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How Diagrams Can Help Us Communicate With Clients

The spoken word is considered the quintessential vehicle of psychotherapy. Yet, when it comes to auditory processing, we all have our limitations. In fact, our brains devote more resources to visual processing than all other senses combined. Charles M. Boisvert, the co-creator of Visually-Enhanced Therapy, thinks diagrams can serve the therapy session on many levels – and help us engage with harder to reach clients.

‘I hear and I forget…I see and I remember… I do and I understand’ Confucius

A colleague and I recently attended a conference. The next day we were discussing a client, and tried to recall whether the presenter had said anything that might inform our understanding of the case. “Now, what was it that they said about…”, we both found ourselves wondering. We had sat in the conference for six hours, listening intently. Yet the next day, neither of us could remember a single relevant point!

This speaks to our difficulty, as humans, in processing verbal information, and then recalling it later. Traditional psychotherapy, historically referred to as ‘the talking cure’, uses a communication platform with implicit goals and assumptions. It operates on the premise that our auditory processing skills are intact and can be used effectively to understand, internalise, and apply the information exchanged during the therapy encounter. In therapy, the verbal dialogue is considered the quintessential vehicle to effect change and achieve goals. 

But anecdotal comments from clients suggest that relying solely on auditory processing may have its limitations. How often, for instance, have you heard a client say, ‘I wish I could write all of this down…’? Interestingly, research in allied counselling fields (such as communication, education, cognitive science, and learning and memory) suggests that relying solely on auditory processing may not be the most optimal way to learn and use information exchanged during conversations. Findings from these allied fields can inform how we design psychotherapy, and how we can augment its application.

So I and my colleague Mohiuddin Ahmed, PhD, have devised a unique approach to communicating information in psychotherapy, called Visually-Enhanced Therapy (VET). Visuals (which can include diagrams, worksheets, handouts and movement exercises) can serve multiple functions in the therapy session, such as:

  • Lessening the ‘cognitive load’ of the therapist and client 
  • Organising thinking
  • Focusing a tangential client 
  • Activating more ‘relevant’ thinking capacities 
  • Minimising rehearsal of ‘stored verbal habits’ or ‘redundant verbalisations’
  • Engaging a low verbal or depressed client
  • Providing a shared collaborative ‘visual field’

We don’t wish to underestimate the therapeutic value of verbal communication in traditional psychotherapy. But augmenting verbal communication with verbal-visual communication can facilitate the exchange of information, enhance the chances of clients remembering the dialogue, and enhance their ability to use the information outside of the therapy session. Visuals can also help us engage challenging clinical populations that may not respond optimally to traditional verbal therapy interventions.

So simply hearing the message alone may not be adequate in enabling us to more fully understand and recall the details of conversations. The next time you see your client, ask them what they remembered from the last session. If they struggle to share details, try writing something down this time, or using a diagram. You may be surprised what they now remember. You may discover that a picture really can, sometimes, be worth a thousand words.

Using Diagrams in Psychotherapy: A Guide to Visually Enhanced Therapy by Charles M Boisvert and Mohiuddin Ahmed, is published by Routledge (


Charles M. Boisvert

Charles M. Boisvert, PhD. is a professor of clinical mental health counseling in the Department of Counseling, Educational Leadership, and School Psychology at Rhode Island College and a practicing psychotherapist at the Rhode Island Center for Cognitive Behavioral Therapy (RICBT) in North Kingstown, R.I.

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