When Ellen Fisher Turk took her first nude portraits of a sex abuse victims two decades ago, and later of an anorexic, the photographer with a background in special education had little idea that she would become a seminal figure in the sometimes controversial world of phototherapy.
"My thinking was that going through the nudity part was similar to going through a phobia; you're afraid of going on a plane, you go on the plane," Turk said. "[But] I don't think it is necessary to be nude, it's just to be seen.
"I think that pictures are very, very extraordinary," she said.
Even before the New York-based Turk took her first photos of incest victims in the early '90s, she wasn't the only one to recognize that photos can help people who can't find solace or communicate in words alone.
She's now part of a disparate movement that goes by many names. What's known as phototherapy in England, for instance, is called therapeutic photography in North America. Even within the same country, experts disagree about what phototherapy really is or really does.
On one end may be professional photographers who intend for a single studio session to be therapeutic, and who may or may not undergo training in psychology. On the other are Ph.Ds who use the medium of photography to cut through the talk and get to visceral emotions.
Turk's work with incest victims, women suffering from eating disorders or even the terminally ill merged the worlds of photography and therapy. But she always prefaces her observations about how phototherapy works with the caveat that she's neither a scientist nor a licensed therapist.
During a photo session, Turk said she tries to show the victim's humanity and beauty in the series of photographs. Some anorexics walk away with a vision of themselves as others see them: ill but not fat. With incest victims, Turk said the women often walk away with compassion for themselves.
"With incest, I've see that as children, they took it as they did something wrong," Turk said. "What they see uniformly in the context of the photos is a lovely person, and they see a way to have compassion for that person."
Turk's clients often come to her through knowledge of her work or are referred to her by therapists. She doesn't tell them how to pose but rather lets them move around and use her as a trusted outside observer.
"I'm not coming to the shoot with a critical self," she said. "I want the photographs to see what is beautiful about them, not what I think is beautiful."
Turk has gained widespread acclaim for her work as art, as well as a therapeutic method. But she always approaches each project from the perspective of a special-needs teacher, she said.
"I always used whatever materials I have as a way of helping," she said. "As I photographed [my first client], I saw that over a period of time there was some changes in her."
Other people in the world of phototherapy say they came as artists not caretakers but realized the process of their work could be cathartic for the subjects of photographs, too.
Rosy Martin worked as a photographer in the United Kingdom for years and began exploring therapeutic photographs in the 1980s with phototherapy pioneer Jo Spence, a woman who documented her breast cancer through photos.
Eventually, Martin said, she got some training in psychology but still views the process with an artistic eye.
"It's very much giving someone the autonomy to tell their story and it's very much them performing their story," Martin said.
Martin said she screens her clients and meets with them several times before choosing a topic for a phototherapy session, most often a historical re-enactment of a memory in which the client role plays as the important people in that memory.
Martin will later bring back her clients to talk about the various photographs that, she said, helps her clients feel compassion for themselves and the people in their past.
"I think you do, actually, have to know something about photography and its language," Martin said. "And you have to know something about therapy and how to create safety and trust and provide permission and containment."
Indeed, many people in the field of phototherapy worry that, in the wrong hands, a person with identity issues could walk away from from a photo-posing photography session in worse shape than he or she came, regardless of whether the photo shoot was nude.
"I've known people who weren't ready to confront their bodies directly," said Judy Weiser, a licensed psychologist in Vancouver, Canada who does not photograph her clients. "It can be an intense experience.
One patient sought out Weiser after a session with a photographer went wrong. "The patient said, 'I saw myself and I suddenly realized my life was a fraud,'" she said.
Weiser was one of the early pioneers who helped to develop phototherapy as practiced by therapists today. "Therapy practices use people's personal snapshots, family albums and pictures taken by others," she said.
For 30 years, Weiser and a group of other psychologists in North America have explored, studied and refined the use of photography as a medium for therapy. Much of her research and a host of information about the different forms of phototherapy can be found on her Web site.
Weiser said the dawn of the Internet made it possible for therapists to notice other work around the world defined as phototherapy, and she's quick to point out that there's a difference between professional therapy and something that's therapeutic.
"Vitamins are therapeutic and someone can recommend a daily vitamin, but it's different than when a doctor tells you you have some deficiency and you need to take this vitamin," Weiser said.
"Photographers can help people by making pictures where they look good and make them feel better. It's therapeutic," she said.
Weiser said photographs in therapy can be abstract photos proven to elicit different responses from people, or they can be family album photos the therapist asked the client to bring to the session, or it can be photos the therapist asked the client to take as an assignment.
In each case, Weiser said the photos serve as an emotional catalyst in the therapy.
"Some people use words, and some people use words and photographs," she said. "I have found that when I use photos, it goes quicker than when I don't. It makes the therapy deeper and thicker."
Weiser said it would be questionable on ethical grounds for therapists to take studio portraits of their clients and show them publicly, making the practice of phototherapy among photographers who don't have a license to practice psychology even more controversial.
While most therapists may not take studio portraits of their patients, there are a few that do something similar.
Joel Walker, a psychiatrist in Toronto who invented the Walker Visuals that are commonly used in photo therapy, said he has occasionally used photos of a client taken during a session as a means of therapy.
Walker remembered a particular woman who suffered from uncontrolled bipolar disorder for years, but was finally able to confront her problem through photographs.
"I took pictures of her when she was so depressed," he said. "She was lying down, barely able to get up ... I also took a picture of her when she was manic."
Walker said the photos worked because the brain can't tune out an image in the same way it can tune out a conversation or something written. The photos were an undeniable vision of her moods.
"She took the two pictures and put them up on her fridge at home and, two weeks later, she was on medication," Walker said. "It made all the difference in the world, she started taking medication and her life turned around."