The Role of the Sandtray Therapist: a discussion of the value of the therapeutic relationship & the importance of a therapist’s own sense of Self.
Sandtray therapy (STT) is a psychotherapeutic model of healing that is often classified as an expressive or creative therapy. As such most therapies that include any form of art, movement, music or sensory techniques are expressive. STT allows the sand player to visually show the therapist where development has stagnated, issues such as trust or more readily mistrust can be seen in the sand worlds. Approaches can be aligned to that of the therapist or the organisation under which a therapist works. These considerations determine many aspects of therapy; however, the role of a ST therapist is a unique one. A Sandtray therapist (ST) has in his or her bag of skills a unique sense in which he or she senses, observes and listens to the client, trained ST therapists are well versed in reading the non-verbals, assessing body language and listening to the silence as their clients gaze into their own sand worlds in self-reflection. In this paper we will explore these aspects of whole brain healing and the important role the Sandtray therapist (ST) plays in the relationship.
The role of the therapist as research is now highlighting, has been shown to be a significant factor in the attachment and self-regulation process of reprogramming the brain including brain circuitry building and amygdala & emotional regulation. Dan Seigel 92007) refers to ‘mirror neurons’, in the therapeutic alliance these are the actions and behaviours of the therapist as directly reflected towards the client. A smile, a nod, but also a felt sense, empathy as a non-verbal attuned communication that says I am here, and I do not judge. Therapists also support clients by giving them a safe, positive, nurturing environment, this is referred to as interpersonal neurobiology important aspects in attachment but also according to L. Cozolini (2017) in the educational setting as teachers help children projecting of the mirror neurons develop and change. How one brain interacts with another has important effects on how the brain functions. For the growing child social interactions are one of the most powerful forms of experience that help shape how the brain gives rise to the mind. Knowing this it brings to light the importance of a therapist who has done some form of Socratic questioning to bring them closer to the truths of ‘Know Thyself’. When we truly know ourselves, then we can better understand others. When we do our own healing, we make our whole- self available to the client.
Research suggests that to have a coherent understandable verbal output, certain regions of the brain must be developed, other regions must be inhibited. The therapist needs to be the listener, making sure the client in talk therapy is not flooding your mind with intrusive associations. This is extended to sand worlds; a therapist must never interpret another’s sand world. As Roxanne Rae (2013) suggests, we can be directive in the initial commencement of therapy, if a client needs a suggestion, much like in talk therapy when we might say, “tell me what brings you to therapy today”. This prompt is simply that, it is not in essence directing a client to build a certain world, but it taps into their creative imagination to a beginning, as all artists know the beginning is the hardest, but once the energy flows, the vitality of the safety is felt, the secure attachment and the right brain activation align and the client then begins to process using the ‘bottom up’ sensory motor that Pat Ogden (2015) first coined as the term ‘bottom up’ approach to describe how the hands or the body experience a felt sense. In STT triggered by the sand, the hands are the receptors of this sensorimotor, in turn signals are sent to the brain recognised by the right brain neural networks and overrides any logical left brain thinking.
At critical moments a therapist can be triggered by their clients non verbals, a sand world or a sandtray miniature may trigger a memory that has formed part of their own attachment schema. Family of origin is an integral aspect of any psychotherapy, as we look at family, environment, community and more to see the whole of the person. Family of origin is a shared experience, which determines the client’s (and therapists) pattern of physical arousal, social behaviour and emotional responses to others. If we as therapists have not discovered our own flaws and imperfections within this dynamic, then we will experience triggers.
Therefore, as a therapist we need to understand the complexities of our own design, how our own building blocks have been formed. Interpersonal neurobiology includes how our DNA were encoded when our brains were being built. If you are aware of how you were conceived whether out of love or fear, rape, abuse, mistrust it will affect how you are and how you perceive yourself to be in the world. Attachment affects us to our very core; the amygdala affects our re-action and response to arousal. How we heal or not is an area of epigenetics which is an area of brain health, neuroplacticity, metabolic functioning and future behaviour first developed by Bruce Lipton (2012) and helps to explain family origins and inherited traits. Yet our social interpersonal neurobiology remains the vehicle in which we travel. The STT therapist can take on the role of instructor, gently reminding clients there are many roads and many ways but the healing is in the roads travelled.
Neuroplacticity and the role of the therapist
A therapeutic relationship should be based on trust, this is the first building block in the recovery of a secure attachment. When a therapist has eye contact with a client, listens unconditionally, feels comfortable in their silence and shows empathy and understanding it sends the signal to the client that they are emotionally available and perceptive. This is a secure attachment in the making, an adult who is ready to find a secure attachment through STT will explore their family of origin more readily in their sand worlds. They may have a lack of recall, denial, disassociation or minimize significant events, all indicators for the therapist that their may be insecure attachment. A well trained Sandtray therapist reads the sand worlds, reads the non-verbals, the body language and listens to the adult attachment verbal language.
The ability for attuned communication is the most important felt sense a therapist can build upon to aid in establishing secure attachment between therapist and client. In silence or Mindfulness, a therapist can sense someone else’s state and communicate, nonverbally (most important) and verbally (less important), our felt understanding of their emotional experience. “In order to provide this kind of contingent communication, enough implicit, amygdala-based perceptual bias needs to be modulated to be able to sense others somewhat as they are. The integrative social circuits of the middle prefrontal region are the culminating location for numerous streams of information that allow us to receive and send attuned signals to another person, many of which occur in microsecond intervals, well below the level of conscious awareness”, Badenoch, Bonnie.
In adult attachment the role of the therapist can be a reflective one, where transference and countertransference become a part of the therapeutic process. There has been much said about this transference so all therapists should be aware of its value and its consequences. George, Kaplan, and Main (1985) developed the Adult Attachment Interview (AAI), which enabled researchers to assess attachment representations in adolescence and adulthood. In this interview, clients reflect on their childhood attachment experiences and together with the therapist explore the impacts of their experiences on their own personality and behaviour. AAI coding system (Main & Goldwyn, 1985/1991) identifies secure and insecure patterns of adult attachment using three main classifications: autonomous, preoccupied, and dismissing. As ST therapists we are aware of the unconscious nature of complexes and how these raise their ugly heads in the form of behaviour, actions and negative thoughts and self-talk or rumination. To classify insecure attachment in adults it is necessary to reflect differences in mental representations that are based on differences in the organization of attachment experiences, Bowlby (1969, p. 80) called them the “internal working models.” In Sandtray therapy assessment we observe, listen and using attuned communication we experience the clients felt sense, the process of assessment looks at the sand worlds created, the case history, verbal communication any patterns; autonomous, preoccupied, and dismissing, to build an overall picture. This borders on a spiritually psychic attunement that no other therapy that has its framework in cognizant theoretical applications can say they possess. STT assessments can be crossed referenced on all these multiple levels.
A child with complex trauma
The young girl was aged 8 when she started STT. In her short 8 years she had experienced 8 fosters homes and numerous respite carers. As a ward of the state she had also been given numerous assessments, tests and diagnosis. In STT however, this child began her healing from a new beginning. As ST therapists we understand that there is a history, we recognise the value in assessment and a case history is important in establishing a therapeutic plan. However, the theory has us believe that in order to establish attachment with a child, it is important that the ST therapist not be directed by these diagnoses, but to start as though the child were able to be re-born, so to speak. To have our minds clear of any pre-conceived notions or ideas about what a childhood trauma looks like.
Her current foster mother had voiced her inability to show the same care for the child as she did her siblings. This was understandable as the young girl used anger and violence as her coping mechanism. Mirroring the exact responses used by her drug addicted biological mother who was in and out of violent relationships until her children were taken from her. At age 3 this young girl was sent from foster home to foster home, with each carer experiencing her violent behaviour, each carer wanting to understand, help change, but unable to task this disorganised attachment that set off conflict behaviour in the young girl. This behaviour was assessed in ongoing psychological assessment and each time the data indicated complex trauma, conflict behaviour, aggression and other trauma-related disorders.
This young girl was never directed in Sandtray to create a sand world of her trauma. This would be re-traumatising and is not a part of the framework as originally set up by Dr Margaret Lowenfeld developer of Sandtray Therapy, instead the therapeutic plan was to give her choice from the beginning. This meant on occasions doing sand worlds together, spending time with hands in the sand talking, times looking at the sand tray objects and giving them meaning. For a new therapist to Sandtray this may have been avoided because of a lack of trust in the process. And yet that was exactly the purpose of the plan, to build trust. Erikson’s psychosocial stages set as the basic building block as trust, Maslow’s Hierarchy of Needs sets amongst his order safety and security. For the therapeutic relationship to progress long term these basic needs would become the building blocks to her newly formed schemas.
Piaget theorized that schemas were always being changed by processes that he called “assimilation” and “accommodation.” According to Piaget, assimilation is the process where a person learns new information by incorporating it into something they already know, such as the play aspect to STT. Accommodation, on the other hand, is what happens when a schema changes in order to accommodate different knowledge. We could say here that once she began to trust in the STT process then her newfound knowledge was translated into her sand worlds. Piaget claimed that cognitive development was developed by equilibration, which is the attempt to balance accommodation and assimilation. A Sandtray therapist acts as the balance between the two worlds of a child (or adult) and the sandtray gives the client a stage in which to enact new ways of being.
In effect what this child had been given was a platform on which the following approaches can be accommodated in STT: Biological, inner bodily activities of which the young girl when asked “where do you feel that”, always replied in my head and on some occasions she would place her hand on her stomach and say “here”. Behaviourist, the observable responses and reactions of which had brought her to STT initially by her OOHC service who recognised that this young girl would benefit greatly from the neural integration that STT offered and the ability to form a new secure attachment with the therapist. Cognitive, mental processing which comes when a child or adult has completed a sand world and without prompting or directive, but through reflective techniques is able to verbalise a narrative. Once this is established the therapist can introduce CBT into the framework to help establish the client’s new trauma narrative. Psychodynamic, unconscious conflict, theory of personality, psychotherapy which in our girls’ case can be all the related complexes that establish as a result of poor parenting, abusive environment and inability to self-regulate emotional conflicts and control behaviour. Humanistic, the ability to attain free will, thoughts of overriding motives, conscious control. Sociocultural, functioning within their social & cultural environment. Which for the young girl meant that living in an environment where neglect, drugs, multiple partners for her mother and other disfunction where the norm. This formed her building blocks which affected her current behaviours and thoughts. Evolutionary, nature v’s nurture. The inheritance of DNA, pre-programming and epigenetics.
Taking on the role of therapist, educator or teacher allows a connection with your client to be viewed through various lenses. STT is where the story is told and where the healing begins. Attending in a way that brings out your curiosity and theirs, opens their thinking to the existential aspects and questions of life, such as where do I belong? Whether this is a conscious action or not. This allows your own psyche to open up to innumerable equations, the questions take you on a self-reflecting journey into past and present, they lead to more questioning, which takes you into realms of exploration, into links with ancestors, your relationship with God, Goddess, the unconscious collective, ties to the universe and so on, the interpretation will rely on your beliefs. This is the extent to which you need to be prepared to travel, and in so doing you honour the space being held for the symbols and images that have been chosen by your clients for the Sandtray sand worlds.
Within the Sandtray process the polarities of the mind tilt in favour of the deepest unknowing reaching areas deep, untouched, we have all been there whether we know this or remember, because here is where our dream state delivers messages in code form to help with our regulation. Experiencing the extreme emotions of the polarity serves a purpose, for only once you have experienced the depth of darkness, the great void, do you really understand the other; other’, being the agony of stepping out, one step at a time, and making sure not to slide too quickly to the extreme which is ecstasy. Only to find this was short lived so back you go. Each movement in the process, the depth at which the movement has taken, lessened by previous visits, so that now you see that it is all about getting the balance right and like a pendulum you swing from side to side, ever moving in a momentum that seems to have life and cause of its own. You are pushed along and at each junction there is a lesson, a learning, or an epiphany, a brief meeting with the inner child, you are swung in another perpetual motion to the other side, perhaps this is consciousness and it is here that you consolidate the learning.
Till once more the motion drives us back towards the depths of our being; our unconscious, where we find ourselves back in the past, re-living traumas, experience’s, making sense of chance encounters, family act’s and the equation of self in all this turmoil of emotion. And on it goes, that perpetual swing from one end of the polarity to the other, forming as it goes our self-equation, the changes aligned with the movements of our self-discovery. At each junction we are building resilience, our self-awareness is unfolding, awakening to a greater life’s purpose. In the end life is a constant building, maintaining or restoring of our relationships. Our inherited or conditioned beliefs and values are questioned and our meaning to life takes on our own personal values and beliefs based on the unique sense of our personal belonging.
In conclusion the making of a therapist is one who understands every aspect of the stages of development, can relate theory to practice, but perhaps even to their own self growth. A Sandtray therapist’s role in the attachment and self-regulation process is to be the mirror, the significant other, to stand in the confidence of knowing that your role in the psychotherapeutic healing of your client is a significant one, and one that you respect, value and authenticate at every level. Most importantly the role of the ST therapist in a client relationship is to be the result, the best you can be, the one who dares. For this is how we lead our clients gently into psychotherapy.
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