Promoting the ethical practice of sand therapy

Promoting the ethical practice of sand therapy

Promoting the ethical practice of sand therapy Promoting the ethical practice of sand therapy

THe history of Sand therapy

By Linda E. Homeyer, Ph.D., LPC-S, RPT-S

There has been a virtual explosion in the use of SAND THERAPY: Clients building scenes in trays of sand, using a collection of miniature figures and toys. A quick Google Scholar search between 1929 and 1990 found 158 items for the term ‘sandtray therapy’ and 183 for ‘sandplay therapy’. In the 30 years since, there were 4,250 and 5,070, respectfully. When searching for “sand tray therapy” it jumped to 11,400 entries! (Not all authors use the terms with the definitiveness as is used by the two primary categories reflected in this historical perspective.)

Amidst all this exciting growth of using some form of sand therapy, history and development have been consigned to times-past or viewed as unimportant. With this brief overview, we trust the clinician will become grounded in a valuable understanding of the development of the clinical approach for the elements they are using.

The Originator: Margaret Lowenfeld

A tray, sand, water, and miniature toys: this is the apparatus that Margaret Lowenfeld (1890-1973) began using in 1929 both at her Clinic for Nervous and Difficult Children (later renamed the Institute of Child Psychology, ICP) and in her private work (Lowenfeld, 1979, p. 4). With these materials, Lowenfeld continued her journey to understand the inner world of the child and develop a mental health intervention for children: The World Technique.

Lowenfeld’s intense experience while serving in the Russo-Polish War in eastern Europe in the early 1920s was life-changing. As a medical doctor, she worked with troops along a 400-mile front, in prisoner of war camps, and worked to feed and clothe demobilized Polish college students. She viewed thousands with the diseases which followed the war and noted: "the larger number of the population has the waxy transparency of famine …" (1979, p. 1). She was impressed with the resilience of children under stress. Later, back in London, she observed children with the same “expressions, postures and gestures that resembled those with which I had become familiar in prison camps and famine areas” (1979, p. 2).

These intense experiences compelled her to discover a method to promote the mental health issues of children; a way to allow children to share their inner worlds. Recalling the book Floor Games (Wells, 1911), which she had read as a young woman, and being aware of the developmental limitations of children. When she opened the Clinic for Nervous and Difficult Children in October of 1928, it was complete with trays of sand and a collection of small toys (Lowenfeld, 1993). Anderson reports that Lowenfeld found that in less than three months after a metal tray with sand was placed on a table and a cabinet with drawers containing miniature objects were included in the playroom, “a spontaneous new technique was developed, created by the children themselves” (Anderson, 1993, p. 280-281). The term World first appeared in case notes in June of 1929 (Lowenfeld, 1993, p. 280) and continued to be commonly used by staff in case notes and case discussions. Thus, the World Technique was named.

Lowenfeld also has a strong connection to the field of play therapy. Although her work was referred to by several terms early on, including sandtray and sandplay, she considered those who were trained by her and at her Institute to be play therapists. A review of the literature shows that she is likely the first person to use the term play therapy. Several of her writings use this term and in a letter to The British Medical Journal in 1938, she mentions offering play therapy at the ICP as early as 1930. She states in the same letter, “careful theoretical and practical training is essential for those who are to undertake play therapy” (p. 1281). Lowenfeld clarified that there are "two clearly formulated methods of play therapy, each with its own history and technique" (p. 1281) referring to her work and that of a London colleague, Melanie Klein.

Currently, Lowenfeld’s work is termed Projective Play Therapy. A Lowenfeld Projective Play Therapy course work is jointly offered by the Lowenfeld Trust at Cambridge and Middlesex University.

For further information about Lowenfeld and her work, the reader is referred to her books: The World Technique, 1979 (reprinted as Understanding Children’s Sandplay: Lowenfeld’s World Technique, 1999) and Play in Childhood. Also, many of her speeches and written work are available at http://www.lowenfeld.org.uk/

Others who were trained at Lowenfeld's Institute include John Hood-Williams in the 1950s. He co-edited the book Child Psychotherapy, War and the Normal Child: Selected Papers of Margaret Lowenfeld, with Cathy Urwin (1988). Thérèse Woodcock trained with and was supervised by Lowenfeld during the years 1969-1972. Woodcock is currently the primary trainer of the Lowenfeld Technique. She wrote: Expressing the Shape and Colour of Personality: Using Lowenfeld Mosaics, 2006.

Contemporaries of Margaret Lowenfeld and adaptions of her World Technique:

· Charlotte Bühler, 1934, a child developmentalist became interested in cross-cultural research after watching children building Worlds while visiting Lowenfeld’s ICP. Bühler developed a standardized diagnostic assessment based on Lowenfeld’s work: The World Test and later renamed The Toy World Test. She was able to differentiate clinical vs non-clinical populations and identified components of the clinical subjects’ trays (Bradway et al, 1981; Bühler, 1951). Bühler used 160 – 300 miniatures which were used on a table or the floor.

· Hedda Bolgar and Liselotte Fischer, 1930, Austrian clinicians developed the Little World Test which also differentiated normal from a clinical population. They used a standardized 232 miniature figures on a large table, without sand (Mitchell & Friedman, 1992).

· Ethel Dukes, 1938, Medical Director of the Institute for Child Psychology (ICP), reports the first play therapy research study in The British Medical Journal (1938, p. 213-215). One hundred fifty-four subjects, aged 2.5 to 17 years of age, participated in play therapy at IPC during the years of 1930-1935. While not at the level of current rigorous research standards, improvement was found.

· Hanna Bratt, 1933; Goesta Harding, 1949; Margareta Sjolund, 1981; Bratt learned of Lowenfeld’s work and developed The Sandtray, the Swedish version of the World Technique. Her work expanded to the formation of Erica Institute in Stockholm. In the 1940’s Harding, after studying with Lowenfeld briefly (Turner, 1998), further developed The Sandtray for diagnostic and therapeutic play which uses standardized materials of sandboxes and miniature toys. The Sandtray became to be known as The Erica Method (Nelson, 2011). Sjolund is the current author of Erica Method publications (1981, 1994).

· Erik Homburger, 1938, who later changed his name to Erik Erikson, developed the Dramatic Productions Test as part of a larger research project with his Harvard colleagues. Homburger/Erikson used a prescribed collection of small toys and human figures, discovering several subjects (college students) spontaneously re-enacted early childhood trauma. He used a square table, without sand.

· Laura Ruth Bowyer, 1956, published her work in research in developmental/normative studies of Lowenfeld’s sand tray worlds (Mitchell & Friedman, 1994). Bowyer added sand to her research to see if it was important, as many had ceased using sand in their clinical work. She found that “the use of the sand increased the richness of expression, added more information to the analysis of the production, and gave an added dimension to the experience of creating the World” (Mitchell & Friedman, 1992, p. 33). With the blessing of Lowenfeld, she also wrote The Lowenfeld World Technique (1970) which includes a comprehensive history and uses of the World Technique (Hunter, 1998). Bowyer is also published under the name Ruth Pickford

(Mitchell & Friedman, 1993).

Reviews and information about other assessments using small toys and a designated space or tray can be found in an article by Rie Rogers Mitchell and Harriet S. Friedman in Sandplay: Overview of the First Sixty Years, 1992. Lowenfeld was concerned “that my whole research and therapeutic method should not be misunderstood or distorted when part of the equipment is borrowed and adapted to a different purpose” (cited in Mitchell & Friedman, 1992, p. 12).

Sandplay Developer: Dora Kalff

Dora Kalff (1904-1990), a Swiss Jungian child analyst learned of Lowenfeld’s work after hearing her speak in Zurich in 1950. Psychiatrist Carl Jung, having himself heard Lowenfeld speak at the International Congress in Paris in 1937, encouraged Kalff to study with Lowenfeld. In 1956 Kalff went to London and studied with her at her Institute for a year. Kalff adapted the method, “infusing a symbolic, archetypal orientation” … seeing “the sand tray as a means of contacting and expressing preverbal levels in the unconscious, thus activating regenerative energies” (Mitchell & Friedman, 1992, p.34). Kalff (1971) acknowledged Lowenfeld’s important contribution: "She understood completely the child's world and created with ingenious intuition a way which enables the child to build a world—his world—in a sandbox" (p. 32). According to Martin Kalff, in her practice in Zollikon, Switzerland, "…my mother recognized that the creations of the children in the sand correspond to the inner psychic processes of individuation described by C. G. Jung. She developed her method for working with these patterns of individuation in the children's work, and in agreement with Margaret Lowenfeld, she called this method Sandplay” (Kalff, 2004, p. vii). Kalff began presenting lectures in California to the Jungian community from the 1960s until her death in 1990. Internationally, her work continues with the International Society of Sandplay Therapists and component national societies.

Other Clinical Theories and Approaches

It is not surprising, even from the very formation of sand therapy, that many diverse applications would follow. Various clinical theories and adaptations of Lowenfeld’s and Kalff’s initial work exist today.

In fact, Lowenfeld stated clinicians would see in any created World “components and constructs that support their views,” not as “merely a result of wish fulfillment” on the part of the clinician, but “because they are almost certainly to be present there” (1993, p.7).

For purposes of organization, there are two categories: Sandtray (all those NOT Jungian/Kalffian and may or may not derive from Lowenfeld’s World Technique) and Sandplay (those that are specifically Jungian/Kalffian/psychodynamic).

Other Sandtray Therapy Applications:

The term 'sandtray therapy' is an umbrella term for all non-Jungian uses of sand therapy. Below are those who are identified as having developed or expanded the use of sand therapy in the various categories.

· Adlerian

o Terry Kottman, 2001, founder of Adlerian Play Therapy (AdPT) incorporates the use of a sand tray into her work with children. She teaches workshops on “Adlerian Applications of Sand Tray Play Therapy” (see her website www.ecouragementzone.com )

o Other authors have written about various uses of sandtray: early recollections with Even & Armstrong; lifestyle analysis with Sweeney, Minnis, Homeyer; in clinical supervision

with McCurdy & Owen; and with substance abuse treatment with Monakes et al.

· Gestalt

o Violet Oaklander, 1978, developer of Gestalt child therapy. She authored: Windows to Our Children (1978/2015, 2nd ed); Hidden Treasure: A Map to Child’s Inner Self (2006). Oaklander integrated the use of sand tray with many other expressive techniques in her work of Gestalt child therapy.

· Humanistic

o Steve Armstrong, 2008, author of Sandtray Therapy: A Humanistic Approach. He shares he became intrigued by the use of sandtray therapy while a doctoral student at the University of North Texas. Trained primarily from a Gestalt perspective, he now integrates that but is primarily Person-Centered.

· Solution-Focused

o While there is no prolific clinician/author in this area, book chapters have been written by Elizabeth Taylor, 2015, Solution-Focused sandtray Therapy for Children; and, Daniel Sweeney, 2011, Integration of sandtray therapy and solution-focused techniques for treating noncompliant youth. Other authors of journal articles: Elizabeth Taylor; Donald R Nims, 2007; Yvonne Garza; Marcella Stark & Rebecca Frels, 2014; Rachel McBrayer & Julia Chibbaro, 2012. Also, in the book by Linda Homeyer & Daniel Sweeney, 2017.

· Transactional Analysis

o Roger & Christine Day, 2012, wrote Creative Therapy in the Sand: Using Sandtray with Clients. The book provides a review of the clinical theory, application to sandtray, and case examples. Roger is a Certified Transactional Analyst in Rugby, Warwickshire, UK.

· Cross-Theoretical

o Linda Homeyer & Daniel Sweeney, 1999, wrote the book, Sandtray Therapy: A Practical Manual, which provides basic information on how to set-up a sandtray therapy room, how to curate a collection of miniature figures, session protocol, and other information for understanding the process from a variety of clinical theories. It is now in its third edition, 2017.

· Sandtray-Worldplay (ST-WP)

o Gisela Schubach De Domenico, Ph.D., LMFT, RPT-S, 1984, is the creator of what she describes as having “innovative and dynamic techniques . . . that goes beyond Lowenfeld, Jung, and Kalff” (1999). De Domenico has researched children’s and adults’ use of sandtray which resulted in the creation of her training series of the Vision Quest Intro Symbolic Training Series. She studied with John Hood-Williams. She has written: Sandtray-Worldplay Manual.

· Mindfulness-Based Sandtray Therapy

o Dottie Higgins-Klein, 1999, developed “a body-mind approach that integrates Sandtray theory with mindfulness meditation principles, which nurture conscious awareness of a person's whole-life experience.” Spontaneous and directed sandtray therapy provides a simple yet profound way to be with people through the joys and pains of living. Dottie has written Mindfulness-Based Play-Family Therapy.

· The Body-Brain Approach of Sandtray Play TherapyTM

o Rita Grayson, LCSW, RPT-S, 2015, Rita studied extensively with DeDomenico (Sandtray-Worldplay) and Relational Neuroscience with Bonnie Badenoch. The Body-Brain Approach sources the wisdom of the body to bring implicit pain and fear into conscious awareness where it can be met and repaired within the therapeutic hold of the therapist.

· Virtual Sandtray®

o Jessica Stone, Ph.D., RPT-S and partner Christopher Ewing, 2015, developed a new media interpretation of a physical sandtray. It is a way to take sandtray therapy to places where a physical sandtray is not possible (hospitals, crisis zones, and more) and for clients who engage in therapy more easily through the use of technology, clients with tactile/sensory issues, and those who may have other difficulties accessing a traditional tray.

· SandStory Therapy®

o Lara Kasza, 2018, developed Sandstory Therapy and states that it has its roots in Lowenfeld’s sandtray therapy and the narrative tradition of story-telling. “This is a gentle and safe way of working therapeutically with sand and symbols within a contained sandtray that offers clients the opportunity to tell their 'story in the sand'.” Kasza practices in London UK.

· Narrative Sand Therapy©

o Dee Preston-Dillon Narrative sand therapy activities include the poetics of representation, therapeutic metaphor with three-dimensional images, symbol amplification and active imagination, and gestalt dialogues to enhance meaning-making.

Other Sandplay/Jungian Applications:

· John Allan, 1998, a Jungian analyst and professor in British Columbia, Canada, taught on the use of the sand tray, particularly in the school setting. He authored: Inscapes of the child’s world: Jungian counseling in schools and clinics, 1998.

Professional Associations

1982: The Association for Play Therapy (APT) was founded by Charles Schaefer and Kevin O’Connor to promote the value of play, play therapy, and credentialed play therapists. Many sandtray therapists found a professional home within this organization as there was no professional association specifically for sandtray therapists. Many sandtray therapists, but not all by any means, are also play therapists. They have three designations: Registered Play Therapist, RPT; School-Based Registered Play Therapist, SB-RPT; and, Registered Play Therapy Supervisor, RPT-S. See: https://www.a4pt.org/

1985: The International Society of Sandplay Therapy (ISST) began in Dora Kalff’s home in Switzerland. It now has several Member Societies around the world The ISST or a member society has established criteria to be a Certified Sandplay Therapist, CST; and Certified Sandplay Therapist-Teaching Member, CST-T. See: https://www.isst-society.com/

2015: The Association for Sandplay Therapy (AST) was formed to incorporate Dora Kalff's values of loving kindness, clarity, and humility in the professional practice of Sandplay. The AST credentials well trained Sandplay therapists as Registered Sandplay Therapist, STR; Registered Sandplay Therapist-

Consultant, STR-C; and Registered Sandplay Therapist-Consultant Teacher, STR-CT. https://www.SandplayAssociation.com/

2019: World Association for Sand Therapy Professionals (WASTP) exists to promote integrity and ethical practice in the therapeutic use of sand. It is a non-profit organization that is inclusive of a variety of clinical theoretical orientations and approaches to sand therapy. See other page