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Open Cards

Co-designing an innovative toolkit for therapists working working with individuals and families dealing with the complexities of sexual trauma

2011

Israel

Overview

I worked with a team of experienced clinicians to co-design a toolkit to support therapeutic work with individuals and families with a history of sexual truama and incest. The process included idea generation, product and service design development, prototyping and implementation.

My approach

This is a complex and challenging field of work where many practitioners were finding it difficult to engage families to discuss this shameful subject of sexual abuse in their family, and lacked tools to support them.
Victims of sexual trauma and abuse often know their perpetrators - members of their family or close network - and are bound in impossible and complex relationships with them. The therapeutic process supporting victims and sometimes whole families to heal is notoriously difficult. Shame and trauma have a real impact on people’s ability to communicate and make sense of information.

Overview of the design process

Ideation and exploratory prototyping

We began by mocking up different types of cards, showing different styles, helping the team to conceptualise and narrow the design brief

Design development through iterative prototyping

We prototyped a deck of ‘Life Event’ cards, based on a list of key life events that the team had generated, which they knew to be pivotal moments in relation to traumatic events in the family

Final deck of Live Event cards and Emotional Timeline

Through the course of several months our prototyping and learning activity generated more and more ideas for improvement and new sets of cards and ways of working with them. For therapists, this process was safe and gradual. They might only use a small number of cards or try using the Emotion Timeline at certain points, when they felt confident to do so.

Final deck of Thoughts and Feelings Cards

Following several months of prototyping, seeing and hearing their the team of therapists try this out, legitimised the process and grew their sense of curiosity and opportunity. Management approved a small budget to commission an illustrator to work with us on a new deck of cards.

First prototype deck of Emotion and relationship cards

Following a period of prototyping with this new deck, the team noticed that when asked to select cards that resonated with how they felt, children often chose cards with animals that they liked.

Final deck of Emotion cards

Working with our illustrator, we worked on a new concept of Emotion cards that would use a single animal, to avoid the bias we saw in the previous prototype. We began with a ‘child-like fox’ character and learned after a few sessions that girls and boys respond differently to these characters. We switched to Panda bears, which elicited less of a gender bias.

Codifying and producing toolkit and training programme

After almost two years of development the team was awarded a grant to produce and distribute this product at scale. We worked together to create a ‘user manual’, in both English and Hebrew, aimed at therapists and social workers. The manual included case vignettes, describing various situations in which different tools were used, and to what end.

Impact

Ten years on, hundreds of therapists and social workers across Israel have undergone training and purchased the toolkit. New joiners to the therapeutic team report that the toolkit has helped them in managing complex therapeutic conversations and processes. The revenue generated by the sales of the toolkits funded future print runs, making this an economically sustainable product for the organisation that not only helped to improve its clinical impact and expertise, but also raise its profile in the field.

“Working at the Shiluv Institute at Jerusalem, in the sexual abuse unit, I use a precious and powerful tool to ease the healing process of the clients. It is a set of therapeutic cards which was developed in the unit... The tremendous healing efficacy of the cards resides to me in the fact that it can create (even in a session or two at the beginning of the work) the feeling/thought in the client that coherence and healing are possible.”

Psychotherapist

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