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The Therapeutic Use of Photography in Clinical Social Work: Evidence-Based Best Practices


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This project systematically identified evidence-based interventions using photography in mental health practice. The initial search of the literature produced 4,929 hits, title reviews reduced this set to 225 possible studies, abstract examination refined this list to 81, and analyzing the articles determined that only 23 meet selection criteria for inclusion in this project: psychosocial-oriented intervention within the domain of social work practice with supporting empirical data. The majority of interventions involved assignments that included taking photographs or creating some kind of photographic product (e.g., collages, time-series of snapshots). Typically, these photographic activities were done in group or individual therapy and focused on social skills, coping skills, self-esteem, or identity for adults and adolescents. The empirical support for these protocols was usually from case studies or single-group design evaluations, all reported practical or theoretically significant improvements, and three produced statistically significant effects. This article will then discuss the implications of findings and direction for future research.
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The Therapeutic Use of Photography in
Clinical Social Work: Evidence-Based
Best Practices
Vaughn A. DeCoster MSW PhD LCSW ACSW a & James Dickerson MSW
a Social Work Department , University of Southern Indiana ,
Evansville , Indiana , USA
Accepted author version posted online: 18 Jul 2013.Published
online: 20 Dec 2013.
To cite this article: Vaughn A. DeCoster MSW PhD LCSW ACSW & James Dickerson MSW PhD LSW (2014)
The Therapeutic Use of Photography in Clinical Social Work: Evidence-Based Best Practices, Social
Work in Mental Health, 12:1, 1-19, DOI: 10.1080/15332985.2013.812543
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ISSN: 1533-2985 print/1533-2993 online
DOI: 10.1080/15332985.2013.812543
The Therapeutic Use of Photography in Clinical
Social Work: Evidence-Based Best Practices
Social Work Department, University of Southern Indiana,
Evansville, Indiana, USA
This project systematically identified evidence-based interventions
using photography in mental health practice. The initial search
of the literature produced 4,929 hits, title reviews reduced this
set to 225 possible studies, abstract examination refined this list
to 81, and analyzing the articles determined that only 23 meet
selection criteria for inclusion in this project: psychosocial-oriented
intervention within the domain of social work practice with sup-
porting empirical data. The majority of interventions involved
assignments that included taking photographs or creating some
kind of photographic product (e.g., collages, time-series of snap-
shots). Typically, these photographic activities were done in group
or individual therapy and focused on social skills, coping skills,
self-esteem, or identity for adults and adolescents. The empiri-
cal support for these protocols was usually from case studies or
single-group design evaluations, all reported practical or theoret-
ically significant improvements, and three produced statistically
significant effects. This article will then discuss the implications of
findings and direction for future research.
KEYWORDS photography, photos, phototherapy, mental health,
clinical social work
Address correspondence to Dr. Vaughn A. DeCoster, University of Southern Indiana,
Social Work Department, 8600 University Blvd., Evansville, IN 47712. E-mail: vadecoster@
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2V. A. Decoster and J. Dickerson
Photography has long been found to be an emotionally powerful means
of expressing human experiences. Not long after Louis-Jacques-Mandé
Daguerre’s development of a reliable photographic process in 1838, pho-
tography began to appear in the mental health profession. In 1856, London
psychiatrist Dr. Hugh Welch Diamond, considered the father of psychi-
atric photography, began photographing patients as a means to monitor
progress (Burrows & Schumacher, 1990). Over a hundred years later, mental
health practitioners continued to recommend the photographing of psychi-
atric patients and families to aid in assessment and to recall client specifics
(Coblentz, 1964; Graham, 1967). Smith, Sanders, Smith, and Weinman (1965)
used photographs of current hospitalized psychiatric patients to measure
patient awareness (orientation) and to evaluate the effectiveness of three
“socioenvironmental” treatment programs. At the macro-level, prominent
social workers of the late 1800s to early 1900s like Jane Addams and Paul
Kellogg strategically used photographs to advance their social causes. They
were later referred to as “social photographers” (Huff, 1998). Relatedly, Szto
(2008) details documentary photography’s role as a “social change tool” in
early, between 1897 and 1942, U.S. social welfare policy. Although these
and many other professionals recognized the potential of this medium, it
was not until later that its therapeutic use became more apparent in the
helping professions.
The 1980s through 1990s witnessed significant growth in the use of
photography in mental health with training workshops, the establishment of
a professional association, international conferences and a dedicated jour-
nal, PhotoTherapy Quarterly. During this same time clinical scholars were
prolific and, in particular, two seminal works in the field were published:
PhotoTherapy Techniques (Weiser, 1993) and Phototherapy in Mental Health
(Krauss & Fryrear, 1983). Practices involving photography flourished and
were typically classified into three categories: photo art therapy, therapeutic
photography, and phototherapy (Weiser, 2010). In photo art therapy, spe-
cially trained art therapists focus on the process of client photography as
therapeutic. Therapeutic photography, in contrast, centers on self-initiated
individual or group photo-based activities done outside a professional help-
ing relationship. PhotoTherapy, on the other hand, is the use of photographs
or photography by mental health therapists in psychotherapy. Although the
dedicated organization, the conferences, and journal ceased, the applica-
tion of photography as an accepted tool in professional health practices
remains. This is evidenced by the continued work throughout the helping
professions. Nevertheless, scholars have yet to conduct a systematic identi-
fication of evidence-based best practices. Hence, the purpose of this study
is to identify and rank-order empirically supported clinical practices that use
photography as an intervention.
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Therapeutic Use of Photography in Clinical Social Work 3
The social work profession strives for evidence-based practice, recog-
nizing its benefits and challenges (Jenson, 2005; Morago, 2006). The present
study’s investigators’ exploration of the literature on the therapeutic photog-
raphy yielded numerous possibilities for social workers. The interventions
appeared relatively easy, sometimes as simple as clients taking photographs
or collecting family snapshots then discussing these with their therapist.
As experts attest, though, photographs have a powerful affect on people and
whereas the activities appear uncomplicated, the actual therapeutic imple-
mentation requires practitioner expertise (Krauss & Fryrear, 1983; Weiser,
1993). One of the researcher’s advanced training in PhotoTherapy confirms
this observation. The initial literature review and training also raised con-
cerns about the clarity of procedures (systematic, repeatability) for these
potentially powerful methods and evidence supporting usage with specific
problems and populations. Hence, the apparent simplicity of therapeutic
photography without systematic protocols or clear evidence regarding the
benefits or risks turns unknowing clients into research subjects.
This project is part of a larger program of study to advance the scien-
tific rigor in the use of photography with mental health practices. This will
be achieved through the application of the scientific approach (i.e., applied,
translational research models) to the art of behavioral health practice using
photography. This advances an emerging trend of quantifying qualitative
methodology and data seen in the social sciences since the 1990s (Miles &
Huberman, 1994; Patton, 1990). Social workers and other mental health pro-
fessions pride themselves on being “scientific practitioners” yet, to date, the
literature lacks a review or a quantified assessment of this practice methodol-
ogy. Using a systematic method to evaluate past studies, this project identifies
best practices via methodological rigor and statistically significant outcomes.
This study systematically identified, summarized, and rated clinical interven-
tions involving photography or photographs. Researchers adapted protocols
developed in other best-practice investigations (Cummings, Cooper, &
Cassie, 2009; DeCoster & Cummings, 2005), with specific steps: define study
inclusion criteria, systematically search literature, summarize interventions,
rate methodological rigor, then rank-order practices according to rigor and
significance of outcomes. This investigation’s dataset of empirical articles
began with an expansive literature search in English language peer-reviewed
scientific journals over the past 100+years (1897–2013), followed by a sys-
tematic review of article titles and abstracts; finally culminating with an
analysis of the final set of published studies.
A boolean search of six electronic databases (i.e., CINAHL—nursing and
allied health, MEDLINE, PsychInfo, PsycARTICLES, SocINDEX, and Social
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4V. A. Decoster and J. Dickerson
Work Abstracts) began the process, with resulting publications being sub-
jected to a systematic analysis in order to extract works relevant to the
present study. After trial searches that used various combinations of key
terms, the following search terms were identified as relevant: photography
or phototherapy or photographs or photos or images or pictures AND inter-
vention or activity or method or approach or model or strategies or treatment
or therapeutic AND health or mental health or psychiatry or social work or
counseling or psychology or therapy. Article titles from the initial search
were then reviewed for duplicates and ineligible titles (e.g., studies focused
on physiological medicine or non-photographic approaches easily discerned
from the title).
The second step involved reviewing the abstracts from screened titles
to further eliminate unqualified studies. Third, resulting articles from the
abstract analysis were read and included in the final collection if they met
these criteria: (1) Paper included totally, or in-part, a psychosocial oriented
intervention; (2) Intervention was considered within the domain of social
work practice knowledge or skill; and (3) Authors offered some form of
empirical evaluation of supporting data for the intervention effectiveness.
Finally, the remaining studies meeting selection criteria were summarized,
categorized, and rated using an adapted version of the Methodological
Quality Rating Scale (MQRS, Miller et al., 1995). The MQRS evaluates the
methodological rigor of a clinical study according to characteristics; such
as research design, theoretical foundation, treatment integrity, standardized
measures, dosage, subject attrition, and generalizability (see Appendix A).
Completing the process, studies were then rank-ordered according to this
methodological rigor score and the reported significance of outcomes to
create a listing of best-practices. The following is a discussion of those
The systematic literature search initially identified 4,929 peer-reviewed arti-
cles. Title reviews reduced this set to 225 (4.5%) possible publications. Nearly
20% (892) of the preliminary articles rejected for this study focused on body
image and associated disturbances, and did not include any specific form
of photography. Other excluded works had foci such as self-concept (185),
eating disorders (169), visual perception (139), memory (109), human sex dif-
ferences (88), and obesity (67), again lacking any identifying photographic
elements. The next level of extraction, a review of the 225 article abstracts,
further eliminated those lacking a photographic component or health care
foci, resulting in a third set of 81 (36%) articles.
Of those 81 articles, only 23 (28%) meet the selection criteria. Excluded
papers, typically, presented basic (non-therapeutic) photography research
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Therapeutic Use of Photography in Clinical Social Work 5
or interventions that lacked empirical evidence or testing. Examples of dis-
qualified basic research articles included the popular photovoice technique
(Clements, 2012; Drew, Duncan, & Sawyer, 2010; Poudrier & Mac-Lean, 2008;
Wang, Yi, Tao, & Carovano, 1998), client photo stories (Lassetter, Mandleco,
& Roper, 2007; Sitvast, Abma, & Widdershoven, 2010; Wallis, Winch, &
O’Campo, 2009), and expressed emotion in photographs (Pulkkinen &
Aaltonen, 1998). Although the works depicted in these rejected studies may
have therapeutic value to participants, the projects were not designed or
intended for clinical use. Examples of excluded intervention articles lack-
ing empirical data included the application of hermeneutic photography to
foster meaning in mental illness (Sitvast & Abma, 2012), photo-reminiscence
(Krauss, 2009), phototherapy using snapshots and family albums (Weiser,
2008), photographs in perinatal social work (Minton, 1983), phototherapeutic
intervention to improve adolescent self-concept (Blinn, 1987), and instant
photography in psychotherapy (Hunsberger, 1984). Although these interven-
tions and techniques may have great promise there is a lack of supporting
evidence regarding effectiveness. The final dataset, consisting of the 23 iden-
tified studies was then summarized, categorized, rated for methodological
rigor, and then rank-ordered.
Table 1 summarizes the 23 studies included in this investigation as
evidence-based photographic interventions for clinical social work and indi-
cates the most frequently occurring modes of intervention are group (39%)
and individual (35%) sessions.
Many interventions had multiple focuses. For the 38 reported foci, 28%
involved some form of social or coping skill set like (i.e., communication or
interacting with others), 21% addressed some form of self-concept, esteem,
or identity, and 15% focused on enhancing some form of personal general
or event specific insight. Additionally, of the 23 intervention studies, 35%
targeted predominately adult, 26% elder, and 22% adolescent populations.
In regards to measurement and design, 48% used case-study, 35% time-
series single-group, and only 17 (%) used an experimental design. Selected
studies had an average of 21 subjects (i.e., participants, and/or clients), aver-
aging 33 years of age, with the majority (57%) being male. Psychologists
(43%), social workers (30%), and psychiatrists (13%) were the predominant
professions conducting this work.
Two categories of photography intervention emerged from the 23 stud-
ies: creating original photographs/photo-products or integrating existing
photos. From those two categories, 74% interventions involved the first classi-
fication of taking original photographs or creating some kind of photographic
product (e.g., a collage, a time-series, or a story) as part of a therapeutic
assignment. For example, elders were given Polaroid (i.e., instant) cameras to
photograph mostly themselves and others attending a senior activity center.
These photographs were later discussed in small groups and then publically
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TABLE 1 Summary of Studies
Author Mode Focus Target Population Intervention Design Ss Age Female Outcomes Discipline
Aronson (1976) Assertiveness,
attitude re self,
Elder, ADC Polaroid
public display.
Wkly 45 min.
session for
6 weeks.
E 15 75 90% positive attitudes re
older & younger
Combs (1977) Ind Insight Adult, out-pt MH Photo assignments,
discussed with
TS 22 20 50% insight. Psyc
Cosden (1982) Ind Social skills, esteem Adol, resident
Photo & darkroom
CS 2 20 0% social interactions,
confidence, calm,
Darrow (1983) Grp Identity, aggression,
Adol, out-pt MH Unstructured,
photography &
TS 13 13 100% grp interactions,
expression of
conflicts, concerns.
DeCoster (2012) Ind Post-war
post-trauma stress
Combat veterans Client-directed,
social worker
assisted, activity
of post-war
photo story.
TS 6 47 0% general wellbeing,
reduced PSTD
symptoms (PCL-M).
Fryrear (1974) Grp Self-concept Adol delinquents,
Five wkly photo
E300% self-concept,
Hogan (1981) Grp Insight, self-image School age children PhotoTreatment,
4-10 wks of
60 min. sessions.
−−−−insight SocWrk
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Kajiyama (2007) Ind Behavioral problems Elder
therapy, viewing
familiar personal
photos w/music.
TS 46 −−pos. interactions,
engaged, <
agitation. Caregivers
w/pos. & neg.
Kaslow (1977) Family Assessment Families Family photo
projective use of
personal photos
in family
CS 3 −−depth of family hx,
memories, familial
interactions, insight
re roles, patterns.
Kaslow (1979) Ind Assessment Adult, out-pt MH Photo
projective use of
personal photos
in psychotherapy.
CS 1 0% insight Psyc
Levin (2007) Class Communication
Elder, stroke Modified
5 wk curriculum,
2-3 hrs. per class.
CS 5 −−communication,
processing or
physical change,
1:1 interactions in
Lindfors (2009) Grp Trauma memories Adult, out-pt, PTSD Reenactment
staging &
reviewed by grp,
4 day intensive
CS 1 100% insight, grp
Marchall (2007) Grp Attitudes re program Elder, caregiver Viewing 13 positive
photos of seniors
in ADC activities.
E 71 30-70 56% Pos. attitudes re
ADC, p. <001.
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TABLE 1 (Continued)
Author Mode Focus Target Population Intervention Design Ss Age Female Outcomes Discipline
Milford (1983) Workshop Self-esteem, social
skills, grooming
Adol, grp home Non-directed,
self-portrait photo
albums done
1.5 hrs/6wks.
E 12 12-16 0% self-concept,
grooming, behavior,
social skills, p. <
.10, .05, .02.
Nelson-Gee (1975) Ind Verbal expression Child out-pt MH Polaroid used as
tool, 2x wkly
45-90 min. each.
CS 1 5 0% Verbal expressions,
use of "I", ability to
abstract, sequence
Okura (1986) Class Insight, public image Elder "Who are you,"
CS 60 73 50% Insight into aging as a
search for peace.
Schormans (2010) Grp Insight, public image Adult, learning
Photoshop editing
11 pre-selected
photos, grp task,
1-2 hr. meetings,
1-3x/wk for
3 mths.
CS 4 50% grp cohesion,
self-advocacy skills,
sense of
empowerment &
van den Steen (2005) Class Visualization of
combat trauma
Adult, combat vets Computer prgm to
create visual,
graphic, map,
text trauma event
QE 18 0% depth to stories,
event recall &
Walker (1991) Ind Insight, mortality Adult, out-pt MH Non-directed, client
interpretation of
set of 4 photos,
wkly/3 mths.
TS 1 34 100% insight, expression
of emotions,
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Weiner (1997) Grp Ego-gratification Elder, dementia,
create ADC photo
TS −−−interactions, pos.
emotions, anxiety.
Weiser (2004) Grp/Class Insight, past issues Adult, out-pt MH PhotoTherapy
5 primary
TS 7 85% insight Psyc
Wikler (1977) Ind Termination from
Caseworker Photo exchange
between case
worker and
TS 6 80% guilt, loss, rejection,
Wilson (2007) Class Empowerment,
needs assessment
Early adol,
strengths, issues,
engage in critical
dialog &
collective action
plans. 90 min.
sessions lead by
grad & HS
student, 25 wks.
CS 122 11 53% active engagement,
critical analysis &
Mode Design Intervention Outcomes
Class CS - Case study Wkly - Weekly Increase
Grp - Group E - Pre/post test control group experimental design Mthly - Monthly Decrease
Ind - Individual QE - Non-equivalent quasi-experimental design
TS - Simple time-series design, single group
1. First colum lists only the first author of each study.
2. All outcomes were improvements and statsitically significant at p. <.05orbetter.
3. Subjects (Ss) included only those completing study for all conditions.
4. Ages are averaged across conditions.
5. - Not reported
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10 V. A. Decoster and J. Dickerson
posted at the senior activity center (Aronson & Graziano, 1976). In another
example, instant photography was used to take snapshots to stimulate com-
munication with a non-verbal 5-year-old boy diagnosed as “emotionally
disturbed with minimal brain dysfunction” (Nelson-Gee, 1975, p. 160). Later
studies included photography as a means to encourage self-expression for
persons with aphasia (Levin, Scott, Borders, Hart, Lee, & Decanini, 2007)
and sought to improve adolescent boys’ social skills through non-directed
photography activities with individual clients (Cosden & Reynolds, 1982).
Milford, Frynear, and Swank (1984) studied the use of patients creating
self-portrait photo albums with partners.
Further analysis of the present dataset revealed that several clinicians
developed and tested photo activities to foster insight among adults (Combs
& Ziller, 1977), latency age school children (Hogan, 1981), adults with intel-
lectual disabilities (Schormans, 2010), and American and Japanese elders
(Okura, Ziller, & Osawa, 1985). Similarly, group-based sessions involving
photographic tasks were developed to enhance the identity (i.e., self-
concepts) of male juvenile delinquents (Fryrear, 1974) and troubled female
adolescents (Darrow & Lynch, 1983).
Also identified during analysis were three groups of scholar-clinicians
who developed photography protocols for addressing trauma, one through
a psychodrama-like “re-enactment phototherapy” process (Lindfors, 2009,
p. 397), another by multimedia re-exposure of the combat experience (van
der Steen, Brinkman, Vermetten, & Neerinex, 2010) and a third through
post-war readjustment via photo reminiscence (DeCoster & Lewis, 2012).
Additionally, two projects sought to enhance the “ego-gratification” among
elders with dementia individually (Weiner & Abramowitz, 1997, p. 48) and
collectively for elders in an adult day program (Marshall, Craun, & Theriot,
2009). Similarly, one project used photovoice as a youth empowerment
strategy (Wilson et al., 2007).
Of the 23 studies included in the dataset, six (26%) studies incorporated
existing photographs, snapshots, into the therapeutic process. For example,
in one study a psychologist used photo reconnaissance as a psychodynamic
assessment tool in individual and family therapies (Kaslow, 1979). In another,
those working with Alzheimer disease patients found that patients who
watched videos of familiar, family snapshots would decrease in the likeli-
hood of exhibiting behavioral problems (Kajiyama, dib, Tymchuk, Boxer,
Kixmiller, & Olinsky, 2007). Incorporating snapshots also was shown helpful
at increasing insight in individual psychotherapy with adults (Weiser, 2004).
Lastly, exchanging personal snapshots of one another between clinicians and
clients eased feelings of guilt and loss at termination (Wikler, 1977). As men-
tioned previously, using a systematic method to evaluate past studies, this
project identifies best practices via methodological rigor and statistically sig-
nificant outcomes. The following section will discuss the methodological
rigor of this study.
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Therapeutic Use of Photography in Clinical Social Work 11
As part of the final analysis, researchers independently rated and scored
the methodological rigor for each of the 23 articles using the MQRS,
achieving a 92% inter-rater agreement. Overall, the MQRS summed scores
ranged from 0 to 17 out of a possible range of 0 to 32. The average
MQRS score was 8.5 (SD 8.54). Similarly, there was a mode and median
of 8.0 (see Table 2 for category specific ratings and summed scores).
Mentioned previously, the final step included a rank-ordered analysis of
the interventions by their MQRS values and whether authors reported
statistically significant findings (see Table 3). The majority of the selected
studies specified the underlying theory for the approach and addressed
treatment integrity through training or defined protocols. Half of the studies
identified the research design and almost a third discussed generalizability of
findings. However, roughly a fourth reported using standardized measures
or considered intervention dosage (i.e., clients receiving less than the
complete course of treatment). Findings also indicated a low number of
studies that incorporated post-intervention maintenance, discussed attrition,
and none conducted blind follow-ups to confirm effects. Although all
studies described their interventions as having positive effects, only three
specifically reported statistically significant improvements, with the authors
adjusting the rank-order accordingly.
This project systematically identified evidence-based interventions using
photography in mental health practice. The initial search of the literature
produced 4,929 hits, title reviews reduced this set to 225 possible stud-
ies, abstract examination refined this list to 81, and analyzing the articles
determined that only 23 meet selection criteria for inclusion in this project:
psychosocial-oriented intervention within the domain of social work prac-
tice with supporting empirical data. The majority of interventions involved
assignments taking photographs or creating some kind of photographic
product (e.g., collages, time-series of snapshots). Typically, these photo-
graphic activities were done in-group or individual therapy, focused on social
skills, coping skills, self-esteem or identity, targeting adults or adolescents.
The empirical support for these protocols was usually from case studies or
single-group design evaluations, all reported practical or theoretically signif-
icant improvements, and three produced statistically significant effects. Key
findings include these methods are adaptable, uncomplicated, theoretically
based, and supported by mostly case study evidence from marginal evalua-
tion methods. In general, the methods and improvement areas all are within
the realm of social work knowledge, skills, and practice principles.
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TABLE 2 Individual Article MQRS Ratings
First author (Year)
Maintenance 6. Dosage
8. Blind
follow-up 9. Multi-site
Lindfors (2009) 1 4 2 0 0 4 4 0 0 2 17
Milford (1983) 4 4 2 4 0 0 0 0 0 2 16
Fryrear (1974) 4 2 2 3 0 2 3 0 0 0 16
DeCoster (2012) 1 2 2 4 0 0 3 0 0 2 14
Levin (2007) 1 2 2 0 2 2 4 0 0 0 13
Aronson (1976) 4 4 2 0 2 0 0 0 0 0 12
Marchall (2007) 4 4 0 3 0 0 0 0 0 0 11
Okura (1986) 0 4 2 0 0 0 0 0 2 2 10
Kajiyama (2007) 1 4 2 2 0 0 0 0 0 0 9
Hogan (1981) 1 4 2 0 0 0 0 0 2 0 9
Wilson (2007) 0 4 2 0 0 2 0 0 0 0 8
Weiser (2004) 0 4 2 0 0 0 0 0 0 2 8
Walker (1991) 0 2 2 0 0 4 0 0 0 0 8
Combs (1977) 2 4 2 0 0 0 0 0 0 0 8
van den Steen (2005) 2 0 2 2 0 0 0 0 0 0 6
Weiner (1997) 1 2 2 0 0 0 0 0 0 0 5
Darrow (1983) 1 2 0 0 0 0 0 0 2 0 5
Schormans (2010) 0 2 2 0 0 0 0 0 0 0 4
Nelson-Gee (1975) 0 2 0 0 0 0 0 0 0 2 4
Kaslow (1977) 0 2 0 0 0 0 0 0 0 2 4
Cosden (1982) 0 2 2 0 0 0 0 0 0 0 4
Kaslow (1979) 0 2 0 0 0 0 0 0 0 0 2
Wikler (1977) 0 2 0 0 0 0 0 0 0 0 2
Possible range 0-32
Actual range 0-17
Mean rating 8.5
Mode rating 8.0
Median rating 8.0
First column lists only the first author of each study.
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Therapeutic Use of Photography in Clinical Social Work 13
TABLE 3 Rank-Ordered Best Practices
Ranking Study
Improvements significant,
(p<.10 or better) MQRS score
1 Milford (1983) Yes 16
2 DeCoster (2012) Yes 14
3 Marchall (2007) Yes 11
4 Lindfors (2009) No 17
5 Fryrear (1974) No 16
6 Levin (2007) No 13
7 Aronson (1976) No 12
8 Okura (1986) No 10
9 Kajiyama (2007) No 9
10 Hogan (1981) No 9
11 Wilson (2007) No 8
12 Weiser (2004) No 8
13 Walker (1991) No 8
14 Combs (10977) No 8
15 van den Steen (2005) No 6
16 Weiner (1997) No 5
17 Darrow (1983) No 5
18 Schormans (2010) No 4
19 Nelson-Gee (1975) No 4
20 Kaslow (1977) No 4
21 Cosden (1982) No 4
22 Kaslow (1979) No 2
23 Wikler (1977) No 2
Second column lists only the first author of each study.
These interventions were creative, often non-directive with uncompli-
cated protocols, making replication as well as adaptation to other conditions
easy for clinical social workers. For example, Aronson and Graziano’s
(1976) intervention utilized five straightforward assignments over the course
of 6 weeks: take a Polaroid of a friend in the group, a favorite spot in
the senior activity center, an individual picture with artificial lighting that
was then followed by flash lighting, and finally the images of non-group
members were photographed. These assignments were discussed in-group
each week, then exhibited on a bulletin board for others to view. Whereas
Schorman’s (2010) project required social workers to have a working knowl-
edge of the photo editing software (i.e., Photoshop), the intervention itself
was straightforward. The group explored their thoughts, feelings, and per-
ceived stories from 11 images of other adults with intellectual disabilities;
this was followed by actively “transforming” the images using Photoshop to
fit their own strength-based narratives. In an effort to be more parsimonious
and direct, Okura, Ziller, and Ocura (1985) directed American and Japanese
elders to take 12 pictures so they could “ ... know something about the
things you feel are important in your life—your world. ... Tell us about
YOU” (p. 250). Additionally, numerous protocols were client directed.
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14 V. A. Decoster and J. Dickerson
Client-directed protocols involved the therapist serving as a facilita-
tor to the process and not as the primary source of healing. Lindfors’
(2009) re-enactment phototherapy with participants collectively working
through past traumas is one example of healing outside of the clinician-
patient paradigm. Similarly, there is Walker’s (1991) process for a terminally
ill client self-selecting one of four projective images and to talk about “...
her thoughts, feelings or fantasies evoked by it” (p. 125). Client-directed pro-
tocols allowed this woman to set the depth and pace of care to release
her suppressed emotions. In further support of client-directed protocols,
Weiser’s (2004) five PhotoTherapy techniques (i.e., photos created/taken or
of the client, self-portraits, family or photo-biographical albums, and photo-
projectives) emphasized client choice and personal interpretations because are much like ‘mirrors with memory’, serving as markers of what
(and who) has mattered most, and later talismans holding back the blurring
that advancing years impose” (p. 23).
Unfortunately, the simplicity, flexibility, and variety of protocols suggest
a lack of sophistication in clinical application and imprecision for scientific
replication. A degree of systematization is needed to assure a consistent
intervention across time and provider. At present, many of the interventions
are highly dependent on individual practitioner discretion, skill, or expe-
rience. The growing field of translational research, the testing of clinical
protocols in the less than controlled environment of real-world practices
(Brekke, Ell, & Palinkas, 2007; Palinkas & Soydan, 2012), suggests these
adjustments are indeed acceptable, a realistic view of practice outside the
more controlled academic environment. The present criticism is not to negate
these methods from practice but to caution social workers to be precise and
transparent in their inclusion, expand deficit protocols, clarifying the meth-
ods, procedural steps, and adaptations. Therapeutic photography methods
and foundation theories are certainly within the knowledge and skill lev-
els of social work, making them accessible to practitioners. Furthermore,
the therapeutic photography’s predominate client-directed, client-centered
approaches, embracing experiential and interpretive diversity, cultural sen-
sitivity, with clients as the experts, shows to be an excellent fit within the
social work paradigm. The art of social work practice necessitates practi-
tioners to individually adapt techniques to address client uniqueness. This
practice reality of altering intervention protocols, unfortunately, complicates
building a foundation of empirically validated interventions.
This body of work certainly has intrinsic value, appealing to providers
and clients to communicate difficult problems or emotions, with incredi-
ble potential to access experiences even at the sub-conscious level. Client
self-reports of enhanced insight or feelings from a photographic activity or
a clinician’s observed improvement of their mood or behavior does have
merit. According to Bloom, Fischer, and Orme (2009), determining whether
therapeutic changes are meaningful requires significance at practical, theoret-
ical, and statistical levels. In other words, clinician beliefs that photographic
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Therapeutic Use of Photography in Clinical Social Work 15
interventions produce practical and theoretically significant changes in their
clients, without statistical evidence, are at risk of numerous biases (social
desirability, practitioner, cultural). The evidence supporting these methods,
as a whole, is marginal. Furthermore, the methodological weakness of exist-
ing research, with the average MQRS percent score of 26%, raises concern
for the scientific validity of supporting evidence. As with the inconsistency in
intervention protocols, social workers should not dismiss these techniques,
but endeavor to evaluate their effectiveness, as they should for all of their
interventions, using evaluation strategies now being taught in social work
programs and expected in today’s practice environment.
In conclusion, this project has shown the remarkable potential of
photography in mental health, based on solid theoretical foundations and
practice principles well within the social work paradigm. Social workers
should not be deterred from using these methods, as long as they recognize
and improve protocol and supporting evidence deficits. Hence, future work
in the incorporation of photography and images into mainstream clinical
social work practices needs to develop and empirically validate unambiguous
intervention protocols, preferably using an experimental design with random
assignment to condition and standardized measurement instruments. These
empirical deficits and needs are common for relatively new approaches; nev-
ertheless, the allure of photography and these studies show its promise as a
powerful tool to improve the lives of people being served by social workers.
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APPENDIX A Methodological Quality Rating Scale1(MQRS)
Methodological Criteria Rating (points)2
1. Study Design 0 =Single group, observation only; 1 =Single group pre-test/post-test; 2 =Quasi-experimental
(non-equivalent control group); 4 =Randomization with control group.
2. Theoretical Foundation 0 =No information on the theoretical basis for intervention provided; 2 =Some information
provided on the theoretical basis for the intervention; 4 =Theoretical basis discussed for
intervention described in detail.
3. Treatment Integrity 0 =No standardization specified; 2 =Intervention standardized by manual procedures, specific
4. Measures 0 =Reliability and validity of measures not reported or inadequate; 2 =Reliability and validity of
some measures moderate to high, others not reported; 3 =Moderate levels of
reliability/validity reported for majority of measures; 4 =High levels of reliability/validity
reported for majority of measures.
5. Length of Follow-up or Maintenance Phase 0 =No follow-up; 2 =Less than the intervention phase; 4 =Equal to or greater than the
intervention phase.
6. Dosage30=0–2 sessions or no discussion of number of sessions received; 2 =3–9 sessions; 4 =10+
7. Dropouts/Attrition 0 =No information provided on withdrawals or attrition; 1 =Insufficient information provided
on withdrawals or attrition; 3 =Provides numbers of study participants who withdrew and/or
were lost to follow-up, but no explanation provided; 4 =Withdrawal/attrition numbers
provided and explained.
8. Blind Follow-up 0 =Follow-up conducted by non-blind or by an unspecified person (or no follow-up); 2 =
Follow-up by person blind to participants’ treatment condition.
9. Multisite 0 =Single site study; 2 =Parallel replications at two or more sites.
10. Generalizability 0 =No discussion of generalizability of findings; 2 =Discussion of generalizability of results
(e.g., sample characteristics, site, treatment)
1Adapted from Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker, N.S., Bien, T.H., Luckie, L.H., ...Tongian, J.S. (1995). What works? A methodological analysis
of the alcohol treatment outcome literature. In R.K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives. (2nd ed.,
pp. 12–44). Needham Heights, MA: Allyn & Bacon.
2Scores range from 0 (low) to 32 (high).
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... These processes can affect access to narrative elements as well as expressive language capacities (Perryman et al., 2019;Schouten et al., 2019;van der Kolk, 2014). Applications of principles of narrative therapy have been demonstrated to support positive outcomes for adolescents struggling with a wide range of emotional challenges (Coholic, 2009;Combs & Freedman, 2012;DeCoster & Dickerson, 2014;Edmondson et al., 2018;Maree & Pienaar, 2009 Power is the ability not just to tell the story of another person, but to make it the definitive story of that person. The Palestinian poet Mourid Barghouti writes that if you want to dispossess a people, the simplest way to do it is to tell their story, and to start with, "secondly." ...
... The current media climate, as it intersects with youth culture and decreased stigma around mental illness and treatment, presents a uniquely rich context in which to pioneer creative interventions with young people around many issues of great relevance and considerable concern. Many assert the efficacy of creative methodologies that center story when treating young people, particularly identifying expressive arts therapies and narrative work as supportive of adolescent mental health outcomes (Coholic, 2009;DeCoster & Dickerson, 2014;Edmondson et al., 2018;Faranda, 2014;Manuel, 2010;Noland, 2006;Warner, 2013). An existing body of work has endeavored to leverage new media to support mental health with various populations, including youth in state care (Denby, 2016;Despenser, 2006;Rice, 2013Rice, , 2014Rose et al., 2016;Schwan et al., 2018). ...
... A substantive body of research demonstrates that expressive arts interventions, narrative-based therapies, and various applications of media arts (especially photography) support positive therapeutic outcomes for young people struggling with a wide range of emotional concerns (Anderson & Cook, 2015;DeCoster & Dickerson, 2014;Edmondson et al., 2018;Maree & Pienaar, 2009). However, as has also been demonstrated, the demand for interventions that meet the generation of digital natives in this particular moment in time, and In manners that center their nuanced experiences and array of cultural influences related to their mental health and wellbeing, steadily outpaces the supply of modalities and practitioners fit to the task. ...
Over the past decade, and especially within the last three years marked by the COVID-19 pandemic, increases in major mental health concerns among youth have been noted by many experts on adolescent health and well-being (Racine et al., 2021). When these trends are considered relative to specific subpopulations of youth (i.e., those with histories of complex trauma and engagement with the child welfare system) an even more concerning story begins to take shape. Young people who entered the pandemic in vulnerable spaces with regard to many aspects of their lives (academic, social, emotional, physical health) have, by in large, become even more vulnerable over its course (Goldberg et al., 2021; Herrenkohl et al., 2021; Murthy, 2022). The current trends around declining adolescent mental health and increasing awareness of the troubling impacts of complex trauma within the context of COVID-19 demand ever more sophisticated and creative approaches to mental health care access and interventions. Today’s adolescents, across demographics, subsist in environments that offer 24-hour access to the news cycle, one another, and the curation of their own metanarratives (as well as both a worldwide audience and the means to construct and share their personal stories) but a finger swipe away. Some argue the immediate and inconsistently mitigated availability of information, media (social and otherwise), and related forms of interpersonal interaction reinforce the aforementioned trends around adolescent mental health, particularly with regard to rates of depression, anxiety, and suicidal as well as self-injurious behaviors (Primack et al., 2017; Schor, 2021; Twenge et al., 2019; Twenge 2020). While this perspective holds, a counter narrative exists. Incredible potential rests in harnessing available technologies, means of media production, and digital access, especially as they relate to societal shifts during the pandemic, within a more broadly defined therapeutic space to support youth reimagining stories, redirecting impulse, and resurrecting possibility. This dissertation explores a theoretical framework and practical application related to one such clinical approach through two interrelated parts. The first consists of a conceptual paper that positions the history and conventions of documentary work (as a specific media arts form) as a potent mechanism to engage narrative constructs (as a particular clinical approach), orienting their intersections toward child welfare-involved youth. This conceptual paper is operationalized by a sample application, in the form of a discrete session that resides in a structured intervention protocol, that further explores and demonstrates the power of documentary arts methods within narrative-based clinical interventions to animate discourse and facilitate post-traumatic growth and healing.
... A core concept in photovoice is that images teach (Wang, 1999). Photography can be an emotionally compelling tool to articulate human experiences, spark meaningful dialogue, and achieve social change (DeCoster & Dickerson, 2014;Wagner et al., 2016). Photographs allow people to express ideas and experiences that may be difficult to articulate in words. ...
... Given the significant betrayal and erosion of trust that survivors have commonly experienced (Cordisco Tsai et al., 2020b), the use of photographs may provide an emotionally safe way for survivors to share their experiences. Research exploring the therapeutic use of photography in clinical social work has found that integrating photographic activities into group and/or individual therapy can result in increased confidence, enhanced self-concept, reduced PTSD symptoms, decreased anxiety, and greater insight and awareness among clients (DeCoster & Dickerson, 2014). ...
This study explores the psychosocial impact of photovoice participation among survivors of human trafficking and gender-based violence. Photovoice is a community-based participatory research (CBPR) method grounded in empowerment theory, feminist theory, and documentary photography. While survivors, practitioners, and scholars have increasingly called for survivors to co-produce research pertaining to their own experiences, limited research has explored the impact and the potential of photovoice participation with this population. This article presents findings from a photovoice study with survivors of human trafficking and gender-based violence in the Philippines (n = 34). Five themes emerged from a thematic analysis exploring the psychosocial impact of photovoice participation: enhanced self-efficacy, inspiration, sense of belonging, bravery, and overcoming shame. The use of photography provided opportunities for survivors to share about their experiences with peers in an emotionally safe manner. Photovoice shows promise as a psychosocial intervention that can help survivors to construct new self and collective narratives, build autonomy, and strengthen supportive community. Findings suggest that photovoice can serve both as a research method and a psychosocial intervention for survivors, holding particular promise for low-resource contexts in which psychosocial interventions are limited.
... Furthermore, the potential priming as well as ongoing therapy might have also helped participants to make the associability of dysfunctional beliefs easier as indicated by the participants' feedback on CAT-DB, i.e., "dysfunctional beliefs were confusing in the beginning but became ever clearer." To further improve the intervention procedure, it might be beneficial to visualize such beliefs, e.g., photography, drawings or classical imagery techniques, as this seems to help patients access their own dysfunctional beliefs in therapeutic settings (64,65). It might be helpful to not just provide examples for concrete dysfunctional beliefs but also to name concrete situations in which such beliefs popup to enhance accessibility. ...
Full-text available
Dysfunctional cognitions are a crucial part of depression. Cognitive therapy aims to modify dysfunctional beliefs. Typically, dysfunctional beliefs are questioned, and patients are trained to think of alternative functional beliefs. We developed a computer-assisted, avatar-based adjunct for cognitive therapy that aims to reduce dysfunctional beliefs and symptom severity. Besides, it aims to promote alternative functional beliefs. In a randomized controlled trial with 34 patients diagnosed with major depression currently undergoing inpatient treatment at the university psychiatric hospital in Regensburg, Germany, participants were randomly assigned to receive either treatment as usual (TAU) or computer-assisted avatar-based treatment for dysfunctional beliefs (CAT-DB) in addition to TAU. In CAT-DB participants are faced with a virtual avatar expressing their personal dysfunctional beliefs. Participants are asked to contradict these and express alternative functional beliefs. Assessments of conviction of dysfunctional beliefs, functional beliefs and symptom severity were done shortly before the intervention (pre-treatment), right after the intervention (post-treatment) and 14 days later (follow-up). The reduction in conviction of dysfunctional beliefs and symptom severity, and the increase in conviction of alternative functional beliefs at post-treatment and follow-up were significantly greater for the group receiving CAT-DB. Our study provides an indication in favor of the effectiveness of CAT-DB for depressive patients. It is a simple tool that could support classical cognitive therapy. Further studies at different centres, with larger sample sizes and varying therapeutic contexts are required to prove the effectiveness of our intervention.
Narrative Practice (NP) seeks to help clients author a new narrative about themselves by investigating the history of their values; it is a journey from reflective explorations to preferred identity expressions. This article is an autoethnographic study of a narrative practitioner’s experience throughout the past decade. The study identified how the practice has adopted technology and how technology has, in turn, shaped the practice. It unearthed four potential technique extension domains: i) setting contexts, ii) utilising communication modalities, iii) designing data capture and comprehension methods, and iv) circulating preferred narratives. The conclusion section discusses implications for further development.
Physicians, who have been taught to put the needs of others before their own and not take time for themselves, are finally recognizing and acknowledging the importance of self care1–4 Taking a photo every day, termed daily digital photography, is a simple, accessible practice that can be easily implemented by clinicians as a practical, daily, stress-relieving, self care strategy. Even busy physicians can access their cellphones for brief self care breaks, snap, and share a quick photo and view calming nature photos.5,6 Taking daily photos is one of the quickest and accessible self-care strategies. With over 85% of adults in the United States carrying smartphones,⁷ a great majority of the population has readily-available self care tools literally in their pockets (or bags). Today's phones are portable wellness devices with multiple apps that can be accessed regularly for well-being check-in's. With built-in cameras, smartphones can be used for taking stress-reducing, wellness-enhancing digital photographs. This new media technology gives anyone with a smartphone the potential of being a photographer. When linked with other beneficial activities like walking, getting out in nature, creativity, mindfulness, and connecting with friends and family, daily digital photography becomes a highly effective, creative practice to improve well-being, relieve stress, and cope with everyday challenges.8–12 The numerous health benefits of photography and taking photos have been researched in different populations. In the health field, photography has been studied with nursing and medical students,13,14 and with patients. Some patient groups studied include those with cancer,¹⁵ with HIV or AIDS,16,17 with dementia,18,19 and with mental health diagnoses.²⁰ Therapeutic photography has successfully been used for some time with veterans in treating post-traumatic stress disorder, military sexual trauma, and other mental illnesses.21–26 During the Covid-19 pandemic, different types of photography projects were undertaken with medical and nursing students,13,14 used by photographers,27–30 and the public31–34 as supportive practices to promote connection, facilitate well-being, improve mental health, share coping strategies, and provide encouragement in challenging times. The purpose of this article is to inspire readers to take daily photographs with their cellphones as a simple, intentional, self care strategy to decrease stress and improve overall well-being. Using the built-in camera found on their readily-accessible smartphone, clinicians can calm, create, connect, and participate in daily self care by posting a photo (or more) everyday.
La psicoterapia della Gestalt permette l'uso delle immagini e delle fotografie nel processo terapeutico in ragione della sua natura fenomenologica orientata al processo. Le fotografie di-ventano un mezzo che consolida la consapevolezza dei pazienti, facilitando la dinamica figura/sfondo. Questo articolo offre un excursus teorico che spazia tra la fototerapia e la psicoterapia della Gestalt, con riferimento ai capisaldi della epistemologia gestaltica come la consapevolezza, la concentrazione e la presenza ai sensi. Propone altresì una trattazione sulla correlazione tra le recenti ricerche neuroscientifiche sui neuroni specchio, il campo di indagine della neuroestetica, il concetto di conoscenza relazionale estetica e quello di risonanza corporea, come sfondo teorico alla validità dell'uso della fotografia nei processi trasformativi terapeutici. Gli autori concludono con esempi di applicazione del mezzo fotografico nel processo di terapie individuali.
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Individuals who experience chronic homelessness are at a greater risk of experiencing social anxiety. Phototherapy helps individuals reduce social anxiety by serving as a barrier between subject/object. This session looks at research and discusses the impact of phototherapy on social anxiety with people who are chronically homeless.
This dissertation examines the social and material dimensions of undocumented migration through Mexico along freight railways commonly known as La Bestia, or “The Beast.” I draw on mobile ethnographic fieldwork in and around migrant shelters across Mexico between 2014 and 2016. Echoing “prevention through deterrence” tactics along the U.S.-Mexico border, this period was characterized by intensified policing along railways that pushed people away from well-trodden railway corridors and into more circuitous and uncertain routes—in other words, into the “shadow of the beast.” I show how, in addition to these policing operations, humanitarian mechanisms have also reconfigured migrant pathways as practitioners and migrants negotiate intersecting understandings of dignity in the face of pervasive violence. Migrant shelters proliferate what I refer to as shelter vision, the uncomfortable and often paradoxical practice of working to sustain clandestine pathways while also striving to remedy the route’s indignities by making them visible to state bureaucracies. This combination of secrecy and publicity, which is evident in the most mundane aspects of shelter work, illuminates the organizational and interpersonal dilemmas that unfold when people who are shot or beaten while hopping freight trains face a decision: heal and keep moving, try to hire a smuggler, or seek formal humanitarian recognition, something that tends to involve dialoguing with presumably corrupt bureaucrats. I also consider how these negotiations reverberate beyond shelter spaces by following a group of men and women as they come to live and work alongside each other in northern Mexico. Based on time spent in unassuming boarding houses and off-books welding workshops, I outline shifting dynamics of hospitality and camaraderie between citizens and non-citizens as Mexico increasingly becomes not only a space of transit for Central Americans, but also a space of tentative settlement. In this way, I show how tensions of mutuality and mistrust that are evident in migrant shelters also pervade migrants’ journeys well beyond these spaces as migrants who receive formal humanitarian recognition come to rely on the very networks of organized crime from which they flee. Ultimately, this dissertation examines how shelter workers and migrants strive to align seemingly incommensurate moral economies—humanitarianism and human smuggling—amid a transnational immigration enforcement apparatus that churns people through displacement, detention, and deportation. I argue that constructing dignified pathways for people migrating without authorization requires a pragmatic approach to idealized frameworks, one that is attentive to the implicit exclusions that underlie inclusive rhetoric.
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PhotoTherapy Techniques use therapy clients' own personal snapshots and family photos (and the feelings, memories, thoughts and information these evoke) as catalysts for therapeutic communication and healing. This article discusses this flexible system of interactive techniques and demonstrates how they can be used by any kind of trained Therapist regardless of conceptual orientation, professional affiliation, preferred intervention model or approach (or degree of prior familiarity with photography itself), as well as how these techniques can be of particular benefit in Arts Therapies practices. After a brief review of theoretical underpinnings, comparisons of similarities and differences with Art Therapy (and Therapeutic Photography), and an introduction to the techniques in general, each of the five major PhotoTherapy techniques is presented and illustrated with anecdotal examples from the author's professional practice as an Art Therapist, Psychologist and Trainer of these techniques.
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There has been an increasing focus on the process of translating research into practice in all fields of health and social services. This focus has shed considerable light on the potential for social workers to play a pivotal role in conducting translational research and facilitating research translation. This article examines new opportunities, directions, and methods for engaging in translational research and research translation; provides examples of social worker leadership in specific translational research studies, methods development, training programs, and National Institutes of Health-funded Clinical and Translational Science Institutes; and describes a strategy for research that meets the specific needs and draws upon the specific strengths of our profession.
This is a study of documentary photography in American social welfare history. The study examines the emergence of photography as a tool of social policy, and in particular, key practitioners who shaped the perception of American social welfare. Within the social welfare literature, this topic is largely unexamined yet invaluable to an understanding of American social welfare. Photography performed a highly instrumental role by providing visual evidence as an innovative way of seeing and analyzing social problems. This image-based approach to social welfare analysis influenced how society viewed itself and the social environment. The goal of this study is to understand this influence by exploring the emergence of documentary photography and the practice of documentary photography as a tool of social welfare policy.
These four points denote the considerable educational and research efforts needed to fully connect EBP to the more ambitious goal of integrating science and intervention. The interest in EBP affords educators, researchers, practitioners, administrators, and policy officials a unique opportunity to improve connections between science and practice. It is critical that we move in concert to take advantage of this opportunity.
The literature was reviewed on subsequent adolescent pregnancy, self-concept, and phototherapy. It appears that there has been a lack of empirical investigation into (a) the social-psychological factors related to repeat pregnancies; (b) the relationship between self-concept, locus of control, and repeat pregnancies; and (c) strategies to be used to intervene to prevent repeat pregnancies among adolescents. If poor self-concept has been linked to adolescent pregnancy, and phototherapy has been shown to improve self-concept, phototherapy may prove effective in improving the self-concept of the pregnant adolescent, thereby reducing subsequent pregnancy. A specific phototherapeutic intervention, consisting of eight distinct steps, is suggested as a possible component of a comprehensive program of information and counseling for adolescents during pregnancy.
In the first few decades of the 20th century, the social work pioneers leaned heavily on the then new technology of the camera. Ironically, the names of even the leading social photographers are far better known among photographers than among social workers. This article examines the contributions of a few avatars of social photography that were closely connected to the social work pioneers. The career of Paul Kellogg, a social work pioneer who was most associated with social photography, is also briefly examined. Finally, the article suggests that today's social workers should follow the lead of the social work pioneers and use modern technology to put images back into social work campaigns.
This paper will discuss the use of photography and videotape in unstructured early adolescent girls' therapy groups. The focus is on two illustrative groups and explores the use of these activities in various stages of the groups' development. Adolescent issues of identity, sexuality and aggression were among the themes observed.