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Sand Therapy Competencies: Principles, Practice, Presence©

Level I


Exam

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Exam Organization:

This exam is designed to teach, not test memory. Exam questions are meant to reinforce course information.

There are nine (9) topics in bold caps. Under each topic are Key Terms and an Assertion. The first question in each topic presents core ideas that are either true or false. Of the 5 or 6 core ideas only one is false.

Following the core ideas is a set of questions each of which is either True or False.

The final topic Training, Case Consultation and Supervision presents seven (7) scenarios.
Decide if the professional in each scenario responded to the challenging situation in a way that seems to meet “best practice” expectations.

Exam Topics and Questions:

Topic 1. PRINCIPLES 5 questions


Key terms: Intentionality, purpose, safety, freedom, permission, empowerment, presence, meaning

Assertion: Guiding principles are basic to all forms of Sand Therapy.

1. Which one of the statements below is FALSE? _____

a) The therapist is mindful of the purpose for using sand and symbols, has a clear intention for their use, and has assessed that the approach is appropriate for the particular client.


b) The therapist sets safety parameters prior to using sand with clients, and maintains a high level of protection for the client and his/her sand scene from environmental influences, or viewing/comments from others such as parents, spouses, siblings and the next client.


c) The therapist avoids leading the client. Engagement is empowering for the client, not objectifying. Existential permission flows from the clinician, supporting the client’s freedom and spontaneity to create a sand scene without interference from the therapist.


d) The therapist is fully present during creation of a sand scene, avoids distractions, maintains focus while silently resonating, wondering, and accessing the therapist’s own imagination to make connections, avoids symbol concretization, aware of their own projections, and appreciates that there is unknown potential meaning.


e) Regarding the use of symbols in sand, guiding principles are not grounded in philosophy and psychology.


True or False

2. Intentionality is about the intention of the client selecting symbols. _____


3. The use of symbols in sand is a diagnostic tool for assessing trauma and abuse and serves as a
well-researched personality test. ______


4. Meaning for client symbols in their sand scene rests primarily with the client. ______


5. Therapist attention while a client creates a sand scene is best focused on note taking, looking
into a symbol dictionary, reviewing the client’s previous photos, arranging their schedule
bookings. ______

Topic 2. CULTURE 6 questions


Key terms: Voice, ethnic and cultural identity, myth and symbol meanings, alienation /otherness

Assertion: Culture permeates the entire process of Sand Therapy.

1. Which one of the statements below is FALSE? _____

a) A client’s ethnic identity, and personal interpretation of icons and symbols anchored in his/her culture have a significant influence on the client’s perception of figurines, arrangement in a sand scene, and receptivity to meaning-making during engagement.


b) The therapist’s capacity to understand and respond to sand scenes is based in awareness of his/her cultural leanings and both conscious and unconscious cultural dispositions.


c) Additional knowledge of cultures different from one’s own identity, and awareness of those symbols and mythology, will aid the therapist to resonate and empathize with the client.


d) The client is vulnerable to cultural projections of the therapist, especially tone and attitude that are alienating creating a sense of otherness. Images and stories of existential experience, Otherness, invisibility, and identity are commonly present in sand scenes.


e) The client is the expert on his/her familial heritage/ values, religious-socio-political leanings, gender and economic dispositions, and choice of language used during engagement with his/her sand scene. Voice and other psychological constructs are anchored in culture.


f) Clinicians do not need a great many symbols to work with a diverse client population.

g) Generic miniature figures are adequate for any cultural group.


True or False

2. Symbols used outside a client’s religion are irrelevant. _____


3. Ethnic identity is always explicitly represented in a sand scene. _ ___


4. A therapist using sand should acquire some knowledge of world religions, ethnic populations,
and literature on culture. _______


5. Client experience of alienation, being marginalized, feeling invisible, and memories of
oppression are likely images to emerge in a sand scene. ______


6. Therapist-client engagement can reenact the client’s experience of “otherness”. ______


Topic 3. ETHICS 6 questions


Key terms: Power, boundaries, immersion, symbol impact, scope of expertise, clinical competence and
readiness

Assertion: Ethical principles provide guidance for a therapist’s responsibility regarding skill acquisition, depth of knowledge, supervision, competency claims, use of therapy approaches.

1. Which one of the statements below is FALSE? _______
a) It is the responsibility of the therapist to pursue in-depth study and obtain a solid ground of knowledge, clinical skills, for use of symbols in sand as a projective process.


b) It is the responsibility of the therapist to recognize the power of symbols and their effect on the therapist and client. Related to symbol knowledge, the therapist works to expand his/her awareness of layers of meaning within sand scenes.


c) It is essential for the therapist to find ways to immerse in personal exploration of his/her own sand scenes in therapy and supervision. It is of value to explore creative ways to use sand in training settings such as in workshops and group work. The clinician studies symbol meanings, explicating cultural, social, and familial significance and reflects on his/her personal sand process.


d) The clinician obtains feedback during case consultation specific to the use of symbols in sand scenes, examining his/her countertransference insights, boundaries working with clients, and his/her clinical style of engagement with clients. This includes the therapist’s use of silence, commenting, reflecting, directing, and physical presence. Feedback from colleagues, supervision, and case consultation combined with the therapist’s personal immersion should be processed with a well-informed professional.


e) The therapist refrains from recommending, directing or persuading the client to use Sand Therapy. Sand Therapy is not a prescription. It is not for the convenience of the therapist. The clinician avoids potential harm using sand with especially vulnerable clients such as trauma survivors, clients experiencing deep grief, and client’s with physical limitations.


f) It is the responsibility of the therapist when teaching or promoting any form of Sand Therapy to present his/her background to students/participants. This may include describing his/her specialization and theoretical leaning in the use of sand, or scope of training for use of symbols in sand. Taking on a teaching role should include a statement of the ethical use of symbols in sand and safety for experiential work.


g) There is no problem sharing sand trays and figurines with non-trained colleagues or interns so that they can use them with their clients.


True or False

2. It is essential for clinicians to work through their own sand scenes with someone trained in the clinical use of sand beyond an introduction. _____


3. All the professions (psychology, social work, counseling, psychiatry) have an ethics principle or code that covers the importance of competence with use of techniques before use with clients. This helps curb the use of clients as experiments in therapist learning. _______


4. Clinical supervisors using sand in supervision do not need to be well-informed on sand. Instead, supervision certification or job position are adequate. ________


5. With certification as a specialist in expressive therapies such as art therapy (ATA) or in play therapy (APT) or family systems or addiction there is no need for in-depth training to use symbols in sand. _______


6. Suggesting a directive to create a sand scene should be used with clear intention, rarely, and be purposeful with the safety of the client in the forefront of the suggestion. Prompts that narrow the scope of client experience to contain boundaries and ensure safety may be particularly appropriate for some clients, compared to the overwhelming generic “create your world”. There should be a balance including non-directive sand and silence. _______


Topic 4. ENGAGEMENT 6 questions


Key terms: Projection, engagement, interpretation, metaphor, narrative, mental images, theory
constructs, boundaries, mental representation, facilitation

Assertion: Sand Therapy is a projective process requiring requisite clinical skills for engagement.

1. Which one of the statements below is FALSE? ________

a) The therapist understands clinical aspects of projection and knows how to create safe and conscious use of projection, appropriate to the therapist’s theoretical stance.


b) The clinician is aware of the neurological drive to represent personal and collective experience and perception through projection, and how this connection with symbols is integral to the clinical use of sand.


c) The therapist withholds interpretation. The essential feature is a mindful presence to client readiness. The therapist may remain in respectful silence, respond with active listening, and remain receptive to their own and the client’s imagination. Other ways of responding may include amplification, forms of gestalt, play therapy, and drama therapy to facilitate client engagement with his/her sand scene.


d) The therapist is familiar with therapeutic metaphors and understands the role of states of awareness for both client and clinician when using therapeutic metaphors with symbols in sand.


e) The therapist understands social construction (how we construct lives, shape perception, and interpersonal dynamics) when using narrative, voice, drama, and gestalt dialogues with symbols in sand.


f) The therapist has well-defined personal and clinical boundaries, such as heightened awareness of the therapist’s personal projections onto the client and the client’s sand scene.


g) Projection is only relevant to clinicians using a psychodynamic approach and is not a significant factor with Child-Centered or other play therapy approaches.


True or False

2. Engagement with a client after completion of his/her sand scene requires the clinician discern client emotions, client readiness and receptivity to engage; client need for greater safety; therapist awareness of expectations for both client and clinician; when there is any client hesitancy the clinician makes clear that the client selects what they wish to share. ______


3. A therapist trained in cognitive-behavior therapy should always initiate engagement from this modality. _______


4. Discussion between therapist and client regarding content of the sand scene is necessary for a more meaningful, complete use of symbols in sand. _______


5. A clinician should have a symbol dictionary ready at hand to immediately explain to the client possible interpretations of the client’s sand scene. ________


6. Engagement with silence is a powerful tool to protect client’s not able to talk about trauma. _______


Topic 5. THEORY 6 questions


Key terms: Psychological theories, Western and non-Western cultural influence, modern and post-modern perspectives, mental representations, core ideas, constructs, philosophical family tree, match between theory and process

Assertion: Theories shape a therapist’s perception of a client’s problem situation – case conceptualization. Theories guide how clinicians respond to clients and their sand scenes. Theories guide the clinician to bridge sand therapy process to an overall treatment program.

1. Which one of the statements below is FALSE? ______

a) Carl Rogers’ Client-Centered, Child-Centered approach emphasizes heightened attending, an alert witness, maintaining boundaries to avoid interfering, deep empathy, and engagement with the client in play or in silence with a focus on validating the client. Rogers’ is most often used in Sandtray therapy. The clinician engages in active listening, empathy, authenticity, and congruence.


b) Jungian Archetypal theory informs Sandplay therapy. This is an analytic approach that supports a client’s process towards individuation. Outside of strictly analytic or Kalffian Sandplay, Jungian and Rogerian perspectives can be combined to understand and respond in Sand Therapy. 


c) Approaches that blend different constructs and clinical procedures can effectively integrate imagination, projection, and process for sand scenes. Theories might include Rollo May and Irvin Yalom’s Existentialism; Vygotsky and Erikson’s developmental theories; Family Systems’ Parts theory and Daniel Seigel’s approach; Narrative’s social construction and Milton Erickson’s therapeutic metaphors; Eric Bern’s Transactional Analysis and Gestalt therapy; Alfred Adler, Virginia Axline, Alice Miller and Margaret Lowenfeld; drama and art therapy; Harry Stack Sullivan and William James.


d) The therapist is knowledgeable to guide, facilitate, and process a sand scene, maintaining especially clear boundaries with a keen eye on the complexity when more than one client is present such as with a parent-child, in group therapy, with a family, and with couples.


e) There is little need for therapists to use theory to conceptualize or guide their process with clients in sand since it is a general play therapy technique.


True or False

2. There is only one theoretical approach to effectively grasp meaning and respond to clients when using symbols in sand. ______


3. From the perspectives of existential psychology, Analytic theory, and Narrative Therapy sand scenes will have a conscious descriptive component as well as underlying, unconscious meaning. _______


4. During the creation of a sand scene, the client-centered or child-centered therapist should frequently reflect their observations of the activity of the client, both non-verbal and verbal expressions. _______


5. An effective way to understand how theory influences a therapist’s grasp of symbols in sand is to study published cases from a variety of approaches and practice conceptualizing sand scenes using different constructs. ______


6. It is not essential to study theory beyond graduate courses for clinician competency with symbols in sand. _____

Topic 6. COMPETENCIES 6 questions


Key terms: Regarding proficiency with sand therapies clinicians strives to ground their work in theory, best practices, and preparation for competence with sand. Clinicians are committed to continued study of the wide range and depth of this specialization. Clinicians are alert to the importance of projection and mental representations; examine research on creativity, the imagination and active imagination; they practice amplification, therapeutic silence, and mindful engagement; they appreciate the complexity of sand scenes and the embeddedness of memes and culture; they develop skills to discern a confluence of meanings, symbol meanings across cultures and generations; they explore therapeutic metaphors and increase an aptitude for mindfulness and altered states of consciousness; they examine the role of language for metaphors, myths, poetics; and clinicians seek feedback on their work with their client’s sand scenes.

Assertion: It is the responsibility of the therapist to develop competencies for ethical use of symbols in sand, including ways to conceptualize the relationship between a client and his/her sand scene, ability to create effective mental representations to resonate with a sand scene, and appropriate ways to engage and facilitate process in Sand Therapy.

1. Which one of the statements below is FALSE? ____

a) A clinician striving to be attentive, placing focus and priority on the client, is mindfully present, attending in silence as the client creates a sand scene, focusing on the client’s verbal and non- verbal expressions, listening to layers of story if any is given.


b) A studied therapist using sand examines the role of language, narrative, poetics, myth and metaphor and is aware of our neurological inclination to make associations – to triangulate meaning and relationships connecting symbol-story-self. And, the therapist stays conscious of his/her personal and cultural associations to symbols the client places in his/her sand scene.


c) A therapist mindful of the influence of culture is aware of idiosyncratic as well as archetypal meanings for myths, symbols, and rituals. The therapist notices but does not comment on symbol placement, symbol qualities, possible connection among symbols in the sand scene.


d) With ethics in mind the therapist avoids manipulations such as interruptions, suggestions or interpretations regarding the figures in the sand scene that serve the therapist. And, when the client invites the therapist to engage with him/her, to take on the role of a figure, to act out stories in the sand, the therapist is practiced with play therapy to follow the lead of the client.


e) Licensed therapists can make use of Sand Therapy, while rejecting the relevance of symbols, language, and metaphors.


True or False

2. Regarding the use of symbols in sand, a clinical mental health license or association affiliation indicates the competency level of the therapist for Sand Therapy. _____


3. The level of depth a therapist takes on during their own immersion in sand enhances their competency with clients. _______


4. Setting aside time for reflective practice, arranging symbols to reflect the therapist’s experience of clients, challenging oneself to stretch beyond the constraints of a preferred theory, and obtaining feedback from informed colleagues are all valuable in the development of  competency. ______


5. Professional training beyond an introduction to the use of symbols in sand, reviewing selected readings from published works over the last 50 years, and engaging in advanced study in different approaches to the use of symbols in sand grounds competency in sand. ______


6. It takes patience, mindful care, time, and a commitment to study beyond practice with clients, to maintain the integrity of clinical work in sand and respect the power of the process. _____

Topic 7. RESEARCH METHODS 7 questions


Key terms: qualitative research design, phenomenology, hermeneutics (psychology), cross-cultural design, grounded theory, case study, multi-method, heuristics, field work, post-modern, literature review, research vs case documentation

Assertion: A qualitative research design or a multi-method approach that integrates qualitative and quantitative methods is appropriate for the study of clinical use of sand and symbols.

1. Which one of the statements below is FALSE? _____

a. A phenomenological study of a client’s experience while creating sand scenes would focus on the client’s lived experience, analyzing bracketed common themes, and what influenced his/her experience in creating a sand scene. _____


b. A hermeneutic research design (through the lens of psychology) could seek to understand the interpersonal dynamics between therapist and client, between supervisor and intern, between a community of individuals and sand as a viable therapeutic approach, or between a client and his/her sand scene, emphasizing the context, interpretation and meaning for content of sand scenes. _____


c. Cross-cultural research methods explore meaning and experience across cultural boundaries (including subcultures within a dominant culture). Cross-cultural research, field work, and indigenous research methodologies will likely contain implications for multicultural clients, examining memes unique for participant cultures, as well as universal themes which may be represented in sand scenes. _____


d. A case study approach may compare sand scenes at different developmental stages for one client across the life span; examine the experience of a client within an immediate developmental stage through multiple sand scenes; or go into great depth on one sand scene for a single client. _____


e. Researchers in the study of symbols in sand (Sandplay, Sandtray, Sand Therapy) should only use an experimental research design which establishes dependent and independent variables in order to be viable, credible research. _____


True or False

2. Phenomenology – How we study lived experience in sand therapy allows for both a study of process and symbol meaning from the perspective of the participants (for example, exploring the commonality of experience in group therapy). ______


3. Hermeneutics – A study that seeks to understand symbol meaning in a sand scene may propose an initial theoretical stance, test that interpretation of meaning from several perspectives, and return full circle to critique the initial theory, highlighting contrasts and overlap from the emerging meaning and interpretation. ______


4. Grounded Theory - is a qualitative research method, using rigorous, systematic analysis. For example, Grounded Theory would be very useful to explore how meaning is constructed by clients and by therapists during the same session; or a study of counseling or social work interns using sand over a series of supervision sessions gathering information on presuppositions regarding the use of symbols in sand and reflections/ insights on process; or a study of teaching methods when sand is taught in
graduate courses or at conferences. New insights may emerge from this collaborative process to discover how participants construct, process, unpack, and share meaning. The purpose is to distinguish threads of meaning with an eye on the emergence of new theory. ______


5. Case Study – a research method that is frequently used to demonstrate the relevance of sand scenes for a client; illustrate the application of theory to conceptualize a client’s sand scene; demonstrate the power of sand therapies to support clients’ psychological integration; unpack the layers of identity- experience-perceptions for a client over time. ______


6. Cross-Cultural – A research method that stands alone or combines with other methods to examine the importance of culturally relevant traditions, social-political arrangements, and the myths, symbols, memes and metaphors that emerge in sand scenes relevant to the populations studied. Indigenous psychology and field work may also be a feature of this research method. ______


7. Doctoral studies that focus on clinical use of any form of symbols in sand should focus on design to validate the received view of the graduate institution, current evidenced-based theories, or the values/intention of a funding source. _______

Topic 8. THE LITERATURE 6 questions


Key terms: books, dissertations, peer reviewed articles, blogs, web sites, white papers, conference presentations, workshop handouts, course materials from psychology and mental health disciplines, and literature across disciplines – science, anthropology, philosophy, mythology, multi-cultural resources, indigenous traditions and representations, historical evolution of practices

Assertion: A study of the literature for the clinical use of symbols in sand should include historical and current literature within differing theories, across disciplines, including multicultural perspectives, and case material applied across the lifespan.


1. Which TWO statements below are FALSE? _____and _____
a. Clinicians who use sand with clients study the literature from different practice approaches, including books, dissertations, international journal publications, and early historical literature relevant to play therapy, psychological theories, and the expressive arts.


b. Books on symbols are helpful to build a language to understand culture-specific and universal meaning, a way of amplifying and resonating with a sand scene while not concretizing symbols in the sand. A variety of symbol books will be most helpful to balance a therapist’s symbol language beyond classical or a one-culture dimension.


c. Books on Sandplay and on Sandtray are especially helpful to set up the clinical setting and to highlight important guidelines such as therapist preparation, skills for engagement, specific boundaries for sand, the relevance of developmental stages, gender, and the limited scope of a single theory-as-lens to understand and respond to clients and their sand scenes.


d. Books on Sandplay are especially valuable to illustrate the power and depth of symbols in sand through case presentations.


e. It is essential that clinical supervisors and graduate faculty present a range of literature to interns and graduate students before interns and therapists new to sand use it with clients.


f. It is not essential for therapists to read journal articles, original publications on sand, or even dissertations on the use of sand if they attend workshops and conference presentations.


g. YouTube videos are one of the best ways to learn how to use sand with clients—hence, there is enough case material in video format that it is not necessary to read published literature on sand.


True or False:

2. Reading an array of literature on variations of symbols in sand helps therapists develop an understanding of theory as a lens to discern meaning, purpose, and process in the context of engagement. ______


3. Literature, such as Parabola magazine, global mythology, multicultural fairy tales, symbol dictionaries, graphic novels, fantasy movies, and video-game related mythology helps therapists build a secondary vocabulary rooted in imagination and helpful to create mental representations when reflecting on sand scenes. _______


4. Reading science and related mind-body-brain literature outside disciplines in mental health (such as works by Daniel Dennett, Candice Pert, Mihaly Csikszentmihalyl, Natalie Rogers, Julia Cameron, Joseph Campbell), as well as cultural anthropology, consciousness studies, poetics, and creativity research help therapists develop their capacity to envision layers of meaning in a sand scene beyond the constraints of clinical theories. _______


5. Regarding culture, readings in indigenous psychology, ethnic identity, and cultural experience from the perspective of those who live within the identification are vital to inform both therapist and researcher about the complexity of identity, cultural walls within the experience of the clinician / researcher, and aspects of identity that are present in a sand scene. _______


6. Reading the literature from only one approach to sand is adequate since a therapy technique relies on therapist initiative, not on published theory or case material. _____

Topic 9. Training, Case Consultation and Supervision 8 questions


Key terms: Competency expectations for clinician educators and supervisors who work with interns and licensed therapists are embedded in the philosophy of the professional providing the service. The following assertion and questions in this section are anchored in the literature as well as my own philosophy as a clinician-educator, trained therapist and academic professor. Hence, these are presented within the limitations of the scope of my lived experience, the literature I am familiar with, and that of those who trained me. All therapy, supervision, research, and training for professionals is anchored in the perspective of the professional doing the work and we should remain mindful, clear, forthcoming, open and direct regarding both the benefits and the limits of these viewpoints.

Assertion: Competency for clinician-educators and supervisors who work with interns and licensed therapists are embedded in the philosophy of the professional providing the service. Competencies for those who teach others in sand are similar to competencies for the use of sand with clients.

Competencies for clinical supervisors depend on their discipline, supervision course work and practice within their agency or professional field as well as how well-informed they are on the clinical use of sand.


1. Which ONE statement below is FALSE? ______
a. Professionals who train therapists should be mindful of social, cultural and ethical expectations for professional training; dangers of marketing strategies; problems in clinical application; and professional best practices for accurate, informed, appropriate presentations most relevant to participants.


b. Clinical supervisors should be familiar with the literature regarding different approaches to symbols in sand; understand the basic training needed to avoid clients becoming experiments; be mindful of therapist boundaries for safe use of sand; be aware of methods to determine client readiness and aware of appropriate approaches for various client populations; keep a judicious stance when combining sand with other therapy interventions; well-informed on the relevance of culture in the use of symbols in sand; be thoughtful regarding use of sand appropriate for treatment goals; be discerning regarding clinician capacity for appropriate use of sand as a projective process; and be cautious and alert to covert suppositions in the use of sand, especially regarding dangers and problems if supervisee uses sand in conjunction with talk and behavior therapy.


c. Universities that offer courses in play therapy or expressive arts that include an introduction to sand should be aware of professors’ competencies for clinical use of sand; include curriculum with specific aspects of its limits and dangers, especially with trauma clients; professors should emphasize the additional training essential for an
ethical use of this complex therapeutic approach; review and recommend a range of published literature; and should assert that a course alone does not prepare or
adequately train a student to use symbols in sand with clients.


d. Continuing education certifying agencies in each mental health discipline should be well-informed on the dangers and risks for use of any approach to sand therapy as a
projective process and require an ethics component to the workshop or course. Review of training proposals should include a statement regarding the safety for experiential
work. There should always be an emphasis on permission to keep private whatever emerges during a learning experience and strong boundaries to keep safe participant
clinicians, students, and research participants.


e. Granting agencies and graduate departments should be mindful of the importance of clinician and trainer competencies including aptitude regarding the influence of culture. Certifying organizations should be aware that clinician/trainer immersion in their own sand scenes is essential prior to teaching others about such engagement and process. Professional organizations should understand the power of sand, potential problems of its misuse in order to set judicious standards and give careful discernment of proposals for dissertations, conference presentations, workshops, university courses, research, and public promotion.



f. Anyone should be able to teach and supervise others in sand therapy because once a therapist and supervisor has their discipline’s license and the job of supervising, they
are qualified to promote and encourage the use of sand by untrained others.


The Scenarios: Answer each as either Yes or No

Read the following seven (7) scenarios. Decide if the professional responded to the challenging situation in way that meets “best practice” expectations, to maintain a safe, ethical and appropriate approach for use of symbols in sand.


2. Intern: An intern new to a clinic asks the clinical supervisor if he/she can use the sand tray in the play room with a child client who wishes to play in the sand. The supervisor suggests a way forward to help contain the process, directing the intern to remain mostly attentive and silent, to use a Child-Centered recognition when the client indicates a desire to connect and avoid interfering when the child is focused on his/her scene, schedule a supervision session to review the experience, and the intern should begin reading and training in the use of sand. ______


3. Therapist: An adult client enters the therapist’s office and seeing shelves of figurines and a sand tray they use a critical tone saying that they don’t want to do anything childish. In a supportive empathic tone, based on considerable background supervision and immersion in their own work, the clinician explains that use of the sand tray is not required, “the tray is useful to show a part of an individual’s life story, a scene from an experience, or as a stress reducing experience. If at some point you wish to explore the use of figures to represent your experience it is available during our work together. In my practice, adults, teens, couples as well as children often find the creation of a sand scene helpful to process difficult experiences.” ______


4. Supervision: A therapist seeks a new supervisor to maintain licensure. The therapist has had a basic introduction to sand, his/her previous supervisor guided the clinician’s use of sand, and the therapist intends to continue with sand. The therapist locates a new supervisor that is nearby and much more convenient. During an initial interview the therapist learns that the supervisor is convinced that only cognitive behavior therapy is appropriate with clients and that the use of expressive therapies such as sand and art are superficial and not the most effective use of the therapist’s time. That stipulated, the supervisor agrees to do supervision on condition that they will not discuss any use of sand. The therapist agrees with the contract  thinking his/her own experience is enough to handle any issues with clients and their sand scenes. _______


5. Continuing Education: Clinical license, CE accreditation, organizational certifications and teaching. Where is pitfall for quality care? A therapist applies to obtain continuing education certification for social workers, counselors, and marriage and family therapists. They wish to teach sand therapy techniques often used in play therapy. The oversite agencies see the applicant’s clinical experience and proposed workshop details and certifies for each discipline. However, the presenter has little experience teaching professional education courses and only a basic understanding of clinical uses for sand. They have little expertise addressing problems that may emerge during the workshops and no experience with case consultation. The knowledge they have to share is diluted from using secondary sources such as videos. However, the presenter sees a serious gap in expressive/ play therapies in their geographic area and would like to support the community and colleagues. Somehow the needs of the clients are falling through the gaps in the circle of clinician preparation, accrediting, and providing appropriate, clearly needed therapies. The accrediting agencies took a stance that it is not their oversite responsibility regarding how much knowledge and experience the presenter has in a specialized area since the official application does not screen for proficiency with teaching or with specific sand therapy problems/competencies. The question is this: what is the way forward to meet services and maintain quality? Should the accrediting agency be responsible for continuing education oversite or should it be the professional organizations, or the organization sponsoring the presenter? Should someone address professional education competencies regarding projective techniques like sand, art, and drama therapies? Should some agency be informed on the dangers of mass teaching a technique without attending to specific trainer aptitudes, proficiencies, and distinguish the skills necessary to teach and facilitate a training using a projective process? Do we have a systemic cycle with dangers and vulnerabilities for all participants – client-therapist-trainer-license agencies? _______


6. Client: A client is in a session and emotions regarding an early trauma begin to overwhelm him/her. The therapist directs the client to use the sand tray to express these emerging emotions. This experience in sand opens the trauma and the client escalates with distress. Time ends and the client leaves in distress. The client goes to court with their attorney seeking damages against the therapist on grounds the therapist was incompetent causing more suffering. The therapist’s defense is that they have a license to do therapy, he/she is a registered play therapist, and has years of experience. The attorney for the client points to the suffering and trauma of their client and the literature that points to the received preference for evidence-based therapies. The judge gives the win to the client. Later the clinician reflects on the multiple organizations, agencies, trainings, university courses, interactions with colleagues, and past supervision to consider where there may have been misunderstanding, misinformation or perhaps inadequate preparation or too many assumptions about competency. The therapist comes to the conclusion that the circle of responsibility is wide. The clinician’s plan is to get a consult on the case to process his/her own distress on the entire experience. The clinician moves forward and is open to feedback and learning to avoid opening
trauma through the use of sand. ________


7. Case Consultation: A team of clinicians from various mental health professions gather to examine three of their client cases, each therapist using a different approach with sand. The consultant reminds staff of cores ideas to keep in mind – confidentiality, boundaries, the value of projection, transference, countertransference, mental representations, mindful engagement, clinician intentionality, the relevance of culture, theory-as-lens, the client as expert, and the importance of a therapist immersing in their own sand scenes. Each clinician presents a brief on his/her client with photos of the sand scenes, and states a question or concern. After colleagues pose questions and comment the consultant asks if the three case presenters would like to create a sand scene representing his/her concerns – for their clients and for their clinical perceptions. The therapists create three distinct scenes and the consultant demonstrates ways to understand, resonate with, and respond to each therapist – to respond to the clinician and teach ways to work with clients. Colleagues are attentive witnesses for each sand scene. Closure for the consult is a group process that validates each clinician. The consultant reviews staff insights and validates the team for their continued integrity regarding the use of symbols in sand. ______


8. Online Teaching: A therapist takes an online course in Sandtray or Sandplay or Sand Therapy and decides to begin using small objects with clients. They purchase a sand tray, buy sand and a few toys. Not recalling some of the important aspects of the complexity of the projective process, with no face-to-face training, the therapist sees that some clients find the play enjoyable. Clients are eager to return to play in the sand. Returning clients increases the therapists financial base considerably, keeps clients returning and increases his/her esteem among local colleagues. The therapist writes a column for the local newspaper regarding the success of his/her clients, pays for ads, does a television interview and is now seen as an expert. The therapist now has very little time, sees no need to immerse in his/her own sand process or read the literature, and is very happy with his/her success. They have indeed become a competent expert. ______