Sandtray Therapy in Eating Disorder Treatment | Alsana
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Islands of Lost Toys:
The Use of Sandtray in the Treatment of Eating Disorders

By: Alison Greenlee, LMSW

“From the first touch of the sand, there is often a palpable release of tension as the
body begins to find its natural rhythm again.” -Bonnie Badenoch

What is Sandtray Therapy?

Sandtray therapy is an experiential, tactile intervention that creates safety, distance, and containment as clients gain access to the unconscious parts of memory and experience. Sandtrays can be directive or non-directive, as clients use a tray or box filled with sand and use a wide variety of images to create a scene, which reflects the client’s internal experience. Sandtrays can be static or dynamic, in which clients create a single scene in the tray or practice shifting dynamics. Homeyer and Sweeney (2005) define sand tray as an “expressive and projective mode of psychotherapy involving the unfolding and processing of the intra- and inter-personal issues through the use of specific sandtray materials as a non-verbal medium of communication, led by the clients and facilitated by a trained therapist.”

Why Sandtray?

Sandtray is a whole-brained approach that promotes an improved connection between the right and left sides of the brain, releases blocks that are put up through words, and facilitates integration (Flaherty, 2013). The pictures and stories created in the tray access the right brain and stimulate memories and emotions, while the processing of the tray provides visual information to the left brain (Flaherty, 2013). The arrangement of miniatures and stories that are created are representative of the client’s inner world and allows for healing without using words. As the unconscious is at work, it also allows for therapeutic distance, containment, and safety created through the therapeutic relationship, environment, and the space of the tray itself.

          Benefits of sandtray include (Homeyer, et. al, 2005):

– It gives expression to non-verbalized emotional issues

-It has a unique kinesthetic quality

– It serves to create a necessary therapeutic distance

-It provides and creates a safe place for a reaction to occur

-It is an inclusive experience within relationships

-It provides boundaries and limits, which promotes safety

-It provides a unique setting for the emergence of therapeutic metaphors

-It is effective in overcoming resistance

-It provides a needed and effective communication for clients with poor verbal skills

-It cuts through verbalization as a defense

-It creates a place to experience control

-Transference may be effectively addressed

-Deeper intrapsychic issues may be accessed more thorough

Sandtray Use with Treatment of Eating Disorders

Sandtray work is especially effective in the treatment of eating disorders for a number of reasons. Many clients with eating disorders struggle with oscillating between rigidity and chaos. When struggling with chaos, the sandtray allows for the necessary boundaries and containment needed to slow down and understand their inner experience while also regulating emotions. When struggling with rigidity, sandtray allows for necessary boundaries and containment needed to step out of cognitive defenses and access more play and creativity. As clients work in the sandtray, they are able to connect effectively and gain awareness of several of the underlying factors of the eating disorder. Also, as so many clients with eating are emotionally underdeveloped and lack an emotional language, it allows for clients to truly be met where they are at in a developmentally appropriate way to release blocks and increase internal understanding and reflection. It has been my experience that as clients are working to increase their emotional language, that they will often refer back to a specific sandtray scene or miniature they chose to represent a feeling. For example, many clients will say, “It’s like the dragon,” often to describe how anger feels; or when needing a resource for strength, power, and/or lightness, they will often refer to a Pegasus or a Phoenix. Specific miniatures of scenes from a sandtray can serve as a sort of bookmark to allow clients to more easily access and recognize emotions when feeling them in the moment. Along with integration, sandtray can also assist clients in creating a coherent narrative, as they begin to recognize similar themes and miniatures throughout multiple trays.

With support from the therapist, clients are able to explore and practice shifting relational dynamics, emotional regulation, and increase response flexibility. Whole-brain approaches that promote integration, such as sandtray, are essential in the treatment of eating disorders to access the deeper, underlying factors needed for deep healing, that simply talking will not allow.

Here at Alsana in St. Louis, all of our therapists have basic training in sandtray with a few having more advanced training. Sandtray can be utilized at all levels of care in individual, family, and group therapies.

Below are several examples of directives and ways sand tray has been used in the therapeutic process:

Individual Therapy

  • To explore the client’s internal experience at the beginning of the work. This directive can also be used at different times throughout the client’s stay to assess change and progress.
  • Explore family/relationship dynamics of past and present
  • Explore client’s different layers (i.e., what I show to the world vs what I feel inside)
  • Trauma processing
  • During meal/snack sessions to explore different emotions, blocks, etc that come up throughout
  • Explore barriers to recovery, relationships, launching, etc
  • Explore future goals
  • With client’s who struggle with verbal processing
  • With client’s who want to remain cognitive as a defense
  • Resourcing—A safe place or containment space can be created in the sand and the client can take a picture to use outside of the session. The scene can be recreated in sessions if needed. Miniatures can also be used to represent resources of strength, nurturance, power, etc. The client can take a picture of a miniature(s) or if possible, borrow the miniature if needed as a tangible way to access the resource.
  • It can be used to continue the sculpt done in expressive for further processing.
  • Sandtray can also be used as a starting ground for modality work or incorporated into modality work such as:
    • IFS
      • Use miniatures to represent different “parts,” practice internal dialoguing, unblending, etc.
    •  EMDR
      • Use miniatures to represent nurturing/protective figures; create safe place or container
    • Somatic Experiencing
      • Client’s can track through the body while working in the tray to deepen the experience, etc
    •  Expressive
      • Continuation of sculpt in expressive group, use miniatures to represent different figures, people, feelings and then work to embody
    •  Art
      • Further processing of art agenda, create art depicting feelings after gaining new insight during the sand tray, etc

Family Therapy

– To visualize and share individual internal experiences

  • How each person experiences the relationship dynamics
  • Communication within the relationship
  • How they would like the relationship to look like and steps to get there.

Group Therapy

  • Attachment/Family and Relationships Groups
    • Explore the relationship with your primary caregiver
    • Parenting styles— how you were parented/how you parent yourself
    • Relationship dynamics
    • Can be used by facilitator to create a visual of left/right brain and/or neurosequential model of brain development to provide psychoeducation on interpersonal neurobiology
    • How relationship dynamics would have to shift to reparent yourself/support your recovery
  • Body Image Group
    • How I feel in my body
    • How I feel in the world in my body
    • How I perceive others see me in my body
    • Body Image timeline
    • **How I feel in my body and how it affects my place in the community
    • Messages received around masculinity/feminitity
  • Addictions Group
    • What my addiction looks/feels like
    • What is underneath the addiction
    • How addiction affects my relationships
    • **How the group feels in supporting each other around addictions. What needs to shift?
  • Community Dynamics
    • **Where everyone feels in the community. What needs to shift to be more supported?

Sandtray in group therapy can happen in different ways. Two to three individuals can create more detailed and/or dynamic trays, while the rest of the group observes, asks questions, and gives feedback. Another way it could look includes each member of the group having a small, individual tray and only a few miniatures with a very directive prompt. Finally, large, group size trays can be used where each member of the group places 1-2 miniatures in the tray together. Directives labeled with (**) indicate directives to be used in a large tray with everyone placing miniatures in it together. Sandtray in the group setting allows clients to:

– give both objective/subjective reflections

– witness the vulnerability involved in the creative process

– get a look into the inner world of peers and into each other

-reflect on how they relate to others experiences

– reflect on community dynamics, including cohesion and barriers, while creating a safe and contained place to confront and then process.

References

Flaherty, A. (2013, July 23). Sandtray and the Subconscious. Retrieved from

http://southernsandtray.com/sandtray-and-the-subconscious/

Homeyer, L. & Sweeney, D. (2005). Sandtray Therapy. In C.A. Malchiodi (Eds), Expressive Therapies (pp. 162-183). New York, NY: The Guilford Press.

 

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