How Sand Tray Therapy Works

British child psychiatrist Margaret Lowenfeld developed and began using sand tray therapy (also known as sandplay therapy and World Technique therapy) in 1929 to help children with mental health problems. Later used to help teens and adults, as well, the therapy employs small toys and sand in a tray as tools for the client to develop solutions and coping strategies.

Types of Play Therapy

Sand tray therapy is a type of play therapy. Other common types of play therapy include:

• Bibliotherapy, which uses literature to explore specific concepts or skills
• Cognitive behavioral play therapy, which uses play to help a child learn how to think and behave differently (such as asking the child to give their doll or stuffed animal advice on how to handle a stressful situation)
• Filial therapy, which aims to teach parents how to interact with the child through play
• Imaginary play, which uses toys such as dress-up clothing, puppets, and action figures to spark a child's imagination

Techniques

In sand tray therapy, a combination of play therapy and art therapy, the client creates scenes with miniature toys in a tray filled with sand. The toys include anything from farm animals and dinosaurs to people and cars. Trees, fences, gates, doors, and buildings are common, too.

Those who offer this type of therapy believe clients create worlds that represent their internal struggles or conflicts. After sandplay, 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.

What Sand Tray Therapy Can Help With

Sandplay therapy has been shown to benefit the following issues:

• Attention-deficit/hyperactivity disorder (ADHD)
• Aggression
• Anger management
• Anxiety disorders
• Autism spectrum disorder
• Depression
• Divorce
• Grief and loss
• Low self-esteem
• Physical and learning disabilities
• School-related problems
• Social issues
• Trauma and crisis

Benefits of Sand Tray Therapy

Research shows that sand tray therapy reduces the symptoms of many mental health issues and increases resilience. In addition, sand tray therapy:

• Can 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
• Is typically a pleasurable sensory experience that facilitates the natural expression of emotions as part of individual, group, or family therapy
• Can help increase emotional expression while reducing the psychological distress of discussing traumatic events or experiences

Effectiveness

Studies show sand trays are an effective way to treat a variety of problems and can be used in many different populations.

• A study in Korea found that sandplay therapy as part of school counseling led to improved self-esteem and significant changes in emotional problems in fourth- and fifth-graders.
• 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.
• In China, a study involving boys with Asperger's syndrome, a diagnosis that the DSM-5 has since retired and today would be considered level one autism spectrum disorder (ASD), 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.

Things to Consider

Some people view sand tray therapy as confusing and time-consuming or too dependent on the therapist’s clinical expertise, noting that the interpretations of sand pictures may be subjective or ambiguous. In addition,

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 your needs.

How to Get Started

If you think that you or a loved one might benefit from sand tray therapy, talk to your healthcare provider, who may be able to refer you to a therapist.

• Find a certified professional. While any psychotherapist may be able to provide sand tray therapy, some therapists are specifically certified in the approach. Sandplay Therapists of America offers a directory of certified sandplay therapists.
• Call your health insurance provider. Inquire whether sand tray therapy is covered and, if not, whether the therapist accepts payment on a sliding scale.
• Know what to expect. Sand tray sessions are 30 to 60 minutes long 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.
• Be prepared to answer questions. At the end of each session, your therapist may take time to talk about your sand tray. For example, they might discuss why the domesticated animals in your sand tray are caged while the more dangerous animals 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.