Cards Are Well-Suited to Therapy Goals

It seemed only natural to me as an occupational therapist to use cards in my practice.

When one is raised as an only child, as I was, learning to play alone becomes an important skill to develop. Our family had a copy of Penguin Hoyle which had the directions for every card game known. On rainy days, I would take the book out and teach myself any number of games. My favorites, of course, were the various solitaire games. I learned a number of them and would turn to them when I was alone to fill the hours.

One game of solitaire in particular struck my fancy, and became a source of great interest long into my adult years. This game is played with two decks of cards and is very complex. In due time, everyone in my family became expert in this game. My mother played it every evening in her widowhood, and it was a great companion to her. My children all learned the game as well.

As members of my family learned the game, an interesting thing happened. It no longer was a game played alone. Because of the complexity of the game there are many choices of moves, and everyone adopted their own style of play. As soon as someone set out the cards, everyone else gathered around and had something to say about the play. It seemed that one could view the options better from the side, so having a companion comment on the game was often helpful. Disputes did come about, but the companionship of the decision making was welcomed by everyone, and everyone recognized that the player had the last word.

One year during the holidays, I received a wonderful gift from my son. It was a computer disk with a game on it. Magically, the solitaire game that had amused my family over the years was now a game for the computer called Arachnid. This game, whose origins had been lost in time, now had a name. It has a home on my laptop computer and comes with me on trips to while away the hours of travel. It is never boring, and is a well loved friend.

Having found such enjoyment in card-playing in my experience, it seemed only natural to me as an occupational therapist to use cards in my practice. I found many uses, not only in the playing of games, but in mixing, dealing and sorting the cards. I have used them as a manipulative tool for hand patients and stroke patients. Building a house of cards takes considerable manipulative skill. I have set students seated cross-legged on rocker boards to the task of sorting cards, to enhance their balance and righting reactions. Clubs to the right, spades to the left, hearts in front and diamonds behind. I have used them as a memory tool for patients with head injuries and I've used cards for socialization purposes. I've taught children with learning disabilities to count and do simple arithmetic using cards. War and go fish are great favorites for kids. Casino uses addition skills. Rummy calls for sequencing. Canasta and bridge are grown-up favorites.

Card games are variable in complexity and format. Analyzing these games for their various qualities can turn them into great therapeutic tools. For example, a wide array of cards may be a problem for a patient with a visual field cut. That wide array may help the patient remember to turn his or her head to compensate. Some games require counting, enhancing cognitive memory. Alternating colors and building from low to high call on still different perceptual skills. Other games call for planning ahead.

So pick up a book of card games and learn some yourself. They will expand your therapeutic repertoire as well as provide a new set of leisure activities for yourself. And if you want to know how to play Arachnid, read on. Just remember, it takes many hours of play to learn this game, and you will win only rarely. But when you do, you will be delighted, and you will probably be hooked forever.

Mix two standard decks together. Deal 10 cards, face down and separate from one another. Repeat three more times on top of the first ten cards, totaling 40 cards in 10 stacks. Deal one card each onto the first 4 stacks. Deal the next 10 cards right side up on each of the stacks. There are now 54 cards dealt. The object of the game is to place cards in a sequence from ace to king in each suit. You may move any card onto any other card regardless of color or suit. You may move any number of cards of the same suit together onto any other card. You may not move cards together that are of different suits. If you move a card and reveal a down-facing card turn the down card face up. You may move any card into an open space. If you move a king into an open space, you cannot move it out as there is no place to put it. It is best to try to gain as many open spaces as possible, as this will permit you to move cards in and out of the space to manipulate the play. When you cannot make any other moves, deal out an additional 10 cards on top of the others. That will make the array very complex and will require a great deal of planning and problem solving. Good luck!

Here's an easier one that uses one deck. Count out 13 cards, placing them face down. Deal 1 single card above and to the right of the 13. Deal 4 cards, one under the single card and to the right of the 13, and three more to the right. The single card is the base number card. For example, if you have dealt a 3, all 3's are to be placed alongside the first 3 and will serve as the base for each suit. A 4 is placed on the 3, a 5 is placed on the 4, and so on. An ace is placed on the king, a 2 on the ace. When 3 through 2 are played in one suit, remove the suit. The cards are manipulated so that reds and blacks are alternated. When you are unable to play any cards, turn over three cards from the pile left in your hand, repeating until the deck is finished. Then repeat. This is a little tricky, but fun. Enjoy!

Estelle B. Breines, PhD, OTR, FAOTA, is program director of the occupational therapy program at Seton Hall University School of Graduate Medical Education, South Orange, NJ. She is nationally known for her study of the creative process in therapy and is the author of three OT texts. Readers may e-mail Dr. Breines at or at

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