Is sandplay therapy only for children or does it work for adults too?

The assumption that sandplay belongs exclusively to children is understandable — sand, miniature figures, and tactile play carry obvious associations with childhood — but the clinical and empirical record tells a different story. Sandplay therapy is practiced with adults across a wide range of presenting concerns, and the evidence for its effectiveness with adult populations is now substantial.

Dora Kalff, the Swiss analyst who founded sandplay in 1956 after studying Margaret Lowenfeld's World Technique in London, designed the method from the beginning as a depth-psychological approach rather than a developmental one. The theoretical ground is Jung's analytical psychology, and the therapeutic aim — what Kalff described as creating "a free and protected space" for the psyche's natural healing capacities — applies equally to an adult in crisis and a child working through developmental disruption. The sand, water, and miniature figures are not props for regression; they are instruments for accessing what Wiersma et al. (2022) describe as "conscious and unconscious processes" in a way that bypasses the limitations of purely verbal communication.

That bypass is precisely what makes sandplay valuable for adults. Many adult clients — particularly those carrying trauma, somatic symptoms, or early preverbal wounding — find that language fails them not because they lack sophistication but because the material lives below the threshold where words operate. Roesler (2019) notes that sandplay "changes the focus of therapy away from solely verbal communication or cognitive insight," and that this nonverbal quality is "especially applicable in working with children, and with adults with trauma, distress, disabilities, and migration issues." The nonverbal approach lowers the threshold for engagement and provides a contained, direct means of working through difficulties that conventional talk therapy cannot easily reach.

The neurobiological dimension is worth noting here. Wiersma et al. (2022) cite emerging neuroimaging research showing that sandplay improved synchrony in frontotemporal networks, potentially facilitating memory retrieval and reprocessing with an optimal degree of cognitive control — and that symptom improvement in adults with generalized anxiety was associated with improved functioning in the limbic system and prefrontal cortex. These are not findings about child development; they describe adult brain systems involved in affect regulation and trauma processing.

The meta-analytic evidence is striking. Wiersma et al. (2022) analyzed 40 studies from eight countries representing 1,284 participants and found an overall effect size of Hedges' g = 1.10 — a large effect by any standard. Crucially, this effect held across internalizing symptoms, externalizing symptoms, and ADHD presentations alike. The randomized controlled trials reviewed by Roesler (2019) include adult populations presenting with generalized anxiety disorder, depression, interpersonal difficulties, social anxiety, and trauma from natural disasters. One study found that group sandplay provided to earthquake survivors in Nepal produced significant improvements across all dimensions tested. Another found that adults with interpersonal avoidance showed a 62.8% decrease in social avoidance scores and a 55.1% decrease in social distress scores after eight sessions.

Chiara Tozzi's account of sandplay as a form of active imagination illuminates why this works at a depth-psychological level. She describes a patient who, touching the sand with eyes closed, experienced for the first time something solid that "held" her — a mound formed by her own palm's imprint fitting perfectly beneath her hand:

It was the first time she had felt something so solid under her hand. Something that "held" her, that she could hold on to, and that she could entrust herself to.

This is not a child's experience of play. It is an adult encountering, through the medium of sand, something the psyche had not previously been able to receive — a transitional object in Winnicott's sense, simultaneously found and created, inner and outer at once. The hands' impulses in the sandtray, Tozzi argues, are analogous to the visually imagined images of classical active imagination: the unconscious speaks through gesture and touch as readily as through vision.

Individual format consistently outperforms group format in the outcome literature — Wiersma et al. (2022) found a significant difference favoring individual treatment — but both formats show large effect sizes, and group sandplay has demonstrated particular effectiveness for adults with social anxiety and interpersonal difficulties. The method has also proven viable in settings where language barriers make conventional psychotherapy impossible, including work with traumatized refugees and disaster survivors.

The short answer, then, is that sandplay is not a children's modality that adults can borrow under special circumstances. It is a cross-cultural, psychodynamic method whose nonverbal, multisensory character makes it especially suited to the kinds of material — preverbal, somatic, traumatic, imaginal — that adult psyches carry and that language alone cannot adequately hold.

Dora Kalff — portrait of the founder of sandplay therapy and her Jungian roots
Active imagination — the depth-psychological practice sandplay extends into tactile and kinesthetic registers
Individuation — Jung's term for the movement toward wholeness that sandplay is designed to support
Trauma and depth psychology — on the body, preverbal memory, and the limits of verbal therapy

Sources Cited

Wiersma, Jacquelyn K., Freedle, Lorraine R., McRoberts, Rachel, and Solberg, Kenneth B., 2022, A Meta-Analysis of Sandplay Therapy Treatment Outcomes
Roesler, Christian, 2019, Sandplay Therapy: An Overview of Theory, Applications and Evidence Base
Tozzi, Chiara, 2017, Active Imagination in Theory, Practice and Training