Resources and Links

Suri, R. (2012). Sandplay: An adjunctive therapy to working with dementia. International Journal of Play Therapy, 21(3), 117–130. https://doi.org/10.1037/a0027733

https://worldsandtherapy.org/

Prologue

I’m so glad you’ve decided to join me today. Life is busy, and there are thousands of other podcasts you could choose, so I’m honored that you have picked this one. Our download numbers have been very encouraging, so thank you!

Our topic for this episode is sand therapy. Some call it sandplay therapy, some sand tray therapy, and some use the universal title of sand therapy to include all therapeutic uses of sand tray work. Sandplay is a specific term that refers to psychological work done with a trained sandplay therapist. It’s fascinating work, largely building on Jungian theory, and includes lots of symbols and archetypes and delving into the collective unconscious. As you can tell, it requires extensive training, including doing your own analysis. You can learn more about becoming a certified sandplay therapist at sandplay.org. The Handbook of Sandplay Therapy by Barbara Turner is a great resource for learning more, too.

Most counselors, social workers, psychologists, marriage and family therapists, and other helpers use sand tray therapy, which has looser guidelines about the tray size and color, the type of sand, the types of miniatures and how to use it all. This is what I use. I like Homeyer and Sweeney’s book Sandtray Therapy: A Practical Manual for a comprehensive how-to. I am not trained in sandplay.

Now, I’ve got to tell you that of all the expressive arts that we will talk about this season, this one was the one that scared me the most… until I started using it. It seemed so elusive and “out there” to me. I had trouble imagining how it would work. But, with some training and willingness to try something outside my comfort zone, sand tray has become my favorite of the expressive arts. Now, I can’t imagine doing therapy without this available. Maybe it will become one of your favorites, too. Maybe it already is.

Sand in Therapy

Sand therapy is an amazing way for you to both see a client’s work. It looks pretty different with children versus adults, but it offers a place to bury, hide, battle, escape, barricade or reach up to the spiritual. The miniatures chosen to represent people and things provide rich information. And movement in the tray indicates inner change. For those who enjoy that left-brained analytical part of helping others, work in the sand provides plenty of themes and subtle information.

The tray provides a boundaried context for the work. I don’t interpret sand tray work. In my theoretical approach, I leave that up to the client. But I do notice things, and with older clients, I’ll ask questions about them. Things you want to notice about the client’s work and the tray include things like: are they doing work outside the tray, on the edges of the tray, or completely within the boundaries of the tray.

The sand provides a grounding context. Literally, it’s dirt. Some clients may just talk and run their fingers through the sand or make patterns to calm and soothe, grounding themselves. With the sand, you want to notice what is above and below. Clients will often bury what they aren’t ready to address, putting it out of sight… but it’s still there in the sand. My Jungian friends would say this is what is below the conscious level. Of course, clients may also bury in a literal sense when expressing grief and loss. Sand is a moveable medium, so clients can make hills in the sand and elevate certain things. Often this has a spiritual context.

If you use a tray with a blue-colored bottom, then clients can also use that as a representation of water. This can provide boundaries separating parts of the tray or represent a journey. Some clients may even use the water to show a place of rest or refreshing. Some counselors will have actual water available to use in the sand, which makes it firmer and moldable. Some will have a wet tray and a dry tray to make sure that the next client always has a dry tray to work with or one to switch out for the next client.

The miniatures are what make this such a visual medium. It allows clients to work in metaphor and from a third-person perspective, and I think that distance seems to really help some clients to delve deeper. With miniatures, clients can represent a parent as a kitten or a predatory lion, and at first sight, you begin to understand that client’s perception of the situation. With miniatures representing people, you want to notice obvious characteristics, but also how close they are to others, any groupings of people and who is outside the group, and any size differences. Not always, of course, but usually the bigger one has more power.

Other miniatures will give it context, so trees, rocks, houses, and so on are important to have available. Some help clients navigating transitions, things like bridges and pathways. Transportation miniatures (things like cars, planes, rescue vehicles, etc.) are useful for the ability to come or leave or escape a situation. Soldiers can battle, and don’t we have a lot of battles in life? See how metaphors work so well in the sand?

What Materials Are Needed?

At a conference once, I heard someone joking refer to those who use sand therapy as hoarders. The supplies used in sand can quickly multiply and take over a space. Some practitioners have an entire room dedicated to sand therapy, with rows of shelves crammed with miniatures. I found that the more I used this expressive art, the more I found that I wanted to add to enrich the options available to clients. Too much can be visually overwhelming, but it is certainly a temptation. But, you can create a small sand tray that is light enough to be mobile and still do deep counseling work.

The first material that you need is sand. This sounds simple, but there are really a lot of options. I personally think that if you do sand work, you should have at least one tray with traditional, brown sand. You can buy a big bag of sand for about five bucks at a home improvement store. If you want to reduce dust and bring out the shiny bits, then wash it in soapy water, rinse and let it dry completely. This is probably a good idea every once in a while with a little bleach to reduce germs. But, you might also want a tray or two with other types of sand. Some like to use Kinetic sand. It’s more expensive, but so much fun to play with…. and your clients might like it, too. My kids love this. You might also explore using different colors of sand. Jurassic Sand is a company that offers plenty of options. I would recommend using higher quality colored sand instead of craft sand, like that used for art bottles, which is finer and might make for itchy noses. While I think clients will do their work with the tools available, I have found that the kind of sand used makes a difference in the way they do their work.

Next, you need a tray to hold the sand. Sandplay therapists follow specific guidelines on the dimensions of the tray and the rectangular shape. According to the sandplay therapists of America website the standard size is 19.5 inches by 28.5 inches and is 3 inches deep. The inside of the tray is blue to represent water and sky. However, sand tray practitioners use all different kinds of sizes and shapes, and they may or may not be blue inside. The first time I attended a training with Dr. Linda Homeyer, I saw a photo of an octagon tray and I thought, “I didn’t know you could do that!” Since then, I’ve used cake pan-sized round trays, too.

So once you have a tray with sand, you need miniatures. You don’t have to have a room full of miniatures, but it is helpful to have some miniatures in these categories: people, animals, nature objects, bridges, barriers, the elements (fire and water), vehicles, sacred symbols, mythical creatures, and other metaphoric representations. You want these to be small enough to fit well in the size sand tray that you use, but you also want varied sizes. Tiny, fairy garden ladybugs convey different things than a cockroach that is twice the size of what represents the client. Varied sizes of similar things also help to show families. Some like to have a basket for the client to use to collect the miniatures they choose to bring to the sand.

Next, you’ll need a few tools for smoothing the sand, raking it, scooping and dumping. These are for your clients, but you also will need to be able to start every session with a smooth tray of sand. The very best smoothing tool I have used is a heavy cardboard paper plate cut in half for a nice, wide edge.

Finally, you’ll need a way to display the miniatures. There are lots of options, but carefully consider you and your client’s threshold for visual clutter. Many people use rows of thin shelves and group the miniatures by category. With this method of organizing, the client can see everything available by looking around. The challenge to this is that it requires you to put everything back in the same place and potentially get irritated if certain miniatures are prone to falling over. Another method is to group miniatures in bins that are labeled. This reduces visual clutter, can create a tone in your office by the type and color of bin used, and may make it quicker for a client to find what is needed. The drawback is that a bin labeled “vehicles” doesn’t help with a right-brained, nonverbal selection of an ambulance when the client doesn’t know why she picked it yet. Some people like to be able to put them away or pull them out as needed with clients. I know someone who used an old video cassette storage case that could be opened or closed, but when it was open, all the miniatures were lined up and grouped on the shelves. Play therapy people are so creative!

Prompting or Not?

I’ve said before that I am strongly person-centered in my theoretical orientation. The great thing about having a theory is that it helps you conceptualize how you do this work with clients, but theory doesn’t pigeon hole you into only a specific way of doing things. As you become more solid in working from your theory, you will start to integrate other things, but the way you integrate them is guided by your fundamental theory. Who you are is an essential part of your work. For me, this means that I am as non-directive as I can be while being very attuned to the therapeutic relationship. I facilitate empathy, genuineness and unconditional positive regard. When a client is unsure how to proceed or has a strong need to people please, however, they may need a little directiveness to be able to proceed. So, I prompt when using the sand in therapy. I prefer the most open-ended prompt I can use with the assurance that clients can do it however they like, but I will be more directive when needed, because preserving the safety in the relationship is fundamental to my theoretical orientation. I like prompts like, “Show me that in the sand” or “Show what that experience was like” or even “Show me that nightmare or dream.” As you can tell, I gravitate towards “Show me” prompts, including show me feelings.

Some people prefer more specific and more directive prompts. That works, too. I like to use sand trays in play therapy supervision, and then, because it isn’t therapy and because I have to be very aware of time, I will suggest more specific prompts like, “Show me what it is like to be at your site with your site supervisor” or “Use whatever miniatures or other things in this room you like to show us a case conceptualization of that client.”

Prompt according to your purpose and your theory.

Sand Therapy Across the Lifespan

Children

With young children, you might opt for a sandbox rather than a sand tray. They may even want to put their feet in the sand. You could use a smaller sand tray, too. With younger clients, their play in the sand is often fluid and story-based. They will act out battles, move miniatures around, bury and dig up, and repeat. They usually approach sand work like they do other play, so storytelling and role-playing are common ways that kids use sand. I almost never ask children questions about their work because they usually can’t articulate abstract thinking yet. They often don’t recognize the symbols and metaphors, but don’t let that fool you into thinking they aren’t doing some deep level work.

Adolescents

Adolescents may or may not get excited about figuring out what the symbols mean, depending on where they are in their cognitive development. Some may think this mysterious expressive art will reveal all, which could be intriguing or frightening. Even if you don’t make interpretations, older adolescents may feel scrutinized or concerned they will reveal too much. Many, though, will find this less threatening than typical talk therapy as they can look at the sand tray and not have to make eye contact as they explore vulnerable areas. Generally, adolescents and older will create more static sand trays, scenes that they may adjust and change, but usually aren’t continually changing as they talk.

Adults

Adults, in my experience will do deep and quicker work in the sand tray. Because this may be something new and different, adults tend to need a prompt to begin. Then, they need to assemble the tray in silence. I may do some reflecting, but if the client is silent, I will usually sit back and watch quietly, too. During this part of sand work, talking or asking questions moves them out of creative right-brained work and into cognitive left-brained work, which may be disruptive to the work. Of course, all clients are not the same, so some will talk you through their process as they are selecting miniatures and setting up the sand tray. Take your cue from your client.

I’m not sure if it is me or the nature of doing sand therapy, but I find that this expressive art seems to go deep, touching core needs and areas that are harder to access through talking. As a result, it often brings forth strong emotional and sometimes somatic responses. The pattern that I tend to see is this. The client sets up the scene in the sand, we begin to verbally process what they have created, we get to a deep, core need, a strong feeling response happens, we sit in the pain together, then the client is able to begin to make changes in the tray. So, if you use this expressive art, you must be comfortable sitting in the stuck with the client for a bit. Before rushing in to rescue the client from the discomfort, allow them to experience it in safety. Then, a gentle, “What would you like this to be like instead?” may facilitate moving out of that stuck place and into healing.

Interview with Timothy Hollar

[The interview portion of this episode was not transcribed. To listen to the interview click the episode link at the top of the page.]

Research Summary - Sandplay with Dementia

When we think of sandplay or sand tray work, we typically think of it as a modality for kids. But what if sand tray therapy could actually be beneficial for several age groups, including older adults! After all, that is the theme of this podcast—play therapy across the lifespan. So today I’m going to talk about an article published in 2012 in the International Journal of Play Therapy titled, “Sandplay: An Adjunctive Therapy to Working with Dementia.”

The American Medical Association states that 1 in 14 people over 65 will develop dementia and that this number continues to rise because people are living longer. Clearly, this is a neurological disorder that affects many people and their loved ones. CBT is the most widely used psychological treatment for dementia; though, studies have also shown that music therapy, art therapy, and family therapy are also effective.

Sandplay is rooted in Jungian psychology which posits that humans have a fundamental drive for wholeness. In sandplay, the client is presented with a rectangular sand tray with a blue bottom, which provides the impression of water. Clients are given access to diverse miniatures and they are free to create whatever they wish in the sand. Their sandplay isn’t analyzed or judged in the session. Over a few sessions, the client and the therapist together will view the completed sand tray and at this point, the therapist may offer an interpretation or point out themes.

In this modality, there is an emphasis on bringing the unconscious to consciousness, which may be particularly beneficial for people with dementia, many of whom experience difficulty due to a loss of cognitive functioning. This can be really confusing and often frustrating for a person who used to be fully functioning. In more severe stages of dementia, clients can experience a loss of language, so verbally expressing oneself may seem difficult or impossible.

This is one reason that sandplay may be of relevance to working with this population. Another reason is that people with dementia have a better long-term memory compared to short-term memory. Therefore, sandplay may be a way for them to work through the past and reflect on their life experiences. And because people who have dementia typically experience developmental regression, a nonverbal modality like sandplay may be a noninvasive and safe modality. And lastly, from a neurobiological perspective, there is emerging evidence that links growth and recreation of brain cells and neurons with sandplay therapy.

The author of the article shares two case examples that demonstrate these principles with individuals with dementia. She also references research completed in 1995 by Akimoto, who used sandplay therapy with brain-injured elderly clients. In that research, Akimoto says, “The sand trays seemed to reveal the patient’s latent capacities, whereas intelligence testing highlighted their deficits.” How powerful is that?! Sand tray work has the capacity to be a real source of hope, self-expression, and meaning for a population that typically gets overlooked.

Conclusion

I want to thank our Sand Technique guest, Timothy Hollar for that great idea for ending work in such a meaningful way.

I’ve given you a lot of information today, but it only touches the surface of using sand in therapy. You need training to ethically use this expressive art, extensive training if you are interested in sandplay, but the good news is that workshops are more readily available than in the past with the growing interest.

Here are your action steps if you want more knowledge about using sand in your therapy work. If you want to learn more about becoming a certified sandplay therapist, check out sandplay.org. At this point, I’m not aware of a national credential for sand tray, but there is a new organization forming to include all practitioners who use sand in therapy. You might want to get involved there or attend the first conference in May of 2020. You can learn more at worldsandtherapy.org.

Finally, I want to leave with you one bonus tip. A fellow therapist shared this with me, and it is now my favorite self-care tip for transitioning out of work and preparing to go home and leave my work at work. I do my own sand tray at the end of the day. It’s my tray, so it can include client or student concerns that I’m carrying, my own life challenges, problems that I am working on, or any other stressful things. I put it all in the sand tray, pause for a couple of minutes to review it, and then put the miniatures away, symbolically putting them away for the day and leaving them in the office. I don’t get to process these with someone else, but I’ve found it to be a really helpful practice that settles my mind and allows me to not bring all that psychological work home with me. Maybe it will help you, too.