Integrating Sand Tray Therapy Into Trauma Treatment: A Guide for Therapists

For some clients, talking is not the easiest way to approach traumatic experiences. Sand tray therapy offers another expressive medium: clients arrange sand and miniature objects to represent experiences, relationships, or emotions, with or without words. It may not seem like much, but the impact can be very powerful.

The therapist’s role in sand tray therapy is to support the client’s choices and pace, and to explore the scene’s meaning with them rather than assume what it represents. This guide covers how to introduce sand tray work in trauma treatment, respond to what emerges, and connect the activity to the client’s goals and readiness.

Key Takeaways

• Sand tray therapy is a cross-theoretical, nonverbal approach that can complement a primary trauma modality rather than replace it.
• Sand tray work can be integrated into broader approaches such as EMDR, IFS, TF-CBT, somatic, or psychodynamic therapy as a flexible expressive activity. How clinicians combine them will vary; these integrations are best understood as adaptations, since published guidance is based mainly on case reports and conceptual articles rather than validated protocols.
• A trauma-informed approach includes client-led pacing, stabilization before trauma-content, and caution with acute symptoms, difficulty grounding, and dissociation.
• Telehealth and cultural responsiveness require deliberate choices about tray format, miniature collections, and how meaning is made.

What Is Sand Tray Therapy, and Why Does It Fit Trauma Work?

Sand tray therapy is an expressive approach in which a client uses sand and miniature objects to create a scene or story. Depending on the approach, the therapist may invite the client to build or change a scene and talk about it, while leaving the client in charge of what to include and what it means. The figures do not have fixed meanings; the client’s understanding matters most.

For some clients, creating a scene offers another way to approach feelings or experiences that are difficult to describe directly. They can choose what to represent, how much to share, and whether to change the scene. This may support a sense of choice and control in the session, though the therapist still needs to monitor the client’s comfort and readiness.

Sandplay vs. sand tray: a distinction that matters

Sand tray therapy traces back to Margaret Lowenfeld’s “World Technique,” which she developed in late 1920s Britain. A pediatrician, Lowenfeld used sand and miniature figures to let children create scenes or “worlds” in play.

In the 1950s, Dora Kalff, a Jungian psychologist who studied with Lowenfeld, adapted the method using Jungian ideas and called her approach Sandplay Therapy. So the terms are related, but they don’t always mean the same thing: “sand tray therapy” is often used broadly, while “sandplay” can refer specifically to Kalff’s Jungian approach.

Kalffian sandplay is primarily non-directive and centers on a “free and protected space.” Sand tray therapy is cross-theoretical, meaning as the practice has evolved, clinicians can integrate sand tray therapy with a variety of approaches and across populations.  This article uses the term “sand tray” broadly while flagging sandplay-specific points.

Why the format suits trauma

Trauma-related material is often sensory, implicit, or difficult to put into words, and a sand tray lets clients represent what they’re processing without narrating it. Creative arts approaches offer a nonthreatening way to express trauma, and the tray works as a tangible medium for externalizing internal states. When a client projects their experience onto the sand tray, this helps create distance, titrates exposure, and in Kalff’s tradition the tray’s boundaries act as a regulatory and protective factor.

What the evidence supports

Research on sandplay and sand tray approaches for trauma is promising, but still limited. In a 2026 randomized study, 102 Syrian refugee children ages 5–13 with PTSD received sandplay, art therapy, or standard counseling for 12 weeks. On average, PTSD scores fell more in the sandplay group than in the other groups, despite that more children in the sandplay group had severe PTSD at the start. The results are encouraging, but they need to be tested in other groups and settings. 

A 2021 study followed 60 children ages 6–10 who had experienced maltreatment and lived in shelters. Children who received sandplay showed improvements in emotional and behavioral problems, and the changes were still present six months later. 

The adult research is much thinner. In a 2024 study, five adults with trauma exposure took part in seven to nine sand tray sessions; trauma symptom scores decreased for four of them. Although the study included only five people, it still offers an early finding about sand tray therapy’s efficacy with an adult population. 

The research offers some support for continued study and thoughtful clinical use, but it does not yet show which clients are most likely to benefit or how sand tray compares with established trauma treatments.

Who Is Sand Tray Therapy Appropriate For, and When Should You Be Cautious?

Sand tray work may suit clients who are interested in using objects, images, or hands-on activity to explore experiences and emotions. It can be offered to children, adolescents, or adults when it fits their goals and the therapist has the training to use it. A client does not need to create a scene or explain it in a particular way: participation, pacing, and whether to discuss the tray should remain choices the client can make.

The key question is whether the activity supports this client’s treatment goals at this point in care. To use sand tray therapy, explain what the exercise involves, invite the client’s preferences, and check in as you go. Trauma-informed practice emphasizes safety, collaboration, and client choice.

Use clinical judgment about timing and support

Pause or adapt the activity if it increases distress beyond what the client can manage, makes it difficult for them to stay oriented to the present, or feels unwanted or confusing. Offer choices such as stopping, taking a break, grounding, or shifting to another activity. Assess current safety and immediate needs, and address them in treatment planning. Conduct safety planning when your assessment identifies significant risk, and make note that dissociation, substance use, and emotional dysregulation may create barriers to engaging in trauma-focused treatment; these concerns call for assessment and support, not automatic assumptions about what a client can or cannot do.

Also consider access and fit. Sand, miniatures, and a visual activity may not work for every client because of sensory, mobility, cultural, or personal preferences. Some adults may also see the activity as childish or feel self-conscious using it. Explain why you’re offering it, make clear that participation is optional, and ask what the client thinks. If it doesn’t feel like a fit, offer another way to work toward the same goal.

Sand tray therapy should not replace a full assessment or a trauma treatment with stronger evidence when one is indicated. For clients with PTSD, trauma-focused treatments such as trauma-focused CBT or EMDR have strong evidence bases and sand tray work can be incorporated into these models. Sand tray work can also be considered as an adjunct when it fits the client’s goals and needs.

Training and scope

Sand tray has no single universal credential, and competency standards remain debated. Check your licensing board and ethics code, get formal training in each modality you’re utilizing, and seek consultation as needed, especially on complex cases.

How to Integrate Sand Tray Therapy With Trauma Modalities

Sand tray work can be incorporated into trauma treatment as an expressive activity alongside other approaches. The therapist can use it to support a specific goal—such as helping a client describe an experience, notice a response, or reflect on a relationship—while keeping the treatment plan grounded in the client’s needs and the therapist’s training. The examples below show ways clinicians may adapt sand tray work within different modalities; they are not standardized protocols.

EMDR

The tray fits naturally in history-taking, preparation, and closure phases of EMDR, , and it can regulate distance during desensitization.

• History taking: A “my world” tray maps people, places, and events without requiring a narrative. Note what sits close, what sits far, and what is missing, and treat those as questions to check with the client rather than conclusions.
• Preparation: Build resource trays: a calm place, helpers or protective figures, and a container for material set aside. Consider pausing mid-build to practice dual awareness by noticing the present.
• Assessment: Have the client build the target as a scene, then complete the standard elements: image, negative cognition, emotion, body location, and baseline SUD and VOC.
• Desensitization: If direct access is too much, build the memory at a symbolic distance with animals or a story world, then move closer as tolerated. Clinicians have used this to reenact implicit memories with figures. Run bilateral stimulation while the client looks at the tray or after short builds. When processing blocks, offer adaptive information through the tray rather than through talk. Invite the client to add a helper, a protector, or a missing caregiver, and let them decide what belongs.
• Installation and body scan: The client adds a figure representing the positive cognition, then scans the tray and the body together.
• Closure and reevaluation: Close with a resource or container tray. At reevaluation, revisit earlier trays to see what has changed.

With clients who dissociate, slow the pace, keep trays at a symbolic distance, and orient between builds. EMDR training comes first, and the tray supports, never replaces, the protocol.

Trauma-focused CBT

The tray can help deliver specific TF-CBT components. 

• Psychoeducation, relaxation, and affect modulation: Use trays for affect identification, such as “show where worry shows up in your world and what helps.” A coping-toolkit tray gives the client a concrete picture of the skills they’ve learned.
• Cognitive coping: After a client builds a scene, ask what thoughts go with it. When self-blame or other distortions surface, test an alternative by adding a figure, such as someone who knows the facts or an adult who was responsible.
• Trauma narrative: Because narrative formats are flexible, build the narrative in chapters, with one tray per segment or hot spot. Photograph each stage, then have the client add captions or dictate the story. Assembling the photos into one sequence keeps the end product a coherent narrative of facts, thoughts, and feelings. Keep exposure gradual, check distress as the client builds, and pause for coping skills when it rises. The process is not forensic, so follow the client’s perceptions rather than fact-finding.
• Sharing with a caregiver: In conjoint sessions, the child can walk the caregiver through the photographed trays. Prepare the caregiver first, because readiness for sharing is a clinical judgment.
• Safety and the future: A tray of safe people and places supports body safety and safety planning work.

IFS

IFS and sand tray both externalize inner experience, so the tray makes a natural third dimension for parts mapping. A stepwise approach is to introduce protectors and exiles, have the client name each part and give it an age and gender, and then choose a miniature for each. The client places the miniatures to show roles and relationships, and you record and photograph so you can recreate the tray next session.

Several moves make the tray more useful:

• Unblending: Have the client move a part’s miniature to a distance until they feel curiosity toward it. If curiosity doesn’t come, ask which other part is reacting and add a miniature for that one.
• Part-chosen figures: Ask each part to choose its own miniature rather than choosing for it.
• Protector–exile mapping: Place protectors in relation to the exile, and ask what each protector fears would happen if it stepped back. Don’t approach the exile until the protectors agree.
• Self: Some clients represent Self with a figure. Others prefer to keep it as the observing position outside the tray. Follow the client’s preference.
• Unburdening: The tray can show a burden as an object that can be released or removed, while the standard IFS steps stay in place.
• Continuity: Begin each session by re-placing the miniatures and asking what has changed.

When there are many parts present in a session, take one cluster per session. The tray can also map autonomic states alongside parts, which helps clients who struggle with parts language.

Somatic and sensorimotor approaches

The tray fits sensorimotor work through its sensory material and its boundaries. Sensorimotor psychotherapy aims at reorganization rather than re-experiencing, and tray work should share that aim.

• Start with orientation: Invite the client to touch the sand, notice how it feels, and orient to the room before building.
• Track the body during the build: After a placement, ask what they notice in their body. Watch for shifts in posture, breath, or impulses to move.
• Pendulate spatially: Designate one area of the tray for resource and another for activation. Move attention between the two so the client stays within their window of tolerance.
• Respond to arousal states: Fast, crowded building suggests hyperarousal, so slow down and orient. Stalling, flatness, or inability to choose suggests hypoarousal, so offer a simpler resource scene or fewer figures and invite movement.
• Work with protective actions: Let clients enact defensive responses symbolically, such as a figure that runs, shields, or calls for help. Then follow with brief movement exploration in the room.
• Map autonomic states: Have clients choose miniatures to represent states like activation and shutdown, and place them to show how they move between them.

Symbolic enactment complements body-level completion but doesn’t replace it.

Jungian and psychodynamic frameworks

Kalffian sandplay is best supported through setup and stance. The classic setup offers two trays, one with dry sand and one with damp sand, each painted blue, along with a wide shelf of miniatures. The therapist holds a “free and protected space” and offers no interpretation during the process. Meaning emerges over time, and a series of trays creates an ongoing dialogue between conscious and unconscious material.

When working with clients who’ve experienced trauma, follow the client’s pace and look across the series rather than at single trays. A common pattern is wounding content early and healing content later, though individual trajectories vary. Notice what the tray evokes in you, because transference and countertransference appear in the work and belong in supervision or consultation.

The traditional Jungian approach is called Sandplay. If you’re using a sand tray and miniatures within another therapy approach, call it sand tray work unless you’re trained in and practicing Jungian Sandplay.

Play therapy, narrative, and attachment-based work

Play therapy. Just as in sand tray therapy, in non-directive play therapy, the therapist lets the child lead. Incorporate the two modalities together by using trays alongside other play-based tools.Family work can use a joint tray where caregiver and child build together.

Narrative therapy. The tray can support the tasks of  externalization and re-authoring, which narrative approaches describe as separating the problem from the client, restoring agency, and co-creating a new story. In practice, the sequence may look like this:

1. Have the client give the problem a name and a figure.
2. Map its effects by placing figures to show what it does to relationships and daily life.
3. Look for unique outcomes, moments when the problem had less influence, and place them in the tray.
4. Rebuild the scene around the preferred story.
5. Invite a trusted outsider witness, perhaps by sharing photographs, to reinforce the new story.

The Therapeutic Sandstory Method adds storymaking and narrative letter writing for children and adolescents.

Quick reference

Adapting Sand Tray Therapy for Telehealth

Sandplay has been adapted for telehealth in three ways: online sandplay, assisted online sandplay, and virtual sand tray. The most common is online sandplay, in which the client builds in their own sand setup while the therapist witnesses remotely.

Other practical options include:

• The client directs the counselor on what to place and where, which loses some of the tactile element and limits figure choice.
• The client builds in a bowl or box of sand with whatever small objects are available.
• Screenshots, taken with the client’s permission, can serve as reference points in session notes.

Digital trays are available, but peer-reviewed outcome research on them has not been published, so treat them as an adaptation rather than an equivalent. Confirm the client’s location and a safety plan before trauma-content work, allow extra time for grounding at the end, and review the privacy practices of any platform you use.

Making Sand Tray Therapy Culturally Responsive

Start with humility, not a symbol dictionary

Cultural competence approaches can lead to stereotyping, while cultural humility assumes there is always something you don’t know. The literature holds a useful tension here. Some authors say prior knowledge of a client’s ethnic background helps. Others warn against relying on a priori cultural knowledge instead of exploring culture within the conversation. Use cultural knowledge to inform your questions, not to assume what a client’s identity or experiences mean.

Build a collection that reflects your clients

A collection of sand tray items should include figures representing various ethnicities, careers, and religions, alongside a range of roles, animals, nature, fences, and buildings. Also consider family structures, body types, abilities, and emotional or relational pieces. When a client wants something you don’t have, that gap is clinical information.

Frequently Asked Questions

Is sand tray therapy evidence-based for trauma?

Research is promising but still limited, so sand tray therapy is not as well established for trauma as treatments such as trauma-focused CBT or EMDR.

Do I need specialized training to use sand tray therapy?

Training in the specific approach matters. A sand tray activity used within your existing clinical scope is different from offering formal Jungian Sandplay or presenting yourself as a sand tray therapist; those approaches call for specialized preparation, and training organizations outline specific standards (International Society for Sandplay Therapy; International Association for Sandtray Therapy). Work within your competence, especially when using the activity with trauma, and seek training or consultation if you plan to use it regularly.

What is the difference between sand tray therapy and sandplay?

Sandplay is Kalff’s primarily non-directive Jungian method. Sand tray is a cross-theoretical approach that can be directive or non-directive. 

Does sand tray therapy work for adults?

It may help some adults, but research is too limited to know how well it works. In one small study, trauma symptom scores decreased for four of five adults after seven to nine sessions. Some adults may find the activity childish or feel self-conscious, so explain why you’re offering it and let the client decide whether it feels like a fit.

Can sand tray therapy be done over telehealth?

Yes, though adaptations differ in how much of the tactile experience they preserve. Practitioners have used online sandplay with clients building in their own setups, as well as lower-tech options like having the client direct the therapist.