Attending a Photolanguage group in the psychiatric ward of a day hospital in Lyons for one year led me to think about the function of gazes in re-processing one's self-image with this type of mediation, from inter-subject exchanges to intra-psychic paths. Through the clinical profile of a patient, Antoine, we will see how his evolution within the group was facilitated by the peculiarities of photographs. For reasons of space, reference should be made to the article presenting Photolanguage for the methodology and for the way in which the technique is applied.

Clinical profile: Antoine's progress

Antoine was 30 years old. He had been unemployed for some time and his family history and childhood were marked by traumatic events and deprivation. His father died when he was 4, following which his mother entrusted him to the social services. Passed on from one children's home to another, Antoine had spent long periods as a tramp, and had several short disastrous relationships alternated with homosexual experiences. Motivated by a wish to return to a normal life in society, Antoine, who attended the day hospital, took part assiduously in a semi-open group of 11 patients suffering from a wide variety of narcissistic disorders. Alongside the clinical psychologist leading the group and a nurse, I attended the group sessions as a trainee. I will consider here the material gathered in the first 14 sessions.

Initially , in presenting his photographs, Antoine remained defensively anchored to concrete language, but then began progressively to internalise the question and to answer in a more genuine way. During the second session , when presenting the photograph of a smiling woman talking on the telephone, Antoine said " Sometimes I clutch the telephone", expressing his difficulty in believing that a link could be maintained in the absence of the object of love . At the fifth meeting he commented on the photograph presented by the nurse (a stork - traditionally the bearer of an answer to the question of origins in children's beliefs - on its nest), expressing for the first time a metaphor: " In the photograph I see the fact of building one's own nest ", he said, placing us in the position of parents amazed to see the progress of a baby towards psychic independence. Precisely because the facilitators agreed to take on the parental role he had attributed to them, Antoine progressed in the co-building of an early relationship . Antoine arrived at the eleventh session late, for the first time. We immediately noted a change in him: ever since the start of the group sessions he had always turned up looking unkempt and unwashed, but this time he had cut his hair, shaved and used perfume. The question on that day was: " Choose a photograph you like". Antoine spoke of the pleasure of sharing with others, presenting the photograph of man playing bowls, of which he stated: " It is the pleasure of the game, they want to play! ". It seemed that Antoine could at last replace his habitual choice (protective women) with the photograph of a group showing the playing area and signalling the creation of a transitional space within the group: its capacity for rêverie therefore seemed to be good enough , from Antoine's point of view, for the group experience to replace the maternal function he had fantasized about since the first session. When the psychologist presented a photograph of children drinking mugs of milk, Antoine pointed out: " One of them is amusing, the one with that tuft of hair ... ". The members of the group smiled, benevolently directing Antoine to the link with his new hairstyle.

The twelfth session , with the question " What are the nicest and the most unpleasant times for you in the hospital? Answer with the help of two photographs ", gave Antoine the opportunity to express his aggressiveness, commenting on the photograph of a group in a restaurant. He complained that in hospital the collective meal was the only shared pleasant moment. The unpleasant aspect, which he evoked using the photograph of a chemist's shop, was, on the other hand, linked to Friday afternoons, when the patients left the hospital taking their medicines for the weekend with them . His criticism continued throughout the session, tolerating and expressing the ambivalence he felt for the hospital, which until then had been heavily idealised. On the one hand Antoine was projecting his anger towards his mother onto the group and its facilitators, on the other he was making his first steps towards an attempt at separation.

During the thirteenth session , we suggested that the group should say what each of them appreciated in their relations with the others. When Antoine's turn came, he presented his photograph - a clown - in a confused manner: " He is a person ... who looks at himself in the mirror before putting on his make-up and then ... afterwards, transforms himself so as to present himself to other people ". The psychologist asked Antoine: " Is it perhaps a matter of changing in order to move towards a meeting ..? ". Antoine then presented his second photograph, a hairdresser: " It makes me think of when I went to have my hair cut, and how the others looked at me". Shortly after this, I presented my photograph : two hunters talking together, one of whom was a dwarf. Antoine claimed: " That was the photograph I had chosen, instead of the one with the clown, but I could not find it on the table ... " (like the other facilitators, I too had taken my photograph after the patients had taken theirs). He continued: " I chose it because the other person may look at the dwarf in a certain way ...". It is possible to imagine that Antoine had seen this photograph during the time allotted to him for his choice but then, when the time came for him to take it, it had been too difficult for him to find it again, in the sense given to the term by Winnicott. In leaning on my choice, Antoine could express himself with reference to a photograph that would have been too devaluating for him to choose personally.

During the fourteenth session, for the question " What do being alone and being together mean to you? ", Antoine presented the photograph of a woman lying on a road with her son clinging on to her, and said: " This is a mother with her son; they are together. I do not have any children but I have some nephews and sometimes I spend time with them... ". The group said: " This photograph has already been chosen ... ", referring to another session. Precisely because we had already worked on that photograph, Antoine was able to choose the illustration of this desperate contact with his first object of love. Instead of remembering that he had not had a family, Antoine could consider a mother who, in turn, had been abandoned. He formed an image of himself facing the future and placed himself, by reversing the concept, in the position of a potential parent. Thus, he confronted an aspect of his masculinity: the possibility of being a father.

Later, we found the thread of the inter-subjective topic of the previous session thanks to the exchange concerning a photograph presented by another patient, Claude. This was of a woman putting on her make-up in front of a mirror. Claude explained that this woman was transforming herself in order to meet other people. Like the woman, the clown was made up. It was sensed, as another member of the group stressed, that in both cases it could be a matter of a defensive mask. At the same time, however, the exchange concerning these photographs enabled different self-images and their potential for transformation to be activated and worked through again. With a worried look, Antoine answered Claude: " But that is make-up . it's a woman ... ". Antoine was asking (himself) about the difference between sexes, asking implicitly what a man could do and what a woman could do, continuing in his search for a sexual identity. Claude answered: " Bathrooms are made for men, too. Men can shave ... "; assigning in this way a value to the signs of sexual differences, evoking castration and rendering explicit a more positive self-image, that reassured Antoine. Later, he observed that the characters present in the photograph of another patient (a family at table) were eating and talking. The psychologist addressed Antoine: " You associate these two pleasures: eating and exchanging ... " verbalising the perceptive chaining. This latter was accompanied by very strong affection, since at this point Antoine confided in the group: " I'll be going on holiday soon, and will join up with the rest of my family. It is the first time, and this is something enormous for me ... ". The syntactic formula he used showed that in "re-introducing" himself into his family Antoine experienced a genuine integrating effect on his person.

A first summing up: building of a self-image

Having overcome the initial description of himself, Antoine moved on to integrate what the group sent back to him, working through his image again and re-activating the resources of his Ego. What was Antoine acting out when he went to the barber and two weeks later presented us with a photograph of a hairdresser - a male character (stereo)typically connoted as a homosexual? Using the photograph as a mediation between himself and the therapist's gaze, Antoine was asking the group to acknowledge him, and placed himself in a search in which the face of the other person was seen as a primary mirror of the self. Antoine's request to be acknowledged was reiterated when he commented on the hair of one of the children in the psychologist's photograph. The work of representation is possible because the setting retained its role as a non-variant throughout the sessions, letting Antoine ask the group and the facilitators to adopt a gaze reaching beyond appearances.

In the clinical exchange, the importance of the degree of identification that is possible with the facilitators and the scope of the alliances and of the supports that enable Antoine to mobilise can be grasped. The exchanges of imagination also act as supports for identification processes: " So is exchanging imagination not equivalent to exchanging identifications, and to facilitating exchanges of identification and their plurality within the group? ", wondered C. Vacheret. The identifying link between Antoine and myself is declined in a sort of fraternal rivalry, a struggle between siblings to win the love of the mother/psychologist. His claim to the photograph with the two hunters presented by me permitted the expression of a conflictualisation of the transferential situation, when Antoine said that he had looked for it but not found it. In this way he could complete the presentation of his photograph, the clown, pointing out that in this context it is a gaze that discriminates between the presence or the absence of a handicap. Thus, the contour of a narcissistic restoration started to be outlined, together with the re-arrangement of a more integrated image of himself. The sensory stimulus of the mediation has an integrating effect on the partial areas of the body and on an Ego that is first and foremost bodily (Freud) by mobilising the senses, while the photograph, by mobilising thought through images, triggers off the process of association, otherwise very weak in Antoine, as is often the case in situations characterised by that sort of deprivation. The question and the delivery (" the rules of the game of Photolanguage© ") encourage the translation of perceptions into words and thus the work of re-connection, of rebuilding of the bond (Freud's Bindung ), which is characteristic of the preconscious system and of increasingly complex secondary processes.

Antoine's initial functioning within the group followed the logic of ideal demands, and often brought us together around the isomorphic pole, in an understanding fantasised as totalising. Progressively, together with C. Vacheret, we see how: " The subject and the group, mobilised by the ideal of the Ego, are referred to the idealized objects in a process of secondary identification. They support the difference between sexes and between generations in particular, and this implies a psychic task of bereavement ". Antoine was able, by means of a task of re-connection, to start this double bereavement - paternal and maternal. Towards the end of the meetings, Antoine started to let his anger emerge, while in the earlier phase he took on the accommodating role of the "good patient". We can assume that he reproduced the attitude he adopted as a child in order to meet the needs of his depressed mother, but that he also took on a re-narcissising role for the illiterate adult that he is today. When Antoine told the psychologist that he was about to go on holiday with his family, he was clearly expressing the fact that he was able to lean on the group along his therapeutic path leading him to draw close to his family again. In externalising his anger and directing it towards the group and the facilitators, Antoine faced up to more genuine needs, progressing towards a degree of greater differentiation. In this case, the hypothesis that the group setting defined by the mediation of Photolanguage© may create the conditions needed to re-activate early interactions and re-introduce what the subject is lacking, that is to say the capacity described by Bion as maternal rêverie and called the gamma function by F. Corrao, applies. Photographs as a mediating object re-topicalise the structuring gaze of the mother, which is pre-verbal and precedes the mirror stage described by J. Lacan. The reflection in the mirror acquires meaning solely if it is accompanied by verbalisation on the part of the mother, explaining to the child what he sees. Thus, the comments accompanying the photographs are a search for a meaning. This experience is similar to that of the newborn baby meeting the gaze of a mother who, as H. Lichtenstein says, reflects the newborn, with the double meaning of the verb "to reflect". The mirroring function in this Photolanguage© group enables work to start on representations of the self, which are structured according to the different levels of gaze mentioned. The mirroring appears to be considerably amplified by the images proposed: someone took the photograph, someone presented it and, lastly, someone chooses it. The photographs chosen by Antoine and his comments enable us to understand how to begin with he places the narcissistic conflict outside himself (in the various different female figures) and then within himself (photographs of the hairdresser and of the clown). Subsequently, acceptance of opinions other than his own and of the relativity of the photograph enable him to get out of fusional relationships.

Photolanguage© enables the participants to speak with timing and in ways that are valorising for everyone. This valorisation is also achieved through the possibility of facing up to and of criticising the photographs presented by the facilitators. The method enables the interior referential world of the subject to be explored, with the intention of enhancing the positive parts, which are adaptable and re-activatable, and treatment to be proposed that arouses the protective functions of the Ego, this being a priority aspect for Antoine and for the other patients in this group, all of whom present risk behaviours.

Conclusion

A group using Photolanguage© mediation is a space-time container that enables a proto-mental experience. In the framework of the model of transformation proposed by R. Käes with the notion of group psychic apparatus, we know that a single element of the field cannot be transformed if the transformation does not concern it as a whole. Antoine's path must therefore be considered within the overall dynamics of the group, as a place for re-topicalisation, and for rebuilding earlier bonds between interior and external objects, since the photographs facilitates the necessary conditions for regression. Through Antoine's evolution we see how transfer is a learnt relational mode but also a search for a valorising image of self laying the foundations for an unaccomplished bereavement . It passes through the photograph, through the group object", and through the facilitators. The clinical work leads to the representation process: since they must structure a story, the associations, representations and affective atmospheres connected with them can become first preconscious and then conscious.

As an medium, the photograph enables the bonds to be structured, lowering antagonisms. The inter-subjective exchanges and the gamma function start up the transformation process, that leads to a new and creative vision and to a re-organisation of objectual relationships. Within the time-span of the session, a psychic bonding of the disconnected and fragmented parts of the Ego is accomplished and the self-image is worked through again in a process of differentiation supported by the repetitiveness of the method and on the stability of the setting.

The symbolisation appears to be the outcome of two movements, pone of which self-representative and the other meta-representative. In the same way in which the Other - specifically the mother - enables the child to have a representation of himself while he is playing or thinking, the Photolanguage© method fulfils this function for the participants through rêverie , the gaze and the support of the group and of the facilitators, and the subject can represent to himself that he is representing.

Photolanguage mediation was fundamental for Antoine to start a psychic process in this group, since it has created the necessary conditions for re-activating the early interaction of being seen and recognised, basing himself on the photographs. We have seen how the mirror function of the group, amplified by Photolanguage© mediation, enables work to be carried out on the representations of self that are structured in the different levels of gaze applied within the group. In the framework of this psychic work, Photolanguage© mediation facilitates a self-representative re-arrangement and narcissistic valorisation of the re-activatable parts of the Ego, and offers the opportunity to relativise and to become sufficiently detached from the photograph for a "meta" gaze to form.

Each of us, in his own way of living in the world, has internalised a constant gaze that determines us partly. It may happen that this gaze immobilizes us. But when it can be translated into words we understand, as Winnicott said, that: " The basis for any healthy and stable psychic structure can undoubtedly be traced back to the reliability of the internalized mother, but this capacity is supported in turn by the individual. It is indeed true that people spend their whole lives carrying the lamppost against which they lean. But somewhere, at the start of it all, there must be a lamppost that supports itself, otherwise the reliability would not be introjected". The Photolanguage© method represents, through photographs, the characteristic dual narcissistic and objectual polarity of the medium. From re-activated early experiences and new objectual investments, the members of the group build up new self-images.

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