Anna Chiara Sabatino: Director, Lead Researcher
Affiliation: University of Salerno
Gianluigi Foglia: Participant, Patient
Antonio Iannone: Participant, Patient
Valeria Saladino: Psychologist, Researcher
Title of work: Video-pharmakon: Mobile filmmaking as Therapeutic Creative Practice
Length: 6 minutes and 2 seconds
Video-pharmakon (2020) is the title and audio-visual outcome of a clinical research-intervention project aimed at Autism Spectrum Disorder (ASD-1, DSM-5) 8-25 year old kids and adolescents. Within a narrative medicine framework, the experimental protocol implemented by the therapeutic team consists in an interdisciplinary integrated approach involving multiple video-based techniques (from cinematherapy to documentary video therapy) and an increasing degree of participation for patients. In the latest protocol phases, participants perform amateur mobile filmmaking, shooting audio-visual self-narratives through mobile smartphones. Such footage is edited together with documentary clips recorded by the therapeutic team during the whole project, in order to be administered like a “medication” that fosters a rehabilitating collective and self-video modelling.
PEER REVIEW 1
Which aspects of the submission are of interest/relevance and why?
This is a worthy submission with the project and abstract in good standing. The methodology of engaging with children with disabilities through participatory filmmaking approach may not be a new phenomenon but when it is applied effectively, it always proves to be a worthy exercise. Case studies have shown that this form of creative engagement has positive effects on the individuals involved. Hence, it also becomes clear from this film that the experience for the child is indeed a positive one. He seems empowered by the opportunity to co-direct as well as star in the film.
The submission does live up to its potential. Perhaps slightly more focus could have been devoted to the process of participation such as “becoming a co-director” and what it meant for the child. Further, including more footage of the child at the end of the process would have provided more signals to the study in terms of impact. I am unclear as to what shaped the duration of the film, but I would argue that more footage which demonstrated the process of integration and hence transformation could have strengthened the piece, but it is not a requirement that this be done.
How does the submission expose practice as research?
Whilst the abstract would benefit from a more defined research question, the work is well contextualized within specific artistic fields.
Fundamentally, this approach follows in the tradition of seminal documentary works such as Jean Rouch’s Chronicle of a Summer (1961) in which participants are able to watch themselves perform in interviews and conversations, on screen. Notably, an Australian example of this work is BUS STOP FILMS which is a leading organization employing people with disabilities and giving them the opportunity to create fiction and non-fiction films.
This work takes the experience of filmmaking and engaging with children with disabilities to a new level by involving participants in the production process. The juxtaposition of the various elements of this story is innovative in my opinion.
I believe there is new knowledge identified in the creative work that is most visible in the child’s transformation which is clearly effective.
I would have loved to hear from the parents about how they think their son has changed or not changed but I am not arguing for this extra work to be done.
PEER REVIEW 2
Which aspects of the submission are of interest/relevance and why?
The concept of using audio-visual techniques in clinical research-intervention projects is a compelling one, and the project seems to have a clear aim of helping ASD-1 kids and adolescents through an interdisciplinary integrated approach. The use of narrative medicine to frame the experimental protocol is also a promising aspect of the project.
Does the submission live up to its potential?
The use of amateur mobile filmmaking as a way for participants to create audio-visual self-narratives is an innovative approach that could be particularly effective for ASD-1 patients. However, it is unclear how the therapeutic team ensures the safety and privacy of the participants in this process.
Finally, the statement refers to the administered footage as a "medication" that fosters rehabilitating collective and self-video modelling, but it is not clear how this "medication" is administered, how often, or how the therapeutic team measures its effectiveness.
Overall, the concept of using audio-visual techniques in clinical research-intervention projects for ASD-1 kids and adolescents is promising. However, the description could benefit from more detailed information about the experimental protocol, the patients' involvement, and the safety measures taken during the project. Additionally, a more detailed explanation of the administered footage and its effectiveness would be helpful in understanding the impact of this innovative approach.
How does the submission expose practice as research?
The submission shows what it looks like when children with ASD-1 co-direct and collaborate on mobile filmmaking. The process is the main contribution of the film, and it is very interesting to watch how mobile filmmaking centres these children’s aesthetic and content decisions. The way that these children are shown to be creating, editing, discussing, and viewing their mobile film creations is a useful contribution and should be included in the issue.
Within the framework of an interdisciplinary neuropsychiatry, psychology and film studies convergence, Video-Pharmakon is the title and the audiovisual outcome of a clinical research-intervention project aimed at Autistic Spectrum Disorder (ASD-1, DSM-5) young patients and their families (Sabatino et. al 2021). Based on the principles of art-therapies, among which cinematherapy is considered as synonymous of filmtherapy (Malchiodi 2012), Video-Pharmakon proposes a definitional and pragmatic distinction between the audiovisual therapeutic practices, describing cinematherapy as the process of viewing, filmtherapy as the vision of a disorder-targeted content (Saladino et. al 2020). The project also outlines a therapeutic protocol which merges strategic psychotherapy with various audiovisual techniques, delineating a circular and transformative path, both creative and therapeutic, which allows the patients as spectators and makers of their own movie, to access a cognitive, emotional, and pragmatic experience through a performative representational device (Bruzzi 2006). The cinematic dispositif (Foucault 1980; Deleuze 1992) is therefore characterized by a participatory-documentary (Nichols 2001) and self-representational approach (Rascaroli 2014), which is preferable within a narrative-oriented therapeutic setting and narrative medicine framework.
Video-Pharmakon’s experimental protocol, implemented by a therapeutic team composed of a neuropsychiatrist, a psychotherapist and a filmmaker, consists in an increasing degree of participation culminating in therapeutic filmmaking (Cohen, Johnson, Orr 2015), an amateur and self-representational form of mobile filmmaking that young participants perform through their smartphones (Schleser 2014). In parallel with the creative process designed for the young participants, parent training sessions are held during the project phases, in order to guide family members in learning functional and targeted educational strategies. All the phases of the described protocol are videotaped within a “Therapeutic Set” (Sabatino 2022), which methodologically and clinically contributes to define the theoretical and pragmatic centrality of the cinematic device and the participatory creative practices and process required for the targeted goals.
In this context, the collected audiovisual material – the short movie made by the participants, the documentary footage shot during the whole project – is edited by the therapeutic team as an intermedia (Montani 2022) “video-medication”, that fosters a rehabilitating collective and self-video modelling. The presented video-research is one of the customized and person-centered “video-medications;” a Video-Pharmakon as described and presented so far.
In this perspective, the theoretical and operational framework offered by the Sightlines Journal presents itself as a valuable and innovative forum for exchanging interdisciplinary knowledge and affirming contemporary academic standards with respect to non-traditional research outputs.
To address the valid annotations aroused by the reviewers, both regarding the process, the quality and the modes of patients’ participation, I would like to state the different audiovisual therapeutic techniques involved in Video-Pharmakon protocol, which consists in five different phases as described below.
Phase 1. Family System’s Inspection
After the quantitative and qualitative assessment with tests and interviews conducted at time 0, the first phase of the protocol involves an on-site visit to the family’s home. During this phase, the professional filmmaker and the psychotherapist interact with participants by inviting them to narrate their daily life and show their fantasies, fears, desires, and needs, through role-play and ludic methods.
This phase creates a first alliance between the team and the family, and facilitates compliance with the audiovisual tool, such as the camera. Indeed, the use of the video camera can stimulate reflections on daily dynamics, usually automatically acted. The inspection is useful in data collection on the family system and in emerging unconscious contents within the family member.
Phase 2. Documentary Videotherapy and Parent Training
During Phase 2 of Video-Pharmakon protocol both participants and their families are filmed in their everyday life. This collected footage is then edited and administered in one or more Video-Pharmakon, especially during the parent training sessions (4-5 sessions in two months), conceived to guide parents in learning educational strategies for promoting the higher well-being of the family system.
During this phase, which requires Documentary Videotherapy methods and strategies, young participants are also interviewed in order to collect audiovisual footage to edit before-and-after storytelling, which is going to be shown in a maintenance Video-Pharmakon.
In this phase, both participants and families experience a preliminary self-review on the therapeutic setting which requires them to be main characters and spectators, with a limited amount of creative participation.
Phase 3. Therapeutic Filmmaking
During the following phase, Video-Pharmakon protocol involves a Therapeutic Filmmaking action, which requires young participants to be scriptwriters, directors and filmmakers of their own self-representative video. In this phase the filmmaker acquires the role of facilitator, who supports the creative process of video production, step by step, to achieve the narrative goals of the young participants.
During the first session of Therapeutic Filmmaking, the professional filmmaker and the psychotherapist explain the phases of production, the main rules of communication, and the basic techniques of the construction of audiovisual narratives.
A couple of selected participants proceed together with the story writing, storyboarding, filming, and editing, following the planning developed together. Parents, meanwhile, are involved in parent training sessions and maintain a logistical support role, contributing to shifting the focus of the relationship from family to a friendship relationship. The psychotherapist facilitates the interaction and interpersonal exchanges among peers and monitors the emotional and behavioral elements of the participants, promoting collaboration toward a shared goal. The main aim of this phase is to support and promote a process of subjectification, implementing intersubjectivity.
Phase 4. Cinematherapy
During the Cinematherapy phase, the couple of participants watch their self-representative video in a movie theatre, together with their families. This moment is characterized by a collective sharing of the final product, while working as therapeutic restitution of the whole productive process carried out.
Such self-representative Video-Pharmakon, a self-video-medication realized during the Therapeutic Filmmaking phase, represents, for both patients and families, a new perspective, emphasized by the transition from the Therapeutic Set to the movie theatre, where the psychotherapist facilitates feelings and emotions to emerge, reinforcing the patients with supportive feedback.
After one week, both the parental couple and the children watch again, and separately the video with the filmmaker and the psychotherapist, commenting on it and sharing thoughts and emotions about the content and experiences.
Phase 5. Outcomes Management
One month after the end of phase 4, the team conducts a first follow-up with the same protocol of tests and interviews used in the preliminary phase of the study. In order to preserve therapeutic progress, in this phase some maintenance measures are in order.
The data collected from this follow-up aims to reinforce the strategies education learned, positive outcomes, and family progress. The psychologist and the filmmaker edit a final Video-Pharmakon aimed to manage the positive outcomes over time.
The maintenance Video-Pharmakon contains the images collected throughout all the project phases, sections of the self-representative Video-Pharmakon made by the young participants, and the footage documenting the various stages of the intervention. This phase consists of two sessions in which parents and children participate separately. One week after the first follow-up, participants are administered the maintenance Video-Pharmakon, which is customized and tailor-made for each participant, both young ones and parental couple: the psychotherapist provides the parental couple with specific prescriptions, to be carried out at home during the time until the second follow-up. After three weeks, participants watch their maintenance Video-Pharmakon again with the psychotherapist reinforcing behavioral strategies learned during the project, and promoting future perspectives.
Bruzzi, Stella. 2006. New Documentary. New York: Routledge.
Cohen, Joshua, J. Lauren Johnson and Penelope Orr, eds. 2015. Video and Filmmaking as Psychotherapy: Research and Practice. New York: Taylor & Francis.
Deleuze, Gilles. 1992. “What is a Dispositif?” In Michel Foucault: Philosopher, edited by Timothy Armstrong, 159-166. London: Harvester Wheatsheaf.
Foucault, Michel. 1980. Power/Knowledge: Selected Interviews and Other Writings 1972-1977, edited by Colin Gordon, 194-195, New York: Pantheon Books.
Malchiodi, Cathy. 2012. “Art Therapy Materials, Media, and Methods.” In Handbook of Art Therapy, edited by Cathy Malchiodi, 27-41. New York: Guilford Publications.
Montani, Pietro. 2022. L’immaginazione Intermediale. Perlustrare, Rifigurare, Testimoniare il Mondo Visibile. Milan: Meltemi.
Nichols, Bill. 2001. Introduction to Documentary. Bloomington: Indiana University Press.
Rascaroli, Laura, Gwenda Young, and Barry Monahan, eds. 2014. Amateur Filmmaking: The Home Movie, the Archive, the Web. USA: Bloomsbury Publishing.
Sabatino, Anna Chiara. 2022. “Audiovisual Means to Therapeutic Ends. Cinematic Dispositif within Medical Humanities.” Cinéma & Cie 22 (39): 56-89.
Sabatino, Anna C., Filippo Fimiani, Francesca F. Operto, Grazia M.G. Pastorino, Filippo Petruccelli, Valeria Saladino, Valeria Verrastro, and Giangennaro Coppola. 2021. “Therapeutic Filmmaking, Strategic Psychotherapy and Autism Spectrum Disorder: An Integrated Approach,” Journal of Psychological & Educational Research 29 (2): 56-89.
Saladino, Valeria, Anna Chiara Sabatino, Chiara Iannaccone, Grazia Maria Giovanna Pastorino, and Valeria Verrastro. 2020. “Filmmaking and Video as Therapeutic tools: Case Studies on Autism Spectrum Disorder,” The Arts in Psychotherapy, 71 (November). https://doi.org/10.1016/j.aip.2020.101714.
Schleser, Max. 2014. “Connecting Through Mobile Autobiographies: Self-Reflexive Mobile Filmmaking, Self-Representation, and Selfies.” In Mobile Media Making in an Age of Smartphones, edited by Masha Berry and Max Schleser, 148-158, New York: Palgrave Pivot.