Case Studies / Clinical Stories
Real sessions. Real children. Real change. De-identified clinical stories from psychologists using the PILA Card System in practice.
Clinicians choose tools they can picture using. Below are real, de-identified accounts from psychologists, counsellors, and therapists describing how they introduced a PPU deck into a session — what they saw, what shifted, and what they would do next time. These are not testimonials. They are clinical narratives written for other clinicians.
Case 01 — Selective mutism, age 8. Presentation: Eight-year-old presenting with selective mutism in school and clinical settings. Three prior sessions with limited verbal engagement. Deck used: PILA Cards (Deck 1), introduced in session 3. What happened: The clinician placed three PILA cards on the table without comment — I won't rush you, Big feelings are okay, You belong here. The child reached for the third card within ninety seconds. By the end of the session the child was pointing to cards to indicate yes and no. Clinical reflection: The cards bypassed the verbal demand entirely. Within four further sessions, the child had moved to Feelings Intensity Scale check-ins and was speaking in short sentences during the Modal Verb phase. Frameworks engaged: Polyvagal co-regulation, trauma-informed practice, expressive scaffolding.
Case 02 — Dysregulation and shutdown, age 10. Presentation: Ten-year-old referred for emotional dysregulation and frequent shutdowns at school. Strong avoidance of feelings talk. Deck used: Feelings Intensity Scale (Deck 2), followed by Anchor Cards (Deck 3). What happened: The child pointed to the high-intensity card at session opening. The clinician did not ask why. Instead they moved to Anchor Cards and offered: You don't have to believe it yet. The child kept the card I am someone who can ask for space beside them for the rest of the session. Clinical reflection: Removing the demand to verbalise — and removing the demand to believe — created the room for engagement. Frameworks engaged: CBT cognitive reappraisal, self-discrepancy theory.
Case 03 — Anxiety and language avoidance, age 9. Presentation: Nine-year-old with generalised anxiety, school refusal, and a pattern of saying I don't know to all clinical prompts. Deck used: Modal Verb Cards (Deck 4) into Modal Sequences (Deck 6). What happened: The child picked up I could from the modal verb spread. The clinician laid out a Modal Sequence: I could, try, BRAVE. The child took the card home. Clinical reflection: The three-stage arc gave the child a complete story of identity without requiring them to claim it yet. The parent reported the card was placed on the bedside table. Frameworks engaged: Cognitive flexibility, identity scaffolding, language-as-regulation.
Want to share a de-identified case from your practice? Submit a clinical story via the Contact page. Browse the Evidence Base for the underlying research.