Many adolescents and young adults struggle with self-esteem. For young people battling and recovering from cancer, treatments can take more than just a physical toll on one’s body. They can create a lasting impact on mental health and self-image long after remission.
With an ocean between them, two doctors set out to study what would happen when young cancer survivors saw themselves in a new light utilizing a technique called Framed Portrait Experience (FPE). Dr. Emanuela Saita is a researcher at the Catholic University of the Sacred Heart in Milan, Italy and Dr. Chiara Acquati teaches and researches at the University of Houston. Together, they conducted a study on the efficacy of FPE among young adults and adolescents.
The Framed Portrait Experience uses both therapeutic photography and re-enactment therapy to promote increased self-esteem. On the other side of the lens, the subject has the creative control to create new photographic representations through preformative re-enactments. Transformation and embodiment are key to this process. A 2008 study in the European Journal of Psychotherapy and Counselling found that photography can be a useful medium in the field of oncology. To conduct a FPE, patients take self portraits during chemotherapy treatment, then they review and discuss the image in a clinical interview at the end of treatment. If successful as an intervention, FPE can aid in coping with one’s cancer diagnosis and lead to positive self-representation.
In February 2020, The Journal of Adolescent and Young Adult Oncology published Saita and Acquati’s study. The study describes how the FPE is designed to function: “This intervention is rooted in four guiding principles: first, that cancer originates an affect-laden experience; second, by the recognition of the biopsychosocial challenges of experiencing cancer during adolescence and young adulthood; third, FPE recognizes the relevance of autobiographical narration for one’s sense of self, and, finally, by the use of photographic portrait as a medium to facilitate this narrative.”
The ability to tell one’s story through portraiture puts the individual in control during an experience where everything else can feel like it’s falling apart. FPE provides the space to express one’s emotions, whatever those emotions may be, surrounding their cancer journey.
To conduct their study, Saita and Acquati recruited 20 individuals who were diagnosed with leukemia between the ages of 12 and 19. At the time of the study, participant ages ranged from 18 to 26 and 55.6 percent were women.
Ten of these participants completed the FPE while the other 10 acted as the control group. Two of the control group did not return completed surveys making the total number of participants 18. All participants also had to have received chemotherapy at the participating institution, a pediatric cancer center in northern Italy. In their conclusion, the researchers acknowledged that their sample size is small. However, their results showed that FPE can lead to increased self-efficacy, a better self-perception and an increased ability to face future challenges.
Behind the lens was a portrait photographer who doubled as a licensed social worker. But it was the survivors who were in the driver’s seat creatively. Participants selected three settings and included three objects to represent their past, present and future.
In an interview with the University of Houston, Acquiti recounted how one of the participants decided to take her “past” portrait with her father while he fixed a car because her father was a constant fixture during her cancer treatment. Her “present” portrait took her to a riverbank for a serene image of self-reflection. For her “future” image, she dressed as a street performer making people laugh.
“The goal is to retell their stories in contexts meaningful to them,” Acquiti told University of Houston. “It can be very emotional and challenging, but we hope that by looking back from a distance now that their cancer treatments are over, they can move forward with their lives.”
The research duo printed the images and utilized them in a clinical interview. Participants completed The Body Image Scale to measure their self-esteem as it relates to their body and appearance. The Rosenberg Self-Esteem Scale, General Self-Efficacy Scale and Brief COPE questionnaire also guided interviews. Survivors who participated in the FPE reported higher self esteem.
The study found that FPE can be an accessible, low-cost and easy-to-implement intervention. Though the study worked with a professional photographer, anyone with a smartphone could theoretically help a survivor complete a Framed Portrait Experience.
Forget zits! While still developing and learning to love themselves and their bodies, adolescent and young adult cancer survivors face serious health challenges. After making it to the other side, it’s worth reflecting on the impact for one’s mental health. Self portraiture won’t erase any past experience, but it may just be the key to unlock healing.
The Framed Portrait Experience study was published in the Journal of Adolescent and Young Adult Oncology, Vol. 9 No. 1. To explore more studies centered on AYA cancer from this journal, visit liebertpub.com/loi/jayao.