Part two: Using the visual to unlock the stories and ‘translate’

The purpose of using a visual method to explore personal experiences of self-harm was an attempt to counter some of the reported problems people with personal experience of self-harm encounter generally and in relation to research. By adopting what you might call a more tailored, exploratory, bottom up approach I hoped to firstly enable people to express what they felt was important about their experience of self-harm, and secondly, enable them to express their experiences of self-harm in a different way. Potential limitations in relation to conventional methods have been discussed previously (see 2.3.3). Through this, I hoped to gain access to unrestricted experiences that might be difficult to articulate to broaden our understanding of some of the reasons why people self-harm. Part one of this discussion has discussed the

findings in relation to extant theory and empirical evidence surrounding the functions of self-harm, and suggested how the findings from this study might serve to enhance our understanding of particular functions, part two will discuss how the method might have contributed.

3.8.2.1 Did the method ‘work’ for people who self-harm?

That is, did it promote self-understanding, expression, communication and focus during interviews (Drew et al., 2010); was it useful in accessing unpredictable information and establishing rapport (Hurworth et al., 2005)? For some, it would seem so. Participants enjoyed using this method and it allowed them time to prepare and choose what they wanted to show and discuss in terms of their experience, including what they didn’t want to show, and from some of the accounts it would seem reasonable to suggest that the method did promote self-understanding, expression, communication and focus.

Throughout the interviews there was a constant interaction between the pictures and the verbal content.

Using this unstructured approach with images allowed for the unveiling of complex, unpredictable and detailed narratives which may not have been accessed through

interview alone, including controlled access to the ‘unseen’ (to be discussed - 3.8.2.3).

Indeed, trying to follow up on all of the unpredictable and complex stories proved difficult at times and both the participant and the researcher struggled to keep track of the rich discussion. Nonetheless, using this method seemed to change the typical research dynamic in that it enabled a change in the voice of the interview and participants took control of the representation and interpretation of their experience.

The method enabled articulation of several different, difficult topics such as, sexual abuse, death, relationship difficulties - both familial and relational, violence, religion, homosexuality, alcoholism and other mental health problems or diagnoses.

Similar to the suggestions of Mannay (2010) & Harper (2002) where photographs provided a different way of knowing and understanding something which can be taken for granted, one of the participants reported how the method prompted her to think about her experience of self-harm in a different way “it made me think about what would represent it you know, represent it in a different way that I’m used to, but yeah no it was interesting”. Moreover, in the same way participants in the study of Cooper and Yarborough (2010) reported articulating experiences for the first time through the use of images, participants in this study reported how it was the first time they had spoken in such an honest and detailed way about their experience of self-harm. Of course this sort of response might be related to factors other than the method, for instance, rapport and who participants feel comfortable to communicate with, and having the opportunity to talk in what they perceived to be a safe, non-judgemental environment. It is worthwhile noting here that the extent to which people with personal experience of self-harm found it difficult to talk was sometimes questionable and so with one of the participants I explored how she seemed quite able to communicate with me; her response was largely related to her perception of me and my understanding; “I think its cos I know you have some understanding of self-harm and I know that you're not going judge whereas other people will, other people have got no experience of self-harm and it’s a hard thing to get your head round you know and there the people that are saying you know you've just got to stop doing it”. So while the method certainly appeared valuable for all the reasons discussed, this particular response might suggest one the main strengths lies in its ability to establish a good rapport.

3.8.2.2 A ‘good fit’

One of the main purposes of adopting a visual methods study with people who self-harm was to enable them to feel as though they were in control of the research process and offer them a different form of expression. It has been interesting to see how those

key features, which were initially identified as barriers to research, were in actual fact discussed by the participants as their functions of self-harm. Perhaps then through offering a different form of expression, different to those enabled through conventional methods, yet similar perhaps to their chosen form of expression (self-harm),

participants felt more able to express and communicate their experience of self-harm.

Similar to the way they used their body as a way of expression and substitute for language, they used the pictures.

The way participants used pictures in this study might also support the suggestion that people draw upon visual images during times of psychological distress (Holmes et al., 2005, Hales et al., 2011, Holmes et al., 2007). As discussed previously (3.1.1.2), studies carried out by Holmes et al (2007) and Hales et al (2011) both showed how participants, during times of psychological distress, were more likely to describe their experiences in the form of imagery. In a similar way, the two males in the study, Oliver and Richard, both talked about their experiences in a very visual way, Richard in particular presented pictures to represent the contents of his flashbacks, whilst Oliver described how art often captured his own intra and interpersonal experiences.

Moreover, the use of metaphorical and figurative speech featured widely throughout most of the participants’ accounts which would suggest a propensity to describe experiences of distress through imagery.

3.8.2.3 Seeing the unseen: controlled access to the ‘private’ and the

‘hidden’

Adopting a visual approach enabled the researcher to ‘see’ what was usually hidden and private, whilst enabling the participant to choose and be in control of what they wanted to show. This controlled access was perhaps less exposing and ‘costly’ for the participant. Experiences of hostile care and negative reactions to self-harm have been well documented in the literature (Gough and Hawkins, 2000, Pembroke, 1994, Spandler, 2001, Huband and Tantum, 2000, McCann et al., 2006) and were reported by participants in this study, including the need to portray an external self which is different to the internal self by way of protection. For example, the visual and verbal accounts sometimes captured a sense of conflict between external and internal persona. Tori and Theresa in particular both discussed how despite their extensive history of self-harm and suffering they were reluctant to be perceived by others in this way. They both maintained quite a hardy external persona, which Tori referred to as her ‘front,’ yet they both chose to show images which captured what was behind their

‘front’. Tori for example allowed me to see the space in which she self-harmed and the

tools she used, and Theresa captured images that represented her vulnerable and fragile self. In this way the method seemed to enable a ‘safer,’ more controlled form of expression and disclosure, and for some it was reportedly the first time they had spoken in such an honest and detailed way about their experience.

While the method seemed appropriate and valuable to those participants with personal experiences of self-harm, on reflection it may not be entirely suitable for everyone or every topic, including self-harm. A critique of visual methods, including ethical challenges, will be discussed in part three, followed by recommendations for future