Building Capacity: Six Ways to Use Bricks, Blocks, and Tiles in Clinical Work
If you’ve ever handed a client a bin of bricks, blocks, or tiles “just to build rapport,” you already know how fast the room can change. Hands get busy, shoulders drop, and suddenly a client who had very little interest in answering your questions is building, experimenting, showing you things, commenting on what you’re making, or narrating an elaborate story about why that tower absolutely needed seventeen windows. What’s easy to miss in that moment is that building doesn’t become an intervention simply because a clinician put materials on the table. The clinical work is in what happens around the build.
There are dozens of ways to use building clinically, and just as many things to build with. LEGO, Tegu, Magna-Tiles, Jelly Blox, Plus-Plus, K’NEX, GobiDex cubes, and a bucket of ordinary wooden blocks all make different things possible. The six structures below aren’t protocols or activities to reproduce step by step. They’re ways of organizing the interaction — and your own attention — around what you’re asking of a client, how they respond, what the two of you notice, and what happens next. They can overlap, change halfway through a session, and work differently depending on what you put on the table.
The examples aren’t prescriptions either. They’re snapshots of what each structure might look like when it meets an actual clinical need.
Open-Ended Building: when the goal is expression or engagement. Here you put out building materials and get out of the way. No steps, no agenda — just simple prompts like “tell me about this part” and reflections that stay with the client’s themes instead of steering them.
Sometimes the build becomes representational and gives a client another way to communicate about family dynamics, recent events, or experiences they don’t have words for yet. Sometimes nothing symbolic emerges at all. The building simply creates a way of being together that asks less of direct conversation and makes interaction more accessible. Both can be clinically useful.
For example: A clinician is working with a child who reliably answers questions with the minimum number of words necessary. A couple of efforts to get a conversation going have produced little beyond “fine,” “no,” and “I don’t know.” Rather than asking better and better questions, the clinician pulls out the building materials and says, “Let’s just build.” Maybe it’s LEGO, maybe Magna-Tiles, maybe Jelly Blox — whatever the child is inclined to pick up and use. The clinician builds too, noticing what changes when conversation is no longer the price of admission. Maybe the child comments on a piece, narrates what they’re making, incorporates the clinician’s creation into their own, or says almost nothing but begins interacting through the build. The intervention isn’t tricking the child into talking. It’s changing the conditions under which interaction is being asked to happen.
Instruction-Following Building: when the goal is navigating demands. Following instructions can target planning and sequencing, but sometimes the clinically relevant part isn’t whether a client can follow directions. It’s what happens when something outside of them tells them what to do. For some clients, the experience of a demand itself can trigger an involuntary threat response, including when the requested action is something they enjoy, want, or would otherwise choose for themselves. A complex LEGO, K’NEX, or Plus-Plus set can create an unusual situation in which an externally structured sequence is attached to something the client genuinely wants: the instructions are how this particular spaceship, roller coaster, animal, or elaborate contraption becomes possible.
For example: A teenage client experiences almost any directive as activating, even ones attached to things they actually want — being told to grab their coat, sit down, or start homework can trigger the same response as being told to stop something they’re enjoying. The clinician brings in an elaborate K’NEX set connected to one of the teen’s interests, ambitious enough to require sustained instruction-following across dozens of steps. The teen wants the finished coaster, but getting there means repeatedly encountering the demand built into “Step 1, then Step 2, then Step 3.” The clinician notices where activation begins and helps the teen experiment with ways of preserving agency while navigating the structure: perhaps they decide when to start, keep possession of the instruction book, choose when to pause, or decide how help will be offered. The goal is building more room between something is asking something of me and a threat response that can make even wanted activities inaccessible.
Client-as-Teacher: when the goal is competence and agency. Flip the expertise. Instead of teaching the client how to build something, ask them to teach you. This works particularly well when a client already has expertise with a particular building medium. The clinician’s job is to genuinely occupy the learner position: listen, attempt what the client describes, ask questions when you don’t understand, and let their knowledge determine what happens next. This works because the expertise is real. Performing incompetence about something you already know how to do is a different interaction entirely.
For example: A quiet child who tends to disappear into other children’s ideas is especially skilled with Magna-Tiles. The clinician gets them out and asks, “Will you show me how you build your cool trains with these?” Now the child actually knows something the clinician doesn’t. They choose the pieces, demonstrate the technique, correct the clinician when they get it wrong, and decide what the clinician needs to know next. Communication gets practiced along the way, but the larger experience is one of demonstrated competence: I know how to do this. Someone else can learn from me. The same structure could happen with a client who can make astonishingly intricate Plus-Plus designs, knows exactly how K’NEX pieces fit together, or has figured out things to do with Tegu that the clinician genuinely hasn’t.
Collaborative Building: when the goal is relational. Ask two or more people to make one thing together and an impressive amount of relational material can appear without anyone being asked to describe their relationship. Your job is less about the quality of the finished product and more about noticing how decisions get made, how influence moves between people, whose ideas survive contact with the group, and what happens when priorities differ. Those observations become material for curiosity, something the clinician and family can explore together.
For example: A clinician gives a family a pile of building materials and asks them to build a home together. What happens next is the interesting part. Does everyone immediately argue about who gets to build the walls? Does one person decide where every window goes while everyone else follows? Does the family divide the project into territories — you do the roof, I’ll do the walls, someone else can landscape — or do they negotiate each decision together? There isn’t a correct way to build the house, and none of those choices tells the clinician what the family “really” does outside the room. Instead, the build gives everyone something concrete to wonder about. You three split that up incredibly quickly. Is that usually how you get things done together? Or, I noticed everyone had an idea about those windows. What was happening there? Notice first, get curious second, and let the family help make meaning of what happened.
Constraint-Based Building: when the goal is cognitive flexibility. Constraints don’t have to mean artificially withholding the red bricks or imposing arbitrary rules. Sometimes changing the properties of the medium creates enough constraint all by itself. When difficulty adapting to changed circumstances is already interfering with something a client wants or needs to do, a familiar building activity can create a smaller and lower-stakes place to explore what happens when Plan A stops being available. The goal is helping the client discover flexibility that serves something they want or need — and to find that flexibility on their own terms rather than shaping it around the clinician’s preferred Plan B.
For example: A 19-year-old client, recently living independently for the first time, frequently has a clear picture of how something is supposed to work and gets stuck when the available circumstances can’t support that plan — a pattern that shows up as much in a scheduling conflict at work or a dispute with a roommate as it does in a session. LEGO building has been going well, so the clinician brings out GobiDex cubes and invites the client to try building the kinds of things they usually make with LEGO. The cubes don’t offer the same range of tiny pieces and specialized shapes. What happens when the usual strategy simply isn’t available? Maybe the client experiments until they find another way to represent the same idea. Maybe their elaborate LEGO architecture becomes decidedly Minecraft-esque because cubes are cubes and there is only so much one can reasonably ask of them. The useful part is figuring out alongside the client what makes adaptation possible when reality refuses to cooperate with the original plan.
Repair/Rebuild Tasks: when the goal is persistence. For this structure, you need a task where something might genuinely not work. This makes sense when setbacks tend to interrupt a client’s access to things they actually want to keep doing — perhaps a mistake ends the homework attempt, losing a game means leaving the activity entirely, or frustration makes it difficult to return to a project even after the feeling itself has passed. Rather than deliberately destroying something a client has invested in, choose a task and medium where failure is an ordinary feature of the challenge: build the tallest tower you can, make a bridge that can hold progressively more weight, or create a vehicle that can survive the length of a track with hills and speed bumps.
For example: A client who has difficulty returning to activities after something goes wrong is trying to build a Magna-Tile tower taller than the table. It gets impressively high, somebody bumps the table, and the whole thing comes down. There it is: a real setback inside something the client wants to be doing, without the clinician having to manufacture one. What happens next might be taking a minute before touching the pieces, figuring out why the base failed, asking the clinician to stabilize one side, deciding the second tower doesn’t actually need to be quite so absurdly tall, or trying the exact same ridiculous plan again. Persistence doesn’t have to mean gritting your teeth and reproducing the original attempt. The clinical opportunity is in discovering what helps this client regain access to purposeful action after disruption.
The same observable behavior can mean something different depending on the structure around it. A client insisting on doing everything themselves during an open-ended build may give you something to wonder about in the story they’re telling. During a collaborative build, the same behavior gives you something to get curious about together regarding shared activity. During an instruction-following task, it might raise questions about help-seeking, the usefulness of your support, their experience of external direction, or simply what they think of your instructions. Behavior gives you somewhere to look, a starting point for wondering what it might mean.
The building medium isn’t neutral either. LEGO bricks, Tegu blocks, Magna-Tiles, Jelly Blox, Plus-Plus pieces, K’NEX, and GobiDex cubes don’t just make different-looking things. They ask different things of the person building with them. Their size, resistance, sensory qualities, visual complexity, connection mechanisms, stability, and range of available shapes all change the task.
Those differences aren’t incidental. Choosing the building medium is part of designing the intervention. If manipulating the material takes most of a client’s available motor, visuospatial, or sensory-regulation capacity, that demand can obscure whatever you actually intended to explore or practice. On the other hand, sometimes those properties are exactly what you want to work with. Adapt up, down, or sideways: larger pieces, fewer pieces, pre-sorted materials, a squishier material, a less stable connection, more representational possibilities, fewer of them, or a completely different building system.
The goal isn’t to make the build universally easy. It’s to know what you’re making hard and why.
That same principle applies to the clinical structure. You may know what you intend to work on when the materials come out, but the client will give you new information as soon as the activity begins. Follow it. A task designed around sequencing may reveal that the instructions themselves are creating a barrier. A collaborative build may suddenly produce something the family wants to talk about. A constraint intended to practice flexibility may show you that the client has an excellent reason for refusing it. Intentionality doesn’t mean forcing the activity to keep serving the purpose you assigned it before the session. It means being able to say what you’re doing, why you’re doing it, what you’re noticing, and why what happens next makes sense in response.
The same structure can serve different clinical purposes, which is why the purpose has to be explicit in the documentation. Instead of “client engaged well with building activity,” you get something closer to “clinician supported client in completing a structured building task to target planning and sequencing related to difficulty completing multi-step routines at home” — followed by what the client actually did, what support changed their ability to engage, what you learned, and how that connects to functioning outside the session. A structured activity doesn’t become medically necessary just because you can attach a clinical skill to it. The connection has to run all the way through: an identified need affects the client’s functioning, the intervention addresses that need, and the client’s response gives you information that matters for treatment.
Sometimes that happens with a $200 LEGO set. Sometimes it happens with a pile of Magna-Tiles, a handful of Tegu blocks, or some Jelly Blox that have already collected every piece of lint in the office. The materials give you possibilities. Clinical work happens in what you and the client do with those possibilities — how you structure the build, how they respond, what you notice together, and where you go from there.
