A Cross-Cultural Intervention

Nicole Chen Counsellor

Penang, Malaysia

A symposium presentation by Nicole Chen

Nichole Chen presented her article “A Cross-Cultural Intervention” (download the PDF) at the International Counseling and Social Work Symposium, January 6-7, 2009, Universiti Sains Malaysia, Penang, Malaysia.

About the Author

Nicole Chen has been actively involved as a trainer in self-growth programs for parents, couples, youth, and children, and has worked as a counselor in non-governmental organizations, educational institutions, and at a private counseling centre. She received a Master’s in Counselling from the University of Malaysia and is a Board-certified (Malaysia) Registered Counselor.

A Cross-Cultural Intervention

The OH Cards consist of two decks, each with 88 cards: One of miniature water colour paintings that refer to aspects of daily lives, one with words that provides a verbal backdrop for the paintings. A combination of any two decks of painting and word are capable of bringing a significant meaning for the client. In the process of working with OH Cards, the client will bring personal intuition and individual experience to bear in order to complete the meaning of the cards. The uniqueness of OH Cards is in its adaptable approach to different ethnic backgrounds and cultural traditions and is flexible to be used as a counselling tool in individual or group settings. The general objective of this paper is to create awareness among therapists on OH Cards as an alternative counselling approach that can be used as a cross cultural counselling therapy tool. The specific objectives of this paper are (1) to introduce the OH Cards approach to helping professionals, (2) to share a set of essential guidelines in using the OH Cards approach in counselling therapy and, (3) to share therapists’ experiences in using OH Cards in their helping profession.


The OH Cards deck was initially published in 1981, and has become widely used as a tool for personal growth and interpersonal work. Currently it has been widely used in 33 countries and has been translated into 15 languages. It was introduced to practicing therapists in Malaysia since 2007. The OH Cards have been successfully used by teachers, story tellers, social workers, counsellors, art therapists, occupational and speech therapists, psychotherapists and hypnotherapists, trauma and relief workers, care givers and many others.

About OH Cards

The OH Cards were created by Elohim Raman in 1976 and consists of two decks of cards, each with 88 cards. On one set, there are miniature water colour paintings that reflect daily lives and on another set, words that provide a verbal backdrop for the paintings (France & Lawrence, 1993). Together, it offers 7744 possible combinations which supply different meanings and interpretation to the client. A combination of any two decks of painting and word are capable of bringing a significant meaning for the client. This is because in the process of working with OH Cards, the client will bring personal intuition and individual experience to bear in order to complete the meaning of the cards. The uniqueness of OH Cards is in its adaptable approach to people of different ethnic backgrounds and culturaltraditions and is flexible to be used as a counselling tool in individual or group settings.

A cross-cultural approach

Generally, most of the counselling approaches are rooted from Western and European values and perception of the world (Sue D. & Sue D. W., 1999, Trusty, Looby & Sandhu, 2002). In Malaysia, with groups of multiple ethnicities, the multicultural approach in counselling is a requirement and cannot be denied by practitioners. Corey (2001), believes counseling approaches can be broadened by integrating multicultural perspectives. In support of Corey’s statement, there are studies proposing that counselling educators be responsible in guiding future counsellors in the forming of a therapeutic procedure that that can be connected to all clients, counting in racial and cultural minorities (Vontress & Jackson (2004). The above justification provides an important perspective for practitioners to be aware of and be prepared with cross-cultural approaches in counselling practice. learning effectiveness through experiences.

The OH Cards have been translated into 15 languages which include Chinese, Danish, Dutch, Finnish, English, French, German, Hebrew, Italian, Japanese, Norwegian, Polish, Portuguese, Spanish, and Swedish to cater to the needs of different countries. Furthermore, there is a plan to translate OH Cards into “Bahasa Malaysia” to cater to the Malay language speaking client in Malaysia and Indonesia. Currently, OH Cards have been widely used in 33 countries which include Asia, Europe and other western countries. The usage of OH Cards is dependent on the therapists’ creativity. It provides the space and freedom for the therapist to decide on the ways the cards can be used and the therapist can base it on the cultural setting that he or she is living in. As a conclusion, the OH Cards are considered as a tool that can be applied to multicultural settings because it is a form of approach that can assist clients to have a deeper understanding of themselves based on their own interpretation on the encountered experience through the cards.

Therapeutic elements in OH Cards

Powerful Insight. The OH Cards itself seem very simple as a deck of cards yet it is capable in assisting clients to listen to the inner messages within them. It is capable of providing a deep insight about ones self. In client centered therapy, Rogers believed a formation of ‘insight’ in a person starts with first, understanding about self, second, requires self-acceptance, and third, continues with forming new actions to decrease dependency of help (Kathy Jo Hall, 1997). The OH Cards are capable of playing a significant role in increasing self understanding of a person by the client just listening to the messages that come within them through the cards. However, the powerful insight that is revealed in some circumstances might create uncomfortable feelings within the client. Therefore, the therapist will then have to play an important role in assisting the client regarding self acceptance and developing new behaviors.

Projection of the Unconscious. Psychoanalytical theory perceived the unconscious aspect of human beings as an accumulation of all experiences, memories and suppressed issues (Corey 2001). According to Corey (2001), there are studies that conclude that substances of unconsciousness can be obtained through a person’s behaviors and one of the ways to obtain the unconscious substance is through projective techniques. One of the purposes of OH Cards is to assist individuals to look into the unconscious aspect. There are many first time users who experienced and responded “Oh!” when using OH Cards (France, H. & Lawrence, J., 1993). In this context, the cards are used as a safe tool for personal projection. What the client sees and understands of the meaning of the cards is a form of projection of the unconscious aspect in them.

Essential etiquette and rules

The therapeutic elements of the cards are able to facilitate personal growth in a client. However it can be easily misused if the therapist does not practice good etiquette and rules in using the OH Cards. The therapist is reminded to understand the importance of following the etiquette and rules to facilitate openness and trustworthiness. There are five keys points to keep in mind while using the OH Cards (Lawrence J., & Raman Ely, 2005):

  • Honor each other’s privacy – The individual has the right to choose to pass or not to play the drawn cards. He or she can do it without providing any reason, nor revealing the cards. No confrontation and inquiring are allowed.
  • Honor each other’s space and time – No disruptions are allowed.
  • Honor each other’s intelligence and imagination – It is important to keep in mind that there is no “correct interpretation of the cards”. Only individual’s who draw the cards will have the right to interpret the meaning of the cards. No other interpretation or re-interpretation is allowed.
  • Honor each other’s integrity – No contradiction or arguments of a person’s interpretation are allowed. However, inquiries are allowed to fulfill others’ (therapists / group members) curiosity of the interpretation and clarification of something that is shared to enhance better understanding of a person.
  • Honor each other’s individuality – No assumption is made on the part of the interpreter that others would see and understand what he or she interprets.

How to use the OH Cards in therapy

There aren’t any fixed rules of how OH Cards should be used. It is very much based on the therapist’s objectives, creativity and context of using the cards. In using OH Cards as a therapy tool, here are the guidelines for the therapist:

  1. Prepare the client to be ready to look into in-depth issues. Ensure that the client is informed that the outcomes of the activity might create uneasiness in them. This will require clients to be courageous and have willingness to understand their self better.
  2. Lay picture cards and word cards each in a row facing down.
  3. Request the client to choose a picture card and a word card.
  4. Combine both the cards (word first and picture second) with both card faces up. Allow the client to spend some time to connect with the cards.
  5. Request the client to describe the picture and later describe the word.
  6. Request the client to focus on the feelings that emerge from the combination of both cards.
  7. Request the client to relate the interpretation to the client’s present life condition. Remind the client to use the present tense and the “I” statement in expressing their feelings. If possible, try to discourage clients to use “I think” or “I should”.
  8. If required, the client can continue to draw another set of cards and the therapist will then continue with steps four to step seven.

Malaysian Therapists’ Experiences

As was mentioned before, the OH Cards approach is very new to Malaysian therapists. There are not many therapists that could be interviewed because of the limited practitioners in using the OH Cards. For this paper, 3 therapists have been identified to share their experiences in using the OH Cards in their counselling practice. The following are the common points that emerged from the therapists’ sharing:

Benefits of OH Cards

Gentle and respectful approach. The therapists agreed that the OH Cards provided a gentle and respectful way to journey with the client for their personal growth. In using OH Cards, the client is given a freedom to decide whether to play or withdraw from the activity. This form of freedom supplies a sense of empowerment for the client. According to the Social Work and Practice and People of Color (2004), empowerment is defined as a process where an individual forms and enhances his or her personal skills in implementing interpersonal power. The OH Cards approach allows clients to proclaim authority over determining when he or she is ready for change.

Zooming on inner emotion. The OH Cards encourages the client to connect with their inner emotion, which builds a form of respect for oneself. The client who has been in denial of his or her feelings will greatly benefit through participating in the OH Cards activity.

Revealing unconsciousness. The therapists agreed that the OH Cards was a very powerful tool in enlightening the client of unconsciousness aspects. It is very powerful in revealing the truth in a person.

Challenges in using OH Cards

Less emotion and less connection. One of the challenges encountered by therapists was when working with people who had lost touch with emotion for a period of time as they may face difficulty in connecting with the cards. It will therefore require the therapist to teach the client on how to connect with their feelings first before starting to use the cards. Having less emotional connection with the cards will definitely reduce the effectiveness of the cards in bringing awareness to the client.

The truth can be painful. The OH Cards were able to assist clients to see their true self. Some felt good of the new discovery. However there were some who felt threatened by the discovery, especially when the clients were not ready to know the truth. In this context, the therapists played an important role in observing for client readiness to look into the unconsciousness aspect before using the cards on clients. One of the advantages of the OH Cards was that it enabled a creation of awareness within the client in a very short period of time during the session. However it could also create a risk in that the client could stop seeing the therapist because he or she was not ready to see what actually happened in them. The therapist is therefore reminded to be gentle and to follow their client’s pace before deciding to use the OH Cards.


As a conclusion, the OH Cards is a new counselling tool that is worthwhile to practice in a counselling setting because it enables to provide important therapeutic elements in assisting clients’ personal growth. However the effectiveness of the cards as a counselling tool could be questioned because there are very few studies that had been conducted in connection with using the OH Cards in a counselling setting. Therefore, more studies are recommended to be conducted to objectively assess the effectiveness of the OH Cards as a counselling tool. Further investigation on which aspects that the OH Cards are effective in to provide personal healing to clients are also required to concretely assess the true power of the OH Cards.


  • Corey, G. (2001). Theory and Practice of Counseling & Psychotherapy. (6th). CA: Brooks / Cole.
  • France, H., & Lawrence, J., (1993). OH Cards: A process for Interpersonal Exploration. Guidance Centre: Ontario. Vol. 8 No. 4
  • Kathy Jo Hall (1997). Carl Rogers. Retrieved 29 November 2008 from www.muskingum.edu
  • Lawrence, J., & Raman Ely (2005). The little book about the OH Cards. Kirchzarten : OH Publishing.
  • Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice (2nd ed.). New York: Wiley.
  • Social Work Practice and People Colour. A process-stage approach. (5th ed), by D. Lum pp. 254-262. Copy right 2004. Reprinted with permission of Brooks/Cole-Thomson Learning.
  • Trusty, J., Looby, E. J., & Sandhu, D. S. (Eds.). (2002). Multicultural counseling: Context, theory and practice, competence. New York: Nova Science.