Creative use of imagery frees expression among patients

Leaders at the Gosnold on Cape Cod addiction treatment organization are finding an innovative way to unlock emotional expression in patients who struggle to convey feelings with words. In the process, they also are meeting an organizational goal of integrating technology from people's everyday experience into the clinical setting—a place where technology has not always been welcomed in traditional treatment practice.

After having tested the application of Expressive Digital Imagery (EDI) techniques with patients in its three-to-five week rehabilitation program, the Massachusetts treatment organization now is making this clinical tool available to counselors across a wide variety of its treatment settings. In a typical use of EDI in a treatment setting, individuals create and manipulate photographic images and then discuss them in group therapy.

The founder of the nonprofit institute with which Gosnold works on this project does not use the words “art” or “photography” to describe the activity, but says the self-expression with digital imagery that occurs in EDI reflects a power of visual imagery that existed long before people could take pictures on portable digital devices.

“It's enabling expression that often wouldn't otherwise happen,” says Steven Koppel of the Boston-based EDI Institute. “What I'm hearing patients say is, 'We're now able to share things that we were sick of talking about and wouldn't otherwise express.'”

Gosnold president and CEO Raymond Tamasi originally met Koppel, who has a business and not a clinical background, through his participation in a group devoted to exploring innovations. “I learned about the idea to use photographs in a way to enhance the clinical experience,” says Tamasi.

Gosnold proceeded to purchase half a dozen tablet computers and have patients take a photograph and manipulate the image through use of an app. The idea would then be for each patient to present the image in group, discuss what it conveys, and hear feedback about the message from fellow patients.

“We found that they were talking about the image in a way that was much more revealing and open than if they were just talking about themselves,” says Tamasi. “In the feedback, people were talking not about the other person, but the image.”

Koppel, who says the technology has applicability across a range of healthcare disciplines, recalls a particularly moving example he encountered in an addiction treatment setting. “A younger individual took an image of the front seat of his car and made it look ominous—very dark and blurry,” he says. The patient originally had been skeptical about this form of expression, but in group he showed the image and described how in the past he would drive to an isolated spot and stay (and use) for hours so that he could avoid encountering his parents when he finally returned home late at night.

“He said that he would be taking home the image to serve as an active reminder of the life he didn't want to return to,” says Koppel. For the patient, it would become something he could reach for when the urge to use threatened to overwhelm.

“We view EDI as a technique to integrate into existing evidence-based therapies such as cognitive-behavioral therapy, family therapy and mindfulness groups,” Koppel adds.

The EDI Institute has created a closed online platform for facilities to use in employing this technique. Individuals can take or use their own pictures or can acquire images from a royalty-free image service. Gosnold and other customers pay what Tamasi calls a nominal licensing fee to use the platform.

Tamasi adds that there have been no problems associated with improper use of the technology, or with the practice of giving patients more access to technology than has been the case in the past.

Gosnold transition

This example of exploring innovation on Gosnold's behalf reflects an ongoing process that has led to this month's announcement that Tamasi will be transitioning out of day-to-day operational roles at Gosnold and focusing his efforts on broader innovation to benefit the organization. Tamasi will remain as president of Gosnold, and an individual with whom he has worked on projects in the past, Richard Curcuru, has been hired to take over as CEO.

Curcuru most recently has served as executive director for behavioral medicine for Tenet Healthcare's Northeast region. Prior to that he worked as executive director of behavioral health at Cape Cod Healthcare, which placed him alongside Tamasi in efforts to improve overall clinical services in the region.

The transition at Gosnold will be phased in over the next six months, Tamasi says. Curcuru begins work at Gosnold on April 18.

Tamasi says the move reflects two primary goals: normal succession planning for the organization, and an effort to devote more time to contributing toward broader advances in addiction treatment—innovations that also will help Gosnold in the long run. One area of emphasis on Tamasi's part, for example, will involve exploring ways to avert hospitalization and rehospitalization for persons with addictions.

“This is about trying new ideas and finding new ways,” says Tamasi. “The continuum of care is long here, so Gosnold offers a fertile lab to test out ideas.”