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Picture Cards for
Non-Verbal Activities
in Child Therapy

Clients can sometimes find it difficult to express themselves verbally. Sometimes, this difficulty is the reason the child was referred to therapy in the first place. In other cases it is a temporary situation or period during which the child finds it difficult to talk about specific issues, to describe their feelings and thoughts or to answer the therapist’s questions.
Whatever the cause or the nature of the limit to verbal expression, it is often useful to offer the child a non-verbal mode of expression instead...


Working on a Specific Relationship in Individual Therapy

The following can be a helpful intervention when a client in individual therapy brings up difficulties s/he is facing in a relationship. It can be at work - between the client and a colleague/employer/employee, it can be social, or a relationship with a family member.

  1. After the client’s description of the situation,  the therapist invites him/her to choose a card that represents how it feels to be a part of that relationship.


Illuminating Stories in the Client's Family Gallery

The purpose of this activity is to help adult clients explore challenges related to their family.
In the first stage the therapist invites the client to build a metaphorical photo gallery of around 5 photos depicting their family. 
The client can choose cards to represent typical daily scenes, meaningful memories, specific relationships and/or important family events...

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End-of-the-Year Activity Using the River Metaphor

In the first stage, the therapist suggests: “Choose a river card that can represent this period, when one year is about to end and a new one to begin”. The client puts the card on a blank paper.
In the second stage, the therapist says: “Observe this river. Note what it looks like and what state it is in during this point in time. Now write the thoughts, feelings and body sensations that this river evokes in you..."

IMG-Using Projective Cards in Therapy with Adolescents - In Relation to Clients’ Interests

Using Projective Cards with Adolescents; Music, Movies, Books...

Following are three suggestions for using projective cards with adolescents in a setting of individual  therapy.
In these activities, the illustrated cards serve as conversation prompts based on the fields of interest of each client. Being curious about clients’ hobbies, daily experiences or interests offers them an approachable way of sharing their world with the therapist.

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The Rabbit Knows

An imaginary session with an adolescent, 
Including a Step by Step Overview of the Therapeutic Considerations behind the application of the Projective Cards during the session.
                                    * * * * * * *
“I don׳t know” her slouched shoulders answer me.

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A Blanket

My young client enters the therapy room. In the last couple of sessions, he would almost run in from the waiting room, but today he enters slowly and freezes in his place as I close the door behind him.
“I am happy to see you Jack,” I smile towards him, putting a hand on his shoulder. I really am.
His head bent, he whispers, “Hi.” Or maybe it is a sigh, I am not sure...

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Group Therapy Activities with Projective Cards

“The River” and “Roads” decks of cards are useful projective tools that can facilitate therapeutic processes in individual and group sessions. The cards can serve as prompts for group discussions and for group activities including role-playing, storytelling, creative art and more. Following are easy to follow suggestions for using “The River” or “Roads” cards in therapeutic groups of adolescents and adults...

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"Yes"​, "No"​, and "I Don’t know"​ - Helping Clients to Express Themselves

“Why do they keep coming if all they say is ‘Yes’ or ‘No’ as answers to my questions?”
“How am I expected to get to know them when I hear        ‘I don´t know’ over and over again?”
“Will I be able to find more topics to raise before I start shrugging my shoulders in indifference as they do?”
Therapists may sometimes experience this kind of frustration and ask themselves similar questions...

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Supporting Self-Esteem (Activity 3/3)
- Coping Skills

This is the third suggestion for using “Roads" and "The River” decks of projective cards to help adolescents and adults work in therapy with issues related to self-esteem.
These issues are manifested in a range of ways that may challenge clients in various areas of their life.
Projective Tools can serve as valuable therapeutic means for helping clients to foster positive self-esteem. Working with visual metaphors in therapy can facilitate a process of clients gaining new positive perspectives...


Supporting Self-Esteem (2/3) Connecting with Strengths

This is the second of three suggestions for using “Roads" and "The River” decks of projective cards to help adolescents and adults work in therapy with issues related to self-esteem.
Issues related to self-esteem are manifested in a range of ways that may challenge clients in various areas of their life.
Projective Tools can serve as valuable therapeutic means for helping clients to foster positive self-esteem...

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Supporting Self-Esteem (1/3) Metaphorical 
Anchors of Confidence

First of 3 suggestions for using “The River” and “Roads” decks of projective cards to help adolescents and adults work in therapy with issues related to self-esteem.
Issues related to self-esteem are manifested in a range of ways that may challenge clients in various areas of their life.
Projective Tools can serve as valuable therapeutic means for helping clients to foster positive self-esteem...


A Carriage Viewed from Outside and from Inside

An Example of Using Story Cards in Settings of Individual Therapy or Group Therapy.
There are various ways of using Story Cards in therapy. As in any other intervention, the therapist decides to use a specific therapeutic activity with the cards based upon the clients’ needs and abilities as well as the therapeutic goals.
Here is an example of using our Story Cards...

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Using “The River” when Working with the Issue of Relationships

“The River” Set is a useful tool for settings of Family therapy, Group therapy and Individual therapy. The cards offer an additional mode of expression and a way to process of issues. Cards can serve as prompts for discussion or activities involving art techniques, role-play, storytelling and other methods. Following is an example for using “The River” Set when working with relationships in settings of Group therapy or Family therapy...


Expressive Therapy in Groups of Children Dealing with Grief

When working with a group of children who are dealing with grief, the therapist can invite each child to choose a card of a train carriage that s/he would like to work with.
Each child can then present the card to the group and put it on the floor next to a card chosen by another child so that a train is formed. This ‘group train’ actually includes all the members’ carriages and it can...

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Stations in the Life of the Client

The image of train stations, can be used metaphorically when working with issues relating to places or social settings of the client’s life. Following is an example using ‘The World of Trains’ Set.
"The World of Trains" Set is a therapeutic tool including a deck of 50 Illustrated Cards and a deck of 50 Story Cards within an imaginary World of Trains....

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Facilitating Children’s Online Group Therapy with Cards

During this period we are facing new challenges as mental health professionals. Conducting online therapy with individuals and groups requires us to adjust our techniques in creative ways.
Following are suggestions for using cards to facilitate online group therapy with children...
(The examples use ‘The World of Trains’ Set)

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Ideas for Online Group Therapy with Adults & Adolescents

This post includes 3 suggestions for facilitating Online Group Therapy sessions with Adolescents or Adults, using "Roads"​ & "The River"​ cards.
Suggestion 1: 
The therapist chooses a Road card in advance and shows it to the group, asking: "If this card were to represent the current period in our group's journey, how would you describe it?"...

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"The World of Trains"​ Set used for Behavioral and Social issues

A shortened example of intervention using "The World of Trains"​ set to facilitate therapeutic work with behavioral and social issues;
A young child was referred due to his aggressive behavior at school. During the session he shares an experience of social difficulty.
1 - The therapist suggests: "Choose cards and build a train that could suit your classmates, if they were...


Using Projective Cards in Online Sessions
with Adults

Projective cards can be useful therapeutic tools in this period of uncertainty. The cards were designed to help clients share the issues that they are struggling with and process them.
During the therapeutic process the client and the therapist can both work metaphorically with the images and relate to issues in the client’s life that these images evoke...


Jogging Shoes:
Using Cards
in Difficult Times

These are heavy times for me now,” my client, a woman in her 60s, starts the session. “Hearing constant news about this horrible virus and staying indoors and all…”  She stops and sighs.
This truly is a challenging period. Could you try telling me more about how you experience it?
She sighs again, mumbling to herself, “I am not sure I can put it in words…


Using Projective Cards in Online Therapy
with Children

This can be the perfect time to enrich your online sessions with new professional tools. Projective cards enable clients to process the issues bothering them in a ‘safe’ metaphorical space of images and stories.
Working with projective cards can lead to a wide range of creative activities such as storytelling, drawing and role playing, alongside techniques from fields such as play therapy, psychodrama, art therapy, and drama therapy...

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Images and stories
as projective tools
in child therapy

In the following example, the therapist invites a child (client) to tell a story using illustrated cards. The child chooses four cards depicting train-carriages. She lays the cards one next to another, to create an image of a train.
The child says: “… This train looks strong. It drives fast… very fast… I don´t know where it is going and when will it stop…”
Therapist:Which carriage is leading the train so fast?

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Using an image of
“A River” when working with projective cards

Projective cards are a therapeutic tool. Among their other attributes, they add a visual and metaphorical layer to the verbal dialogue.
However, it is important to understand that using colorful illustrations in therapeutic settings is not aimed at “decorating” or ”beautifying” painful or difficult emotional contents. Visual images are not meant to “paint over” the parts of a client´s experiences...


Therapeutic value of projective cards

Projective cards hold a therapeutic value since they add a mode of communication to the therapeutic session.
The illustrations on the cards are visual stimuli which can be used, observed and processed in therapy.
Cards add a visual mode of addressing issues that have been raised verbally. This gives both the therapist and the client a possibility to explore new aspects related to the issues discussed. In turn, it will...

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Using metaphorical cards in Acceptance Commitment Therapy

The metaphor of 'Trains' in mindfulness and related techniques.
"The world of trains" is a therapeutic tool including a deck of metaphorical cards, a deck of story cards and a professional guidebook with suggestions for using the cards in therapy.
Each metaphorical card has an illustration of a particular carriage. Placing the cards one next to the other, will...

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Using projective cards when working with Anxiety

When a client shares an issue of anxiety, the therapist can invite him/her to use cards in order to observe and examine the issue together.
Working with images offers an additional mode of processing for the client and therapist to use in the session. This visual mode supports the verbal mode of dealing with the issue and moreover - it expands it by stimulating other aspects of the experienced anxiety.

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Projective cards for Therapeutic work with Children

An example using "The World of Trains" set of Illustrated cards and Story cards.
Children clients can find it difficult to describe the issues they are dealing with to their therapist. Using projective cards is a way to help children share their feelings and then examine them in a safe, metaphorical context.
This context also encourages children to use their creativity and enables them to be...


Exam Anxiety (#1):
Utilizing Cards with CBT

The following is a suggestion for the application of "The River" Set or the "Roads" Deck when working with adolescent or adult clients experiencing anxiety related to tests.
The client is invited to choose four cards and to place them alongside each other so that they form a continuum (see photo). Each of the four cards represents a different stage of the client's anxiety:...


Exam Anxiety (#2):
Applying Projective-Cards with CBT

The following is a suggestion for using "The World of Trains" set when working with children clients experiencing anxiety related to tests:
A therapist can invite a child who is experiencing test anxiety and let him/her listen to the following story:
"A train is to carry a very fragile and heavy load to a distant station in the world of trains. This is a very challenging journey..."

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Childhood...    is depicted by an endless flow of scenes. It is hidden and discovered through its stories; both the stories we are told and those which we tell ourselves about it along the years.
The therapist may suggest: "Choose a card that holds an image of one moment from your childhood".
´I am here´ the therapist whispers deep inside,
´I am listening. I am watching your lips and your eyes...


Using the Image of
a Bridge
in Therapy

Decks of projective cards offer clients and their therapists a metaphorical medium of communication and of therapeutic work. This metaphorical space is enriched and deepened as the therapeutic process progresses and as additional images (and connections between images) are shared in the sessions.
The image of a bridge enhances the therapeutic and creative work...


Using projective cards in settings of couple or family therapy

The two of us are together in this journey...
What colours do we see in our joint past?
  What does our present time feel like?
    How do we imagine our common future?
Partners in couple therapy are invited to use cards to describe the course of their life together. Each card they choose represents a certain period, an event or a place that for both are meaningful milestones...

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Using projective cards in Group therapy

Therapists leading a group therapy session can invite clients to build a continuum of cards. Each client chooses a card that represents his/her feelings around a question the therapist raises and places the card next to another group member's card.
The common continuum of cards allows the members of the group to share the issues they are coping with....



The blank pages lying ahead may sometimes not be as empty as they seem. Words stemming from previous chapters hang on to these pages, filling them with a guiding purpose or a deeper meaning. It is important to keep these words in mind and in heart.
Yet, sometimes, the memories of steps long taken, leave just a limited place for new images to arise.
Opening our eyes can help us find the balance....

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Examine issues with
an expanded scope of observation

A therapist can guide a client to a process of shifting the focus from a story the client is telling about a card to an enriched story revolving around that card in the context of its environment.
This process is carried out by placing a card on a piece of paper and inviting the client to expand its painted surroundings so that the card becomes a part of a bigger picture....

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