California Society for Clinical Social Work

Professional Development | Advocacy | Connection

Helping Healers Heal: The Use of Sandtray Therapy to Aid Therapists in Processing Vicarious Trauma

Sunday, December 04, 2016 9:17 AM | CSCSW Administrator (Administrator)

Roxanne Rae, LCSW, BCD

Many social workers engage deeply with people who have experienced trauma.  The inherent nature of this work exposes us to compassion fatigue or vicarious traumatization because we use our own lives as a safe container for healing our clients.  Psychology professor Daniel Stern aptly explained that “our nervous systems are constructed to be captured by the nervous systems of others, so that we can experience others as if from within their skin, as well as from within our own” (Stern, 2004). 

It is in this empathetic life-to-life connection to people with trauma that a therapist’s own implicit personal resources and deficits may be revealed.  At times, the effort of maintaining affective synchrony with a trauma victim will pull out the best in us.  As one educator and philosopher put it, “our hearts change others’ hearts” (Ikeda, 2008).  Unfortunately, while supporting our clients, we may also become hopeless, anxious, depressed, or exhibit a myriad of trauma-related symptoms ourselves. 

Trauma work is intimate and requires a network of support for healers to minimize the negative impact of this trauma work on their own lives.  For those of us using expressive arts therapies, we are exposed to our clients’ traumas not only through stories, but through images as well.

Healing arts practitioners can use the very techniques that they employ with their clients to help process the traumas that we experience through our empathetic resonance.  We can also use these methods to explore and heal issues that arise from our own past experiences that may be evoked through trauma work. 

Out of the various expressive arts therapeutic modalities, I most often work with the sandtray due to its multisensory qualities that allow access to the implicit aspect of the mind.  Associated techniques within the sandtray modality enhance neuroplasticity through focused attention, novelty, and exploring emotional arousal.  Sara’s story shows us one way in which this identification and processing of trauma may occur.
A busy mental health professional, Sara requested a sandtray session because she was feeling a bit overwhelmed by her work.  Normally, she felt a rich satisfaction from her trauma work with teens.  When Sara noticed consistently less eagerness as she prepared for work, she accurately considered it a red flag.  She had a history of successfully using expressive arts methodologies to facilitate her own clarity and growth.

Sara began by making a circular sand form, like a hill, in the center of the tray.  On top of it, she placed people holding hands in a circle around a candle.  She then stated, “The world is so crazy, it needs some harmony.”  Quickly she lit the candle (Figure 1).  Then, she brought in images of abuse, torture, evil, and war.  She spoke of the poor state of humanity in today’s world.  Sara specifically referred to “evil atrocities in our world,” such as “rape in the Congo, the training of child soldiers, devastating natural disasters, and the existence of warlords in many regions.”  She was intermittently verbally descriptive as she created her world.

Later in the session, she focused on the small, black, and hunched-over devil as it crept toward the circle of people holding hands around their light.  Sara described this devil as the “creeping…seeping of evil” toward her central figures of “harmony and peace.”  She placed a red broken heart figure as a barrier between the two, saying that the heart was “so tattered the evil is likely to get through” (Figure 2).  Sara made this statement immediately after pushing the heart into the sand.

Through my considered inquiry and our reflection together as she processed the experiences portrayed in her sand world, Sara became able to recognize the connections between her globally-focused observations and her personal stressors.  She also realized that she had become increasingly more sensitive about and less modulated in her response to her trauma clients.

Just like the miniature group of people in the center of her sandtray, Sara felt bombarded by evil and negativity.  She expressed feeling overwhelmed by the intense and graphic images of child abuse that she dealt with in her psychotherapy practice.  Her heart was feeling “ragged and torn” in her attempts to hold onto her own “safe place,” while being present with her clients’ suffering.  Eventually, she acknowledged not only feeling assaulted by her everyday work world and the “big world,” but also by some personal family issues.  Once this realization was acknowledged between us, the focus turned to how she could strengthen and nurture herself.

During the dialogue that followed, Sara placed the “Do Not Enter” and “Stop” signs in the tray.  She moved the “Do Not Enter” sign toward the “devil’s path” and “other evils,” as a way to protect her “harmony and peace.” In the end, her peaceful circle conquered all (Figure 3).  Sara expressed a deeper commitment to strengthen herself to deal with her family difficulties more effectively and created a specific plan to do so. 

As this story demonstrates, a therapist may facilitate a client’s active, conscious engagement with previously implicit features of a client’s life, making what is implicit more accessible.  In this case, Sara was able to see and reflect on the connections between her subtle dissatisfaction with her work and her previously unacknowledged conflicts at home.

The sandtray process provides the opportunity to tap into our own inner wisdom and explore life’s alternatives.  Sandtray teaches and supports awareness of our own processes and how they impact the choices we make within our environment.  In this case example, Sara was able to use sandtray therapy to identify her need to work on strengthening her spiritual and social supports, on forming more effective boundaries, and on taking actions to resolve her immediate family matters. 

For therapists who treat trauma, maintaining an awareness of our work’s inherent interpersonal stressors may aid us in engaging in preemptive as well as reparative self-care activities.  The sandtray offers a unique and deeply personal way for us to explore issues that both stem from, and influence, our capacity to engage with and help our clients transform their sufferings.Roxanne Rae, LCSW, BCD is the author of Sandtray: Playing to Heal, Recover, and Grow (Jason Aronson, 2013, 2015).  She has more than 43 years of social work experience and is licensed in both California and Oregon.  For more photographs, information about Sandtray, and to download the author’s articles free of charge, please visit

Ikeda, D. (2008). My dear friends in America: Collected U.S. addresses 1990-1996. Santa Monica: World Tribune Press.
Stern, D. (2004). The present moment in psychotherapy and everyday life. New York: Norton.

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