top of page

20 Dreams: A Therapy Tool

The 20 Dreams cards are a valuable resource for creative work or interventions within the therapeutic space.

Karen designed the activities below to work in the therapy room with adults, children and young people although some may need to be adapted for the younger client or those with dementia, learning disabilities or autism.

A Therapy session
Image by Maxime

Working Online with 20 Dreams

We do not have a digital version of 20 Dreams as yet, however, if you and the client have 20 Dreams then many of these exercises can be done online. 

Working Face to Face with Clients with Covid 19 Safety Measures 

As I welcome clients back into my therapy room there are a number of changes I need to make to keep everyone safe.


Cleaning art materials, objects and sand trays between clients will not be possible, so I will provide my clients with their own pack of pencils, paper and 20 Dreams cards that only they can touch. But what about my beloved sand tray? How can I do work with the sand tray and still keep my clients safe?


Below is an example of how 20 Dreams can be used instead of sand tray objects. You will need a tray and each client needs their own pack of 20 Dreams, so perhaps try working with the clients you know really value working with the sand tray first.


If you do invest in a few packs of 20 Dreams then you can also try some of the other activities below in the therapy room.

Learn More

A Tray of 20 Dreams Cards 

You will need a tray that is easily cleaned with sanitiser between clients.


Use the 20 Dreams cards like objects in a sand tray. The client chooses images and places them on the tray.


Provide blu tack, as part of the client's art pack to stand the picture or emotion cards up if they wish.


Then work with picture and emotion cards as you would with objects in a sand tray.


At the end of the session, invite the client to take a photo of their tray of picture and emotion cards in case they want to recreate it or refer to it again. 


If your client is happy to do so, then ask them to pack the 20 Dreams cards and blu tack into their client pack.  If not use gloves to pack into their client pack.

Play a co-operative 2 Player Game of 20 Dreams

Play a couple of rounds of 20 Dreams to build the therapeutic alliance and introduce the client to working with the picture and emotion cards. It will warm up the client's right brain, encourage a co-operative atmosphere in the therapy room and give permission for imagination and play in the therapy room. 

It may feel inappropriate to introduce a creative and fun game at the beginning of therapy however, with long term clients an exercise like this will help them shift from left to right brain activity. This is particularly good for clients who think a lot but struggle to articulate their feelings.

Image by Jason Blackeye

Dream Work with 20 Dreams Cards

20 Dreams is a useful resource for dreamwork with clients by using picture cards as symbols in the dream and emotion cards to map the emotional pathway of the dream.


If your client brings a disturbing dream into the session invite them to recall the detail of their dream and ask them to create a storyboard of their dream.


One way to do this is to ask them to fold an A4 piece of paper into 8 segments to create storyboard segments. The client then either chooses an appropriate picture card from the 20 dreams pack or draws an image themselves in each segment to tell the dream.


Invite the client to place an emotion card next to each of the 8 segments of the dream and one final emotion card at the end to reflect how they were feeling when they woke up.

Spend time exploring the different emotions in the dream. For example, you were anxious here in your dream, I wonder if there is anything you are feeling really anxious about?


In time you may want to explore how the dream can change so that your client wakes up feeling a more positive emotion. So if your client wants to wake up feeling calm, then you can explore what could happen in their dream to help them feel calm. 


Create a storyboard with the new ending, add the emotion cards again allowing the client to change any and keep the positive emotion card at the end. Allow the client to retell their dream and talk about how they now feel about the dream.

working with the image.jpg

Working with Images using 20 Dreams

If you are not used to working with images or art in the therapy room then a pack of 20 Dreams is a great place to start.


At the most basic level, the images can be used to get to know your clients likes and dislikes. Simply ask the client to place the picture cards they have a positive or negative reaction to into a pile and arrange them in whatever way they want. Then invite the client to talk about their process of choosing, adding some of your own observations as well. For example, I notice you were not sure about choosing that picture card and I wonder what you are feeling?


Notice the picture cards they did not choose, the speed by which some got chosen and the picture cards they struggled with. From my experience, images chosen early on in therapy turn out to be symbolic for the work as a whole and it is good towards the end of therapy to look back on some of those early images chosen and reflect on the themes of the work and how some of those initial responses to the images may have changed for the client.

working with the image.jpg

20 Dreams and Polyvagal Theory

Both the therapist and the client should have a basic understanding of polyvagal theory before using 20 Dreams in this way. Check out Stephen Porges work at and also Deb Dana for some great training on how to work with Polyvagal theory in the therapy room.


You can use both the picture and emotion cards in 20 Dreams to help a client build a map of their nervous system’s response to stress. The benefit of using picture cards instead of words is that it helps the client use their right brain and is great for those who struggle with literacy and writing.


For example, using the 60 picture cards, ask the client to look at each picture card and then place each card into 1 of 4 piles. If a client is struggling then reduce the picture cards by half, try and get a good variety of images for them to choose from.


  1. Feeling sociable and comfortable - Ventral Vagal

  2. Feeling tense and anxious - Sympathetic

  3. Feeling tired and withdrawn - Dorsal Vagal

  4. No affect

Polyvegal Theory with 20 Dreams

Start with pile 2 or 3, allow the client to choose.

Ask the client to place the picture cards in their chosen pile into a range for example from very tired and withdrawn to a little tired and withdrawn.


Spend time allowing the client to explore each image, exploring their associations with each picture card and being interested and curious, always work from the bottom up, eg from very tired to a little tired. Encourage the picture cards to take on a metaphorical nature, such as "the runner makes me feel stressed because it reminds me of sports day."

To help you can ask the client to find the picture card which makes them feel most tired and withdrawn and then the picture card which has the least effect, then they can slowly fill out the other images in-between.

Image of a man running
Image by Nik Shuliahin

If an image feels too triggering for the client then just acknowledge what it holds for them, ensure they are breathing (7 breaths In, 11 breaths out) and ask them to move onto an image higher on the scale. You could even create a fifth pile of unbearable images and place them face down.


To finish the session do the same exercise with pile 1. If there are no picture cards on pile 1 then be curious and wonder with the client what possible picture cards from pile 4 might help them achieve the beginnings of feeling sociable and comfortable.


In the following session you may want to ask the client if any picture cards have stayed with them, or indeed revisit and continue the exploration of their different states over several sessions.

The benefits of using picture cards. rather than language are that some clients find it easier to identify an emotional state with an image. Language can then come afterwards, you may be able to help clients give their own names to certain states using the picture cards which is a shared language between the therapist and the client.


For example, "I feel like the crawling man today" or "a part of me went up in a hot air balloon when you said that."

Image of a hot air balloon

The emotion cards can help clients identify which emotional state belongs to which part of their nervous system. It is a useful tool to educate and raise self-awareness of the feelings that may be very dominant and those feelings which seem less accessible and where the client is on the Polyvagal scale.


Create a ladder of emotion cards starting with Dorsal at the bottom and ending with Ventral Vegal at the top

Polyvegal theory and a ladder of emotions
mix and match.jpg

Match the Picture Cards
with the Emotions 

Layout the 20 emotion cards then give the client the picture cards.


Encourage the client to instinctively pair an emotion card with a picture card. There are no right or wrong answers. A client may want to put several picture cards next to one emotion card or no picture cards next to other emotion cards.


Enquire as to what the exercise was like for the client and be interested in what they found easy or hard.


Ask the client which pair of picture and emotion cards they are most interested in. If this is difficult ask them about a pair of picture and emotion cards that intrigued you.

Work for a while with that picture and emotion card using I wonder language. For example, I wonder why you matched this picture with that emotion? I wonder what part of the picture reminds you most of that emotion. I wonder what it reminds you of in your own life?

Notice any emotion cards which have no picture cards next to them and be interested in the client's experience of that emotion. Invite the client to draw a picture of an experience, which would go well with that emotion card.

Working with the Body
and 20 Dreams

Working somatically is becoming popular with therapists as we become more aware of how important the body is in therapeutic work.


20 Dreams cards provide a helpful way to work with the body. Invite the client to divide the emotions cards into two piles - familiar and unfamiliar.


Exploring the Familiar


Allow the client to choose an emotion card they want to show you.


Invite the client to make a movement or get themselves into the position which physically represents that emotion for them.


Be curious and ask questions about their position, eg. I can’t see your hands at the moment, what are they doing? What does it feel like inside your rib cage?


The idea is that you find out as much as you can about this position, then the client relaxes and you take on that position. The client then directs you if you have not quite got the position right. In your position tell the client what you are experiencing, check that this is accurate and is similar to the client's experience.


Relax and dialogue together about the experiment, what was it like for the client to see you in their position? What feelings did you both experience?

Exploring the Unfamiliar


Then invite the client to choose an emotion card from the unfamiliar pile, perhaps one which might be paired as an opposite to the familiar emotion card explored.


If the client doesn’t feel able take the lead and make a movement that expresses that emotion card. Invite the client to be inquisitive about this and then invite the client to try your new movement.

If the movement you have made feels too much or big for the client, reduce it until the client feels happy to copy. Keep checking in with them.


Once the client feels familiar enough with the movement try one last experiment. Together at the same time move from the first 'familiar' emotion position to the second 'unfamiliar' emotion position and keep moving back and forth slowly between the two.


Don’t forget to check in with breathing and ensure your client is feeling safe and ok as you do these exercises.


Leave enough time at the end of the session to reflect on the experience.

Image of Group Therapy

Using 20 Dreams in Group work

As a group facilitator, you may want to use the 20 Dreams cards in several ways. 


Play 20 Dreams with a small group of 6 or less, you may either facilitate or play depending on the group's needs. Playing 20 Dreams may naturally stimulate conversations about experiences, dreams and feelings and create excellent material for the group to explore together. 

Encourage enquiry and interest in different stories and responses.


Image of a red rose

Developing Self Awareness with 20 Dreams 

This exercise is a good warm-up for new groups or to encourage fresh stimulation following a change or disruption.

Randomly hand out one picture card to each participant, ask them to look at the card and become aware of their initial reaction. If a member wants to change their card let them. Each member describes the picture card in detail, eg a red rose with a blue background.


Allow a couple of minutes for each member to examine their picture card and then go round the group again and invite them to say something they like about the image and something they don’t like.

I like this picture card because...I don’t like this picture card because...

For example, I like this picture card because it reminds me of my mother who likes roses and I don’t like this picture card because the stem is the wrong colour

Finally, invite the members to think about what their picture card might say to the whole group. For example, the rose is saying “I wish I was outside in the open air.”

Spend some time reflecting on the exercise and allow members to be curious and enquire about other members picture cards. Encourage and model an empathic response to the rose, eg “ahh such a beautiful rose, it feels like it should be out in the open air rather than in this room with all these people?”


For the more established group, you can help them wonder whether the picture card represents a part of themselves. For example, I wonder if a part of you feels a bit like the rose and wishes you were outside in the open air rather than here? Or I wonder how it makes you feel looking at that stem which is the wrong colour?

 Emotion Cards

Checking In and Checking Out with 20 Dreams

Invite each member to choose an emotion when they come into the room.


To begin the session ask each member to show the emotion and say why they chose it before the group process begins.


At the end of the session invite each member of the group to revisit and change their emotion if they would like.


To end the session invite each member to explain why they have kept or changed their emotion. 


This could be something you build into as a regular feature. If members want to add a new emotion to the selection then allow the group to create their own bespoke set of emotions.

bottom of page