Sand Tray Therapy for Speech Development: Expert Review

Amy Yacoub
CCC-SLP
May 13, 2024

Sand tray therapy, which is also referred to as sand play therapy or sandbox therapy, can be used as an effective therapeutic tool for improving speech and language skills for those who struggle with verbal communication. 

The sand tray therapy approach uses sand, miniature figurines, and a safe environment in order to address speech and language goals and facilitate expression. This method can be used with children who are nonverbal or minimally verbal. 

This comprehensive review delves into the world of sand tray therapy to explore its methodology, benefits, and the evidence base that supports its effectiveness for use in speech therapy. This article will also include my expert opinion and experience with sand play therapy as a Speech-Language Pathologist. 

What is Sand Tray Therapy?

Sand tray therapy is a non-directive therapy technique that involves using a therapeutic sand tray filled with sand and miniature objects for creating scenes through symbolic play. The technique is often used to encourage verbal expression in individuals with reduced communication skills. The intended purpose of sand tray therapy is to facilitate self-expression, emotional healing, and personal growth through engaging in symbolic representation with the use of sand and figures. 

Target Clients

Sand tray therapy can be beneficial for children, adolescents, or adults with:

• Social-emotional difficulties

• Speech and language delays

• Learning disabilities

• Autism Spectrum Disorder (ASD) 

• Anxiety or trauma

• Sensory processing disorder 

• ADHD

Benefits

The benefits of sand play therapy include:

• Creates a safe environment for individuals to explore conflicts and emotions. 

• Supports imagination, creativity, and symbolic thinking. 

• Reduces stress and encourages emotional regulation. 

• Provides sensory input and encourages sensory regulation. 

• Improves engagement and attention while working on speech therapy goals. 

How It Works

To engage in sand tray therapy, the individual uses symbolic play to create scenes with miniature figurines in a tray filled with sand.

The client chooses what figurines to use, which can be items such as small toy people, animals, trees, or buildings. The therapist can provide guidance for the client as he or she creates a world reflecting experiences and scenarios of their own. The therapist then observes the client to allow them time to seek solutions or explore the scene on their own. 

The sandplay therapy technique traditionally is largely non-verbal, and is thought to create a bridge between the conscious mind and the unconscious. 

The therapist and client typically engage in a discussion after sand tray play, analyzing specific points such as which figures the client chose and how or why they arranged items in the sand in certain ways. The client might share his or her feelings and thoughts with the therapist at this time. 

Effectiveness

Sandplay therapy is a type of play therapy, and can support a child’s acquisition of developmental milestones.

Is sand tray therapy evidence based? Yes. According to research, sandplay therapy can benefit children in several ways, including:

• Develop self-awareness

• Improve emotional regulation 

• Increase problem-solving skills 

• Improve social interaction 

• Increase self-esteem

• Encourage communication skills 

• Reduce emotional and behavioral problems

Sandplay therapy is traditionally used in psychotherapy, however, it can also be applied in other contexts, such as in schools, speech therapy, and the home environment. 

Sand Tray Therapy Technique: An SLP’s Review

Here, I will provide a review on the sand tray therapy technique. Within this detailed analysis, I’ll review the sand tray therapy technique through my clinical experience and opinion as a Speech-Language Pathologist. I’ll also review sandplay therapy based on documented reviews from others. Let’s explore the methodology, teaching strategies, impact, cost, and other factors about the sand tray therapy technique. 

Methodology & Process 

In my opinion, sandplay therapy is a unique way to engage children and encourage developmental skills such as expressive communication and social interaction. 

Speech therapy often incorporates play-based techniques as a way to effectively target speech and language goals. Sand tray therapy is based on a Jungian psychoanalytic framework, in which the sand tray and the objects used represent the client’s unconscious mind. This framework emphasizes the use of symbolism to explore one’s inner thoughts and feelings. In sand tray therapy, the sand and miniature objects create a safe space for clients to express themselves, revealing feelings such as underlying conflicts that may otherwise be difficult for them to articulate into words. 

I believe that this unique approach could improve a child’s engagement and cooperation during speech therapy sessions. It could also be used to effectively improve the child’s attention while working on speech and language goals with caregivers at home. 

I see the research base supporting the effectiveness of sandplay therapy as evidence that the technique could effectively improve a range of developmental skills in children. 

Teaching Strategies

Sand tray therapy is highly individualized. The therapist or individual using the approach can tailor it based on the child’s age, needs, and goals. The focus during use of sand tray therapy is not typically on teaching specific skills, as guidance or prompting from the therapist is not typically provided during the activity. However, it can be used to create a comfortable space for encouraging communication and emotional expression. Individualized speech, language, and social skill goals may be addressed at another point during the same session that sand tray therapy is used. 

An advantage of using sand play therapy is that it offers flexibility as a teaching approach. It can be adapted to encourage the development of a range of skills, such as problem solving (as children use the sand and objects to represent solutions or work through challenges). It can also be used within a group to encourage collaboration and communication. 

The multisensory basis of sand play therapy makes it unique from other play-based interventions or activities used to improve a child’s communication skills. Multisensory activities can boost a child’s engagement and attention during speech therapy sessions. 

Not only can specialists such as mental health providers use the sand play therapy technique, but it can also be used by other professionals such as Speech-Language Pathologists, behavior therapists, and Occupational Therapists. Through education and observation of the technique, parents themselves can also incorporate sand tray therapy at home. 

Impact

According to research, sand tray therapy can promote improvements in a child’s emotional regulation, communication, and social interaction skills. These improvements can be long-lasting, therefore positively impacting the child’s overall well-being and communication skills. 

Several studies cite the effectiveness of sand play therapy on improving a range of skills in both children and adults. These skills include reducing negative behaviors, encouraging verbal expression, reducing anxiety, and improving problem solving skills.

In my first hand experience as a Speech-Language Pathologist, play-based, sensory activities such as the sand play technique can improve a child’s attention and engagement during therapy sessions. 

Cost

The cost of sand tray therapy can vary depending on the location, therapist’s experience, and session duration. The cost associated with the materials used for sand tray therapy is minimal, and would include the tray, sand, and figures being used. There may be additional costs associated with training and support materials for the technique, such as books and workshops. 

Support

Therapists are typically able to provide support for the child who is participating in sand tray therapy in sessions. Parents or caregivers can also receive guidance on using sand tray therapy at home through a review of the program and demonstration in sessions. 

Parents and caregivers can easily obtain the materials needed to engage the child in sand tray therapy by purchasing a sand tray kit that includes the tray, sand, and a variety of figurines. 

There is not only one single protocol required to follow when using sand play therapy with a child. Professionals, parents and caregivers can utilize a range of online resources such as websites, videos, and books to guide them through using this technique. 

User Reviews

In researching sand play therapy reviews, overall feedback is positive and users appear satisfied with the results. Individuals frequently report significant emotional breakthroughs and improved communication skills as outcomes of using sand trays for therapy. 

Professionals have documented that sand play therapy has lowered the anxiety level of many of their clients. Parents of children with autism spectrum disorder who engage in sand play therapy have reported reduced parenting stress. This relief of parenting stress can positively impact the child’s well-being and help establish a parent-child attachment relationship.  

This positive feedback underscores the effectiveness of the technique in promoting emotional wellbeing and expressive communication development. 

A few potential drawbacks of sand tray therapy are that some therapists are unsure how to introduce the tool to older clients such as adults, and the subjective nature of the technique. The meaning of the scenes the client creates in the sand may be open to interpretation by both the client and the therapist, which could lead to missed explanations. 

Strengths of the Sand Play Therapy

In researching sand play therapy studies and reviews, it appears that the technique offers an effective approach to improving communication skills and emotional well-being. 

• Play-based approach. I find that the most unique aspect of the technique is that it differs from traditional play therapy often used in speech therapy sessions by providing the child with sensory input. 

• Holistic technique. A benefit of sand play therapy appears to be that it can be used not only to facilitate expressive language skills but also social and emotional needs. 

• Safe space for exploration. A strength of sand tray therapy is that it provides a child with the opportunity to engage in an exploration of emotions without a high level of prompts or directives. 

Areas for Improvement

Additional research on the effectiveness of sand play therapy specifically on improving speech and language skills is needed to fully understand the technique’s specific impact on these skills. Much of the existing research on the approach focuses on its effects on psychological well being. 

In my professional opinion, additional resources on the protocol for the sand play therapy technique would be helpful. This could serve as a more specific guide for my sessions. 

In some cases, depending on factors such as location and access to resources, the availability of a therapist trained in using the sand tray therapy technique may be challenging.  

Bottom Line

Sand tray therapy offers a promising approach for speech-language pathologists, mental health providers, parents, and caregivers working with children who struggle with communication. Sand tray therapy allows a child to use creative expression and process emotions while creating scenes with sand and miniature figurines on a tray. While additional research is needed, existing studies provide evidence supporting the technique’s effectiveness in promoting communication, emotional well-being, and social interaction skills. 

Our Methodology: How We Reviewed the Sand Tray Therapy

While conducting a thorough review of sand tray therapy, I ensured a comprehensive evaluation by utilizing a multifaceted approach. I integrated a range of perspectives from a diverse set of sources, which allowed me to present an unbiased, comprehensive analysis of sand tray therapy’s effectiveness. I used the following methodology in my assessment of the effectiveness and value of the sand tray therapy approach:

• Evaluation Criteria: Clearly defined criteria was used to guide my review. This focused on specific key areas, including:
  • Usability
  • Accessibility for diverse users
  • Educational effectiveness
  • Level of support and resources provided

• Evidence-Based Approach: I’ve presented an in-depth examination of how the sand play therapy technique can enhance communication and social-emotional skills. My analysis was developed through research from reputable sources such as research journals and publications. 

• User Feedback: I located direct feedback from individuals who are familiar with the sand tray therapy approach. This feedback enabled a comprehensive assessment of the approach’s impact. 

• Unbiased Opinion: It is important to note that this review is independent and free from any financial affiliations with tools or resources related to sand tray therapy. The insights I have presented here are based solely on my professional experience and expertise with the technique. 

• Expert Analysis: I synthesized my professional experience as a Speech-Language Pathologist in working with children with reading difficulties with the opinions of other professionals in the field, ensuring a well-rounded and informed evaluation. 

Forbrain and Sand Tray as Complementary Speech Therapy Approaches

Forbrain, an auditory stimulation brain training device that utilizes bone conduction technology, can be used to complement sand tray therapy.

Forbrain transmits sound vibrations through specialized headphones, The device amplifies auditory stimuli with the goal of improving individuals’ auditory processing, attention, and communication skills. 

Forbrain can be integrated into sand tray therapy to potentially enhance the effectiveness of this program. The child could simultaneously use the device while engaging in debriefing with the therapist after working with the sand tray. Combining these tools may offer a holistic therapeutic approach, addressing speech and language goals alongside emotional and psychological needs. 

Forbrain may aid in processing and retaining information while students engage in sand tray therapy activities by slightly amplifying the user’s voice. Overall, Forbrain can potentially offer several benefits when used as a tool to complement sand tray therapy in improving communication and social-emotional skills. 

The Use of Sand Tray Therapy with and without Forbrain

Final Words

Sand tray therapy (also referred to as sandplay therapy) is a promising approach for speech-language pathologists, mental health providers, parents, and caregivers working with individuals who have difficulties with communication. The approach encourages the child to use creative expression while targeting speech and language goals. 

Additional research is needed to support the use of sand tray therapy specifically to support speech and language skills. Though existing evidence supports the technique’s effectiveness in promoting communication, emotional well-being, and social interaction skills. 

Parents and professionals using sand play therapy may consider using Forbrain, an auditory stimulation headset, to complement activities. This holistic approach can enhance several aspects of a child’s life with lasting impacts. 

References

Brunei Darul Salam. Journal of Educational and Developmental Psychology, 9(1), 23. DOI: http://doi.org/10.5539/jedp.v9n1p23 

Li S, Lu Y, Wu J. Sandplay Therapy as a Complementary Treatment for Children with ADHD: A Scoping Review. Issues Ment Health Nurs. 2023 Sep;44(9):911-917. doi: 10.1080/01612840.2023.2249990. Epub 2023 Sep 12. DOI: https://www.tandfonline.com/doi/full/10.1080/01612840.2023.2249990

Liu, G., Chen, Y., Ou, P., Huang, L., Qian, Q., Wang, Y., … & Hu, R. (2023). Effects of Parent-Child Sandplay Therapy for preschool children with autism spectrum disorder and their mothers: A randomized controlled trial. Journal of Pediatric Nursing, 71, 6-13. DOI: https://doi.org/10.1016/j.pedn.2023.02.006

Wonders, L. L., & Affee, M. L. (Eds.). (2024). Play Therapy Treatment Planning with Children and Families: A Guide for Mental Health Professionals. Taylor & Francis. DOI: https://books.google.com/books?hl=en&lr=&id=6sH0EAAAQBAJ&oi=fnd&pg=PT11&dq=Play+Therapy+Treatment+Planning+with+Children+and+Families+A+Guide+for+Mental+Health+Professionals+speech+pathologist&ots=G_V8ziAO4W&sig=ubaZ7eEonlmDm_ZYBZW9BV54IJo#v=onepage&q=Play%20Therapy%20Treatment%20Planning%20with%20Children%20and%20Families%20A%20Guide%20for%20Mental%20Health%20Professionals%20speech%20pathologist&f=false

Yaghoobian, P., & Emadian, S. O. (2019). The effectiveness of art therapy with sand play method on behavioral disorders, emotional problems, and communication skills of children. Bali Medical Journal, 8(1), 153-159. DOI: https://api.semanticscholar.org/CorpusID:211571448

Yahaya, A., Maakip, I., Voo, P., Mee, S. K., Kifli, K. H., & SHBIE, U. B. D. (2019). The effectiveness of sandplay therapy to improve students’ self-esteem

Amy Yacoub

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Amy Yacoub, MS, CCC-SLP is a Speech-Language Pathologist. She has over 12 years of experience working with children who have a variety of diagnoses and disorders, including speech and language delays, Childhood Apraxia of Speech, and Autism. She is also an experienced consultant within the field.

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