Using Therapeutic Cards in (ACT) 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 create a visual image of a train.
The cards can be used to represent thoughts, situations, events, relationships or periods in the clients’ lives.
The outline cards in the deck enable clients to draw their own carriages in case they do not find a card in the deck that fits their needs.
Trains vary in features such as length, composition, shape, colour, speed and strength, all based upon the changing choices of the carriages (cards) composing them.
‘The World of Trains’ set can facilitate processes of ACT in several ways, such as:
The therapist can invite a client to choose carriage-cards which represent unpleasant thoughts that the client is often having. For example, the client can choose a card which depicts a broken carriage in order to represent the recurring thought: "I am not good enough".
Or - a client chooses a card depicting a carriage in a dark wood and says; "This card reminds me of the many times I am worried that something bad is about to happen.”
The client is encouraged to describe the card to the therapist as a way to learn together about the nature of the related thought.
Further techniques can involve inviting the client to observe the card, repeat aloud the thought that it represents and then pay attention to the feelings and the body sensations that this thought/carriage evokes.
Alternatively, the client can be invited to place the card on a blank page, and then draw around the card the feelings, body sensations and associations that it evokes. In this technique, the visual mode of expression comes to support and enrich the verbal one.
Naming the carriage that represents the thought is a recommended technique that, combined with the visual image, can facilitate the identification of future similar thoughts at the moment of their occurrence. For example, a client chooses a card with an image of a tank-carriage to represent the recurrent thought: ‘I am under attack’. S/he names the card and the overall experience - ‘war mode’. The image of the card and the name that the client gave it, will serve as cues to help him/her recognize thoughts related to similar issues in the future.
Each carriage illustrated on the cards has a particular environment. Clients can enrich these metaphorical surroundings by placing pictures cut from magazines next to the card or by drawing around it. These techniques can encourage clients to examine the context of the appearance of the thought; for example the places, events or the people present when the client is having similar thoughts.
Placing consecutive cards along a drawing of trails can help clients examine the situations that trigger these automatic thoughts and the behaviour that follows them.
Giving the consequences a visual representation in the form of cards can reveal the ‘prices’ that the clients are ‘paying’ for their responses.
Pointing out the missing parts in the cards or giving a voice to the silent/silenced images can illuminate domains of avoidance in the client's life.
Many techniques can be based on the way clients describe the specific traits of each carriage they choose to work within the session. The weaknesses and needs as well as the strengths and aspirations that characterize each carriage, together with journeys, stations of destinations and other metaphors from the world of trains set - can all assist clients in their effort to define the values they would like to nurture. Later, it can help recognize actions, goals or directions that clients would like to pursue in the different areas of their own lives.
The process of work in itself supports the development and the practice of metacognition. While examining the carriages in the deck, choosing cards to represent thoughts, working creatively with the images and placing cards one next to the other to build different trains – clients learn to observe their thoughts as outside viewers and can gradually begin to differentiate themselves from the content of these thoughts.
The world of trains set is dynamic in nature. Carriages representing thoughts can be added and removed, they can change shape and content and evoke different feelings and sensations. All these can change with time, as one travels from one station to another during life. This supports the perception of the self as a flexible and contextual concept, increasing the psychological flexibility of the client.
When connecting cards to thoughts, each carriage becomes a visual representation of a specific type of thought, while the moving, dynamic, train can represent the ongoing thoughts and experiences which "travel" through the client's mind.
The client thus becomes gradually aware of the changing flow of thoughts that s/he is experiencing. This contributes to the process of cognitive defusion through which clients learn to see their thoughts as acquired stories rather than as a fixed ‘truth’ that they have been assimilated into.
The deck of story cards can be used separately or in combination with the deck of illustrated cards. The Story cards contain beginnings of stories told by different carriages. Clients can be invited to continue these stories according to the guidance of the therapist.
The world of trains is a rich and professional therapeutic set that can facilitate numerous processes of therapy. Therapists are encouraged to use the cards in a creative way that fits both their professional approach and the needs of their clients.
Hopefully, together they will enjoy meaningful experiences along the trail…
To learn how to use these cards and others, please join one of our workshops
Written by Gali Salpeter - Story & Therapy
Expressive Therapist. Spec. Drama and NarrativeTherapy (M.A.)(NFKUT)(I.C.E.T)