sandplay therapy
Sandplay therapy occupies a distinctive and contested position within the depth-psychology corpus. Founded by Dora Kalff on Jungian and psychodynamic foundations, the method enlists a tray of sand and an array of miniature figures to create a nonverbal, three-dimensional symbolic world in which unconscious processes may surface without the mediating pressure of interpretation. The literature divides broadly into three registers. The first is theoretical-clinical: accounts tracing the method's lineage from Margaret Lowenfeld's World Technique through Winnicott's transitional space to Kalff's free and protected space, with ongoing tension between those who foreground symbolic-interpretive work and those who trust the healing power of uninterpreted play. The second register is applicational: a rapidly expanding body of practice literature documenting sandplay's deployment with traumatized children and adults, survivors of collective disaster, individuals with ADHD, anxiety, low self-esteem, and migration-related distress, extending into group, couple, and family formats. The third register is empirical: systematic reviews and meta-analyses—culminating in Wiersma et al. (2022) and Roesler (2019)—that now report large composite effect sizes comparable to established psychodynamic therapies, establishing sandplay as an evidence-based treatment while acknowledging methodological heterogeneity and the need for research sensitive to the method's deeper individuation goals. Connections to neuroscience, narrative therapy, and active imagination further mark the field's contemporary directions.
Sandplay therapy is a cross-cultural, psychodynamic, nondirective, multisensory psychotherapy method founded by Dora Kalff.
Wiersma et al. establish sandplay's foundational identity and launch the first international meta-analysis of its quantitative outcome studies across 40 studies and eight countries.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022thesis
Sandplay Therapy (SPT) is a psychotherapy method utilized worldwide, not only in Western countries, but also in Asia and Latin America with an extensive increase in growth over the past 15 years.
Roesler frames SPT as a globally expanding, nonverbal, Jungian-rooted method with a growing evidence base, and undertakes a systematic cross-linguistic overview of its theory, applications, and empirical standing.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019thesis
The overall results of this study show a large composite effect size of g = 1.10, favoring sandplay therapy treatment over controls.
The meta-analysis establishes sandplay's efficacy with a large composite effect size comparable to other psychodynamic therapies and superior to mindfulness-based therapies across internalizing, externalizing, and ADHD symptom domains.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022thesis
This meta-analysis included 40 studies from eight countries representing 1,284 participants, demonstrating uniformly positive findings for sandplay treatment with many different populations and across diverse practice settings.
Wiersma et al. conclude that the international evidence base uniformly supports sandplay as an evidence-based treatment, warranting recognition within the broader psychotherapy community.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022thesis
With a foundation in Jungian and psychodynamic theories, sandplay has emerged with a specific treatment protocol that emphasizes a nondirective, noninterpretive approach that can tap into unconscious processes.
Wiersma et al. distinguish sandplay from sandtray therapy by its Jungian-psychodynamic protocol requiring a nondirective, noninterpretive therapist stance oriented toward the unconscious.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022thesis
Two opposing viewpoints became visible, one emphasizing the importance of frequent interpretation, the other emphasizing the therapeutic power of play in itself without the necessity of interpretation.
Roesler traces the foundational theoretical tension in play-based therapies—interpretation versus the intrinsic healing power of play—that Kalff's sandplay resolves in favor of the latter, inheriting Lowenfeld's and Winnicott's legacy.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019thesis
Non-verbal techniques may represent the most effective treatment strategy without the risk of re-traumatization.
Roesler argues that sandplay's nonverbal modality makes it uniquely suited for trauma populations—including disaster survivors—where verbal re-narration risks re-traumatization by accessing subcortical sedimented trauma.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
The sandplay process thus provides the conscious personality with means to address conflicts, traumas, losses, etc., as well as the psychic content necessary to further personality development.
Roesler articulates sandplay's dual therapeutic function: resolving psychic conflicts and traumas while simultaneously furnishing material for ongoing individuation and personality development.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
It is a key assumption of sandplay therapy that further sessions invite increased access to the unconscious, thereby stimulating the individuation process.
Wiersma et al. note that sandplay's symptom-level outcome measures incompletely capture its deeper theory, which posits that extended treatment progressively deepens access to the unconscious and activates individuation.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022supporting
Whether in the practice of Active Imagination or in sandplay, this phase consists of a retrospective conscious reflection on the experience.
Tozzi aligns sandplay with active imagination by identifying the Jungian fourth phase—conscious ethical reflection on the imagery produced—as operative in both modalities, underscoring sandplay's kinship with the wider analytical tradition.
, Active Imagination in Theory, Practice and Training, 2017supporting
Recent developments combine the classical approach of SPT with narrative techniques or other art therapy methods and extend the use of SPT, e. g. to the work with couples and families.
Roesler maps contemporary expansions of sandplay beyond its classical individual Jungian frame, integrating neuroscience, narrative therapy, art therapy, and systemic applications with couples and families.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
The SCC covers three essential aspects of sandplay: (a) the thematic content of the scene and the process involved in creating it, (b) the creator's personal story and descriptive words, and (c) the progressive or regressive changes that occur from one scene to the next.
Roesler describes the Sandplay Content Categories instrument as a systematic observational tool enabling reproducible, multi-dimensional coding of sandplay pictures for research and clinical documentation.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
A wide range of child and adolescent mental health problems were treated, including behavioral problems, low self-esteem, trauma, substance abuse and anxiety. All of the studies found significant improvements.
Roesler's effectiveness review demonstrates that across diverse child and adolescent presentations, sandplay produces consistent, significant improvement regardless of diagnosis or setting.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
A large effect size (g = 1.089) was found with the most improvement noted when sandplay was conducted in an individual format, twice per week, and with sessions lasting 50–60 min.
Wiersma et al. report the prior Korean meta-analysis that anchors their own work, specifying the dosage parameters—individual format, biweekly, 50–60 minutes—most strongly associated with treatment gains.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022supporting
Thanks to the support from Japanese colleagues it was possible to translate and include studies originally published in Japanese, Chinese and Korean, which makes this overview the first to include studies in Western as well as Asian languages.
Roesler emphasizes the methodological novelty of his review in being the first to synthesize sandplay research across East Asian and Western languages, correcting a significant anglophone bias in prior literature.
, Sandplay therapy: An overview of theory, applications and evidence base, 2019supporting
Therapy sessions were conducted using primarily a nondirective and noninterpretive stance by the therapist. Each participant made their own picture in their own sand tray regardless of whether the therapy took place in an individual or group format.
Wiersma et al. operationalize sandplay's defining methodological criteria for meta-analytic inclusion, centering therapist non-directivity, non-interpretation, and participant-authored trays as the method's procedural essence.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022supporting
In order to capture the depth of the sandplay method, to expand its theoretical base, and to inform future research, we recommend continued qualitative inquiry, including exploration of the lived experiences of clients who engage in sandplay therapy.
Wiersma et al. identify the limits of quantitative meta-analysis for sandplay and call for qualitative research to recover the experiential and symbolic dimensions that symptom measures cannot capture.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022supporting
The research team created a scoring system to rate each study's quality. Using the APA Division 12 quality criteria suggested for the evaluation of empirically supported treatments.
Wiersma et al. detail the multi-criteria quality scoring framework used to evaluate included studies, situating sandplay research within mainstream evidence-based practice standards.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022aside