# Alternative tools & techniques

Words are not the only door. For children, for low-literacy clients, and for bodies stuck in alarm, the curriculum's toolbox, play, paper, breath, story, often works before talk does.

## The toolbox, tool by tool

| Tool | How it works | Precautions |
| --- | --- | --- |
| Play, games, drawing | A child's natural language; themes surface in the sand, the doll, the picture | Observe, don't interrogate the drawing; keep materials local and familiar |
| Checklists: GAD-7 (Nepali version in the CTEVT course pack), Hopkins Symptom Checklist (HSCL-25), PTSD checklist, sentence-completion, SUDS (0–10 distress scale) | Screen and track change over sessions; SUDS can track distress during exposure when that helps | Nepali-validated versions exist for HSCL/PTSD scales: use them; a screen is not a diagnosis |
| Relaxation: deep breathing, box breathing, progressive muscle relaxation (PMR), safe place imagery, counting, 5-4-3-2-1 grounding | Turns the fight-or-flight body map of [Fear: the foundation](https://manoatlas.com/foundation.md) down by hand: long slow exhale = parasympathetic brake | Trauma clients can find closed eyes or body focus triggering; offer eyes-open grounding first. A five-step sequence for a strong feeling (notice, find, name, exhale, ask) is on [Techniques step by step](https://manoatlas.com/techniques.md) |
| Diary / journal writing | Externalises the worry loop; evidence for CBT thought-work | Privacy at home is real risk: a shared room means a found diary |
| Narrative exposure / retelling | The whole life story built in order, and the traumatic events within it narrated slowly and in detail until they can be told with less distress | Only with training, consent, stable clients, and time to finish what you open |
| Tree of life / river of life | Draw a life as tree (roots=origins, trunk=skills, branches=hopes) or river (bends=events); strengths-based story of self | Beautiful for groups and children; let meaning come from the client |
| Me-map (social support map) · family map (genogram) | Client at centre; circles for people, distance = closeness. The genogram draws the family tree with its bonds and conflicts | The curriculum's own tools for assessing social support (task 15) and the family environment (task 9) |

**A worked example:** A counselor named Bimal meets a 10-year-old earthquake survivor who is too distressed to talk. Bimal chooses drawing over questioning because the child's natural language is play. He also selects the SUDS scale because the child can point to a number instead of naming feelings. The child's SUDS drops from 8 to 4 after ten minutes of drawing.

Key points

1. Play, drawing, breath, story and checklists reach people that words alone cannot: children, low-literacy clients, bodies stuck in alarm.
2. Grounding (5-4-3-2-1, slow breathing, muscle relaxation) calms the body first so the mind can work.
3. Screening tools (GAD-7, PHQ-9, HSCL-25) track change; they suggest, they never diagnose.
Learn more

Pick one, not all.

Video · 19 min[Sleep is your superpower](https://www.ted.com/talks/matt_walker_sleep_is_your_superpower): pairs with relaxation work: why the calmed body must also sleep.

Paper**Schauer, Neuner & Elbert: Narrative Exposure Therapy manual**: the method behind curriculum "retelling", developed for low-resource settings.

Practice**Denborough, Tree of Life (Dulwich Centre)**: the group protocol, free summaries online.


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*Source: https://manoatlas.com/tools · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*