Often with youth, the most powerful expression is not done out loud.
I remember watching a child build a compelling scene involving fences, a princess, cars, McDonalds food, puppies and a wishing well — all built in silence while the child was using this sacred space to share her trauma narrative of sexual abuse, without words. She smiled when she was finished, we discussed ways the characters in the sand could stay safe in the future, and she left my office walking a little taller and stronger than when she walked in.
For those of you who are unfamiliar, sand tray/play therapy was introduced in 1928 by pediatrician Margaret Lowenfield, who was frustrated with the limitations of traditional talk therapy. She started with a tray, sand, water and small toys, terming it the “World Technique.” There were many iterations of this style and work, eventually evolving into sand play therapy in the 1950s by a Swiss psychologist, Dora Kalff, who integrated Jungian therapy elements. She believed that symbols could tap into the unconscious and not be hindered by the analytical mind. This would lower defenses and allow fast processing of ideas, reveal hidden conflicts, integrate emotions, and ultimately lead to faster healing in the “world” one creates using the tray.
Modern sand tray therapy often utilizes a blue color in the rectangular box to represent the unconscious, water, and sky as imagery. While there are various sizes of trays, they generally shouldn’t be larger than 19.5 inches” X 28.5 inches – so one can view the entire tray without having to move their head. The tray is very important as it “contains” and holds the big emotions, along with the miniatures that are placed into it. At KidsPeace, our youth are provided with miniatures such as people, animals, fauna, and symbolic objects (weapons, religious symbols, road signs, fences, etc.) where youth have the opportunity to select what they are drawn to, and arrange these figures to represent various relationships, conflicts, memories, and even trauma from their lives into this contained space. Our therapists pay close attention to the speed which the youth place objects, the directions the objects face, what they may pick up and then set back down, their facial expressions, and even placement of buried objects. This information is then used with the youth to tell their stories, from their own world and perspective. Clinicians take pains to allow the youth to lead this entire process and remain grounded in control of their experience.
At KidsPeace, this type of intervention is very effective for children and teens, as play is often their natural communication style, especially for youth who historically have not been able to engage in traditional talk therapy. In my experience, it has been particularly effective in processing trauma, grief, anxiety, family/social concerns, and depression. Being multisensory, it engages right-brain processing which is tied to memory, emotions, and imagery which supports full integration of experiences, and is often most powerful in allowing the youth to feel in control with what they share, especially as they are working with miniatures and a space that lends to containment. With the sand tray one is able to activate the right hemisphere of the brain, which processes emotions, imagery and intuition. It promotes bilateral integration between the brain’s hemispheres – bridging trauma and logic. The tactile experience of the sand is able to ”ground” our youth in the present moment.
Often, kids end up at KidsPeace because they have struggled with safe feeling expression, where big emotions are released through big behaviors. Trauma alters the brain; often the amygdala, which controls fear, takes over and becomes highly reactive. Trauma memories become fragmented like broken glass and then become stored through more sensory pathways such as smells, touch, sights, and sounds rather than linear narratives. Traditional Cognitive Behavioral Therapy (CBT) is wonderful evidence-based therapeutic modality; however, for some individuals traditional talk therapy may not work for them due to the way their trauma is stored in their body. Also, some of the abuse our youth have experienced occurred prior to the development of language skills, and they literally are unable to find the words to process their experience. The sand tray modality is a wonderful option when words are just not enough.
Through the generous donation of our KidsPeace senior leadership, we were provided funds to purchase 12 portable sand trays, allowing us to be highly mobile and bring this intervention to the youth as needed, in the moment. We can bring these portable trays to family therapy, at the schools, and even take them outside. We can utilize multiple trays to contain and process multiple therapeutic concepts at once, such as one tray for “old life” and one tray for “new life.” We also were able to purchase an instant camera so the youth is able to take a photo of their tray creation and keep it with pride or share with their family if they choose.
When youth at KidsPeace engage in sand tray work, they are not just playing; they often are able to make their first clinical breakthroughs in therapy and feel clinical success for the first time. I had one teen request his father make him a sand space in his back yard upon discharge as he felt it was such a quick and powerful way for him to release intense feelings in a safe manner when feeling overwhelmed in his home community. I have found sand tray work to be of great benefit when completing the trauma narrative in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). I had a client bury her abuser in the sand every week until she felt she felt safe enough to process her memories of what happened. I had another client hoard food in their house in the tray and tell the story of how they were left alone and neglected, often for weeks on end. I do not know if the youth would have been able to make these clinical gains in the timespan they did without this powerful intervention.
Clinicians have a sacred opportunity to witness and hold space for others sharing their deepest truths. Often, the most profound breakthroughs do not sound like insight … they may simply look like a youth playing with figures in the sand.
Jamie Chubb, LCSW, is the Clinical Director of PA Residential Services at KidsPeace. She completed her post-graduate education at the University of Pennsylvania, earning her master’s degree in social work, and also completed a post-graduate group study exchange to study mental health in the Philippines. Jamie has worked in the mental health field in numerous capacities for more than 20 years. She assisted in opening a program at KidsPeace for female youth impacted by trauma and sex trafficking. Jamie is nationally certified in Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Level 1 Trauma Art Narrative Therapy (TANT), and has received her REBT/CBT Primary & Advanced Practicum via the Albert Ellis Institute. She is responsible for identifying and implementing new evidence-based clinical practices and interventions that can benefit clients according to data-driven measures of quality of care and outcomes.
