Published: October 2026

Keywords:
Visual representation, presenting concern, systemic psychotherapy, polyphony, narrative therapy.

Vicky Pappa

Vicky Pappa is a Psychologist and Systemic Psychotherapist. She holds a degree in Psy-chology from the Aristotle University of Thessaloniki.

She completed her clinical internship at the Adult Psychiatric Department of “Hippoc-rates” General Hospital in Thessaloniki. She has also worked as an educator in private educational institutions, delivering scientific presentations and facilitating psychology workshops.

She has worked in UNICEF Child Protection programmes supporting refugee popula-tions, where she provided individualised psychological support to children, adoles-cents, and families. Her responsibilities also included facilitating psychosocial support groups and parenting support groups, as well as contributing to the design of preven-tion and intervention programmes addressing gender-based violence involving adults, children, and adolescents.

She participated, alongside other mental health professionals, in a crisis intervention programme aimed at providing psychological support to Greek railway employees fol-lowing the Tempi train disaster.

She has also volunteered in programmes supporting vulnerable populations and edu-cational interventions organised by the non-governmental organisation PRAKSIS, in-cluding the Mobile School project and the Day Centre for Homeless People in Thessalo-niki.

She currently works in private practice in Thessaloniki, providing psychotherapy ser-vices to adults, adolescents, couples, and families. She also collaborates with the Centre for Applied Psychotherapy and Counselling (KEPSYSY) at its Thessaloniki branch.

Maria Prenga

Maria Prenga is a psychologist and psychotherapist based in Thessaloniki, Greece. She holds a degree in Psychology from the Aristotle University of Thessaloniki and a Master’s degree in Social Psychiatry from Democritus University of Thrace. She has completed a four-year training programme in Systemic Family Therapy at the Institute of Systemic Therapy of Thessaloniki.

During her studies, she completed internships at the Child Psychiatry Department of Hippokration General Hospital of Thessaloniki and the First University Psychiatric Clinic at Papageorgiou General Hospital. She also participated in an educational visit to mental health services in Trieste, Italy.

She has collaborated with ARSIS–Association for the Social Support of Youth, providing psychosocial support to refugees, and with a therapy centre, offering psychological support and counselling to children and parents. Since 2022, she has been working as a psychologist at the Home-Based Psychiatric Care Service of SYNTHESI, a non-profit civil company operating in Thessaloniki, providing psychological support to people experiencing severe mental health difficulties. Alongside this role, she maintains a private practice, offering psychotherapy and counselling to adults, couples and families.

Her professional interests include systemic psychotherapy, recovery from extreme mental health experiences, psychosis, human development, gender-based violence, human rights, and refugee-migration issues. She has published articles in Cinobo Journal and PsychologyNow.gr. She has also designed and facilitated the experiential workshop Understanding Image Based Sexual Abuse, in collaboration with DataWo and with the support of ActionAid Hellas and Cinobo. She is actively involved in theatre, literature and painting, and is particularly interested in the contribution of the arts to mental health.

Abstract

This paper explores the potential of visual representation as an alternative language for approaching the presenting concern in psychotherapy, drawing on systemic, social constructionist, and dialogical perspectives. The presenting concern is understood as a narrative open to reinterpretation and transformation, rather than as a fixed description of a problem. The paper examines how a shift from verbal language to visual representation may elicit multiple perspectives and alternative narrative possibilities. As part of a small-scale exploratory and reflective inquiry, 28 mental health professionals were invited to select one image from a set of 31 that they felt best represented the presenting concern in a shared fictional couple therapy scenario, and to give their chosen image a title. Participants selected 13 different images and assigned them a variety of titles; these images and titles were then assembled into a digital collage. This multiplicity of representations illustrates how the same therapeutic concern can be interpreted in different ways, without privileging a single or definitive understanding. Although the process did not itself constitute a polyphonic dialogue, it provides an opportunity to reflect on how images may expand therapeutic conversations. Finally, the paper discusses potential applications of visual representation in therapy and supervision, emphasising its role in the co-construction of meaning and the emergence of alternative narratives