Social Dialogue Magazine
art examples
1) Bottle headless: An example of a participant's voice about the impact of addiction on the head of the family. 2) Alcohol and Addicition: An example of pictures that the children presented to the parents at the end exhibition. 3) Broken beer bottle on a rock in the park: An example of a participant's voice about the impact of addiction on the whole family.
article 14 author image

Menny Malka Lecturer, the Spitzer Department of Social Work, Ben-Gurion University of the Negev, Israel

Life in the Shadow of Addiction: How Children Report about the experience of exposure to a parent's addiction through Photovoice

Abstract

Addiction of a parent has a long-term psychological impact on children’s social, developmental, cognitive and emotional levels. The energy required to bear the shame of the parent's addiction and the ensuing family impoverishment, along with the need to take on parental roles at home, greatly challenge developmental processes of individuation that are central to adolescent development. It is often hard for these children to reap the benefits of group work because of secrecy and shame. Thus, it seems that indirect and expressive methods, such as working in the arts, would be helpful in the group setting (Peleg-Oren, 2002b). Art is a natural educational and therapeutic language in childhood that enables enhancement of emotional and cognitive development, and sharing emotional experiences in a more concrete and embodied way than the use of language to describe emotional states, as demanded in adult verbal psychotherapy (Huss, 2012; 2015; Kramer, 2000; Malchiodi, 2008).

The arts also enable indirect expression of the secret by using symbols and metaphors, thus maintaining a sense of safety for the children that allows for sharing but also for keeping the secret (Allen, 2003; Huss, 2012). For children who do not have the chance to play or to experience a childlike role due to home problems, an arts group enables regression, and develops the psychosocial, emotional, and educational advantages of shared play that includes expressing the safe, maintaining boundaries, sharing, and more (Malchiodi, 2008; Winnicott, 1991). The arts become a medium of symbolic reality within the group space that allows for the practice of social communication mediated through the arts and via the group leaders in the here and now. (Wolfgang, 2006; Waller & Mahoney, 2002).

Photovoice photography to empower individuals and groups. This approach provides visual expression and thus agency to individuals, groups and communities by utilizing their active "gaze" to define issues and engage in additional discussion in order to share and further define the issues, so that the hegemony or dominant voices are not the ones that define things (Wang, 1999; Woodlrych, 2004). Arts in general and photovoice are effective with populations who are less verbal due to age, disability, differences in culture, and traumatic experiences that are shameful to express directly, such as abuse (Drew, Duncan, & Sawyer, 2010). The camera enables enough physical and symbolic distance from the experiences to approach them and to share them with others (Levin et al., 2007). With children, then the camera enables children to be witnesses and phenomenological describers of their own difficult social experiences in an indirect way that does not endanger them psychologically or socially.

the camera enables children to be witnesses and phenomenological describers of their own difficult social experiences in an indirect way that does not endanger them psychologically or socially

This is also relevant when working with teenagers who do not want to directly expose their social life to adults. It enhances the relative power of youths in relation to adults because the youths control visibility and symbolic construction of their own reality. Thus, the camera becomes a bridge to the children's experiences that is a more embodied and appropriate way of addressing them than through direct questions based on adult knowledge (Drew et al., 2010; Lal, Jarus & Suto, 2012(. The use of a camera is also psychosocially enhancing, as it develops new skills, enables "having fun", and enhances a sense of efficacy and agency, which children often do not have (Moletsane et al., 2007; Strack, Magill, & McDonagh, 2004). This use of photovoice is less often described in the literature in relation to children who are dealing with parental addictions. We identify a need for innovative methods to intervene and research this population, burdened with secrets and shame, that relates both to the micro and macro levels of experiences, and thus enables both releasing the external secret and building internal self-esteem. Sharing these images with parents, creates yet another level of systemic externalizing of the secret. The group intervention was based on the use of photovoice with this group for 15 structured sessions that were held over a period of four months. It has been published more extensively in terms of methods, in Arts in Psychotherapy,( Malka et al, 2017). The following themes emerged from the photovoice (Some of the pictures are illustrated above in Figure 1).

Together, the group created posters and slogans showing the dangers of drinking, based on their own images of broken bottles. Photography helped reduce denial of parents’ addiction: As stated in the literature review, a central theme for children of addicted parents is the shame over their parents’ addiction and the need to deny it from themselves and from others. This makes mediation of separation and individuation through peer interaction, and building a fulfilling social reality outside of the home very difficult for them, increasing their isolation. This paper aimed to explore how photovoice can help to achieve the aims of a support group for children of addicted parents: Two central themes or psychological effects emerged from the data: First, we saw how photovoice was effective in enabling developmental growth. Second, we found that photovoice was effective in expressing secret and negative feelings about parents’ addiction in a non-threatening way. The second theme is connected to the first because it freed up energy to deal with development rather than dealing with the negative and secret feelings about the parents’ addiction.

To summarize, the contribution of this paper is that it has highlighted the dual role of photovoice in enhancing natural development and enabling children of addicted parents to approach their pain and defenses in an indirect but concrete manner. This ability to work "inside” but also "outside” was shown to be especially relevant for many groups of children in complex realities. This connection between micro and macro levels of experience can help to externalize rather than internalize the source of the problem for the children. This is concurrent with the aim of clinical social work, that is, to present emotional problems within their social contexts, and on this level, photovoice is particularly relevant to social epistemologies of combining micro with macro perceptions, an area that needs to be articulated more clearly in social work (Huss, 2016).

Regarding practical aspects, it seems that in such a project, the organizational base and parental involvement are very important. To create a basis for the implementation of photovoice, proper organizational preparation is required, including cooperation with the parents' therapists, and preparing parents for cooperation. Moreover, parental involvement and their ability to allow children to share their experiences with group members are a therapeutic element in and of themselves.

References

Allen, P. (2000). Interview with an art therapist who is an artist. American Journal of Art Therapy, 39 p 7-13
Bar-On, N., Levine-Rozalis,M., & Yodelevitz, R. (2000).Groups for children of rehabilitating drug addicts. Jerusalem: National Insurance Institute, Research and Planning Administration (Hebrew).
Chazan, R. (2001). The group as therapist. London: Jessica Kingsley.
Drew, S. E., Duncan, R. E., & Sawyer, S. M. (2010). Visual storytelling: A beneficial but challenging method for health research with young people. Qualitative Health Research, 20, 1677-1688. Gabriel-Fried, B., & Teichman, M. (2007). Ego identity of adolescent children of alcoholics. Journal of Drug Education, 37(1), 83-95.
Hergenrather, K., Rhodes, S., Cowan, C., Bardhoshi, G. & Pula, S. (2009). Photo-voice as community-based participatory research: a qualitative review. American Journal of Health Behavior, 33(6), 686-98.
Huss, E. ( 2012). What we see and what we say: Using images in research, therapy, empowerment, and social change. London: Routledge. 180 pages.
Huss, E. (2015). A theory-based approach to art therapy: Implications for teaching, research and practice. London: Routledge. 200 pages.
Huss, E. (2016). Toward a social critical, analytical prism in art therapy: The example of marginalized Bedouin women's images. The Arts in Psychotherapy, 50, 84-90. Kramer, E (2000). Art as therapy. London: Jessica Kingsley.
Lal, S., Jarus, T., & Suto, M. (2012). A scoping review of the photo-voice method: Implications for occupational therapy research. Canadian Journal of Occupational Therapy, 79(3), 181-190.
Levin, T., Scott, B. M., Borders, B., Hart, K., Lee, J., & Decanini, A. (2007). Aphasia talks: Photography as a means of communication, self-expression, and empowerment in persons with aphasia. Topics in Stroke Rehabilitation, 14, 72-84.
Lust, D. (2013). When a child has a disability: Exploring the experience of adolescent siblings through photo-voice. Occupational Therapy Doctoral Program Department of Rehabilitation Sciences: The University of Toledo.
Malchiodi, C.A. (2008). Creative interventions with traumatized children: Basics of practice (pp. 264-284). New York & London: The Guilford Press.
Malka, M., Huss, E., Bendarker, L., & Musai, O. (2017). Using photovoice with children of addicted parents to integrate phenomenological and social reality. Journal of Art in Psychotherapy. Moletsane, R., De Lange, N., Mitchell, C., Stuart, J., Buthelezi, B., & Taylor, M. (2007). Photovoice as a tool for analysis and activism in response to HIV and AIDS stigmatization in a rural KwaZulu-Natal school. Journal of Child & Adolescent Mental Health. 19 (1), 19-29
Peleg-Oren, N. (2002a). Drugs–Not Here! Model of group intervention as preventive therapeutic tool for children of drug addicts. Journal of Drug Education, 32(3), 245-259. Peleg-Oren, N. (2002b). Group intervention for children of drug-addicted parents using expressive techniques. Clinical Social Work Journal, 30, 403-418.
Rothman, E.F., Edwards, E.M., Heeren, T., & Hingson, R.W. (2008). Adverse childhood experiences predict earlier age of drinking onset: results from a representative US sample of current or former drinkers. Pediatrics, 122 (2): 298-304. 10.1542/peds.2007-3412.
Strack, R.W., Magill, C., & McDonagh, K. (2004). Health Promotion Practice, 5(1), 59-58.
Thompson, N., Hunter, E., Murray, L., Ninci, L., Rolfs, E., & Pallikkathayil, L. (2008). The experience of living with chronic mental illness: a photovoice study. Perspectives in Psychiatric Care, 44(1), 14-24.
Waller, D, & Mahoney, J. (2002) Treatment of addiction in art therapy. NY: Routledge
Wang, C., & Burris, M. A. (1997). Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment. Health Education & Behavior, 24(3), 369-387.
Wang C (1999) Photovoice: a participatory action research strategy applied to women’s health. Journal of Women’s Health 8(2): 85–192.
Winnicott, D. W (1991). Playing and reality. London: Routldege.
Wolfgang, G (2006). The ego-psychological fallacy: A note on the birth of the meaning out of a symbol. Journal of Jungian Theory and Practice, 7(2), 53-60.
Woodlrych, R. (2004). Empowering images: Using photo-voice with tenants with special needs. Housing, Care and Support, 7(1), 31-36.