Sand Therapy

Theory frameworks, key principles, advantages, sandtray approach, sandplay approach, research, benefits, training.

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. A list of References

Feedback welcome!

Background Material

Sand therapy is a nonverbal, hands-on therapeutic approach that uses a sandbox, toy figures, and sometimes water to create miniature scenes that represent a person's inner thoughts, feelings, and experiences. This play therapy technique can help both children and adults process trauma, cope with mental health issues like anxiety and depression, and facilitate emotional healing by giving form to the "inner world".   The process involves creating and interacting with a symbolic world in the sand, which can be discussed with a trained therapist to gain insight and foster self-awareness (Google, 2025).  Sand therapy is widely utilised with individuals, couples, families, and groups of all ages, from children to adults, to discover and deal with deeply rooted emotions and psychological problems (Gawish & Main, 2024).

Theoretical Frameworks

A number of theoretical frameworks underpin sand therapy (Gawish & Main, 2024):

Psychodynamic Theory                   Sand therapy taps into subconscious thoughts and provides a safe area for individuals to explore and express their internal conflicts, feelings, and memories.

Jungian Theory                   Sand therapy is believed to access the individual's unconscious, aiding them in addressing psychological issues, achieving personal development, a sense of belonging, and integration.

Play Therapy      Sand therapy is one of a number of play therapies.  It offers individuals a nonverbal, representational way to process their experiences, resolve problems, and develop coping skills.

Attachment Theory          Sand therapy can help individuals explore attachment patterns, allowing them to express and deal with difficulties including separation anxiety, trust, and boundary setting.            

Object Relations Theory                 Sand therapy allows individuals to explore and process how an individual's early connections with their carer impact on the person's perception of themselves and their connections with others.

Gestalt Therapy                  Sand therapy encourages individuals to interact with the materials naturally and reflect on their creations as visual representations of their interior experiences to increase self-discovery and understanding. 

Sandtray vs Sandplay

Sand therapy exists in two forms: sandtray therapy and sandplay therapy.  They both involve the use of sand for therapeutic purposes in a threat-free environment.  But the approaches have subtle but significant differences. With a foundation in Jungian and psychodynamic theories, sandplay has emerged with a specific treatment protocol that emphasizes a non-directive, non-interpretive approach that can tap into unconscious processes. The therapist does not interrupt while the scenario is being formed; discussion follows later.  On the other hand, sandtray therapy lacks a specific protocol with the therapist using a variety of methods they are comfortable with, including asking questions during the formation of the scenario, to help clients process presenting problems (Wiersma et al., 2022).

Sandplay therapists focus on the unconscious and seek to provide people in therapy with a free, protected space and the opportunity to communicate nonverbally. As such, sandplay therapists do not interpret, interfere with, or direct the person in therapy in any way, and analysis takes place after the therapy session.  Multiple trays are completed as they provide entry into the symbolic world of the client.  Sandplay therapy is widely used with children and adolescents because it does not rely on verbalization of the client’s experience. Aided by the therapist, a person can begin to recognize the relationship between the creation in the sand and their own inner world (Good Therapy, 2020; Holliman & Foster, 2023).  Used as a short-term or long-term intervention, sandplay therapy may be conducted in an individual or group format in a variety of settings including outpatient clinics, community-based settings, schools, and hospitals (Wiersma et al, 2022).

In sandtray therapy the therapist may choose to raise issues or ask questions of the person as the sandtray is being formed.  A variety of practice approaches can inform the discussion around what is presented in the sandtray—the approach to sandtray therapy relies on the therapist’s broader theoretical model.  A broad prompt, such as “Create a world in the tray that depicts your life how it is in the present,” or specific prompt, such as “Using the miniatures, create a scene in the tray about school may be used to commence the session.  The therapist supports the person to find solutions to their problems; problems that emerge because the person is able to manifest in sand the things they would otherwise not be able to vocalize or address in traditional therapy (Good Therapy, 2020; Holliman & Foster, 2023).

Key Principles and Concept

The Therapeutic Setting                 Sand therapy typically takes place in a designated location or quiet, calm, and distraction-free room, which is prepared with a large tray or box filled with sand and a variety of little people and objects.

Creating a Safe and Non-Judgmental Environment             Individuals need to feel accepted, respected, and supported while they explore sensitive and vulnerable aspects of themselves. Individuals must be able to freely express themselves without fear of criticism or judgement, providing a way for profound transformation and growth.

Role of the Therapist      The therapist acts in a supportive and empathetic way, offering gentle guidance and encouragement as individuals explore their inner worlds. Through active listening, reflection, and analysis the therapist assists individuals in making sense of what they have produced and gaining insights into their inner thoughts and feelings.

Overview of the Client's Role       Individuals are encouraged to choose materials that relate to them and arrange them in the sand to form scenarios, stories, or settings that reflect their inner world. The act of moulding and manipulating sand creates a physical and sensory experience that may bring back strong feelings and memories. This approach enables individuals to access their subconscious and gain personal insights that verbal communication alone often cannot provide (Gawish & Main, 2024).

Advantages of Sand Therapy (Gawish & Main 2024)

Nonverbal Expression: Sand therapy gives people a way to communicate without using words. This can be especially beneficial for people who have trouble verbally expressing their feelings and thoughts.

Symbolic Representation: People can construct scenarios in the sand tray that symbolise their inner conflicts, experiences, and feelings.  Exploring and processing difficult emotions and experiences can be facilitated by this symbolic illustration. 

Creative Expression: Individuals are encouraged to be creative and independent by arranging the sand and sculptures anyway they see fit. 

Emotional Regulation: Playing with sand and figurines can help people relax and reduce stress, which can help them better control their emotions.

Managing Trauma: Sand therapy is helpful in dealing traumatic events because it enables people to revisit and bring out their trauma experiences. This can facilitate the integration, relaxation, and cognitive rebuilding of traumatic experiences.

Therapeutic Relationship: The therapeutic relationship is strengthened through the joint process of designing and examining sand tray scenarios. It fosters connection, empathy, and trust, which develops understanding of the needs and objectives of the individual in need.

Integration of Mind and Body: Sand therapy treatment is a useful tool for assisting people in integrating different aspects of their lives or personalities. Individuals can explore opposing ideas, feelings, and identities in a secure and encouraging setting by setting up scenes in the sand tray.

Healing and Release: Creating and examining scenarios in the sand tray can help people release memories and emotions that have been hidden to enable recovery.

Cultural Sensibility: Individuals of different ages and ethnic backgrounds can benefit from sand therapy. Sand tray treatment breaks down barriers of language and culture. It enables users to discuss and investigate their experiences using imagery and basic symbols.  It can be applied in family, group, and individual therapeutic settings as well as in educational contexts.

Easily Accessible: Sand therapy does not require highly developed artistic or verbal abilities. For individuals who might not react as well to conventional talk therapy techniques, it offers an alternate treatment approach.

The Sandtray Process

Sandtray therapy is a dynamic and engaging therapeutic method that takes people through a number of structured phases to encourage deep psychological discovery and healing (Gawish & Main, 2024 unless otherwise noted):

1. Initial Contact and Assessment

In the first meeting, the therapist learns some basic details about the individual's issues, motivations for seeking treatment, and any relevant history, e.g. via a bio-psycho-social assessment.

2. Establishing Safety and Trust

By building a relationship of trust and rapport, the therapist helps an individual feel comfortable enough to explore thoughts, feelings, and experiences without fear of being judged.

3. Introduction and Orientation

The therapist shows the individual how to use the sand tray and goes over the fundamental rules of the procedure. The individual is invited to explore and investigate the sand and the assortment of little items that are available for usage.  Instructions are not always given, and may be open ended (“Show me how you’re feeling at this moment.” “Go ahead and create your world in the sand.” “What would you like to how me today?”) or directive (“Show me what happens when you’re bullied.” “Show me how you play with your sister.” “Make a scene that shows a big decision you made”) (Winnig, 2025).

4. Selection of Figures

Individuals choose figures, items, and symbols from the offered assortment. Individuals are usually drawn to objects that connect with their subconscious throughout the natural choosing process.

5. Creation of Sand Scenes

Individuals draw pictures or landscapes in the sand tray using the chosen figures and objects. Without any thoughtful preparation or spoken explanation, an individual naturally arranges the objects in the sand.  Winnig (2025) suggests therapists pay attention to the client's affect and behavior as they engage with the sand tray, such as how they interact with objects, where and how they place them, how they represent themselves, and anything else that provides insight, such as:

• facial expressions (smiling, frowning)

• laughing or crying

• interactions with objects and sand (gentle, careful, aggressive, destructive)

• resistance to using sand tray or certain objects

• communication (talkative, quiet)

6. Exploration and Expression

The therapist observes and engages in a conversation as an individual interacts with the sand and the made-up scenes using open-ended inquiries and attentive listening techniques.  Winnig (2025) provides the following as examples of these interactions:

Offer reflections to prompt the person to explain things in their own words.

• I notice that…

• At first you seemed _____________, but now you seem ____________.

• You added lots of…

• I saw that you…

Give compliments to validate the person’s work and self-expression.

• I’m impressed by…

• I like how you…

• You did a wonderful job with…

• I’m proud of you for…

• It’s interesting how…

• Great work!

7. Symbolism and Metaphor

The scene in the sand tray represents the individual's inner world symbolically. In order to promote understanding and self-awareness, the therapist works with the individual to investigate the symbolic meaning and imagery of their works.  Winnig (2025) offers the following suggestions:

• If your scene had a title, what would it be?

• How did it feel to create this scene?

• How do you feel when you look at your world?

• How would you make this world better?

• Are you in this scene? Where are you and what are you doing?

• What is [object] thinking or feeling?

• Is there a story you want to tell me about this?

• What is the relationship between [object] and [object]?

8.  Processing and Integration

Together, the therapist and the individual talk about the sand tray scene, examining its meaning and connection to the individual's life. Through this process, the client might process feelings, integrate new ideas or ways to cope, and obtain new perspectives.

9. Closure and Reflection

A review of the sand tray experience comes at the end of the therapeutic session. The individual is free to talk about the ideas, emotions, and the proceeds they had throughout the meeting. The therapist assists the client in solidifying their therapeutic path by offering encouragement and affirmation.

The Sandplay Process

Sandplay therapy Is a nonverbal approach.  A person is encouraged to use the miniature toys, figurines, and objects in the sand in ways they choose while the therapist observes and does not interrupt while privately analysing the person’s interaction.  The design of the sand tray is guided by the person’s imagination and their subconscious. The result is a microcosm of their inner world. After completion, and aided by the therapist, a person in therapy can begin to recognize the relationship between the creation in the sand and their own inner world.

Many children are unable to verbalize emotional states, particularly in the face of trauma, neglect, or abuse. The nonverbal nature of sandplay therapy and the familiar medium of sand can help children achieve feelings of comfort and security and develop their own expression of situations. This method of therapy can serve as a valuable and powerful outlet for children and an incredibly insightful method of gaining access to traumatic experiences.

Sandplay therapy is also very useful in the treatment of children who have been sexually abused. These children will often remain silent for fear of harm or even death. They are often threatened and are in highly anxious states when they come to therapy. The relaxed and interactive setting of sandplay therapy provides them the initial arena of safety that they may need to move toward healing.

Sandplay therapy can also provide emotional release and realization for adults who have been traumatized and show limited response to other forms of therapy. The environment presents an atmosphere free from threats.  Sandplay therapy for adults may help by beginning to facilitate change on a fictitious level (e.g.by altering the sandtray scenario), and an individual can gain the courage and ability to recognize that these same changes can be made in their own life (Good Therapy, 2020).

To summarise: In the safe presence of the therapist, an individual makes images using sand, water, and miniatures, accessing conscious and unconscious processes and the natural healing capacities of nature and the psyche to advance psychological development. The client may choose to play out or tell a story and may speak or remain silent. At the same time, the sandplay therapist listens empathically and provides a free and protected space for healing. With a series of sandplay images a natural transformation takes place with movement toward wholeness of personality, a process Jung referred to as individuation.  Sandplay emphasizes self-directed, nonverbal, hands-on expressive work without interference on the part of the therapist (Wiersma et al., 2022).

Research – Effectiveness

A number of recent metanalyses / scoping reviews of research into the effectiveness of sand therapy show promising results across a variety of study areas.  However, there appears to be general agreement that further individual studies are necessary with larger study numbers across different populations and contexts.  Benito Herce et al. (2024) note it is challenging to conduct sand therapy studies with a large sample, as it requires a large amount of material and time resources with each patient, even though it can be applied in a group setting.  Additionally, each sand therapy process is different, and each person can benefit differently from his or her own experience with sand therapy. Therefore, it is not easy to establish the underlying mechanisms of change common to all sand therapy processes.

One theme that appears to be universally recognised is that sand therapy can be ideal for people who struggle to verbalise problems.  Due to its nonverbal approach and to cultural conditions in a number of countries sandplay therapy has become a popular method, for example, in Latin America and Asia.  However, sand therapy may not suit individuals who have limited creativity.

The results from recent reviews follow.

Benito Herce et al., 2024

The results from a 2024 review of 9 articles (reduced from 362) show a significant effect of sandtray and sandplay practice on post-traumatic stress, internalizing symptoms (e.g. withdrawal, sadness) and externalizing symptoms (e.g. disruptive behaviour, hyperactivity) in children, on adolescents' adherence to therapy, and on the well-being of children who have suffered collective traumatization (natural disasters, bombings, etc.).  Qualitative observations indicate that those who have suffered trauma tend to express similar behavioral repertoires when doing the sandplay. For example, they tend to hide objects more frequently and interact less with sand. 

Holliman & Foster, 2023

This meta-analysis involving 36 studies examined several different presenting problems including anxiety (k = 7, g = 1.425), anger (k = 5, g = .760), depression (k = 7, g = 1.071), parent–child relationship issues (k = 5, g = 3.932), and self-esteem (k = 6, g = 1.588).  The study generated positive indicators about the effectiveness of sand therapy interventions and their possible use with anxiety and depression.  The results supported the use of sand therapy in family work.  Sand therapy was found as effective in group formats (k = 11, g = 1.073) as it was in individual settings (k = 7, g = 1.285). Sand therapy effectiveness was roughly the same for adults (k = 14, g = 1.414), adolescents (k = 8, g = 1.035), and children (k = 14, g = 1.112).

The authors pointed out the paucity of well-designed experimental studies and suggested a need for more quantitative studies.  They also criticized the lack of widely publicized treatment manuals and standardized use of those manuals in sandplay and sandtray studies.

Wiersma et al., 2022

This meta-analysis specifically examined emotional and behavioral outcome measures of treatment with sandplay therapy. 40 studies from eight countries representing 1,284 participants met the inclusion criteria.  One of the most important findings of this study was that sandplay therapy was equally effective across the domains of internalizing behaviors (e.g., anxiety, depression, self-concept, somatic symptoms), externalizing behaviors (e.g., social interactions, parent–child relationships, aggressive behavior, or defiance), and the behavioral symptoms of attention deficit hyperactivity disorder (e.g., hyperactivity, inattention, or impulsive behavior).  The consistent effectiveness of sandplay therapy across domains might lie in its multisensory, symbolic, less verbal, and actively experiential approach.  Sandplay provides people that have barriers to verbal expression with a safe, direct, and contained means to access and work through difficulties.

The benefits of sandplay conducted when one client receives the full attention of one therapist exceeded the results shown when sandplay is conducted in a group setting. These results reinforce the significance of the therapeutic relationship in sandplay therapy.  Although sandplay is often associated with studying children, differences between age groups were not statistically significant.

Roesler, 2019

A systematic search of sandplay therapy articles found 16 randomised controlled trials (RCTs) and 17 effectiveness studies that found significant improvements for a variety of child and adult mental health problems.  In the majority of the studies, a number of 10-12 sessions was administered to the clients in a weekly format.  The current state of evidence highlights a range of potential benefits of sandplay therapy in clinical practice.  It seems to have a potential for the treatment of clients with traumatic stress, disabilities and/or language problems, which are difficult to treat with conventional psychotherapy methods.  The areas showing moderate effect sizes from RCTs: 

Children and adolescents:  ADHD, traumatized immigrant and refugee preschoolers, aggression, peer relationships, cooperativeness, social skills, impulsivity, social anxiety, addiction, anxiety, depression, attachment relations, self-esteem, emotional intelligence.

Adult mental health problems: anxiety, distress, depression, mother-child relations, negative defense styles, social interactions, loneliness, positive self-expression about self and others.

The areas showing moderate effect sizes from effectiveness studies:

Child and adolescent mental health problems: externalizing and internalizing behaviour problems, global self-esteem, emotional and behavioural development, daily functioning at home, school and community, reduction in substance abuse, test anxiety levels.

Adult mental health problems: anxiety, self-esteem, sociality, depression, negative thoughts about self, overall wellbeing, avoidance, self-image, phobia, interpersonal stress.

Benefits

Sand therapy reduces the symptoms of many mental health issues and increases resilience. Clients free themselves of deep-seated negative emotions during sand therapy because they can express their inner thoughts while feeling accepted by the therapist.  In addition, sand 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 by externalising them in a symbolic form

• Provides a powerful way to express difficult emotions and experiences, especially for those who struggle with verbal communication. 

• Facilitates the emergence of unconscious thoughts and feelings, leading to greater understanding and insight into one's inner world. 

• Helps individuals develop coping strategies and find solutions to problems by working through inner conflicts and fostering a sense of control (Google, 2025; Morin, 2024)

Training

Mental health professionals do not need any specific certification in order to conduct sandtray therapy, as long as they are a licensed therapist. Before a person can claim to be a sandplay therapist, they must receive certification from the International Society for Sandplay Therapy (ISST). A mental health professional can legally advertise as a sandplay specialist after undergoing 120 hours of training (Good Therapy, 2020).

Suggestions for Practice

Social workers bring a number of practice approaches to their work.  As such, sandtray therapy would seem the most suitable for a social worker to use in practice as it allows for the worker to question and guide the person as they both form the sand tray and on its completion.  In the discussion that flows from observing the developing sand tray the social worker will be able to draw on various techniques and practice approaches (many of which are outlined on this website) to facilitate and empower the person to address the issues that brought her or him to therapy.

References

Benito Herce, N., Ochoa de Alda, I., Gonzalo Marrodán, J. L. (2024). Sandtray and sandplay in the treatment of trauma with children and adolescents: A systemic review. World Journal for Sand Therapy Practice, 2(1), 1-23.  https://doi.org/10.58997/wjstp.v2i1.74

Gawish, A., & Main, P. (2024). Sand Tray Therapy: A Creative Tool for Healing and Self-Expression for Therapists, Parents, and Schools.  https://www.structural-learning.com/post/sand-tray-therapy

Good Therapy. (2020). Sand tray therapy: Benefits, techniques and how it works.  https://www.goodtherapy.org/learn-about-therapy/types/sand-tray-sand-play-therapy

Google. (2025, September 21). AI Overview (Sand therapy).  https://www.google.com/search?client=firefox-b-d&q=Sand+therapy 

Holliman, R., & Foster, R. D. (2023). The way we play in the sand: A meta-analytic investigation of sand therapy, its formats, and presenting problems.  Journal of Child and Adolescent Counseling, 9(2), 205-221.  https://doi.org/10.1080/23727810.2023.2232142 

Morin, A. (2024). How sand tray therapy works: Playing in the sand is not just for kids.  https://www.verywellmind.com/what-is-sand-tray-therapy-4589493

Roesler, C. (2019). Sandplay therapy: An overview of theory, applications and evidence base. The Arts in Psychotherapy, 64, 84-94,\. https://doi.org/10.1016/j.aip.2019.04.001  

Wiersma, J. K., Freedle, L. R., McRoberts, R, & Solberg, K. B.  (2022). A meta-analysis of sandplay therapy treatment outcomes.  International Journal of Play Therapy, 31(4), 197-215.  https://doi.org/10.1037/pla0000180  

Winnig, S. (2025). Sand tray therapy guide.  Therapist Aid.  https://www.therapistaid.com/therapy-guide/sand-tray-guide