Sand Tray Therapy for Clients with Intellectual Disabilities

In the first half of the last century, British paediatrician and child psychiatrist Margaret Lowenfeld utilised sand and water in combination with small toys to help children express “the inexpressible” after reading H.G. Wells’ observation that his two sons would work out family problems playing on the floor with miniature figures (Zhou, 2009).

Lowenfeld added miniatures to the shelves of her therapy rooms, and the first child who came to use them took the figurines over to the sandbox, playing with them there. Thus, it was a child who “invented” what Lowenfeld came to call “The World Technique” (Zhou, 2009). In the 1950s, Jungian analyst Dora Kalff (Zhou, 2009) extended the use of the sand tray to adults, realising that the technique allowed not only the expression of fears and anger in children, but also processes of transcendence and individuation (in adults) which she had been studying with Jung. She called it “sandplay” (Zhou, 2009).

Sandplay has been defined as a psychotherapeutic technique which invites clients to arrange miniature figures in a sandbox or sandtray to create a “sandworld” corresponding to various dimensions of their social reality (Dale & Wagner, 2003).It involves the use of one or two sandtrays and any number of small objects or figures from categories including: people, animals, buildings, vehicles, vegetation and other natural objects, and symbolic objects.

Using sand and the miniatures gives clients a symbolic way of expressing their feelings and their worldview. Because it does not depend heavily on communicative proficiency, it can be used with a wide range of people with varying verbal and cognitive abilities. It provides a safe way to explore the unconscious, along with overwhelming feelings and life situations. Because it allows the deeper aspects of the psyche to be worked with naturally and in a non-threatening environment, it is highly effective in reducing the emotional causes of difficult behaviours. Sandplay thus helps to strengthen a client’s connection between the inner and outer worlds (Campbell, 2004; WWILD, 2012; Zhou, 2009).

It commonly consists of two central stages, the first involving the construction of the sand picture. Here the perceived need for the counselling session and the specific intentions of the therapist guide the instructions given to the client. Generally, the person is invited to create a sand picture using any of the therapist’s miniatures.

While there can be many therapeutic orientations with varying means of interpreting what the client creates, the sandplay pictures are generally considered to be a projection of the child’s internal subjective world and a representation of his or her worldview (Dale & Wagner, 2003). Because they give the client the opportunity to express negative feelings and unconscious memories which impact on their choices, bringing these to consciousness can be the first stage of disempowering them and allowing their release (Campbell, 2004).

The second stage involves sharing a story or narrative about the created sand picture. Here clients can clarify personal meanings and integrate new feelings and insights that may have emerged through the creation of the sand picture. While the issue of whether or not to interpret the scene is strongly debated, many experts on sand play argue that the therapist’s role is to sit quietly beside the client while the picture is created, sketching what is created (or taking photographs) and making notes on any utterances the client makes while doing it.

The proponents of this method claim that, in this way, the client is safe and free to explore his/her own meanings, leading naturally to the person’s inbuilt movement toward wholeness (Campbell, 2004; WWILD, 2012).

What the research says

Although sandplay is often presented as a robust assessment and treatment tool, there is little research to show with scientific rigour whether the approach is effective with the population in general, let alone with the much smaller group of the people with intellectual disabilities (Zinni, 1997). Campbell (2004) reviews the use of the technique with various subpopulations, such as those with language and communication difficulties, attention deficits, the culturally different, or those who have experienced trauma.

Because of its non-verbal nature, the sandplay process is likely to be useful with clients who have language and communication or cognitive deficits (clients with intellectual disabilities are probably most similar of those she described to this group). Campbell cites a study which demonstrated the ability of sandplay to improve concentration and peer relations in speech- and language-disordered clients (Carey, 1990, in Campbell, 2004). Those with attention deficits are said to be able to achieve greater kinaesthetic involvement with sand than with mere “talk therapy”, and so were shown to achieve a more concentrated focus, with the sand tray minimising distraction and promoting a focusing effect (Carey, 1990 and Vinturella & James, 1987: both in Campbell, 2004).

Abuse experiences are particularly tough for clients to acknowledge, let alone verbalise; thus, sandplay is seen to be highly appropriate for abused individuals, a population which includes most clients with intellectual disabilities. To them it offers a safe place to express through play and symbolic activity the complex emotions related to the abuse (Grubbs, 1994, in Campbell, 2004).

One of the few studies conducted in this area used sandplay therapy as an assessment tool with 52 abused and non-abused children. The results showed significant differences in the sandtray constructions between the abused and the non-abused subjects. The differences centred on the content, theme, and approach, reflecting the emotional distress of the abuse (Zinni, 1997).

Because the fields of counselling and psychology consider evidence-based or empirically-supported therapies to be the “gold standard”, limitations on potential scientific research will continue to hamper the demonstration of effectiveness. Rather, it seems for the moment, clinicians using sandplay will have to be content with the wealth of case studies accumulating, which preclude (comparative) conclusions regarding technique effectiveness.

How to best use this therapy with client with intellectual disabilities

In selecting figures for the sandtray, clients with intellectual disabilities normally can choose items to represent themselves. Where some of this client group have stalled is in picking figurines to represent others in their lives. The problem, according to sandtray therapists, is the tendency of clients with intellectual disabilities to view things in a concrete, literal way. Therapists can help such clients compensate for this tendency by engaging them in conversations about some of the person’s more abstract qualities, such as whether the person is, say, affectionate and cuddly (the client could choose a teddy bear to represent them) or whether the person criticises and “growls” at them a lot (the client could choose a mean-looking dog).

The therapist does not choose the object or ascribe their own associations to, say, a family member the client is trying to represent. Rather, the therapist supports the client to understand the person and the client’s relationship to them in less literal, more symbolic terms. When sandplay figurines take on symbolic meaning, the client is connecting to the unconscious, which supports emotional healing and personal development (WWILD, 2012).

Potential enhancements

As noted above, sandtray therapy works in well as an adjunct to many other therapies, although some strong proponents of sandtray therapy might prefer to think of the sandtray work as the main therapy and other approaches as the supplementary ones!

This article is an extract from the upcoming Mental Health Academy CPD course “Counselling Clients with Intellectual Disabilities: A Look at What Works”.



  • Campbell, M.A. (2004). Value of Sandplay as a therapeutic tool for school guidance counsellors. Australian Journal of Guidance and Counselling (14(2): 211-232.
  • Dale, M., & Wagner, W. (2003). Sandplay: An investigation into a child’s meaning system via the self-confrontation method for children. Journal of Constructivist Psychology, 16, 17-36.
  • WWILD. (2012). How to hear me: A resource kit for counsellors and other professionals working with people with intellectual disabilities. WWILD Sexual Violence Prevention Association Inc: Disability Training Program. Department of Justice and Attorney General Building Capacity for Victims of Crime Services Funding Program. Retrieved on 3 December, 2013, from: hyperlink.
  • Zhou, D. (2009). A review of sand play therapy. International Journal of Psychological Studies; 2009, 1 (2), 69-72.
  • Zinni, R. (1997). Differential aspects of sandplay with 10- and 11-year-old children. Child Abuse & Neglect, 21, 657-668.