Strengthening Brain Injury Support Groups Through Photovoice

By Stephanie Lloyd 

People find their voices in many different ways – photovoice is a way to align what I’m thinking through pictures. –BIA-MA Support Group Leader & Photovoice Training Participant  

PhotovoiceWorldwide staff recently facilitated a training with Support Group Leaders from the Brain Injury Association of Massachusetts (BIA-MA), to prepare them to facilitate photovoice with their group members. Participants gained hands-on experience with the method as they took photos related to a prompt, discussed them with their colleagues, developed captions, and identified common themes. All the photos shared in this blog were taken by BIA-MA support group leaders for this training.  

As we have said before, all our trainings are participatory in nature, and thus are slightly different each time based on participants’ needs and interests. This particular group asked questions and thought deeply about how to adapt the photovoice method for their support group members.  

Here are a few different topics and reflections that emerged during the training sessions:  

  • Overall, taking photos and talking about them increases opportunities to hear about what people have to say. And as Caroline Wang originally envisioned, a successful photovoice project can help participants feel that they have been heard. Support group leaders noted that individuals living with brain injury may use photovoice to help family members understand their experience and to be seen by the community in a different way.  
  • Although there are plenty of options for facilitating photovoice remotely, this group expressed preference for the rich experience of facilitating photovoice in-person. Yet facilitating photovoice remotely may grow in importance if the pandemic continues to prevent in-person meetings for the foreseeable future. PhotovoiceWorldwide will be working with BIA-MA staff to develop written materials, screen shots, and videos on Zoom features and photo sharing that can support use of the technology with support groups online.  Experience during the professional development sessions showed that with tailored training and supports, BIA-MA support group leaders can help their diverse participants fully share their photos and join in discussions online. (For information about facilitating photovoice remotely see our related blog post and recorded webinar.) 
A wooden table

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Photo taken by Laura M. 
  • During discussions, a leader offered that photovoice might naturally attract support group members who are interested in photography. She noted that it is important to emphasize photo content over beauty, and that most important is for participants to take photos that express something they want to say. Leaders suggested emphasizing with your group that photovoice is not about being a professional photographer or creating a “display worthy” image, but about sharing ideas and communicating something of significance.  They noted that when participants use film cameras, they don’t have a chance to erase or delete their images, and sometimes a “bad” photo makes for good discussion. At the same time, however, a digital camera can make it easier for people to “get the picture that they want.”  
A close up of a cage

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Photo taken by Cynthia C. 

At the end of our time together, BIA-MA support group leaders expressed their excitement about facilitating photovoice with their group members and the potential for the method to have value for their groups. One leader commented: “I’m truly looking forward to seeing the creativity of all of the participants. It’s a great opportunity to get to know people on another, more personal level.” 

We truly appreciate this collaboration with BIA-MA, and will continue to support their work to strengthen healing and advocacy for people living with brain injury in Massachusetts. To find out more about their work, please visit: http://www.biama.org/.   

If your organization or team might be able to use photovoice in their work, please reach out so we can design a specialized training to meet your needs!  

Critical Thinking Part 2: Strategies and Tools to Facilitate Critical and Creative Thinking with Photovoice

By Erin Bush and Laura Lorenz

In Part 1 we explored critical and creative thinking in photovoice projects. In this sequel, we look at the ways that facilitators and clinicians can use specific strategies and tools to strengthen critical and creative thinking in photovoice projects. As we learned in Part 1, all stages of photovoice entail critical and creative thinking. Participants use these skills when a) choosing photos to take, b) sharing photos and providing feedback on others’, c) writing and sharing captions, d) receiving and considering feedback, and e) making decisions about where and how the work should be presented.

In Part 2, we suggest three practical strategies to foster critical and creative thinking with photovoice: 1) presenting thought-provoking ‘going deeper questions’ to the group, 2) finding words to share experiences and feelings, and 3) practicing low-stakes caption writing.

Going deeper questions

It can be helpful to have some provocative, follow-up questions in your ‘back pocket’ and use them as needed to encourage conversation. Early in your project, some participants will doubt their abilities. Use questions with your group or with individual participants to encourage talking and sharing.

  • How do you see your role in the project?
  • What might be the ideal end product for you? How can you contribute to that?
  • What are you comfortable sharing about yourself?
  • What is something unique that you know or have experienced that is different from the other group members?

These types of questions encourage creative thinking and may help the participant to see what their unique contribution is. Later on, as participants share their photos and captions, rich discussion can ensue! Some participants, however, will feel hesitant to share. Reminding participants of the project’s larger purpose can be helpful:

  • What do people in our community need to know?
  • Which photos will help our cause the most?
  • Which pictures might have the most impact on our audience?
  • Is there something you have always wanted people to know about your situation/condition?

Remind people that there are no right or wrong pictures, that photos can be literal or metaphorical, and that a photo can help to tell a story. Questions to support photo conversations include:

  • Which pictures “say” the most to you?
  • Which pictures are showing something surprising that the audience doesn’t expect?
  • Which pictures tell a story that we want to share?
  • What are some of the points we can make using our pictures?

These questions can also support decisions about which photos to include in your exhibit.

Finding words

Plan ahead to bolster photovoice conversations by creating a list of words relevant to your project topic. When people are struggling or frustrated, pull out your list and use it to facilitate ideas and conversation. With adolescents and participants living with intellectual disabilities use a word-generating exercise as a warm-up activity. Ask participants to say aloud some words that relate to your project topic while you record them on a white board, chalk board, or flip chart. Return to these words during photo discussions or when identifying themes across photos. Participants use creative thinking to generate words, and critical thinking to select a word they feel is best.

Photovoice projects can stimulate a wide range of emotions, and naming feelings can be hard. However, using a word to describe that feeling can help participants to feel understood and even empowered. Consider using an online tool such as the feeling wheel developed by Gloria Wilcoxi, to identify a specific word for an emotion. Wilcox created the wheel using colors to further represent emotions and help people identify and communicate their feelings. All three of the links below lead to feeling or emotion wheels that can support photo conversations:

Low-stakes practice with captions

With Photovoice we are not left to guess what the photo represents because we can read the caption. Writing captions helps participants to communicate what the photos mean to them. Some people feel confident about writing, others will feel apprehensive and vulnerable. Provide low stakes practice with caption writing before asking participants to write their own. One strategy is to bring some general, non-topic photos to the group and ask participants to take turns describing how they might caption it. Start by modeling an example first. We provide two examples below:

Example 1: Practice with low-stakes caption writing

First ask participants to write a “literal” caption, for example “Family time” or “Playing in the backyard” or “Big brother taking care of little sister.” Next, ask participants to write a “metaphorical” caption that describes a time when they felt surprised about something, learned something new about themselves, or surprised other people. For example: “Many people are surprised when I tell them about my head injury, because TBIs are invisible. People can’t usually tell.” Or “I surprised myself when I started enjoying art after my brain injury.”

Example 2: Practice with low-stakes caption writing

Again, ask participants to suggest a literal and a metaphorical caption – or choose one approach. A literal caption might be “my favorite place to go fishing.” A metaphorical one could describe a feeling: “I am finally at peace after 15 years of activism work. I have found serenity like a calm breeze making ripples in water”. Or “I am getting glimpses of new opportunities for the future, like the mountains peeking up behind the trees.”

Caption writing may still be difficult for some participants. A second strategy is to bring some ready-made captions for participants to choose from when discussing a general photo (not taken by a participant). Have a range of captions printed on strips of paper. Ask participants to choose a caption for a sample photo and explain why they chose it. This exercise can prepare participants living with intellectual disabilities, a communication disorder, or any condition that makes caption-writing a challenge, to talk and think about their own photos in a different way.

Participants will feel more excited about photovoice when the tasks are clear and they have a chance to practice. Writing captions is a critical and creative thinking activity that helps participants to take others’ perspectives into account, enrich their message, and enrich the project as a whole!

Conclusion

Photovoice projects cover a wide range of topics, yet challenges that arise are often similar. Project leaders may need to facilitate strategies that encourage creative and critical thinking to help participants feel more comfortable or confident about sharing. Strategies such as ‘going deeper’ questions can encourage group conversations and new ways of thinking about photos and the project topic. Using a feeling wheel to aid in formulating captions and themes can be helpful. Bringing some general photos and even pre-written captions can provide inspiration. Photovoice projects are designed to be inclusive. Everyone participating in your project wants to know – and feel – that their voice is being heard. We encourage you as facilitators and clinicians to use strategies and tools that can support meaningful participation and communication and critical and creative thinking by all.

More ideas for tools and strategies? Please comment below!

Erin Bush is an assistant professor in the Communication Disorders division at the University of Wyoming. Before attending the University of Nebraska Lincoln for her doctorate, Erin worked in medical and rehabilitation facilities as a speech-language pathologist. She teaches and conducts research regarding acquired neurogenic communication disorders, and her work has mostly been with people who have had a TBI, stroke, or other neurological condition such as Parkinson’s disease. She also has a specific interest in qualitative research methodologies. Erin attended the Photovoice Worldwide training in March and has been working with Laura since that time on blogs as well as an upcoming webinar about critical and creative thinking with photovoice!

Laura Lorenz is co-founder and educator at PhotovoiceWorldwide LLC. She has a PhD in health policy and health services research from Brandeis University and a Master of Education (Instructional Design/Adult Education) from the University of Massachusetts at Boston. Laura has been using photovoice since 2001 with girls, youth, people living with brain injury, older adults, and people living with mental illness. She has published in peer-review journals and books on disability, brain injury, health, healthcare, cost-effectiveness, managed care, rehabilitation, research involvement, sociology, visual education, and visual methods. She facilitates the professional development course ‘Talking with Pictures’: Photovoice.

i Wilcox, G. (1982). The Feeling Wheel: A tool for expanding awareness of emotions and increasing spontaneity and intimacy. Transactional Analysis Journal, 12(4), 274-276.

Meet Our New Intern Carson Peters!

Carson Peters graduated from Grinnell College with a Bachelor of Arts in the Biology of Global Health. She is currently a second-year student in a Master’s of Public Health Program with a focus on Epidemiology at the University of Iowa. She is passionate about global public health and advocacy.  She studied abroad in Brazil, India, and South Africa, in an honor’s global health program, where she focused on infectious diseases research including TB, HIV/AIDS, and Zika. Her experiences abroad inspired her to conduct her senior thesis on women’s cancer as a health disparity in Sub-Saharan Africa. Her research experiences include working at the National Institute of Health’s National Institute of Allergy and Infectious Diseases, Harvard Global Health Institute and the Harvard School of Public Health. She has also worked on Capitol Hill for the Honorable Congressman John Lewis, related to her public policy and advocacy interests.

Why are you excited to intern with PhotovoiceWorldwide this summer?

I am excited to work at Photovoice Worldwide this summer because of the organization’s meaningful and innovative impact on global public health communities; which will allow me to further develop my passion of global health and advocacy.

Who is a researcher or photographer that you admire, or has influenced your work? Why?

I am inspired by Dr. Paul Farmer, a global health scholar, who engages in interdisciplinary global health approaches and research particularly in the global south. His scholarship were frameworks for my senior thesis about women’s cancers in sub-Saharan Africa, focusing on systematic barriers and structural violence. As a global health advocate, Dr. Farmer seeks to be a change agent while using community-based research approaches.

What are your plans for next year? (and beyond?)

I plan to complete my Masters of Public Health in Epidemiology at the University of Iowa next year. To further my education, I am interested in attending a Ph.D. program in Epidemiology or Global Health.

What is a fun fact about you?

A fun fact is that I hiked Table Mountain in Cape Town, South Africa that took 5 hours (just one way) despite being a novice hiker. I won a photo contest with the Global Engagement Institute at Grinnell College for a photo taken during this monumental hike.

What do you like to do in your free time?  

In my free time, I like to travel, try new foods (am a self-designated foodie), read and volunteer. I am currently working on a community service initiative to support and show gratitude to essential workers in my area.

We are delighted to have Carson as part of the PhotovoiceWorldwide team!

Critical Thinking and Photovoice: Part 1

by Laura Lorenz and Erin Bush 

A colleague recently asked us about critical thinking and photovoice, and her interest prompted us to reflect on this topic and share our thoughts. In part 1 – this post – we identify photovoice tasks that use critical thinking. In Part 2 we will share strategies to strengthen critical thinking with photovoice.    

Overview 

Critical thinking is a cognitive process that influences our thinking, attitudes, and actions. A critical thinking process involves reflecting, observing, experiencing, and communicatingi. Usually we are unaware of this process – it takes place whether we pay attention to it or not! With photovoice we get the chance to intentionally look at our lives and circumstances through the lens of a camera. Critical thinking can open our eyes to aspects of our lives and circumstances that might be helping us or causing us harm.  In our daily lives it is difficult to notice what is right in front of us. Because we see that help or harm every day, it no longer attracts our notice or attention. With photovoice, we practice critical thinking when we reflect on our circumstances with new eyes, capture photos of what matters to us, share them with others, and communicate the thoughts and feelings that the photos represent.  

Paolo Freire (1974) encouraged the practice of critical thinking not to deny a fact, but to “see it differently.”ii With a camera in hand, photovoice participants can observe their lives differently through a camera lens. Paolo Freire also encouraged us to “care about the dignity and worth of every person” through critical thinking.iii Without an overarching sense of caring, critical thinking risks causing harm to people. Seeing personal circumstances with new eyes can mean understanding the structural and systemic inequalities – such as poorly resourced healthcare systems or schools – affecting us, and the role these inequalities play in our lives and circumstances.  

Since the mid-1900s, creative thinking has emerged as a complement to critical thinking.iv,v Creative thinking involves developing new ideas to address the problems or support the strengths identified with photovoice. Critical and creative thinking interact to create understanding and inform action.  

Now let’s consider the photovoice steps and tasks that build participants’ critical and creative thinking skills.  

Critical and Creative Thinking and Photovoice 

Step 1: Answering questions with a camera means reflecting and observing. Critical thinking begins right away with photovoice, as  participants observe their surroundings and use their cameras to take pictures that answer questions, such as: what do I think is a strength or a challenge in my life or community? The questions prompt reflection.  

  • What do I care about?  
  • What do I think or feel? 
  • How can I show this in a photo?  

Step 2: Communicating is basic to photovoice. With photovoice, communication involves not only taking and sharing the pictures, but speaking, listening, and writing about them too.  Critical thinking occurs as photovoice group members bring their photos to the group and explain with they mean by communicating what they see in the photo and, comparing and contrasting their own perspective with another’s.  The photo generates dialogue as people talk about their lives, thoughts, and feelings. Group members may experience new empathy for each other and a sense of altruism or caring. Critical thinking occurs again when participants write photo captions, to communicate with people outside the photovoice group. 

Step 3: Observing commonalities by identifying themes. Photovoice can result in a large group of photos to share with others. One recommended photovoice task is to involve participants in grouping project photos into themes. When discussing photos and experiences during project sessions, common experiences and recurring themes likely arise. Identifying themes and using them to group project photos and captions engages our critical thinking skills.  

  • What do these photos have in common?  
  • What name helps to show their commonality?  

Asking these questions can help us identify and name themes. This important cognitive work helps us to observe our common experiences and feel a greater connection with the project and the group.  An exhibit represents a collective experience  that can help us to think creatively and open our minds to possibilities we had not thought of before. 

Step 4: Communicating to power: Advocacy and outreach. Understanding about advocacy and outreach can evolve during a photovoice project. As the deep connections formed through shared thoughts and feelings emerge, photovoice participants often experience a sense of ownership in the data, and   care and concern for what will become of the photos and captions.  

  • Who will see the exhibit?  
  • Where will it be displayed?  
  • Will the “right” people – who can affect change – get to see it?   

We want our work to be viewed by people who will want to see it, are willing to learn something new, and/or have the ability to create change. As we consider the “right” audiences for our photovoice work we engage in critical thinking to determine logically where the display will be most accessible and effective, and the best way to get people to see it. We put ourselves in policymakers’ shoes – what information will motivate them to create change? Creative thinking plays a role as well, allowing us to go beyond the expected outreach efforts and think of new ones. Photovoice participants further promote their work by thinking creatively about ways to increase its visibility. 

Ever-widening Circles. Another way to think about critical and creative thinking and photovoice is through ever-widening circles, from self-reflection or communication with oneself, to reflection and communication with a peer, in a group, and, finally with the community.  

A step-wise process of self-reflection in ever-widening circles can provide a safe, respectful way for people to dig deeper into themselves and their understanding of their lives and circumstances. The process is bi-directional as we can move thru the circles outward and then reflect again on ways that the circles impact us, in turn. An important role for photovoice facilitators is to support critical and creative thinking processes and the learning they can engender – for individuals, groups, clinicians, and communities. 

Conclusion 

Critical and creative thinking are skills that can be developed by people of any age, any level of education, and any level of cognitive ability. Building these skills is a lifelong endeavor. We travel with our photovoice participants for a short time in their lifelong journeys. Practice with critical and creative thinking during a photovoice project can plant seeds for lifelong learning and growth. With photovoice, critical and creative thinking means helping participants to build the knowledge, awareness, and skills needed to reach their goals and dreams – for themselves, their peers, and their communities.   

Next time we will discuss strategies to encourage practice with critical and creating thinking during photovoice. 

Ever-widening Circles 

Photovoice encourages a step-wise process of self-reflection in ever-widening circles. 

A Photovoice Path 

Practice and learning with critical and creative thinking occur at many different points in the photovoice process, from reflecting on about the project topic, to taking a photo, writing a caption, and identifying audiences for your exhibit. 

Writing is a Critical Part of Photovoice 

Writing photo captions encourages critical thinking. Why is this photo meaningful to me? What do I want to tell others? 

Erin Bush is an assistant professor in the Communication Disorders division at the University of Wyoming. Before attending the University of Nebraska Lincoln for her doctorate, Erin worked in medical and rehabilitation facilities as a speech-language pathologist. She teaches and conducts research regarding acquired neurogenic communication disorders, and her work has mostly been with people who have had a TBI, stroke, or other neurological condition such as Parkinson’s disease. She also has a specific interest in qualitative research methodologies. Erin attended the Photovoice Worldwide training in March and has been working with Laura since that time on blogs as well as an upcoming webinar about critical and creative thinking with photovoice!

Laura Lorenz is co-founder and educator at PhotovoiceWorldwide LLC. She has a PhD in health policy and health services research from Brandeis University and a Master of Education (Instructional Design/Adult Education) from the University of Massachusetts at Boston. Laura has been using photovoice since 2001 with girls, youth, people living with brain injury, older adults, and people living with mental illness. She has published in peer-review journals and books on disability, brain injury, health, healthcare, cost-effectiveness, managed care, rehabilitation, research involvement, sociology, visual education, and visual methods. She facilitates the professional development course ‘Talking with Pictures’: Photovoice.

What is your purpose?

By Stephanie Lloyd

Last week members of the PhotovoiceWorldwide community, from around the globe, joined together to talk about “purpose” in their lives. Each person shared a photo (or two) that they had selected and talked about their vision of purpose. Their photos represented responses to the following questions:

  • How do you define purpose?
  • What drives your purpose?
  • Where have you found purpose lately?
“Purpose is a work in progress – something I am always working towards but never sure of arriving.” photo by Laura Lorenz

The conversation moved from outdoor spaces to family to food. Some of the outside photos shared included: hiking spaces, a lake, and a mural on an empty city street. For the participants, these natural images represented connection and a way to decompress in nature to find purpose. One photo shared was a way to talk about finding purpose through a beautiful 5-day hiking journey from Bologna to Florence.

“On the Way of Gods, from Bologna to Florence by foot.” photo by Laura Si​rabella

One participant shared a photo of herself on her first day of teaching as she held hands with her daughter on her first day of Kindergarten. Another participant shared a picture taken of two photos of her grandfather as a child and a grown man, and part of a camera, as he was a photographer, like her. These interesting reflective photos seem to show us that purpose can cross generations.

Prompted by a photo of Jamaican Dukunu (Blue Draws), a corn meal snack wrapped in banana leaves, the group talked about how food brings us together as a connector. Other participants compared the Jamaican dish to Columbian or Costa Rican Tamales, Venezualan Arepas, Chilean humitas, and Polish galumpke. Through our discussion, we decided that “joining around the table is communal, and bridges many gaps.”

At the end of the conversation, we reflected on how photos can be used as a journaling tool, and can also inspire long conversations that teach us. At PhotovoiceWorldwide, we offer these photo sharing conversations as a way for people to shift from formal Zoom meetings and talk through current highlights and concerns, share and learn with others, and inspire positive action. We hope you can join us for the next one at the end of June! 

“We are in it together!” photo by Stephanie Lloyd