Metaphoric Cards An effective tool in therapy
Dr. Ofra Ayalon & Bibi Siso-Ayalon 2011
Nord Center – the Israeli Center for the promotion of "Metaphoric Cards" in therapy
Therapeutic cards, also called Metaphoric Illustrated Cards, are an exciting addition to the professional tool box for use by individual, family and group therapists, coaches, group facilitators and educational psychologists. Our cards include Image Cards (cards with illustrations) and Verbal Cards (cards with words or phrases). Through the mixing and matching of the cards, and the random or intentional pairing of images with words, countless combinations are created that can bridge between feelings and verbal expression. Combining words and illustrations triggers the projection of internal content on external images, thus freeing the expression of sensitive or painful subjects, which can lead to new insights.
For example, during a group counseling session, a school principal complained about the many difficulties he'd been having in managing his staff, although he claimed to be open, generous and easy-going with them. He randomly drew two cards: a OH word card that read: "power-play" and a TanDoo image card showing a blind- folded man in a group.
To his surprise he realized that the conflicts between his self image and his controlling behavior drove him straight to a dead end. The combination between th word card and the image card shattered his familiar and expected mode of action, and enabled him to redefine the way he perceived his role. As a result of this new insight he was ready to move from his previous controlling approach to a more cooperative one.
Metaphoric cards open a window into a person's inner world; associative reactions to the illustrated cards make it possible to reflect upon childhood memories, to recall repressed experiences, and to release blocked feelings. Since the interpretations of metaphors featured in the cards are completely in the eyes of the beholder, the same card can trigger different reactions in different participants.
For example, a mother and daughter experienced extreme difficulties in communicating, and blamed each other for lack of understanding and caring. In a therapeutic session they were presented with TanDoo cards. Each one of them in turn happened to randomly choose the same card, The mother said to her daughter, "You see how much your parents love and protect you?” The daughter said tearfully: "Can't you see that I am suffocating here?" They were now able to identify the differences between them, which was the first step towards a renewed and healing examination of the ways they perceived their conflicts and their relationship.
Left & Right Brain Research of the complementary functions of both sides of the brain attributes logical, sequential, analytical verbal thinking to the left hemisphere of the brain, and feeling, intuition, imaging and creativity – to the right hemisphere. The left hemisphere uses words to maintain our perception of reality, whereas the right hemisphere is less dependant on reality and more open to change and creativity. Pictures are the language of the right brain. The encounter with an image can in itself awaken any array of feelings and touch an individual's inner truth. The combination of verbal meaning with pictorial metaphors assigning verbal meaning to pictorial metaphors bridges between contradictions and conflicting inner experiences. When logical understanding, will and intention do not seem to help solve conflicts, a fresh point of view can help reach a new constructive solution. The metaphor, as the right hemisphere's language, can shatter vicious circles of negative thought and behavioral and create a beneficial change. The metaphoric language created when working with cards enables people to “jump over” their defense mechanisms, which are based on routine, social conventions, etc. (Ayalon, 1992; 1993). When participants are invited to pick a card and use it to introduce themselves, they are able to "reinvent themselves" using imaging, lines, color or shape. The cards invite them to turn to latent resources of imagination to mobilize visual, sensual and intuitive modes of thinking.
For example, during a group introduction activity, a participant drew a card from a COPE card featuring butterfly coming out of the cocoon. She introduced herself as a caterpillar, gray and sleepy, and completely ignored the beautiful array of colors and shades projected by the card. The perception of her inner reality took over. After a second round, when participants had a chance to choose a card that best represents their desired self, the participant held on to her card and said, surprised: "I can actually see here how the cocoon is turning into a colorful butterfly.” OH Cards, as metaphoric projection tools, trigger our fantasy. Going back in fantasy to free childlike behavior without judgment or criticism becomes a healing experience. Imaginary worlds may be created and our creativity is enhanced. The cards help us create a space in which we allow ourselves to invent, make believe and day dream, while knowing all along that the "fantastic reality" is there to serve our coping skills and not in order to cut us off from reality (Lahad, 2003).
Cards as Therapeutic Catalysts Metaphoric cards are an important part of a therapist's tool box. They help trigger processes of trust, bonding and safe communication between therapist and client, in individual or group processes. When we use OH Cards, the therapeutic contract is based on the mutual understanding that any interpretation of the cards exists only in the eyes of the participants. The therapist's role is to raise questions that clarify certain aspects of a process, such as: "when facing a crisis – What helps you? What disturbs you? Who can help you? Who disturbs you? How would you end your story?" Insightful leading questions play a major role in the process of “Pacing and Leading" (Erickson, 2006). "Pacing" enables the therapist to connect with the client with empathy, respect and acceptance, while "leading" is the act of introducing new ideas or insights that lead the search for alternative ways or solutions to problematic issues. This process evolves within the boundaries of the "safe space" of images and symbols featured in the cards. The metaphoric cards help create a "safe space," in which a client feels free to move about safely from areas of pain to areas of healing in a relatively short period. This space can be a concrete or an imaginary one. It can be located indoors (a castle or a cave) or outdoors (a jungle, forest or sunflower field). Clients may choose to be themselves or play one of many varied role, such as realistic roles, desired roles, imaginary roles, etc. The cards serve as agents of unconscious feelings not only for the client, but for the therapist as well. It may well be that card therapy constitutes a neuro-biologic inter- subjective scenario, in which impressions of and reactions to the cards occur between the client's right hemisphere and the therapist's right hemisphere. The metaphoric illustrated card may serve here as a means of experiential non-verbal bonding and therapeutic intervention. The therapist uses the cards to help clients identify their unique ways of dealing with stress, crises and traumas. The following examples shed light on ways of using the cards to deal with various aspects of loss.
Metaphoric OH Cards Help in Dealing with Loss When grief blocks verbal expression of feelings, metaphoric cards often help release them. The cards enable clients to maintain a certain level of distance between themselves and the painful events and protect them when entering personal pain zones. Following her mother's death Pearl, a 15 years old girl, was referred by her school counselor to a therapy group that dealt with coping with loss. Bibi Siso-Ayalon, an experienced trainer with therapeutic cards, used cards to work through delayed grief in the wake of the death of a parent. After a long silence the girl picked up these cards as a response to the following cues: My mother as I knew her during her illness: Every time I looked at my mother I felt that she scared me. She herself was was scared and I was afraid of her fear ("TanDoo").
Me & my Mother: I did not realize at the time that my mother was so lonely and sad, while I felt lonely and deserted by her. … ("Persona")
My mother as I want to remember her: I wish to remember her as healthy as she used to be, enjoying her life, loving, embracing, and standing beside me, with understanding and support. This is the mother I want to remember and keep inside of me forever. ("Persona "). Choking with tears the girl said: "Mother was sick a long time. She sought contact with me, but I withdrew from her. Now she is gone. I don't know who she really was, and I will never know…"
Pearl told herself a "new story" about her mother. This story contained elements from their mutual past, elements of her imagination, and many wishes that remained unfulfilled. The cards functioned as "transitional objects" (Winnicott, 1971), that helped her shift her attachment from the sick and miserable mother who disappeared from her life to the motherly image that lived inside of her, and enabled her to deal with the inevitable separation. Pearl also expressed the mourning process in the form of a farewell letter, in which she wrote a separate message to each one of the three images featured in the cards she had chosen – the three faces of her existent-yet-missing mother. The reflections she found in the cards enabled her to combine the natural and the imaginative into one whole indivisible picture.
Using Cards to Train Helpers of Tsunami Survivors Six months after the tsunami disaster hit Thailand in 2006, our "emergency team" was called to train local helpers in methods of intervention to help survivors cope with personal and community trauma (Ayalon, 2008). It is very important to realize that the local "helpers" were at the same time both survivors and also support agents (Ayalon, 2003). A great number of the helpers who participated in our training workshops had suffered multiple losses of loved ones, loss of homes and destruction of their communities. Many witnessed the disaster first hand, yet they were ready to step up and help children and families of other victims. Some of the teachers had a close brush with death as the big wave hit and destroyed their school, which was empty on that Sunday. They were distressed by how close they came to dying. One of them said: "I can not stop imagining what would have happened if the tsunami hit on a regular week day when the school was full of children." Another said, "I keep thinking who would I save…. and what would have happened to the other children… These pictures haunt me day and night". Using OH Cards, our participants were able to verbalize the horror, fear and despair, and at the same time they used the cards to describe their various ways of coping with the disaster. We managed to discern several types of coping strategies. Later these helpers would be able to refer to them when working with other survivors, encouraging them to cope with their trauma.
Here are some examples of coping strategies, as reflected by the metaphoric cards: When asked this question: "What helped you most to cope in hours of stress and crisis?" participants chose several cards, and used them to describe their typical ways of coping according to BASIC Ph model: Physical coping strategy: "In the following days I immersed myself in the hard work of clearing the wreckage and getting rid of all the debris. Physical activity seemed to have helped me to absorb my grief and anxiety ("COPE").
Cognitive coping strategy: "I was thirty two years old and a mother of three young children when my husband was killed. I wasn't at all ready for life, I didn't know how to run and manage a family on my own. I had to learn fast to plan and list all my chores and duties every single day. Thinking clearly and planning helped me a lot("COPE").
Affect – Emotional coping strategy: "What helped me most was my immense love for my kids at school. I would have liked to be able to express my feelings simply, like a child, to laugh, to cry, just like them." ("COPE").
Faith as coping strategy: "when the tsunami struck I was in the temple, praying. The wave hit suddenly, flooded the road, and then it passed by the temple without damaging it. Thanks to my prayers I was saved by a miracle." ("COPE").
Social coping strategy: "I volunteered to rescue people help those who got injured. Their suffering is stronger than ours. I felt stronger when I helped them." ("TanDoo")
Coping through imagination: "My imagination saved me from drowning. In my imagination I saw rope in the water. I grabbed it and pulled myself upwards. I was saved, even though there was really no rope in the water." ("COPE").
Summary Metaphoric OH Cards help cope with crisis & trauma:
1. They trigger feelings and identify them, gain insight, and enhance the therapeutic dialogue. 2. They can be used as a projective tool onto which unconscious contents may be projected, so that internal pictures that cannot be put into words may surface and be viewed clearly 3. They are metaphoric triggers, symbolic representations of interpersonal situations and intrapersonal. 4. They serve as a therapeutic bridge between the right hemispheres of the brain of both the care-giver and the care-receiver. 5. They serve as a group bonding tool – through the sharing of stories and the creation of mutual narratives. 6. They serve as a means of relieving stress, strain and nervous tension, by providing a fun game with therapeutic qualities, especially by enabling the "inner child" to step up and express itself. The recurring motif in all the above examples is the belief that we are our own best healers. Working with metaphors and symbolism by means of therapeutic cards is a method which effectively accelerates therapeutic processes.
References Ayalon, O. (2008) Beyond Words – Trauma-Healing Experience & Methods in the Wake of the Tsunami Disaster. Community Stress Prevention 6 pp. 32-40. Ayalon, O. (2003) The HANDS project: Helpers Assisting Natural Disaster Survivors. Community Stress Prevention 5 pp. 127-135. Ayalon, O Ayalon, 0. (1993) Post Traumatic Stress Recovery. In: J. Wilson & B. Raphael. International Handbook of Traumatic Stress Syndromes. New York: plenum Press. pp. 855-866. Ayalon, O. (1992) Rescue – community Oriented Preventive Education. Ellicott City: Chevron publications. Lahad, M. (2003). Creative Supervision. London: JKP. Erickson, M. ( 2006) My Voice Will Go With You – The Teaching Tales of Milton H. Erickson (Sidney Rosen, Editor) Thomas Gale. Winnicott , D.M. (1971) Playing & Reality. Middlesex: Penguin Books.