Using the sandtray as an expressive arts intervention with adult clients
 
Marta Garrett
University of Mary Hardin-Baylor Belton, TX USA
 
When counselors and therapists think of using the sandtray as a counseling intervention, they often think sandtray work only as a play-therapy intervention for children (Hunter, 1998).  However, over the last several decades, sandtrays have been included in counseling adolescents and adults more and more frequently (Homeyer & Sweeney, 2011).  When sandtrays are used from a Jungian perspective, this work is often referred to as “sandplay” but today, sandtray work with adults from a variety of theoretical perspectives is growing in popularity (Boik & Godwin, 2000; DeDomenico, 1995).  This article discusses the use of the sandtray as an expressive intervention with adult therapy clients acknowledging there are many theoretical options available to the therapist and outlines how sandtray work (ST) is uniquely suited for a variety of adult counseling populations from diverse cultures and ethnic backgrounds. 

            In counseling settings, a therapeutic sandtray resembles a miniaturized version of a child’s sandbox and fits on a tabletop is designed bring the kinesthetic and malleable aspects of the sand into the therapists office (approximately 30 inches left to right by 20 inches front to back, and about 4 inches deep [see Boik & Godwin, 2000, or DeDomenico, 1995, for multiple examples and photos of sandtrays used in counseling]).  This standardized size and shape of therapeutic sandtrays is designed to encompass the client’s full range of vision without the client needing to turn his or her head.  While sandtrays used in play therapy with children are often made of plastic, sandtrays used in expressive arts sessions with adults are generally professionally crafted wooden boxes with finished edges and a lid.  Typically, the sandtray is presented to adult clients partially filled with dry sand along with a set of miniatures (small items selected to represent people, places, and other important aspects of the clients’ world – real or imagined animals, plants, buildings, etc.).  In the play therapy environment, miniatures are often selected to represent common toys or playful items of childhood, while a sandtray miniature collection designed for use with adults is more likely to include miniature symbolic representations of less tangible concepts which may or may not be toys (e.g., symbols of “good” which could be a represented by a cartoon superhero or a something more abstract).  In the expressive arts sandtray session, the adult client is asked to build a scene in the sand and this is generally processed verbally within the counseling session. 

            Historically, sandtrays have been used in play therapy with children but when integrating the sandtray into adult counseling sessions, which are traditionally talk-based, the decision to use the sandtray can be more complex.  Adults are not typically as responsive to play-based interventions in therapy.  The therapist must carefully consider the specific treatment goals of the client to determine if using the sandtray could be helpful or augment traditional talk therapy in a positive manner. 

Many of the traditional uses of sandtray work with children may be easily adaptable to adult counseling sessions.  For example, ST work with children has long been used as a method of play (e.g., Axline, 1989); therefore, ST work might also be useful to encourage playfulness in sessions with adult clients – if this appropriately meets the client’s treatment goals.  Draper and Willingham (2003) used sandtray with adolescents to build rapport in the session.  ST might also be helpful in building rapport in some adult counseling sessions or in sessions with families or adult group sessions.  Cochran (1996) described using sandtrays to enhance educational environments and psycho-educational counseling goals with children.  It seems logical that this could also be transferrable to adult counseling work.  Little research has been done using the ST as a formalized assessment tool (beyond the early work of Lowenfeld [2007], with children).  However, the ST might have value as a projective measure in certain communities or cultures that are closely-knit or are likely to share similar values or experiential backgrounds (e.g., in some countries, ST miniatures are sold as “sets” vice the more common, dynamic collected group of miniatures that is used in America). 

Within the larger therapeutic venue, ST can be used as a clinical supervision tool or training tool to assist therapists and supervisors to understand complex cases (e.g., Homeyer & Sweeney, 2011).  The ability to re-create or study a client’s ST scene in depth provides additional learning opportunities for both the therapist and the therapist’s clinical supervisor.  ST can also be used as a therapist self-exploration tool to gain insight, personal, and professional growth (Garrett, in press), stimulating the therapist to see his or her own issues in a new and challenging format. 

Based on the theoretical perspective of the client and the type of work being done, ST can be used within a variety of adult treatment modalities (Degges-White & Davis, 2011).  In counseling adults, integrating the ST into the session as an expressive arts intervention is perhaps the most common widely used method.  The ST can be added to a talk therapy session simply by asking the client to create a scene in the same way the therapist might ask a client to draw a picture.  Used this way, the ST is a way of helping a therapeutic client to get in touch with his or her emotions and allow creative energy to be expressed within the safe therapeutic counseling environment (Gladding, 1997). 

As an expressive intervention, the ST can be successfully integrated into almost any theoretical perspective at a variety of levels on a continuum between spontaneity (where the client creates whatever comes freely to him or her) to directive work (where the therapist directs the client to create a specific scene in the sand (e.g., “create a scene to help me understand what happened at your sister’s wedding…”).  Spontaneous ST work may be more suited for work with adult clients who are more creative or artistic.  Theoretically, spontaneous ST is more suited for psychoanalytic, Jungian, or existential work where the focal point of change is more likely to be intrapersonal (LaBauve, Watts, & Kottman, 2001).  Spontaneous or mildly-directed trays can be used to help issues from the subconscious surface to the conscious level; to create awareness for the client (and or therapist).  Specifically, in Jungian work, the use of specific miniatures can be seen as important in understanding underlying themes in the client’s struggles (Pearson & Wilson, 2001).  Additionally, when time is of the essence or access to therapy is limited, indirect ST work may be too time consuming or costly.  On the other end of the continuum, directed trays are typically more appropriate present more hesitant in therapy or whose thought patterns tend to be more “concrete.”   Adult clients who may fear or not value creative expressiveness may respond better to being given specific guidelines or directions for the ST.  Directive ST work with more literal adult clients may function better in solution focused, short-term, or cognitive based work which can often have a more interpersonal focal point of change (LaBauve, Watts, & Kottman, 2001).  Sandtrays can be created to stimulate conversation, emotion, or action in the immediate moment or to teach or model opportunities for clients based on the scarios that emerge in the tray(s). 

ST work, as with most expressive-arts interventions, encourages a wide range of both verbal and non-verbal expression within the counseling session – which can be helpful for adult clients who are experiencing difficultly verbally expressing themselves.  ST can be used to de-emphasize verbal interaction patterns that are not working within the counseling session by encouraging non-verbal expression (e.g., adult clients who have a history of explosive verbal styles/interactive patterns; minimizing intellectualizing or rationalization; Levine & Levine, 1999).  ST is an extremely flexible expressive arts medium where the client and or therapist can choose the level of emphasis on verbal interactions.  For example, a client can create a tray which may not be discussed at all, or may spend several sessions discussing a single tray creation.  This ability to choose to focus the ST session on the creation of the tray or on the verbal discussion of the tray makes ST a powerful and flexible therapeutic tool.  Because of this flexibility, ST can be used with adult clients with poor or limited verbal skills (including those with language deficits); or adults who are unable or unwilling to verbalize their emotions.  ST is also helpful in building understanding and rapport between the therapist and the client.  Because the therapist can see and touch the client’s ST creation and feelings this can minimize the likelihood that a concept being discussed will be misunderstood due to a cultural or language differences.

Within the extensive array of well-researched art-based expressive interventions available to therapists today, ST remains unique (Degges-White & Davis, 2011).  Because ST work is kinesthetic – it appeals to the common childhood experiences of many clients and most find it is soothing or relaxing to stroke and touch the sand (Homeyer & Sweeney, 2011).  This emphasis on action within a session can free or relax clients making them more open to potential therapeutic growth (Homeyer & Sweeney, 2011).  Thus, ST work can be used as a form of  stress relief for adult clients – encouraging them to touch the sand can provide a respite from stressful life situations that may have brought them into therapy and add a playful component to their often serious and driven lifestyles (Homeyer & Sweeney, 2011).   

The use of sand and ready-made miniatures also allows a flexible, three-dimensional aspect of expressiveness that is quick and easy.  Thoughts, emotions, and experiences can be depicted three-dimensionally - built-up or buried in simple scenes or complex scenes that are built in multiple trays.  Sandtrays can be altered, rebuilt, or destroyed as the client desires.  A client can build the sand up to create mountains or move the sand away to create valleys or waterways.  The sand can be manipulated into designs.  Water can be added which changes the entire texture of the sand and even the element of fire can be added to a tray (not recommended for children or teens).  In addition to touching the sand, ST work also involves other activities such as selecting miniatures, building tray(s), and perhaps rebuilding or destroying scenes (and often taking pictures of the scenes for later use or discussion).  This need to be more fully engaged in the session can be appealing to some clients.  Because most adults do not feel confident in their artistic skills, the availability of already created miniatures takes artistic pressure off adults.  They don’t need to create a picture or representation of something based on their own talent, they can merely select it from the shelves (e.g., it is easier to select a dinosaur from the miniatures to represent one’s boss than to draw one from scratch). 

            Perhaps the most widely acknowledged aspect of ST work that makes it a valuable as an expressive intervention for counseling adults is that the sandtray allows for therapeutic distance through symbolic representation (Homeyer & Sweeney, 2011; Pearson & Wilson, 2011).  The tray itself provides a sense of distance from discussing one’s therapeutic issues – it is at arm’s length from the client and it provides a safe and contained space for exploring issues (adult clients rarely build beyond the natural boundaries of the sandtray).  Clients can create scenes in the tray and refer to them in the third person (e.g., “this person feels small…”) even if the scene in the tray clearly represents some aspect of themselves or their lives.  The natural boundaries of the sandtray create a well-defined space for construction allowing clients to feel safe in allowing their emotions to flow into their ST creations.  In the ST, clients are able to experience control within limits which can help lessen the need to control other aspects of their lives.  The use of symbols or symbolic representations can provide a fuller form of expression – for both the client and the therapist (the client may represent issues from a subconscious level while the therapist may choose to use the miniatures to introduce therapeutic metaphors).  The availability of a variety of sizes of miniatures and varying materials (stone, wood, plastic, glass) allows for scenes to be depicted in a literal fashion (e.g., choosing larger items to represent more power or might or choosing symbolic representations like a dragon or a unicorn).

            The use of the ST can open up additional opportunities for a transference-like phenomenon within the therapeutic session.   This can be acknowledged in a symbolic manner – by referring to a specific item in a tray, or the creation of a tray as an entity, and can be reinforced with taking a photo of the tray which can be used as a transitional object to remind the client of the tray or experience and therefore emphasizing change outside the therapeutic session.  

Acknowledging and addressing emotional aspects is an essential component in therapy, but because of the unique three-dimensional aspect of ST work, it allows for this emotional work to be experienced as a sensory level – emotions and feelings can be touched (Homeyer & Sweeney, 2011).  ST with adults can be a successful avenue to help adults recognize, express, and explore feelings of self or others.  Addressing these emotional aspects of the client’s experience can increase feelings of self-acceptance, acceptance of others, feelings of being loved, and feelings of being safe – all of which are useful in addressing self-esteem and self-worth issues.  Addressing emotional aspects in therapy can also help to reduce symptoms of depression and anxiety which can be co-morbid with a variety of other presenting problems adult clients experience.  Because the sandtray session provides the client with a three dimensional product which can be touched, adjusted, and photographed, clients are more fully able to understand and explore complex issues.  Alternatives can be explored by creating solutions in a second tray (while still leaving the original tray intact for comparison).  This can facilitate more in-depth discussion between the therapist and the client and a fuller examination of the underlying issues, patterns of behaviors, or themes in the client’s life.   

ST has been used successfully in the treatment of children who have experienced trauma for some time (e.g., Hunter, 1998; Lowenfeld, 2007) demonstrating there is clear value in using ST similarly in treating adults who have experienced trauma (e.g., Homeyer & Sweeney, 2011).  Since trauma is encoded in the brain at a sensory level, it seems logical to therapeutically address issues of trauma using a sensory-based intervention like ST.  Herman (1997) suggested the following stages to therapeutically address trauma in therapy:  1) establish safety; 2) allow the client to reconstruct the trauma story; and 3) help the client to restore connections with his or her community.  ST work can be effectively implemented in each of these stages.  For example, the ST creates a safe distance from which to observe and describe one’s problems; the ST allows for great detail in reconstructing the trauma story; and the ST can be used with couples, families and groups.  ST work is uniquely suited for addressing trauma because of the containment of the work, and its emphasis on symbolism, projection, and displacement (Schaefer, 1994 as cited in Homeyer & Sweeney, 2011).

It is generally more is helpful to present the ST to adult clients as an expressive arts intervention as opposed to a play-based intervention.  Setting a positive expectation with more mature adolescents or adult clients and having a professional set up with a standardized tray can help adults or resistant clients take the intervention more seriously.  As described, the miniatures serve as the client’s vocabulary in ST work.  Appropriate selection and display of miniatures is critically important in working with adult clients.  The room, the ST itself, the seating, and display of miniatures must be appealing to adults to encourage them to engage in what at first glance may seem more like play.  Where children have no trouble rummaging through bins and containers searching for a particular toy, adults feel more comfortable selecting miniatures from a neatly displayed shelving unit or clearly marked drawers.  These issues are especially important in working with adults who are in crisis or addressing serious issues in therapy.

According to Amatruda and Helms-Simpson (1997), ST scenes and miniature selection can be expected to follow themes commonly addressed within each stage of development along the lifespan (as described by Eric Erikson’s work [Erikson, 1963]).  Adult clients may be dealing with issues related to their continuing search and refinement of their identity,  roles associated with various aspects of adulthood, intimacy and partnering, and generativity (Erikson, 1963), or their trays may resemble variations of existential journeys (Amatruda & Helms-Simpson, 1997; DeDomenico, 1995).  Therefore, the standard categories of miniatures described in the literature  for working with child clients may not be sufficient for clinicians working primarily with adults. Therapists who primarily use ST with adults may want to carefully select their miniatures to ensure the vocabularies of their adult clients are fully represented.  The miniature selection for working with diverse adult populations may need to include: a wider selection of people of all ages with varying skin colors; an array of religious and/or spiritual items (that allow representation of all major religions); vehicles that are more realistic and current (as opposed to toy-like vehicles); nature-inspired items specific to the local geographic area (such as beach items or miniature mountains or a volcano); items that can be used to represent time (such as clocks, egg timers, etc.),  travel (e.g., compasses, globes, etc.), and money (e.g., fake credit cards, an ATM machine, symbols of paper money vice gold “pirate” coins).  Items that have special meaning or symbolic importance to a specific age group, ethnic or cultural group, or the local geographic location may also be essential (e.g., pregnant figures; a character that represents the grim reaper or father time if working with older adults facing end of life issues; medical items; or buildings that can be used to represent local icons).

As described, adult clients often feel more hesitant in working with ST or any other non-traditional-talk-therapy based intervention.  Adult clients may need more reassurance than child clients in any art, play, or activity-based counseling intervention.  In order to ensure adult clients feel relaxed with this type of counseling intervention, it is essential to spend more preparatory time addressing the client’s potential questions about ST and how it may be helpful to him or her.  Therapists using ST with adults may want to have a flyer or handouts about the intervention so that adults who like to learn by reading can take this home and study it before asking additional questions.  Adults can benefit from being specifically oriented to the ST (the therapist should encourage the client to touch the sand and can physically model this by touching the sand and moving it aside then smoothing it out again).  The therapist might invite the client to explore the miniatures (before asking him or her to start building a tray); and reassure the client several times that there is no right or wrong way to complete a scene or a tray (e.g., Boik & Godwin, 2000; Homeyer & Sweeney, 2011).  Adult ST clients may also find it helpful if expectations are made clear (e.g., Will the client be encouraged to talk or remain silent while he/she creates?  What will the therapist do while the client is creating?  How much time will the client have to complete his or her ST?  Will the client be asked questions about the tray when he/she has finished? etc.).

In summary, with appropriate training and supervision, ST can be a powerful intervention tool with adults of all ages and from varying backgrounds and educational levels. The following adult directed tray ideas are provided to help prompt clinicians to think about how ST could be integrated into almost any current clinical practice (Garrett, in press):
 
  • Create a tray that describes your ideas about…;
  • Create a tray about the challenges you have faced;
  • Build a scene that describes your relationship with your mother/father/spouse/significant other/child …
  • Build a tray to show the importance of … in your life (e.g., money, your career, your home, your family, your marriage, etc.);
  • Build a scene that describes a time in your life when …(e.g., you felt confident; you felt scared, etc.);
  • Build a tray about the decision you made to …
  • What does it mean to be a good parent, spouse, worker, etc. …(try using sentence stem completion statements for more ideas);
  • How/where do you see your life in 5 years? (see Bykofsky, 1990, for similar ideas that can be generated from journaling prompts);
  • Create a tray that describes the journey/path you are on…
  • Create a tray that shows what keeps you up at night.
 
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