1
Chapter Two: Validating the World
There are a growing number of research studies on sandplay therapy. Its credibility as a
mental health treatment approach is based on an established, long-standing clinical history,
extensive literature generation, and validation based on published peer-reviewed research. This
research began nearly 100 years ago with the development of Loenfeld's World Technique. In
2021, Wiersma et. al. conducted an analysis of sandplay therapy studies that represented 8
countries. They found that sandplay therapy is an effective treatment method for children and
adults across a variety of mental health disorders.
Amid growing interest in refugees and migration around the world, researchers have
explored the utility of sandplay therapy with migrant children. Stauffer (2008) articulates the
attachment, trauma, and mental health issues inherent in the preflight, flight, and resettlement
phases. Kronick, Rousseau, and Cleveland indicated that children's experiences of detention up
to now have been largely underrepresented. Measham and Rousseau (2010) studied the various
ways that families discuss war trauma experiences and how they relate to their children's play.
Families that were successful in giving their children a sense of safety to talk about their
experiences with them better controlled their conduct. Kronick, Rousseau, and Cleveland (2018)
studied the sandplay narratives of 35 children, aged 3–13 years, in Canadian detention centers.
Three broad themes were identified: confinement and surveillance, loss of protection, and human
violence. The researchers also noted significant figures and themes which were not present in the
trays: teachers or school scenes, friends, or symbols of friendship, and the use of “magic” to
overcome diversity.
Lacroix et al. (2007) investigated the effects of significant media exposure of trauma on
children with a history of trauma by studying 75 immigrant and refugee preschoolers between
2
the ages of 4-5 in a Montreal, Canada classroom. The findings underscore the potential
discomfort brought on by parents' worries about the incident and their exposure to television
accounts of the incident. Parental transmission of experiences (filiation), if they can be worked
through in various ways, can be very positive at different developmental stages. For immigrant
children, host society institutions, particularly schools, play a key role in external transmission
(affiliation). Vicarious trauma and secondary traumatic stress are crucial factors to be mindful of.
For this reason, it is important for clinicians to be aware of other environmental factors and
global events that influence clients.
In a meta-analysis, Cambra examined the efficacy of expressive therapy with refugee
children and teenagers (2019). They studied newly arrived immigrant children in a FrenchCanadian kindergarten. The children were split into randomized control and experience groups.
Parents of the therapy group noted a significant reduction in symptom severity while the control
group exhibited no appreciable difference. The results of the instructors' evaluations showed that
the experience group's symptoms remained unchanged, whereas, in terms of emotional and
behavioral issues, the control group's symptoms drastically deteriorated.
A qualitative study conducted by Popejoy, Perryman, and Broadwater (2020) used
sandplay to process military trauma. Combat trauma, which can result in post-traumatic stress
disorder, was discussed along with the idea of moral injury (PTSD). They found that unexpected
moral choices could cause great remorse or humiliation after soldiers returns to civilian life. All
of the participants shared in a follow-up interview that the session was cathartic and had a
positive impact on their mental well-being.
Ismail et al. (2019) studied the use of sandplay therapy with neglected children. Four
female residents of a Malaysian shelter, aged 10–17, participated in this research project
3
consisting of a single sandtray session. The experience aided the girls’ ability to immediately
find the primary issue. The researchers noted that the use of numerous senses during the therapy
allowed the girls to concentrate during and after they had completed their sandtray. The sadness
of the girls at the shelter home became apparent as the girls reported a lack of relationships with
their peers and distrust, even fear, of their warden at the shelter home, an insight that assisted the
girls’ counselors to focus their ongoing treatment.
In Nepal, Maharjan (2019) studied children, aged 3-16, living in another shelter home.
There were six main themes uncovered in the sandtrays:: 1) The importance of the nonverbal
aspects of sandplay; 2) The role of movement within the psyche in sandplay; 3) The importance
of resilience in children's sandtrays; 4) The importance of cultural aspects in children's sandtrays;
5) The importance of the kinesthetic aspects of sandplay; and 6) The importance of the therapist's
nondirective presence. Additionally, each of the children showed the resilience abilities needed
to overcome trauma symptoms.
Cunningham, Fill, and Al-Jamie (2000) studied three groups of five boys between the
ages of 6 and 11: one group had endured long-term sexual abuse, one group had suffered medical
trauma (long-term hospitalization for a chronic or terminal illness), and a control group without
any history of trauma. The groups consisted of Caucasian, Black, Asian, and Hispanic boys. To
reduce the risk to the respiratory system, the medical team substituted cornmeal for sand. These
participants were invited to create a picture in the tray. They found noticeable differences in the
amount of miniatures placed in the trays: the medical group averaged 9.2, the sexual abuse group
averaged 9.3, and the non-traumatized control group averaged 46.1. The researchers
hypothesized that the traumatized participants' isolation and melancholy are to blame for their
use of fewer miniatures. Participants in the control and medical trauma groups demonstrated the
4
ability to organize, design, and combine the figures into a single image, unlike the subjects who
had experienced sexual abuse. Participants who had been sexually abused did not display any
means of resolving disputes or enforcing justice, and each boy in the group who had experienced
sexual assault put a snake in their tray. Regardless of the group, conflict, and violence were
prevalent themes in all platters. The hospitalized group displayed less hostility, perhaps as a
result of the boys’ reduced levels of energy when setting up their sandtray world,
South African rural children frequently face intergenerational or historical trauma in
addition to structurally produced trauma. In a qualitative study, Ayres (2016) discovered that the
creation of a single sandtray was successful in identifying trauma symptoms. The participant
created her tray from the tray's short side, which was an unusual observation. The researchers
suggest that this is correlated with bodily discomfort and can suggest a history of disease,
wounds, physical intrusion, and trauma.
Sandplay therapy is a multisensory experience that activates different sections of the
brain, allowing the recall and reprocessing of memories with an optimal level of executive
control, which establishes many connections between various brain areas in both hemispheres.
Using Near-infrared Spectroscopy (NIRS), Akimoto et al. (2018) discovered that sandplay
results in brain changes in the surface areas of the cerebral hemisphere. The study involved a
live, real-time short sandplay session with a young, male subject connected to the NIRS which
measures cerebral blood flow that is coupled with neuronal activity. The research findings show
that sandplay therapy causes the left and right hemispheres of the brain to work together, more
specifically, the temporal area and inferior frontal gyrus (IFG) work together; these areas are
associated with creative productivity. Also, the temporal regions belong to the default mode
network (DMN). The DMN activates in the absence of external commands and activity and
5
when people are more internally focused with tasks like autobiographical memory retrieval,
envisioning the future, and taking in the perspectives of others. Additional findings by Akimoto
et al. include the fact that various elements of sandplay therapy, including the therapist and the
sand as a sensory stimulus in the sandbox, as well as the blue hue of the box's bottom, activate
both the DMN and the executive network (ECN). These two networks' dynamic connections may
be what results in an optimally controlled expression of images.
Based on this research, Foo et al. (2020) examined how sandplay therapy affected the
thalamus of a 23-year-old female with generalized anxiety disorder (GAD) and hypothesized that
sandplay therapy reduces anxiety symptoms through thalamo-limbic neural pathways as the
thalamus is crucial for processing sensory input. Another study by Foo and Freedle (2021)
explored whether changes in brain functioning accompany clinical symptom improvement
following the use of sandplay therapy. This study concentrated on the hippocampus, amygdala,
thalamus, and prefrontal cortex, which have been linked to generalized anxiety disorder. They
found that sandplay therapy is beneficial in reducing clinical anxiety symptoms in people with
GAD and may also enhance prefrontal cortex and limbic system neuronal activity.
There are few studies that investigate sandplay therapy for autism spectrum disorder
(ASD). Two studies employing sand treatment with autistic kids are discussed. The first study
involved an Australian case study with a 7-year-old child who participated in one sandplay
session each week for 12 weeks. Between 35 and 40 instances of problematic behavior were
recorded as the baseline behavior. After 12 weeks, there had been a total of 0–5 incidences of
problem conduct.
Lu et al (2010) studied special education lessons for 25 elementary school children,
which began with a 5- to 10-minute opening ritual that featured rhythm and movement exercises
6
followed by a sandplay session. To help some students organize their sandtray narratives,
teachers offered story structure through creative writing. The children showed heightened verbal
expressiveness, engaged and sustained social contact, and enhanced symbolic, spontaneous, and
innovative play after 10 weeks of weekly sessions.
Reading about the successful outcomes of these research investigations is inspiring. The
success of sand treatment is further demonstrated by the wide range of presenting concerns, the
multiple international locations, across cultural landscapes, and by numerous practitioners and
researchers. Neurobiological research is just beginning and is developing a scientific explanation
of how the brain communicates with the sand world builder. The scientific foundation for
further validating this work will continue to be built through additional investigation.
7
References
Homeyer, Linda E.; Lyles, Marshall N.. Advanced Sandtray Therapy (pp. 17-29). Taylor and
Francis. Kindle Edition.