initial themescentered around fears of discovery of incompetence, "craziness," or issues of unknown significance. A good deal ofdiscussion was elicited about the need to look healthy and to "have it all together." Through sharing, the age-olddiscovery that no one has it all together, that one needn't have come from the perfect family to be a good familytherapist, that it is easier to help someone else's family than one's own, was an unplanned therapeutic benefit of theexperience.

The common themes revealed in the content of the photographic presentations themselves related to the degree ofcomfort with intimacy, power, dependency, and tension. Family themes were discovered that helped to account notonly for each individual's style as a therapist but also for the roles played in staff interactions. For instance, thetherapist who clearly had a mediator or "go between" role in his family also attempted to minimize staff tensions andto resolve quickly tensions building in therapeutic hours. Once this role was thrown into sharp relief in the exercise,it also became less functional and less acceptable to both the individual and the group, causing changes in staff andtherapeutic interactions.

Many other themes were revealed and examined, with the result of greater understanding of the themes in one'slife, the feelings of risk experienced by a family, and some greater perspective on the therapy issues likely to stir upone's own history.

SUMMARYFamily photographs provide an interesting vehicle for the study of family structure, communication, styles, and roles of

both patient and therapist families. The technique is a flexible one and can be used in a variety of ways.To study families of origin or three-generational themes, the assignment can be modified to request one to three photos

from each of three generations, photos that contain more than two generations, or a larger number of photographs ofsignificant members of the extended family. The search in itself may help individuals to make contact with relatives theyhave not seen in some time.

Specific themes can also be explored. To study male/female roles and stereotypes, participants may be asked to choosephotos that relate to how their family has worked out these issues over the years. The same may be done for themes ofpower, dependency, or intimacy.

Another interesting variation is to request two photos, one that represents their ideal how they wish the family was and their reality-how the family is; this can help to clarify disappointment, disparities, and goals for the future.

Whichever variation is used, an exercise with photographs can stimulate participants to question not only family myths,rules, and belief systems but also the roles played by each individual member. The resultant altered assumption can create anew perspective and the beginning of the process of change toward more functional and rewarding relationships.

REFERENCES

1. Akeret, R. U., Photoanalysis, New York, Peter H. Wyden, Inc., 1973. 2. Bodin, A. and Ferber, A., "How to Go Beyond the Use of Language," in A. Ferber et al., The Book of Family

Therapy, Boston, Houghton Mifflin Company, 1973. 3. Butler, R. N., "The Life Review: An Interpretation of Reminiscence in the Aged," Psychiatry, 26, 601-602, 1963. 4. Coblentz, A. L., "Use of Photographs in a Family Mental Health Clinic," Amer. J. Psychiat., 121, 601-602, 1964. 5. Elkisch, P., "The Psychological Significance of the Mirror," J. Am. Psychoan. Assn., 5, 235-244, 1957. 6. Graham, J. R., "The Use of Photographs in Psychiatry," Can Psychiat. Assn. J., 12, 425, 1967. 7. Kiell, N., Psychiatry and Psychology in the Visual Arts and Aesthetics, A Bibliography, Madison, University of

Wisconsin Press, 1965. 8. Kleiner, J., "On Nostalgia," Bull. Phila. Assn. Psychoan., 20, 11-30, 1970.

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9. McMahon, A. W. and Rhudick, P. J., "Reminiscing: Adaptational Significance in the Aged," A.M.A. Arch. Gen.Psychiat., 10, 292-298, 1964.

10. Martin, A., "Nostalgia," Amer. J. Psychoanal., 14, 93-104, 1954. 11. Miller, M. F., "Responses of Psychiatric Patients to Their Photographed Images," Dis. Nerv. System, 23, 296-298,

1962. 12. Paul, N. L. and Paul, B. B., A. Marital Puzzle, New York, W. W. Norton & Co., Inc., 1975. 13. Proust, M., Swann's Way, Remembrance of Things Past (A la Recherché du Temps Perdu), translated by C. K.

Scott Moncrieff, New York, Modern Library Editions, Random House, 1928. 14. Robbins, L. L., "Photography," Bull. Menninger Clin., 6, 89-91, 1942.

Reprint requests should be addressed to Carol M. Anderson, Director of Family Therapy, Western Psychiatric Instituteand Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15261.

1Small cakes, the smell and taste of which bring to the author a rush of emotions and memories of the past.

2This use of family photographs was originally described to one of the authors by Alan and Eva Leveton of the Family TherapyInstitute of San Francisco.

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