20 Dreams: A Therapy Tool


To start you off with some ideas Karen has provided some creative ways to use the cards with clients below, however, you may have your own ideas. These cards are designed to encourage creativity, so you can break away from the game and let them be useful in 101 other ways as well.


These exercises will work well 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 and autism.

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

Quiet Desk

Working Online with 20 Dreams

Many of us have been plunged into the online world during this pandemic. There is no digital version of 20 Dreams at this moment, however, if both you and the client have access to a pack then many of these exercises can be done online. There will just need to be more communication about which cards are being used if the camera cannot easily pick up the detail.



As I prepare to welcome back clients into my therapy room I need to make sufficient changes to my practice in order to keep my clients and me as safe as possible.


Cleaning art materials, objects and sand trays between clients will not be possible, so I am planning on providing every client with their own pack of pencils, paper and 20 Dreams cards that only they 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 objects in the sand tray. You will need a tray and each client needs to have 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 then you can also try some of the other experiments below in the therapy room.

Working Face to Face with Clients with Covid 19 Safety Measures 


A Tray of 20 Dreams Cards Instead of a Sand Tray of Objects

You will need a tray that you can easily clean with sanitiser between your clients.  This may be your sand tray without the sand.  


Use the picture cards like objects in a sand tray.  The client sifts through the images and places them on the tray as they like.


Provide blu tack so they can stand the cards up if they wish. (The blu tack can also live in their art pack)


Then just work with the tray and 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 images 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 all of their cards and blu tack back into their client pack.  If not then use gloves to pack away your clients cards into their own client pack, which you can pull out again next time they visit.

Playing a Co-operative 2 Player Game of 20 Dreams

In order to help build the therapeutic alliance and introduce the client to working with images and emotions just play a couple of rounds of 20 Dreams. It will warm up the client's right brain, encourage a co-operative atmosphere in the therapy room and it gives permission for imagination and play in the room as well. 


It may be that introducing something so creative and fun feels inappropriate at the beginning of therapy, however with long term clients doing an exercise like this will help shift them from left to right brain activity. This will be especially good for those clients who think a lot but struggle to articulate their feelings.

Dream Work and 20 Dreams

Of course, 20 Dreams should be a resource for any dream work you might want to do with clients.


The picture cards may or may not be useful depending on the symbols in the dream, however the emotion cards could be helpful in mapping the emotional pathway of the dream.


If your client brings a disturbing dream into the session then Invite them to recall the detail of their dream, then ask them to create a story board of their dream.


One way to do this is to ask them to fold an A4 piece of paper into 8 segments to create segments for a story board.


The client then either chooses an appropriate picture image from the 20 dreams pack or draws in an image themselves in each segment of the paper to tell the dream.


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


You can then spend time exploring the different emotions from the dream. For example, here you were anxious, I wonder if there is anything you are feeling really anxious about at the moment?


In time you might want to explore how the dream could be changed so that your client wakes up feeling a more positive emotion. So if your client wants to wake up feeling calm in the morning, you could explore what could happen in their dream which would help them to feel calm. 


Create a new story board with the new ending, add the emotions again allowing the client to change any and keep the positive emotion at the end. Allow the client to retell their dream and talk about how they feel now about the dream as a whole.

working with the image.jpg

Working with Images using 20 Dreams

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


At the most basic level, the images can be used as a way of getting to know your clients likes and dislikes. Simply ask them to sift through the picture cards and place the ones that they have a positive or negative reaction to into a pile. Ask the client to arrange the chosen images on the table in whatever way they want. Then just 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 card and I wonder what you are feeling?


Notice the pictures they did not choose, the speed by which some got chosen and those images which were more difficult to decide about. These observations will provide you with lots of useful information. From my experience, images chosen early on in therapy turn out to be symbolic for the work as a whole and it is good in the middle or 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 those images may have changed for the client.

working with the image.jpg


Before using the cards in this way both the therapist and the client should have a basic understanding of the polyvagal theory. Check out Stephen Porges work for the theory itself and 

https://www.stephenporges.com and also Deb Dana for some great training in how to work with Polyvagal theory in the therapy setting.


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


For example, using the 60 picture cards, ask the client to look at each card and then to place each card into 1 of 4 piles. If a client is struggling or works slowly then reduce the pack by half, try and get a good variety of different types 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













Start with pile 2 or 3, allow the client to choose (if you have time you may be able to do both).

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


Spend some time allowing the client to explore each image, exploring their associations with each image and being interested and curious, always work from the bottom up, eg from very tired to a little tired. Encourage the images 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 image which makes them feel most tired and withdrawn and then the image which has the least effect, then they can slowly fill out the other images in-between.


If an image feels too triggering to 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 images on pile 1 then be curious about it and wonder with the client what possible images from pile 4 might help them to achieve the beginnings of feeling sociable and comfortable.


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


The benefits of using images rather than language are that some clients will find it easier to identify an emotional state with an image. The language can then come afterwards, you may be able to help clients give their own names to certain states using the images 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."


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


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

20 Dreams and the Polyvagal Theory

mix and match.jpg

Match the Picture Cards
with the Emotions 

This experiment could take the whole session, depending on the client you may want to reduce the number of emotions.


Lay the 20 emotions down on the table for the client to see. Then give them the picture cards.


Encourage the client not to think too much but to instinctively pair an emotion with a picture card. There are no right or wrong answers.


A client may want to put several images next to one emotion or no images next to other emotions.


Enquire as to what the exercise was like for the client, be interested in what they found easy/hard about it.


Ask them which emotion/images they are most interested in (if this is difficult for the client then ask about an emotion/image match which intrigued you).


Work for a while with that emotion/image/ 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 emotions which have no images next to them and be interested in the client's experience of that emotion. Invite the client to draw an image of an experience, which would go well with that emotion.


Working somatically is becoming more and more popular for 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. This example can be adjusted for different clients.


Invite the client to divide the emotions cards into two piles - familiar and unfamiliar.


Exploring the familiar


Allow the client to choose an emotion 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 movement/ 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.


Then relax and dialogue together about the experiment, what was it like for the client to see you in their position? What feelings were experienced by both of you?

Exploring the unfamiliar


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


If the client doesn’t feel able to take the lead then you take the lead and make a movement which expresses that emotion. Invite the client to be inquisitive about this and then invite the client to try the new movement/position once they are sure about what you have shown them.


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/position 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 enough and ok as you do these exercises.


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

Working with the Body
and 20 Dreams


Using 20 Dreams in Group work

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


A small group of 6 or less could play the game as it stands. You may either help facilitate or play as well depending on the needs of the group. Allow conversations about the dreams or emotions to naturally happen, it doesn’t matter if the game is not finished but playing the game may well stimulate conversations about experiences, dreams and feelings to create excellent material for the group to explore together. 


Encourage enquiry and interest in different stories and responses.


Developing Self Awareness with 20 Dreams 


This exercise is a good warm-up for new groups or can be used 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 insists they want to change their card then let them.


Each member describes in detail what they have on their card, keep it factual, eg a red rose with a blue background.


Allow a couple of minutes for each member to examine their image 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 image because...I don’t like this image because...


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


Finally, invite the members to think about what their image 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 more about other members images. 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 image 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 in here?


Or I wonder how it makes you feel looking at that stem which is the wrong colour?



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. Make sure everyone has been seen and heard 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.

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