The Therapy Beat

Therapy Card Decks

A Session in the Palm of Your Hand?

Magazine Issue
July/August 2022
Therapy Card Decks

Last month, driving down the highway somewhere between Washington, DC, and New Jersey, my wife and I found ourselves staring straight ahead in silence after officially running out of road trip games. Taking a chance, I pulled out my phone and clicked on an app innocently titled Card Decks, a tiny pink box with two hearts nuzzling each other.

A dizzying array of colorful boxes filled the screen. One titled Love Maps. Another titled Open-Ended Questions. A third, Expressing Needs. And there are several others, including a trio of boxes filled with little chili peppers labeled “Salsa”—Mild, Medium, and Hot.

We decided to begin with Open-Ended Questions. “Be a ‘dream detective,’” the app instructed. “Alternate roles as speaker and listener.” We added a fun twist: we’d answer the questions on each other’s behalf, then the listener would appraise the response.

I read the first question aloud: “What do you want your life to be like in, say, three years from now?”

I took a moment to think. “You’d like to be settled in your job,” I told my wife, who happens to be a postdoctoral psychology fellow. “Finally making a real salary instead of the pennies they pay therapists-in-training.”

She smiled.

“And you’d like to be traveling more,” I continued. “At least once a year. We’ll probably be looking at houses by then, and maybe thinking about kids.”

“That’s fair,” she responded.

“Next question: How do you feel about our physical home? Any architectural changes you’d like to make?”

Oh boy. Five years ago, she’d moved into my apartment, fully furnished with items I’d bought long before she came along, with the not-so-discerning eye of a poor, recent college graduate (thank you, IKEA). I’ve never heard the end of it.

“Everything?” I laughed. “You can’t wait to get rid of the couch. And the dining room table. And the leather dining chairs. And on the new couch, you’ll have 200 throw pillows—none of which people are actually allowed to sit on!”

She laughed. I did too. Not a bad way to spend a road trip, I thought. Granted, this wasn’t necessarily new conversational territory, but whether or not we recognized it at the time, we were validating each other’s likes and dislikes and thinking more about the future. Our future, together.

For renowned couples therapist Julie Gottman, who created Card Decks with her husband, John, that’s the whole point. Twenty years ago, they sat down in their favorite local bagelry and began to brainstorm the decks that would eventually be featured in the app, drawing from over a decade of research on thousands of couples who’d participated in their famous “Love Lab” experiments at the University of Washington.

Back then, these were physical decks—and “just an experiment,” Julie says. “John and I were doing couples workshops and needed a way to translate our interventions into ways that couples could take them home, without their therapist going home with them.”

Their early decks, she says, “were just giving partners a springboard to explain what they needed from one another.” Decks that followed had different agendas, like helping couples get to the root of what Gottman calls “that vague feeling of discontent that couples sometimes have trouble articulating.” One of their most popular decks, Rituals of Connection, helps them find the language.

Some cards ask big questions, like how you and your partner celebrate holidays and birthdays and decide on vacations. Then there are cards with smaller but no less important questions, like how you have stress-reducing conversations or say good morning and good night—“in a way that has more meaning than just a peck on the cheek,” Gottman says. “Those rituals can be hard to think of. We want to maximize people’s ability to communicate creatively about change in the relationship.”

With 14 decks in total, Card Decks runs the gamut. The Salsa decks, as one might expect, are for couples looking to improve their sex lives. “Many couples aren’t in a place to have sex,” she explains. “Maybe they’ve had a negative sexual experience and they’re tentative about stepping into the bedroom. The Mild deck helps them just focus on having more touch in their lives and conveying physical admiration for each other.” The Hot deck, she says, takes things up a couple notches, suggesting new sexual positions and experimentation like role-playing.

“Mind you,” Gottman adds with a laugh, “John and I were over 60 when we created those decks, so what’s hot for us may be warm for the younger generation.”

Pick a Card, Any Card

Of course, the Gottmans aren’t the only therapists with card decks on the market. There are hundreds—if not thousands—of therapy card decks to choose from, varying in clinical focus and utility. There are decks for anxiety, depression, trauma, panic, anger, and more. Some are instructional, designed to be used in therapy. Some are games, with only a light clinical touch, intended to be played with friends and family. Others fall somewhere in between.

As any play therapist can attest, therapy cards aren’t new. Online play therapy stores are and have long been littered with card games, most geared toward children. But over the last several years, the volume of decks has exploded.

One contributing factor: the pandemic. At its height, game sales boomed as households in lockdown looked for family-friendly digital detoxes. But two years later, the trend shows no signs of slowing down. According to a report from market research firm Grand View Research, the global card game industry is expected to grow annually by nine percent between now and 2025, eventually reaching a value of 7.2 billion dollars. “Manufacturers are focusing on producing simple games with elegant mechanics and impressive artwork to attract more consumers,” the report notes. “The global market is highly competitive.”

Therapy card decks may occupy a smaller share of that market, but as the saying goes, a rising tide lifts all boats. A simple search for “therapy card games” on Amazon generates more than a thousand results, including many games for adults.

Therapy buzzwords abound. There’s Shined Mind: A Card Game for Cultivating Mindful Choices, Coping Skills, and Calm. Another one, called Our Moments, offers 100 “thought-provoking conversation starters for great parent–child relationship building.” There’s even one by the name of Let’s Get Real Bro, a card game “for guys to connect, dig deep, and get real,” which claims one dollar from every purchase is donated to a men’s mental health organization. Unlike the Gottmans’ decks, the vast majority of these aren’t endorsed by therapists, and many give no indication that they’re informed by tested clinical concepts.

Some card decks, like couples therapist Esther Perel’s newly released Where Should We Begin: A Game of Stories, based on her podcast of the same name, are intended to entertain first and foremost. Featuring a stylish, royal blue container designed to look like a box of high-end Belgian chocolates, it’s filled with more than 250 conversational prompts, including “A rule I secretly love to break . . .” and “A dream I’ve never shared . . .” The deck, according to Perel’s site, is designed for “your next date, dinner, or intimate get-together,” rather than having any therapeutic agenda.

But that doesn’t mean the game doesn’t draw from insight Perel has gleaned as a therapist with a keen eye for relationship dynamics. “The pandemic left us missing intimacy and play,” she writes on the game’s sales page. “So I created a game that helped us do both. The game is designed to help us connect and reconnect in a time of social atrophy.”

Of course, the Gottmans and Perel are media juggernauts, backed by savvy marketing teams. There’s an allure to being privy to knowledge that pulls from decades of exclusive scientific research, or, as in Perel’s case, is based on conversations she’s had at dinner parties, in her office, and with her closest friends, family, and colleagues. “Bring Esther into Your Home,” the page beckons.

But if you haven’t achieved a Gottmanian or Perelian level of fame, how do you go about creating a therapy card deck, one that stands above the others? Are card decks a clinical tool, a branding exercise, or something else? And are the more clinically oriented ones filling a need that therapy alone cannot?

Playing Your Cards Right

For therapist Seth Gillihan, creating a card deck felt like a natural extension of the work he’d long been doing with clients. He’s been in private practice since 2012, and says that as a CBT practitioner, he’s often had to rework complex material into simple concepts that clients can understand. That translates well to the world of therapy cards. A good deck, Gillihan says, is quickly and easily grasped. “You can pick it up and use it right away,” he explains. “You don’t have to think about CBT or mindfulness—just a simple practice you can work on today.”

That thinking inspired Gillihan’s first therapy card deck, The CBT Deck for Clients and Therapists, which debuted in 2019. His second, The CBT Deck for Anxiety, Rumination, and Worry, came out the following year. Featuring more than 100 easy-to-learn CBT practices, Gillihan says the decks are more instructional than game-like, with three color-coded card categories. Think, in turquoise, denotes cognitive strategies; Act, in navy, is behavioral techniques; and Be, in yellow, is mindfulness practices.

One of the Think cards is titled “The Worry Station.”

Stop worry from spreading through your life by scheduling daily worry time in the early evening, it reads. Choose a place at home to do all your worrying, and create a “Things to Worry About Later” journal. Whenever you find yourself worrying during the day, briefly write your worries in your journal and set them aside for later. At the designated worry time, review your list, and worry as much as you want for 15 minutes.

In the service of keeping the deck simple and easy to understand, Gillihan limited the instructions on each card to no more than 75 words, which he says clients can easily digest on their own, without a therapist’s assistance. “If your client is overwhelmed with anxiety or depression, just asking them to read a chapter of a book can be a tall order,” he explains. Plus, he adds, “we therapists tend to complicate things with our psychological terms.”

When the pandemic struck, Gillihan found himself using many of the CBT techniques he’d taught his clients, but he also found respite in another project. Since his 10-year-old daughter, Ada, was attending school online, he’d sit down with her at the kitchen table during her half-hour breaks, and they’d brainstorm CBT practices that resonated with kids her age.

“Many times Ada would say, ‘I don’t think kids really use that word’ and find some really lovely way of rephrasing things,” Gillihan says. “We’d have these really sweet mind-meld moments, where we’d say, ‘This doesn’t quite feel right’ and then, suddenly, the answer would come to us and we’d yell together, ‘Yes! That’s it!’”

This father–daughter experiment eventually became The CBT Deck for Kids and Teens, released last year (Ada is credited on the box). Like his two previous decks, this one features Think, Act, and Be cards, but in recognition of its younger audience, it includes colorful cartoons depicting kids of all shapes and sizes using the practices it recommends.

What’s one nice thing you could do for yourself today? one Act card reads. It could be anything, like eating one of your favorite foods, reading a book you love, or wearing your favorite outfit. If it’s hard to come up with ideas, think about what could make this a special day. Ask a grown-up for help if you need to.

Like so many cards, Gillihan says, his are teaching skills. “You’re building a library of strategies you can draw upon,” he explains. “Even if you’re not memorizing the cards, you’re likelier to think back to them next time something difficult comes up.”

A Jack of All Trades

The mass appeal of therapy card decks is clear. They’re portable. They’re affordable. They’re shareable. They’re tangible. They’re easy to understand. They can distill months of therapy takeaways into 75-word touchstones that people can return to again and again at their convenience. And with a therapy deck for what seems like every clinical topic under the sun, no one modality lays claim to them.

Therapist Elena Welsh, creator of The Panic Deck: 58 Strategies to Break Free from Cycles of Panic & Fear and Reclaim Your Life, believes the sky’s the limit for therapy card decks. Their growing popularity, she says, signals a trend toward the democratization of therapy, toward a world where even those who can’t get access to treatment, for whatever reason, get a piece of the therapy pie.

“Whether it’s in entertainment, the news, or social media, we’re seeing a lot more discussions of therapy outside the consulting room,” she says. “I think these card games are part of the movement that’s trying to make skills and tools more accessible. There are a lot of people out there who would benefit from therapy but are left untreated. This feels like a cultural response.”

There’s another reason why therapy card decks will stick around, says Deb Burdick, a retired social worker and creator of the Mindfulness Skills for Kids card deck. They speak to us in a universal language: play.

“Therapy cards are a blessing,” she says. “They may be a vehicle for clinical skills, but many times they’re reaching clients through play—a doorway into the client’s world. They’re a nonthreatening, playful way of showing that you understand them.”

– – – –

Surely enough, as my wife and I cross the border into New Jersey, scrolling through the Gottmans’ Card Deck app and smiling a little bigger with each passing question, that atmosphere of play is palpable. This isn’t therapy, but for a moment, I envision John and Julie Gottman in the backseat, nodding proudly.

“The card deck,” Julie tells me later, “gives people a sense of agency and empowerment, a new way of connecting. A way of expressing their needs with a little bit of help.”

She’s not wrong.

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Chris Lyford

Chris Lyford is the Senior Editor at Psychotherapy Networker. Previously, he was Assistant Director and Editor of the The Atlantic Post, where he wrote and edited news pieces on the Middle East and Africa. He also formerly worked at The Washington Post, where he wrote local feature pieces for the Metro, Sports, and Style sections. Contact: