A well-grounded understanding of the complexities of the human psyche, the mechanisms of therapy, and of attachmentoriented and trauma-informed practice is essential prior to trauma recovery work with sandplay. Extensive experiential and theoretical training, first as a counsellor, and then as a sandplay specialist is essential. Despite its superficial simplicity, the ethical professional application of the sandplay therapy technique requires extensive training, on-going skills practice and regular clinical supervision.

In Switzerland in 1956, Jungian therapist Dora Kalff, mentored by C. G. Jung, developed sandplay therapy for providing therapeutic support for young clients, Her method grew from three sources: Dr Margaret Lowenfeld’s World Technique, the Analytic Psychology of C. G. Jung, and Eastern contemplative traditions (M. Kalff, 2013). Kalff found that the technique also offered a powerful support for adult clients, and soon attracted clients from across Europe and the USA (Kalff, 2003).

Kalff reported on the need to follow client interests and collaborate in offering emotional release activities and various forms of therapeutic art expression (e.g. painting, sculpting with clay) as an adjunct to work with the sandtray (Kalff, 2003). In contemporary counselling this flexibility would be congruent with pluralistic practice (Cooper & McLeod, 2011). The growing practice-based evidence literature, often presented in the form of case studies, has continued to document a wide variety of contexts in which sandplay therapy has supported therapeutic change. Among this literature are an increasing number of reports on supporting traumatised clients, of all ages in recovery from trauma, where sandplay has been used

When observing sandplay therapy in action, for example via a Youtube clip, it is tempting to see it as a very simple process: provide a client with small objects, a container, and the natural material of sand and they will set about constructing images that reflect their external and internal experiences. However, the shaping of sand, the selecting of miniature objects and creation of a sandpicture can be guided by both conscious or non-conscious logic. In the case of trauma survivors, it may be that the creative process emerges directly from implicit, sensorybased memory, and the client may have little to say about their spontaneous creation. This spontaneous creative process provides therapeutic benefit even without discussion or analysis. However, exploration of the sandpicture can be enhanced, if the client wishes, with verbal processing. In trauma-informed work, the verbal processing must be entirely at the wish of the client, and is more likely to emerge later in the therapeutic journey. 

The term ‘sandplay’ has become something of a generic term over recent years. There are several major traditions in using sandtrays and miniatures, for example, ‘sandplay therapy’ the style developed by Dora Kalff and often used by analytical psychologists (e.g. Aite, 2007; Ammann, 1991; Weirnrib, 1983), an evolution of Lowenfeld and Kalff’s work where psychotherapy is not indicated and most often conducted in group settings, now termed ‘expressive sandwork’ (Pattis Zoja, 2011). A more informal style of using sandtrays and miniatures has evolved directly from Lowenfeld’s work used in play therapy (e.g. Axline, 1971; Oaklander, 1988) is now termed ‘sandtray work’ (e.g. Katz & Rekayek, 2010; Mayes, Mayes, & Williams, 2007; Walker, 1998), and the self-discovery expressive therapies style of sandplay that integrates Kalff’s methods and principles within a creative arts context (Pearson & Wilson, 2001). A variety of practice methods exist, side-by-side with Kalff’s original style.

While Sandplay Therapy in Kalff’s style and in the Play Therapy tradition remains a spontaneous undirected process, there are also many reports in the literature of therapists creating somewhat structured activities using these materials. The directed approaches have been called ‘directed sandplay’ (e.g. Boik & Goodwin, 2000; Tennessen, & Strand, 1998) and ‘symbol work’ (Pearson & Wilson, 2001). Boik and Goodwin differentiate between spontaneous sandtray creations and directed processes, however pointing out that once subject matter has been suggested, the facilitation remains non-intrusive. Pearson and Wilson (2001) point out that the directed method of symbol work can be ideal for supporting clients facing an immediate crisis

 Traumatic events have the potential to overwhelm human adaptations and “generally involve threats to life or bodily integrity, or a close encounter with violence and death” (Herman, 1992, p.33). Trauma leaves neurological consequences. Evidence shows that early trauma is “expressed in right-brain deficits in the processing of social, emotional and bodily information” (Klorer, 2005, p. 214). Furthermore, severe maltreatment and lack of significant attachment figures in the early years also leads to adverse brain development (De Bellis, 2001). Traumatic memories appear to be stored in the right hemisphere, which makes verbal expression of trauma memories more difficult (Schiffer, Teicher, & Papanicolaou, 1995). For many traumatised clients reason and executive function may not be readily available, and in general, trauma memories are stored implicitly as sensory-based experiences. Therefore, therapists cannot depend on clients’ use of words. Therefore, the use of non-verbal therapeutic activities is recommended to allow contact with, and expression of, implicit memories (Steele & Malchiodi, 2012). Expressive therapies can provide these therapeutic experiences, and in addition, support the development of the therapeutic alliance with “a caring adult who provides opportunities to create and communicate” (Malchioldi, 2008, p. 153).

“Trauma-informed practice is a strengths-based framework grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological, and emotional safety for everyone” (Hopper, Bassuk, & Olivet 2010, p. 82). Counselling based on this premise creates opportunities for survivors to rebuild a sense of control and empowerment. Trauma-informed care and practice has recognised the prevalence of trauma and its impact on the emotional, psychological and social wellbeing of people (Hooper et al, 2010). What is needed then are ways of support that are sensitive to providing opportunities for clients to rebuild control in their lives.

Traumatised clients may come to believe that the world is threatening and bewildering, and people are neither predictable or trustworthy. This means the ‘need’ for control becomes paramount (Steele & Malchiodi, 2012), since the person responds to their surroundings from these beliefs. Therapists need to create relationships with clients and therapeutic settings that can begin to prove there are exceptions to these beliefs.

Kalff’s emphasis that a core component of sandplay therapy is the provision of a ‘safe and protected space’ (Kalff, 2003) suggests that, in the hands of an experienced, and regularly supervised counsellor, a client’s work in and around the sandtray, can provide a raft of benefits. For example, the therapy room and the sandtray itself provide freedom and containment; the therapeutic relationship engenders trust and safety, and the central therapeutic activity of using sand and symbols allows transfer of trauma from implicit to explicit mode. When memories can be played out safely, symbolically, and non-verbally the process allows resolution without the re-traumatising risk of being required to recount terrifying events.

Imagery has the most potential for therapy when it comes from the client, rather than being provided or imposed by the therapist (Klorer, 2005). In trauma recovery therapist “directives aimed at certain issues are not nearly as effective as the metaphors brought by the client” (Klorer, 2005, p. 218). Sandplay Therapy provides multiple options for clients to generate their own healing metaphors

For clients of all ages, violence toward the body and psyche is difficult to address solely with verbal therapy. A therapist will be well served by having a variety of modalities to rely on when dealing with clients with abuse histories (Zappacosta, 2013). It can also be both painful and potentially re-traumatizing to rely on talk therapy to act as the primary healing agent (Zappacosta, 2013).

Because, when using sandplay therapy, the hands are engaged in touching and shaping the sand, the process invites a regenerative relationship to the body, which has usually been deeply numbed in somatic reaction to abuse. The safety of touching the sand can invite the body to begin to return to a more natural state of aliveness rather than living in varied states of dissociation and compartmentalization (Zappacosta, 2013).

The impact of immigration detention on children was explored through a project where they created ‘worlds’ in the sandtray and from this generated stories to express their subjective experience (Kronick, Rousseau, & Cleveland, 2018). An analysis of the children’s sandtrays, and how they created the images, confirmed that the experience of detention was traumatic

Erik Erikson (1977), the esteemed child psychologist, identified three types of play: traumatic, cathartic and integrative. For young clients working through a traumatic experience, playfulness within a therapy session can help transform the process into one of renewal (McCarthy, 2006). Cathartic play, such as orchestrating long battles in the sandtray, allows the body to rid itself and the psyche of the destructive sensations and experiences of trauma that otherwise become deep-rooted, chronic problems. Cathartic play seen in battle scene in the sand creates a breaking apart of habitual form in the service of a new form (McCarthy, 2006). Cycles of destruction and construction within the sandtrayare very familiar to sandplay therapists. 

With young clients sandplay has been used to improvethe security of adolescent attachment schemas (Green, Myrick, & Crenshaw, 2013), and in group therapy (Flahive & Ray, 2007; James & Martin, 2002). Sandplay has been recommended as an ideal medium for traumatised young clients by a number of authors (e.g., Harper, 1991; Howe, 2005; Troshikhina, 2012; Webber, Mascari, Dubi & Gentry, 2006). Porat and Meltzer (1998, 2013) described the way sandplay has made significant inroads in the healing process of Israeli children impacted on by the trauma of war. McCarthy (2006) also described the way sandplay helps with somatic memory recovery after trauma. In addition, Lacroix et al. (2007) demonstrated the effectiveness of Sandplay Therapy with refugee children recovering from a tsunami. Sandplay has been utilised in the support of young patients recovering from serious illness; for example in hospitals (Miller & Boe, 1990), with those recovering from traumatic brain injury (Plotts, Lasser & Prater, 2008), and with those recovering from cancer (Mindell, 1998). Sandplay effectiveness has been noted as a major contributor to recovery in the treatment of children who have experienced sexual abuse (Grubbs, 1994; Harper, 1991; Hong, 2007; Mathis, 2001; Reyes, 2003; Zappacosta, 2013).

 A complex, longitudinal, qualitative study with sexually abused children, being treated with sandplay therapy found consistent themes played out in the trays: stories of violence, aggression between people, the need for care and protection and ways to resolve conflicts (Tornero & Capella, 2017). While these themes are very familiar to sandplay therapists, and described by Kalff from her extensive clinical observations (Kalff, 2003), it is helpful to have research confirmation that the shifting dynamics in the trays clearly evidenced therapeutic progress. Ultimately the work in the trays allowed these children to assign new meanings to their traumatic experiences (Tornero & Capella, 2017). This study also illuminated the way therapists can be co-participants in the clients’ processes of metaphorical reconstruction. 

Sandplay therapy has been described as highly supportive within adult counselling and psychotherapy (Mitchell & Friedman, 2003). Sandplay has been reported as a core therapeutic tool in treating adults with PSTD (Moon, 2006), with combat veterans suffering severe nightmares (Coalson, 1995), with substance abuse offenders (Garza, Monakes, Watts, & Wiesner, 2011), with eating disorders (Myers & Klinger 2008), in the treatment of borderline personality disorders (La Spina, 2004), with sexual addition treatment (Spooner & Lyddon, 2007), with dissociative disorders (Sachs, 1990), and with adults experiencing traumatic nightmares (Daniels & McGuire, 1998).

Sandplay therapy has been described as highly supportive within adult counselling and psychotherapy (Mitchell & Friedman, 2003). Sandplay has been reported as a core therapeutic tool in treating adults with PSTD (Moon, 2006), with combat veterans suffering severe nightmares (Coalson, 1995), with substance abuse offenders (Garza, Monakes, Watts, & Wiesner, 2011), with eating disorders (Myers & Klinger 2008), in the treatment of borderline personality disorders (La Spina, 2004), with sexual addition treatment (Spooner & Lyddon, 2007), with dissociative disorders (Sachs, 1990), and with adults experiencing traumatic nightmares (Daniels & McGuire, 1998).

When supporting traumatised clients creating a safe environment and strengthening feelings of safety and trust must take priority (St Thomas & Johnson, 2007). The most widely used and seemingly effective approaches are methods that provide reassurance and support while gradually, often indirectly, exploring a traumatic past (St Thomas & Johnson, 2007). This reassurance and safety allow clients to make sense of overwhelming experiences and to identify and express underlying emotion, necessary for healing to take place (St Thomas & Johnson, 2007). 

Unique to sandplay, containment is offered in three different configurations. It is offered within the parameters of the sandtray itself, within the therapeutic relationship, and within the therapy room, which can provide a secure and insulated setting (Zappacosta, 2013).

 For contemporary counsellors working with a range of clients with mild to severe trauma, offering a holding environment with strong boundaries provides the sought after safe and protected space with a reliable other. Kalff emphasised the importance of responding to a client’s need for safety: “If you can provide a free and protected space, you will see the evolution of life as it is taking place in the sand tray” (Turner, 2013, p. 2). A client comes to therapy as a sort of container – filled with anxieties, mixed feelings, losses, hidden strengths, achievements, joys, confusions and remembrances. The therapy room, the therapeutic alliance, and the sand tray, provide safe boundaries in which that container can empty out and replenish.

The process of sandplay creates a shared non-verbal space where therapist attunement, client issues, images and symbols come together. The direction of the healing process is not presupposed or presumed; uncertainty is welcomed not avoided. Working with miniature objects and sand offers a way to expand psychological, emotional, somatic and spiritual possibilities and encourage experimentation that is often avoided by those who are distressed or whose lives carry a legacy of abuse, neglect, emotional upheaval, or trauma. Additionally, at a certain stage of the therapy journey, formerly hidden, positive aspects of the psyche are unearthed and future potential rehearsed in a safe, trusted environment.

 As a psychotherapeutic process over time, possibly over many trays, Sandplay Therapy offers a relational healing space (Cunningham, 2005). The process avoids a client being ‘fenced in’ by therapist bias or agenda. Watching, observing, holding the space, silently formulating - and often abandoning - a working hypothesis, a sandplay therapist allows themselves to visit the individual experience of the inner and outer world that belongs to no-one but the person who created the image (Pearson & Wilson, 2001).

 The box of sand and the small objects provide the client with a space, and tools, outside of themselves, where chaotic aspects of the inner world can be placed, seen, organised, reorganised, reconstructed, or deconstructed. The firm boundary of the tray defines the place where the person takes up an interactive – and active – role in their own change process.

 The focus in Sandplay Therapy is on a safely emerging relationship buildt up between client and therapist, that leads to a client’s enhanced relationship with themselves. A sandplay therapist holds the space open for easeful emergence of a client’s inner material, as well as emergence of their inner resources, which often present clearly in the sandpicture. Sandplay Therapy offers a way for this to happen, free from premature interpretation or direction. The stability of the therapist’s observer role is an integral part of holding and containing a client’s vulnerability as they begin to process, review, question, unravel, transform and restore the foundations on which they had built their sense of self. 

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