Vulnerability in the Process: Participant Perspectives on Using Photovoice to Explore the Experience of Coping with Substance Use and Traumatic Stress

Background and purpose: Photovoice is a qualitative, community-based participatory research method that has been used with many different marginalized groups to document life narratives, raise critical consciousness, and facilitate community change (Wang & Burris, 1997; Latz, 2017). A recent scoping review shows that researchers and persons with mental illness have used photovoice successfully to explore experiences of living with mental illness (Han & Oliffe, 2016). How participants conceptualized and experienced their engagement in the photovoice process is not well understood. The present study uses data from a project where adults with co-occurring substance use and post-traumatic stress symptoms used photovoice to show how they realized feelings of safety within themselves, in their relationships, and in their communities. The goal of this study was to explore how participants understood their engagement in the photovoice process.

Methods: The present study used photovoice to engage participants in exploring the experience of coping with traumatic stress and substance use. Participants (n = 6) were purposively sampled from Seeking Safety groups at a community mental health center in the Midwestern United States. Participants identified primarily as women (83%), white (50%), and had a mean age of 42 years (SD = 11). After collecting informed consent, participants attended an orientation to the photovoice project, took photos over a two-week period, then met with a researcher to discuss selected photos and to reflect on the process of participating in the photovoice project. After transcribing interviews, researchers used reflexive thematic analysis to code transcripts (Braun & Clarke, 2006), situated within a hermeneutic theoretical framework. Participants met with researchers again in focus groups to discuss findings and provide feedback on themes.

Findings: Researchers generated four themes related to participating in the photovoice process: vulnerability in self-expression, connection to everyday life, enjoyment of creative expression, and concerns about artistic composition. Participants reported feelings of vulnerability when sharing and discussing their photos: photovoice requires trust that disclosures will be respected, as the group processes requires intimacy and safety. Second, participants reflected on how photovoice helped them to reflect on and represent everyday life in a way that may inspire astonishment and critical reflection on ordinary experiences. Third, the process was novel for participants, and the act of taking pictures and representing experience for others was enjoyable and contrasted with standard therapeutic activities. Fourth, participants discussed issues around artistic composition, voicing concerns about the ability to take photographs and providing critical reflection on the conscious choices made to represent a concept and the struggle to assert the meanings of their photos.

Conclusions and Implications: Photovoice may be an engaging and enjoyable method of inquiry for persons with co-occurring post-traumatic stress and substance use. Providing individualized technical support and quality equipment can support individuals in participating. Researchers must acknowledge and attend to participant feelings of vulnerability in a way that promotes trust and intimacy within the group process. Photovoice may promote feelings of agency and empowerment, as participants enacted feelings of safety through the photovoice process that were represented in their photographs.