What Is Sand Tray Therapy?

Sand tray therapy, which is sometimes called sandplay therapy, is used for individuals who have experienced a traumatic event such as abuse or a catastrophic incident. Although this type of therapy is used most often with children, sandplay therapy also can be helpful for teens and adults.

When utilizing this therapy, psychotherapists use sand trays to assess, diagnose, or treat a variety of mental illnesses. Research shows that sand tray therapy also can help increase emotional expression while reducing the psychological distress that may come from discussing traumatic events or experiences.

What It Involves

Sand tray therapy is a combination of play therapy and art therapy. The therapist provides the client with a tray or box filled with sand as well as a variety of miniature toys to create a play world. Toys may include anything from farm animals and dinosaurs to people and cars. Trees, fences, gates, doors, and buildings are common as well.

Clients choose which toys to incorporate into the tray and arrange them in any way they want. Meanwhile, the therapist mainly serves as an observer and rarely interrupts the client.

Those who offer this type of therapy believe clients will create a world that represents their internal struggles or conflicts. After the sandplay is complete, the therapist and client typically discuss what was observed—the toys that were chosen, how they were arranged, and any symbolic or metaphorical meanings.

The client may then choose to rearrange the toys based on the discussion. Sand tray therapy may also include talk therapy, other types of play or art therapy, or other types of treatment.

How It Helps

Sand tray therapy was developed by Dora Kalff, who was inspired by working with Margaret Lowenfeld, a British child psychiatrist and developer of World Technique. Kalff's Jungian-based theory also was influenced by Buddhist contemplative practices.

This therapy is based on the notion that if a therapist provides the client with a safe space, the client will use the sand tray to create solutions to their problems on their own.

Research also shows that sand tray therapy reduces symptoms of many mental health issues and increases resilience. Because sandplay therapy is unstructured, it allows clients to experience healing through the therapeutic process.

Clients free themselves of deep-seated negative emotions during sandplay therapy, because they can express their inner thoughts while feeling accepted by the therapist.

Sandplay also may help therapists delve into the meanings that clients develop and assign to their experiences by monitoring their engagement with the toys, or symbols, they choose to play with.

Additionally, sandplay therapy is often a pleasurable sensory experience facilitating the natural expression of emotions. It may be used as part of individual, group, or family therapy.

What the Research Says

Studies show sand trays are an effective way to treat a variety of problems and can be used in many different populations. For instance, a study conducted on 4- and 5-year-old children with externalizing behavior problems demonstrated that these children showed less aggressive behavior after 30 minutes of group sandplay. They participated in therapy twice a week for 16 sessions.

Another small study in Korea included three children who had witnessed domestic violence. It found that supportive music and imagery combined with sandplay therapy improved emotional and behavioral adaptability after six individual sessions. Meanwhile, another study evaluated sandplay of migrant women in Korea. The researchers found that group sandplay therapy produced positive self-expression and reduced negative self-expression.

And in China, a study involving boys with Asperger's Syndrome—which the DSM-5 has since retired as a diagnosis and replaced with autism spectrum disorder—combined sandplay therapy with other forms of treatment. It concluded that sandplay therapy helped develop the boys' psychological well-being and interpersonal communication skills.

Researchers theorize that sandplay therapy may help vulnerable, pre-verbal children with trauma, making it a good strategy for those who are too young to talk about their traumatic experience.

A study supporting this theory was conducted on a 3-year-old orphan with human immunodeficiency virus (HIV). Researchers found that sandplay therapy provided the child with emotional support.

What to Expect

When sandplay therapy is used as part of a treatment plan, the therapist may provide a sand tray and then look for common themes that indicate insecurities or aggressive behavior, as well as resilience and positive emotional expression.

Sand tray sessions may be 30 to 60 minutes in length and scheduled weekly or bi-weekly. After arriving for a session, your therapist greets you and provides you with an empty sand tray and miniatures so you can get to work.

The therapist may ask to photograph your sand trays so the changes in the scenes you create can be reviewed over time. They might also take time to talk about your sand tray at the end of each session.

For example, your therapist might discuss what it might mean if the domesticated animals in your sand tray are caged while the more dangerous animals—like tigers, snakes, or dinosaurs—get to roam free. Together, you may find some meaning in the sand tray.

It’s also possible that there will be little discussion at all. Instead, the therapist may simply give you a safe space to work.

How to Find a Sand Play Therapist

While any psychotherapist may be able to provide sand tray therapy, some therapists are specifically certified in sandplay therapy. For instance, Sandplay Therapists of America offers a directory of certified sandplay therapists.

If you think that you or a loved one might benefit from sand tray therapy, start by talking to your physician. Your doctor may be able to refer you to a local therapist.

You also can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment options in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

It's not uncommon to wonder how using miniature toys in the sand is helping resolve any issues. But sandplay therapy allows therapists an inside look into things that may be troubling their clients. It's especially useful for people who have trouble communicating about stressors.

If you're concerned about the effectiveness of the treatment, express your concerns to your therapist. Together, you can come up with a treatment plan that meets everyone's needs.

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