Play Therapy – Is Sand Play Therapy effective on its own?

Is Sand Play Therapy effective on its own?

Play Therapy can use various specialist therapies for children who have social, emotional, behaviour and mental health problems; including music, dance & movement, art, sand, clay, puppets and storytelling. Lisa Astwood, Practitioner in Therapeutic Play Skills and Play Therapy UK Registrant, looks at how an integrated  approach compares to using one medium.

In a secure attachment a child has a healthy balanced ego and can develop sustained and open relationships. If this is lacking, children find it hard to form meaningful relationships with peers and make academic progress. Play therapy can be used to recapture experiences missed in early relationships.

Len was adopted as a toddler.   e was very nervous and anxious, found it incredibly difficult to finish a task and seemed preoccupied with whether people approved of his actions, work or behaviour. Ron was often disengaged with his surroundings and found it incredibly difficult to sustain or establish friendships. He was an only child with no one to play with; his mother had a full-time job from an early stage.

Len used sand trays in all his sessions. He silently took a whole session to create a tray which resembled chaos, as if he had simply poured everything into the tray. I  felt this represented Len’s unconscious memories of when he was separated from his mother, particularly powerful as there were layers of things piled on top of each  other. In the second session he used wet sand, telling me about the ingredients he was adding to the ‘stew’. The ingredients were re-buried and dug up numerous times  before the stew was complete as if the burying laid memories to rest. In the last session, he used horses to represent a ‘family’, and the tray was more ordered and calm. Subsequently Len has been able to focus for longer and form more productive relationships. His SDQ score moved from 28 to 15, a significant improvement.

With Ron, I focused the first session on sand play. First he knocked over the neatly lined-up figures in the cupboard, happier with chaos. He used the sand to play out a  sort of movie he needed to get out of his head, lining up various army vehicles, soldiers, goblins, werewolves, dragons to create an aggressive battle scene where everything died and no one tried to save anyone. Placing the figures in a line contrasted with the haphazard, reflecting his lack of clarity in his relationships. He was  able to bring his unconscious thoughts and feelings to the fore, using the sand tray, but he found it hard to focus; a variety of media might make him feel less pressured   to focus on one task for an entire session. As he had shown anger and frustration, I chose clay (it is especially good for the release of anger). Ron was instantly drawn to the clay, grabbing it roughly, and splatting it on a surface repeatedly. During one session he made a clay light sabre for role play with me; ‘killing’ me was his way of  acting out his inner feelings. In other sessions Ron used battling puppets to re-enact the subconscious turmoil over his relationship with his parents. By the end of his  sessions Ron’s SDQ score had reduced from 29 to 19 and communication at home was easier.

Using just one medium can be effective; Len was able to use sandplay to re-organise his emotions and it was easy to track the changes in him. For others, focusing on a  single medium is restrictive and access to different media is crucial; Ron needed to act his feelings out in different ways in order to make sense of things. Play Therapy,  at the standard required to be registered with the PTUK Accredited Voluntary Register, integrates the use of many media. For more information see or