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Using Therapeutic 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.

In the following example, the client is invited to choose three cards as follows: 

1st card - A card that depicts the state* of the client before s/he experiences anxiety

2nd card - A card that depicts the state of the client during the anxiety-evoking event 

3rd card - A card that depicts the state of the client after the anxiety-evoking event ends

*The ( state) situation can include the physical aspects (i.e. the way the client experiences his/her body sensations, sensory input, etc.), the emotional aspect (i.e. the range of feelings evoked), the thoughts that arise or any other aspect that characterises the client's experience before, following and after the event. 

The client puts the three cards in a row, one next to the other, to create a card-continuum (see photo).

During the second stage, the client describes the card-continuum. The therapist seeks to understand the idiosyncratic way in which the anxiety-evoking-event is experienced by the client. The therapist encourages the client to enrich the description and asks questions that help the client examine the (varied) different aspects and components of each stage. Alternatively, the therapist can lead the client to delve into the processing of one specific aspect of the experience (for example: focusing on the thoughts that the client is having during each stage or focusing on his/her physical sensations). 

During the third stage, the therapist invites the client to build another card-continuum. This continuum should represent the way in which the client would like to "be" with regard to the anxiety following the treatment. The client is invited to imagine how s/he wishes to feel before a similar event in the future, during that event and after it.

In the fourth stage, the client observes the two continuums together with the therapist. The therapist helps the client identify the factors that can support his/her efforts to manage the anxiety-evoking event in a more (adaptive) helpful way. These factors can either be within the client (e.g. related memories, actions, traits, etc) or in his/her surroundings (e.g. people that the client has contact with or places s/he tends to be in at the time of the event, etc.)

Plenty of other therapeutic interventions can take place based on these two continuums. This suggestion for using the cards can serve as an accompanying technique in the process of establishing a therapeutic contract as well as being useful when framing the expectations of the client from the therapy.

Additional suggestions for using the cards when treating anxiety or when dealing with other issues in therapy can be found in "The River" guidebook or "The world of Trains" guidebook.

To learn how to use these cards and others, please join one of our online workshops 



Written by Gali Salpeter - Story & Therapy

Expressive Therapist. Spec. Drama and NarrativeTherapy (M.A.)(NFKUT)(I.C.E.T)

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