Collage therapy

1. Introduction

Version followed: Japanese collage therapy (コラージュ療法) as conceived by Moriya Hiroyuki (森谷寛之) in 1987 and taught by the Japan Collage Therapy Society (日本コラージュ療法学会), which he founded in 2009 and chairs. It covers the magazine picture collage method and the collage box method, with administration standards taken from the 2022 guidelines for the Collage Therapy Basic Material Sheet Set (Imamura et al.). It draws on JCTS training-seminar and workshop documents (2023–2025), the full text of Ohmae (2012) on cognitive-narrative collage, the publisher listing for Sugiura and Kanemaru (2025), and a Bunkyo University graduate report on box collage with children. Moriya's manuals (1993, 2012) and the text of Sugiura and Kanemaru (2025) are cited but not drawn on directly. [uncertain] Where this guide relies on papers, abstracts and society documents instead, it says so. [source: JCTS 20th training seminar flyer 2024; Ohmae 2012; Material Set guidelines 2022]

What it is. The client cuts pictures or photos out of magazines, pamphlets or similar printed matter, or picks pieces already cut, and glues them onto a backing sheet. The therapist then looks at the finished work with the client and talks about it. Moriya modelled the method on sandplay (箱庭療法) and thought of it as a portable sandbox. He held that the core of sandplay is arranging ready-made miniatures, and reasoned that arranging ready-made flat images on paper should have a similar effect. It needs no sandplay room and is simple to run. [source: Osaka Univ. paper aes17-045, p. 47; Aoki 2009, pp. 31, 37]

How change is thought to happen. In the sandplay tradition it comes from, clients are thought to change by choosing and arranging images freely in a protected setting. This lets them express and then look at material they could not easily put into words. Change is followed across a series of works, not read off a single one. [source: Aoki 2009, pp. 31, 37–38; Imada 2010 abstract] One later variant adds structured questioning about the collage's "protagonist". This is meant to give the client distance from their problem, so the client finds the psychological task themselves and finds it easier to accept. [source: Osaka Univ. paper aes17-045, pp. 54–55] What the sources state outright is thin: they lean on the sandplay rationale and on case reports. [uncertain]

Status. This is a medium used within psychotherapy, counselling, occupational therapy, education and self-development work. It is not a stand-alone school with a manualised protocol. Practitioners deliberately avoid fixing the procedure, to protect its therapeutic value. The cited precedent is Lowenfeld's World Technique, which became a test (the World Test) when it was standardised and lost its therapeutic function. [source: Aoki 2009, p. 31]

2. Framework

No fixed phases. None of the sources gives a phase model, a set number of sessions, or criteria for moving between stages. The structure below is the session format they describe, plus a course structure taken from case reports. [source: Aoki 2009; Osaka Univ. paper aes17-045; Imada 2010 abstract] [uncertain: Moriya's 2012 manual may give more structure; not verified here]

Session format (individual).

Materials: magazines, pamphlets or catalogues; scissors; glue; a backing sheet. The standard backing sheet in the material-set guidelines is eighth-size (八つ切り) white drawing paper. [source: Sugiura & Kanemaru 2025 publisher listing; Material Set guidelines 2022]
Making time: 50–60 minutes is the standard in the material-set guidelines. Studies report about 60 minutes. [source: Material Set guidelines 2022; Aoki 2009, p. 32]
After making: the client looks at and appreciates the work, gives or writes impressions, and may give it a title. The therapist responds or asks questions. [source: Osaka Univ. paper aes17-045, pp. 47–48; Aoki 2009, p. 33]
Leave time after making for appreciation and closure. A 50-minute clinical hour therefore usually needs a shorter making time, or the making and discussion split across sessions. [synthesis]

Course of therapy.

Repeated collages are made over a course and understood across time. In one published case, three collages were made over about four months. The author reports that repeating the process deepens change. [source: Imada 2010 abstract; Osaka Univ. paper aes17-045, pp. 48–52]
Collage can be the main medium, or one option offered alongside talk, drawing or sandplay. [source: Aoki 2009, p. 31, uses listed] [synthesis: how to combine them]
Suggested rhythm: offer collage once a client can tolerate a non-verbal task. Repeat it at intervals such as every session or every few sessions. Compare works across the series. Close by reviewing the series together. [synthesis]

Group format. In the group-individual method (集団個人法), each member makes their own collage in a shared room, then shares in small groups of about four. [source: Aoki 2009, pp. 32–33]

Who uses it. Uses described in the review literature include:

neurosis, psychosis, school refusal and developmental disorders
terminal cancer
severe motor and intellectual disability in long-term care
rehabilitation after brain injury
day services for older adults
self-development in schools and workplaces
nursing education
brief interviews, using postcard-sized collage

[source: Aoki 2009, pp. 31–32] No formal contraindications are stated in the available sources. A training study with novice therapists concluded that collage therapy with clients who have severe psychopathology needs special consideration. [source: Imada 2022, abstract] See section 5 for synthesised cautions. [uncertain]

Professional frame.

In Japan, collage therapy is used by clinical psychologists (臨床心理士), certified public psychologists (公認心理師), counselling professionals and occupational therapists, and in schools. [source: JCTS 20th seminar flyer (target audience); OT circle-frame abstract; Aoki 2009, pp. 31–32]
Moriya holds the 臨床心理士 and 公認心理師 qualifications, is emeritus professor at Kyoto Bunkyo University and heads the Kyoto Collage Therapy Institute (京都コラージュ療法研究所). He conceived collage therapy in 1987, founded the Japan Collage Therapy Society in 2009 and became its chair (理事長). [source: JCTS 20th and 21st training seminar flyers]
Training route: the society's training committee runs seminars that combine a theory lecture with hands-on making (the June 2024 seminar was on preparing the collage box method), and its annual conference holds a workshop day where participants take one morning and one afternoon course. Seminars are open to 公認心理師, 臨床心理士 and counselling professionals, with entry conditions that include a signed pledge (誓約書). Workshops in principle require society membership; non-member psychologists, clinical-psychology graduate students and related practitioners may attend. [source: JCTS 20th seminar flyer; JCTS Workshop 2023 and 2025 guides]
No collage-therapy credential, certification or registration appears in the society's published documents, and there is no "collage therapist" title. The only credential link is that attending both workshop sessions allows a 臨床心理士 renewal training-point application, which the society submits to the Foundation of the Japanese Certification Board for Clinical Psychologists (日本臨床心理士資格認定協会). Practice therefore rests on the practitioner's own professional licence. [source: JCTS Workshop 2023 and 2025 guides] [uncertain: the absence of a credential is inferred from the society's documents; the society does not state it]
Outside Japan, clinicians offering it as art therapy need the local art-therapy registration, for example HCPC/BAAT in the UK or ATCB in the USA. Clinicians who are not art therapists should present it as a psychotherapy technique within their own scope of practice. [synthesis]
The material-set guidelines require the therapist to have made a collage with the set before using it clinically. [source: Material Set guidelines 2022]
University training programmes use simulated individual interviews, repeated sessions and group supervision. [source: Imada 2010 abstract]
Do not use it for interpretation without that experiential training and supervision. [synthesis]

3. Guiding principles

Treat it like sandplay in a portable form. Offer a protected space, accept whatever is made, and avoid directing the content. [source: Osaka Univ. paper aes17-045, p. 47]
Do not standardise the procedure into a test. Keep the instruction open and flexible. Do not score the work as an assessment instrument. [source: Aoki 2009, p. 31]
The maker's account comes before the therapist's interpretation. Ask what the work means to the client before offering any reading of your own. [source: Aoki 2009, p. 38]
Read a series, not a single work. Hold your hypotheses until you have several collages to compare. [source: Imada 2010 abstract; Aoki 2009, p. 38]
Keep it low-threat and easy to begin. Ready-made images take away the fear of not being able to draw. Anyone, of any age, illness or disability, can take part. [source: Sugiura & Kanemaru 2025 publisher listing]
Respect the client's right to decline. In sharing, the maker may refuse any question without giving a reason. [source: Aoki 2009, p. 33]
Respond to strengths, not deficits, in group sharing. Peers avoid negative questions and name what is good in the work. [source: Aoki 2009, p. 33]
Know the medium yourself. Make collages yourself, with the same materials, before you use them clinically. [source: Material Set guidelines 2022; JCTS training flyer]
Keep materials consistent when you compare works. Use a stable material set and sheet size if you want to compare works over time, or compare clients in research. [source: Material Set guidelines 2022 rationale] [synthesis: clinical application]
Process matters as well as product. How the client chooses, cuts and places, hesitates, or leaves space is clinical data, to be noted without judgement. [synthesis, consistent with Aoki 2009, p. 37 on blank space and cut shapes]

4. Intervention inventory

This inventory lists only methods named in the sources cited. Several are known only from titles or abstracts, and are marked so. The step-by-step detail is a working procedure assembled from those sources, with [synthesis] marked where it fills gaps. It is not Moriya's text.

4.1 Magazine picture collage method (マガジン・ピクチャー・コラージュ法, MPC)

Purpose / when: This is the basic form: the client cuts what they like from magazines and pastes it on a backing sheet. Use it with adolescents and adults who can handle scissors and choose freely, especially those who find drawing threatening. [source: Osaka Univ. paper aes17-045, p. 47; Aoki 2009; Imada 2010 abstract]
Steps:
1. Have ready a varied stack of magazines and pamphlets, scissors, stick glue and a backing sheet (eighth-size white drawing paper is the standard). [source: Material Set guidelines 2022; Sugiura & Kanemaru 2025 listing] Screen out graphic sexual or violent material, and anything specific to the client's risks. [synthesis]
2. Introduce the activity briefly and openly: anything may be cut and pasted, in any way, and nothing needs to be explained. [source: Osaka Univ. paper aes17-045 (therapist introduces); wording synthesis]
3. The client looks through the materials, cuts out images, arranges them and glues them down. Allow about 50–60 minutes. [source: Material Set guidelines 2022]
4. During making, stay present and quiet. Note the order of choices, hesitations, pieces cut but discarded, and how the client uses the edges and empty space. Do not comment or interpret. [synthesis; the traditional approach is described as the therapist silently watching, Osaka Univ. paper aes17-045]
5. When the client is finished, look at the work together. Invite their impressions and, if they wish, a title. [source: Osaka Univ. paper aes17-045, pp. 47–48]
6. Keep the original, or photograph it with consent, so the series can be compared later. Agree with the client who keeps it. [synthesis]
Example language (illustrative): "Here are some magazines. Cut out anything that catches your eye and paste it on this sheet however you like. There's no right way to do it." Afterwards: "Let's look at it together. What do you notice? Does it want a title?"
Watch for / working:
- Watch for:
  - long paralysis over choosing
  - compulsive filling of the whole sheet
  - images placed on the back of the sheet, which may show hidden self-aspects [source: Aoki 2009, pp. 37–38]
  - distress triggered by a picture
- Signs it is working:
  - the client becomes absorbed
  - they speak about the work spontaneously
  - themes and composition change across the series [synthesis]

4.2 Collage box method (コラージュ・ボックス法)

Purpose / when: In this method, pieces cut out in advance are stored in a box. The client picks from the box and pastes, so no searching or cutting is needed. [source: Material Set guidelines 2022 (leftover cut pieces may be mixed into materials for methods such as the collage box method); a published case used it across interviews with a woman in her 50s with obsessive-compulsive symptoms (CiNii record title)] It is part of the society's current core training: the JCTS 20th training seminar (June 2024) was devoted to devising the stimulus material for the collage box method, with Nakahara Mutsumi (Kagoshima University) lecturing on preparing the box and on case practice. [source: JCTS 20th seminar flyer]
- Published example with children: in a Bunkyo University graduate report, box collage was used individually with children in a special-needs resource room (通級指導教室), in monthly 45-minute sessions, with white B4 paper, glue, scissors, pens and crayons, and pieces cut from magazines and comics sorted into Sugiura's (1993) ten categories. After making, a short questionnaire asked about the work's title and the child's satisfaction, followed by the examiner's questions. [source: Naito, Bunkyo Univ. graduate report]
- Who proposed the method is not stated in the available sources. The ten categories come from Sugiura (1993, pp. 11–33), cited by Naito; the category names are not verified, so they are not given here. [uncertain]
- Likely indications: limited time, motor or attention difficulties, frailty, intellectual disability, younger children, and settings where scissors are unsafe. [synthesis; use with children: Naito report]
Steps:
1. Over time, cut a wide range of images from varied magazines (and, for children, comics) and store them in a box or tray. Sort them into categories so that each kind of content is represented; Sugiura's (1993) ten-category scheme is the published reference used for this. [source: Naito report] Example content types: people, animals, food, landscapes, objects, words and abstract colour. [synthesis] You may include leftover pieces from the Basic Material Sheet Set, but not leftovers from versions before the 2022 revision, whose backs are plain. [source: Material Set guidelines 2022]
2. Offer the box, a backing sheet and glue, plus scissors if the client wants to trim. B4 paper and 45 minutes worked in the children's report. [source: Naito report] [synthesis: the scissors option]
3. Invite free choice and arrangement, then appreciate the work together as in 4.1 and 4.4 (title, satisfaction, then open questions). [source: Naito report]
4. Refresh the box between sessions. Note any pieces the client keeps returning to. [synthesis]
Example language (illustrative): "These pictures are already cut out. Take any you like and arrange them on the sheet."
Watch for / working:
- The therapist's pre-selection shapes what can be expressed, so keep the range broad. [synthesis]
- Signs it is working are the same as for MPC.

4.3 Standardised material set (Collage Therapy Basic Material Sheet Set)

Purpose / when: This is a published set of 20 numbered picture sheets, plus 3 blank coloured sheets in reconstructed sets, supplied in a sealed, labelled envelope. Everyone gets the same materials, which allows comparison across sessions, clients or research participants. [source: Material Set guidelines 2022; Imamura et al. 2015, 2019]
Steps:
1. Make a collage with the set yourself first. This is required for clinical use and recommended for research.
2. Decide whether the set suits this case.
3. Use one unused set per client.
4. Hand over the envelope, or take the materials out while showing them, as suits the client.
5. Have the client read the envelope label, or read it aloud to them, so they feel at ease.
6. Allow 50–60 minutes, on an eighth-size white board.
7. Do not colour-copy, resize, remove or duplicate sheets.
8. Cite the set by name in any publication.
[source: Material Set guidelines 2022]
Example language (illustrative): "Everything you need is in this envelope. Have a look at the label first, then use the pictures however you like."
Watch for: Fixed materials limit personal relevance. Balance comparability against freedom of choice. [synthesis]

4.4 Appreciation, impressions and titling (post-making dialogue)

Purpose / when: Use this after every collage. It helps the client look at what they made and put it into words at their own pace. [source: Osaka Univ. paper aes17-045, pp. 47–48; Aoki 2009, p. 33]
Steps:
1. Sit beside the client, facing the work, or let them hold it.
2. Ask for their overall impression first. [source: Osaka Univ. paper aes17-045]
3. Invite a title, and optionally a subtitle or a short written explanation. [source: Aoki 2009, p. 32; Osaka Univ. paper aes17-045]
4. Ask open, non-leading questions about particular pieces, positions and empty areas. Always accept "I don't know" or a refusal. [source: Aoki 2009, pp. 33, 37] [synthesis: wording]
5. Offer tentative reflections only if they fit the client's own account. Do not offer symbolic interpretations unprompted. [source: Aoki 2009, p. 38]
6. Record the title, the client's comments and your process notes. [synthesis]
Example language (illustrative): "What is it like to look at it now?" "If you gave it a name, what would it be?" "I notice this corner was left empty. Does anything come to mind about that? It's fine if not."
Watch for / working:
- Over-interpreting, or the client trying to please you with meanings. [synthesis]
- Signs it is working:
  - the client starts linking images to their own life without being asked
  - titles become more personal over the series [synthesis]

4.5 Series work and longitudinal reading

Purpose / when: Use this across a course of therapy, to understand change over time and not over-read any single work. [source: Imada 2010 abstract; Osaka Univ. paper aes17-045, pp. 48–52]
Steps:
1. Date and keep every work, or photograph it with consent.
2. At review points, lay out the works in order with the client. [synthesis]
3. Compare themes, colour, density, blank space, the placement of self-images, and recurring figures.
4. Ask the client what they see changing.
5. In paired or themed works, allow for practice effects: a second work can differ simply because the client has done the task before. [source: Aoki 2009, p. 38]
Example language (illustrative): "Here are your collages from the start until now. What strikes you when you see them side by side?"
Watch for: Do not build a narrative the client does not share. [source: Aoki 2009, p. 38 principle] [synthesis]

4.6 Reading the work: viewpoints described in the literature

Purpose / when: These are hypothesis-generating viewpoints, not scoring rules. The sources give no standardised scoring system. [source: Aoki 2009, pp. 37–38] [uncertain: Moriya 2012 covers "assessment" per its subtitle; its content is not verified here]
Viewpoints reported (Aoki 2009, from cases):
- placing a self-image at the centre turns attention inward
- blank areas may mark what is not yet expressed
- pieces cut into shapes such as hearts, or used as background fill, may reflect ambivalence or unexpressed conflict; one cited study linked such pieces to lower irritability and fewer physical complaints
- frequent ambiguous or cartoon images may suggest projection, or vagueness about the present self
- pairs may suggest a partner, and repeated objects may suggest friends or family
- pieces glued on the reverse may reveal hidden self-aspects
- in a circular format there is no top or bottom, so view the work from all sides
Cognitive-narrative variant viewpoints:
- the protagonist's task
- similarities between the protagonist and the client
- the negative and adaptive self-schemas underneath [source: Ohmae 2012 (Osaka Univ. paper aes17-045), pp. 54–56]
Steps: Hold each viewpoint as a question to explore with the client, not a conclusion. Write hypotheses in your notes, not in reports. [synthesis]
Limits of projective use: These are case-based observations. No scoring system with published reliability or validity data appears in the available sources. The studies cited are single cases or small samples: Ohmae (2012) reports one case, uses no outcome instrument beyond a 0–5 self-rating, and frames schema change as interpretation; the Bunkyo resource-room report analysed six children and did not report the psychometric properties of its mood measure; Aoki (2009) is exploratory with no effect measures. The tradition itself warns that standardising the procedure into a test costs its therapeutic value. So do not score a collage or use it as a test, and never present it as evidence of abuse, trauma or a disorder in reports, court or safeguarding processes. Record what the client said and did, not what the images "mean". [source: Ohmae 2012, pp. 45, 50, 54–57; Naito report; Aoki 2009, pp. 31, 38] [synthesis: forensic caution]

4.7 Group-individual method (集団個人法) with structured sharing

Purpose / when: Use this in classes, training groups, inpatient or day groups, and staff development, where each person makes their own collage and then shares it. Group sharing appears to help keep up the positive mood changes that follow making. [source: Aoki 2009, pp. 32–33]
Steps:
1. Seat members at tables. Each person has a backing sheet, scissors, glue and pens. Magazines come from members or the facilitator, and members may lend them to one another. [source: Aoki 2009, p. 33]
2. Give the theme, if there is one (see 4.8), and about 60 minutes to make. [source: Aoki 2009, p. 32]
3. Form sharing groups of about four. Each presenter has about 3 minutes to explain their work. Peers then give opinions, impressions or questions. [source: Aoki 2009, p. 33]
4. Ground rules: no negative questions; peers point out strengths; the presenter may decline any question without giving a reason. [source: Aoki 2009, p. 33]
5. Optionally, members write reflections. Close with a whole-group summary. [source: Aoki 2009, p. 33]
6. If works will be used for research or teaching, get consent separately, and collect only consented works. [source: Aoki 2009, p. 33]
Example language (illustrative): "In your small group, each person gets about three minutes to talk about their collage. Afterwards, others can say what they like about it or ask a question. You can always say 'pass'."
Watch for:
- Personal disclosure going beyond what a class or training setting can hold.
- Peers interpreting each other's work. Redirect them to what they notice and appreciate. [synthesis]

4.8 Themed collage: "real life" and "me in ten years"

Purpose / when: Use this for self-understanding and future orientation, in students or in career and self-development work. [source: Aoki 2009, pp. 32–33]
Steps:
1. In session 1, the theme is the client's real life now. A photo or picture of themselves goes at the centre, following Capacchione. The client then adds a subtitle and a written explanation. [source: Aoki 2009, pp. 32–33]
2. In session 2, the theme is themselves ten years from now. The process is the same.
3. After both works, the client writes reflections on five prompts:
  - what each work expresses
  - what the present self lacks
  - what the future self shows
  - what to work on over the next decade
  - what they noticed by comparing with peers
  [source: Aoki 2009, p. 33]
Example language (illustrative): "This week, make a collage of your life as it is now, with a picture standing for you in the middle."
Watch for:
- The themes direct the content, which departs from free collage. [source: Aoki 2009, p. 31, on preferring non-fixed procedures]
- Use themes only when the goal is structured reflection.
- The future theme can hurt clients facing loss, terminal illness or deep hopelessness. [synthesis]

4.9 Circular (mandala) collage and circle-frame collage

Purpose / when:
- Circular board: the sheet is cut into a circle, so there is no top or bottom. This is argued to give more freedom, and invites a centred self-image. [source: Aoki 2009, pp. 33, 37]
- Circle-frame collage: in small occupational therapy groups with psychiatric patients, the frame acts as a boundary. Whether patients comply with it or deviate from it is used as material about self-assertion within limits. [source: OT circle-frame collage abstract, Japanese Association of Occupational Therapists]
Steps:
1. Cut the board into a circle.
2. Offer the circle, with or without a centre instruction.
3. Make and share as usual. [source: Aoki 2009]
4. In the OT version, notice whether the client stays inside the frame or goes past it, and discuss that with them as part of the therapy. [source: OT circle-frame collage abstract; detailed procedure not verified, uncertain]
Example language (illustrative): "This time the paper is a circle. You can use it from any side."
Watch for:
- The name "mandala" is the author's label for circular form. Do not present mandala symbolism as fact. [synthesis]
- Paper shape, size and colour effects are not established. [source: Aoki 2009, pp. 38–39]

4.10 Presents-collage (exchange in groups)

Purpose / when: Group members make magazine-picture collages and exchange them with one another as "presents". It was used in a psychiatric rehabilitation setting to improve mood and to work on self-awareness and empathy. The effects depended on the relationships within the group. [source: Shirahata & Ichihara-Takeda 2010 abstract]
Steps (outline):
1. Each member makes a collage intended for another member.
2. Members exchange the collages.
3. Members share their reactions and give mutual feedback.
The pairing method, the instructions and the feedback structure are not described in the available abstract. [uncertain]
Example language (illustrative): "Make a collage as a gift for the person whose name you've drawn. Afterwards we'll exchange them and talk about what it was like to give and receive."
Watch for:
- Unequal or hurtful "gifts".
- Pre-existing conflicts in the group. Screen the pairings, and set a rule that gifts are kind. [synthesis]

4.11 Cognitive-narrative collage (protagonist questioning)

Purpose / when: This is a later variant, cognitive-narrative therapy (認知物語療法) developed by Ohmae Reiko, which combines cognitive therapy with image-expression therapy. After a magazine collage, a six-stage questioning sequence asks the client to choose a protagonist in the work and explore it, then link it to their own life and name their own psychological task. It is meant to help modify schemas while giving the client distance through a character. Ohmae teaches it as a JCTS workshop course. [source: Ohmae 2012, pp. 45–58; JCTS Workshop 2023 guide]
Steps (Ohmae 2012, p. 48, paraphrased):
1. The client makes a magazine collage (the paper attributes the magazine collage method to Moriya 1988) and says what the finished work is. [source: Ohmae 2012, p. 47]
2. Stage 1: the client recalls how the collage was made, chooses a protagonist in it, and writes a story about it.
3. Stage 2: explore what the protagonist perceives through the senses: sight, hearing, smell, taste and body sensation.
4. Stage 3: explore the protagonist's feelings.
5. Stage 4: explore the protagonist's thoughts and cognitions.
6. Stage 5: link the collage to real life. The client gives a title, names the protagonist's task, and says whether the protagonist's experience resembles their own.
7. Stage 6: the client names their own psychological task and rates their progress on it on a 0–5 scale.
8. Repeat across sessions. The author reports deeper change with repetition. [source: Ohmae 2012, pp. 48–50, 54–55] Whether the answers are given in writing on a form or aloud is not specified beyond the written story in stage 1. [uncertain]
Example language (illustrative): "If one figure in this collage were the main character, who would it be? What might they be seeing, hearing or feeling right now? What are they thinking? What task are they facing? Is any of that like your own life? From 0 to 5, how far along are you with your own task?"
Watch for:
- This departs from the silent-witness stance of traditional practice: the therapist actively prompts insight, which the author presents as her considered view, not a demonstrated effect, and the evidence is a single case. [source: Ohmae 2012, p. 45]
- Avoid forcing the protagonist-self link. If sensory or emotional exploration of a distressing image raises arousal, stop at the stage reached and ground the client. [synthesis]

4.12 Group collage formats named in the literature (procedure not drawn on)

Purpose / when: Sugiura's work on group collage and a rotating group collage method (輪番法) are cited as group alternatives. [source: Aoki 2009, pp. 32, 40] Their procedures are not described in the available sources. [uncertain] Other group formats taught at JCTS workshops, procedures not published there: "Life graph with collage" (人生グラフ with コラージュ) group work (Higashi Tomoyuki), for which the course outline says studies suggest gains in sense of purpose in life (生きがい感) and ego-identity development; and collage with older people with dementia living in group homes (Nishimura Yoshifumi). A Hosei University master's thesis (Ishii 2006) studied serial change in group collage; only its title was available. [source: JCTS Workshop 2023 guide; Hosei repository record] [uncertain: procedures]
Suggested safe adaptation: In a joint group collage, members take turns adding pieces to one shared sheet. Agree a rule beforehand that nobody removes or covers another member's pieces without asking. End with each member saying what they contributed. [synthesis, not attributed to Sugiura]
Watch for: Dominance by one member, and members feeling that their space was intruded on. [synthesis]

4.13 Postcard collage in brief interviews (named only)

Purpose / when: A postcard-sized collage is used where session time is short, for example in brief interviews. [source: Aoki 2009, p. 31] No published procedure is available. [uncertain]
Suggested use: Use a postcard-sized card, a small collage box (4.2), and 10–15 minutes of making. Follow with a brief appreciation (4.4). [synthesis]
Watch for: A small format limits expression. Treat the result as a check-in, not as material to interpret. [synthesis]

4.14 Therapist preparation and training exercises

Purpose / when: Do this before using collage clinically, and continue it during supervision. [source: Material Set guidelines 2022; JCTS 21st training seminar flyer; Imada 2010 abstract]
Steps:
1. Make your own collages, using the same materials you will offer clients. The JCTS seminars combine theory lectures with hands-on making. [source: JCTS flyer]
2. Practise simulated individual sessions with peers, one as therapist and one as client. [source: Imada 2010 abstract]
3. Make repeated collages over time to experience reading a series. [source: Imada 2010 abstract]
4. Review the works in group supervision or a case conference. [source: Imada 2010 abstract]
Watch for: Your own aesthetic or symbolic preferences creeping into how you read clients' work. Supervision is the check on this. [synthesis]

5. Handling problems

The sources say little about problems. Apart from the items tagged with a source, everything in this section is [synthesis].

Client refuses or says "I can't do art".

Point out that no drawing is needed. The pictures already exist, which makes collage a low-threat medium. [source: Sugiura & Kanemaru 2025 listing]
Offer the collage box (4.2) so there is no searching or cutting.
Accept a refusal without pressure, and offer collage again later. Never make it a condition of therapy.

Paralysis at choosing, or perfectionism.

Shrink the task: a smaller sheet, a limited collage box, or "pick just three pictures that catch your eye".
Normalise unfinished work. Note the paralysis as material rather than correcting it.

Endless browsing with nothing pasted, or avoidance.

Give a gentle time cue at the midpoint.
Accept a sparse work. Blank space may mark what is not yet expressed. [source: Aoki 2009, p. 37]
Explore the avoidance in words rather than pushing production.

Overwhelm or distress triggered by an image.

Stop the making. Ground the client in the room and their breathing.
Let them turn the picture face down, remove it, or cover it.
Make it explicit that they control what stays on the sheet.
Before the next session, screen the materials for that theme.
For trauma survivors, pre-screen magazines for violence, weapons, sexual imagery, and anything known to trigger them, or use the collage box.
Keep enough time for closure before the client leaves.

Over-interpretation or a rupture over meaning. This happens when the client feels exposed or judged by the therapist's reading.

Apologise and return to the client's own account. [source: Aoki 2009, p. 38 principle]
Keep readings as tentative questions, and remind them they may decline any question. [source: Aoki 2009, p. 33]

Clients seeking interpretations from the therapist, for example "What does it say about me?"

Turn the question back to their associations.
Explain that the collage is not a test and has no fixed meanings. [source: Aoki 2009, p. 31 on avoiding test use]

Group problems: mocking, dominance or oversharing.

Restate the ground rules: strengths only, no negative questions, and the right to pass. [source: Aoki 2009, p. 33]
In class or training groups, limit how deep disclosure goes. Offer individual follow-up if needed.

Non-attendance or non-adherence. Collage is usually done in session, not as homework.

If a client stops engaging, review the series with them and ask whether they want to keep collage as an option.

Scissors and self-harm or aggression risk.

Do a risk assessment before offering scissors.
Use round-ended safety scissors, count the scissors in and out, or switch to the collage box with tearing or pre-cut pieces.
If self-harm or suicidal content appears in a work, respond with a standard risk assessment and safety planning, as you would with verbal disclosure.

Materials and physical safety.

Use non-toxic stick glue rather than solvent-based glue. Avoid craft knives.
Check for allergies, for example to latex or fragrance inserts in magazines.
Ventilate the room if you use spray fixatives, or avoid them.
With frail or motor-impaired clients, set up an accessible table and pre-cut materials.

Eating disorders and body image.

Magazine images often carry thin ideals, diet and food advertising, and cosmetic content. Pre-screen the materials, or use a curated box.
Process any body-comparison material carefully. Do not set any weight or food goals.

Children and young people. The literature reports use with school refusal, developmental disorders and school-age groups. [source: Aoki 2009, pp. 31–32; Kochi reference list]

Get the young person's assent and parental or carer consent, appropriate to their age.
Agree in advance who sees the work. Parents should not receive interpretations of it.
Use age-appropriate magazines.
Follow local safeguarding and mandatory-reporting procedures whenever a child discloses harm, in words or in a work. Respond to the disclosure, not to an inferred meaning of the images.
Never treat a collage as evidence of abuse. There is no validated diagnostic manual for collage in the sources.

Cultural fit.

Magazines carry cultural norms. Offer materials that reflect the client's culture, language, ethnicity, gender identity and age, and ask whether the materials feel relevant to them.
Reading frameworks drawn from the Japanese and sandplay traditions, such as "centre = self", are hypotheses, not universals.

Confidentiality of works.

Treat collages as clinical records.
Get written consent for photographing, keeping, teaching or publishing them, and collect only consented works for research. [source: Aoki 2009, p. 33]
In research, name the material set used. [source: Material Set guidelines 2022]
Agree what happens to works when therapy ends.

Scope.

If you are not trained in collage therapy or art therapy, use collage as a supportive or expressive task, not for interpretation.
Get experiential training, for example through the JCTS in Japan, and supervision before interpreting a series. [source: JCTS 21st training seminar flyer; Material Set guidelines 2022 (therapist must have made a collage with the set)]

Sources

Sources:

Further pages:

Cited via Naito: Sugiura, K. (1993), pp. 11–33, the source of the ten-category scheme for sorting collage box pieces (cited by Naito; probably a chapter of Moriya et al. 1993). [uncertain]

Books and papers cited:

Moriya, H. (1988). Use of collage (cut-and-paste play) in psychotherapy. Seishin Shinkeigaku Zasshi, 90(5), 450.
Moriya, H., Sugiura, K., Irie, S., & Yamanaka, Y. (Eds.) (1993). Introduction to Collage Therapy (コラージュ療法入門). Sogensha.
Moriya, H. (1995). Children's Art Therapy: Sandtray, Drawing and Collage. Kongo Shuppan.
Moriya, H., & Sugiura, K. (Eds.) (1999). Collage Therapy. Gendai no Esprit 386. Shibundo. Includes Irie et al., roundtable on the origins of collage therapy, pp. 5–28.
Moriya, H. (2012). Practical Guide to Collage Therapy: From Its Origins to Assessment. Kongo Shuppan.
Sugiura, K. (1991). Therapeutic factors of collage therapy. Nihon Ika Daigaku Kiso Kagaku Kiyo, 12, 21–28.
Imamura, Futamura, Kato, & Imamanda (2019). Collage Therapy: Reconsidering from Materials. Nakanishiya.
Sugiura, K., & Kanemaru, R. (2025). Hajimete no Collage Ryoho. Shinyosha.

Not verified [uncertain]: who proposed the collage box method, the standard collage box contents (Sugiura's 1993 ten categories), the procedures for the group, rotating, life-graph and postcard collage formats, and the text of Moriya (1993, 2012) and Sugiura and Kanemaru (2025). Verified: the six-stage questioning sequence (Ohmae 2012), and the society's founding, training route and workshop structure.

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