Sandplay

Lowenfeld and the World Technique

A 2026 article in the Journal of the History of the Behavioral Sciences, drawing on Margaret Lowenfeld's personal papers and published works, describes her as a child psychologist who devised the World Technique, a play therapy using miniature toys, sand and water, during the 1920s. It reports that her child-directed practice expanded after the Second World War, that she called the technique a scientific instrument for reaching preverbal experience, and that she was personally acquainted with Carl Jung. Only the abstract was available for this draft.

A practitioner account published in 2024 in the Journal of the World Association of Sand Therapy Professionals dates the World Technique to 1929 and says it was inspired by H. G. Wells's book Floor Games (1911). It adds that Lowenfeld said children themselves invented the method when she offered them trays, small toys, sand and water. This is a teacher's summary from within the sandplay tradition and was not checked against Lowenfeld's own publications.

A 1992 overview in the Journal of Sandplay Therapy, the journal of a sandplay society, names Lowenfeld, H. G. Wells, Erik Erikson, Gerdhild von Staab, Lois Barclay Murphy, Charlotte Buhler, Hedda Bolgar, Liselotte Fischer, Ruth Bowyer Pickford and Dora Kalff among those who shaped the sand tray technique, and says it is now practised worldwide. Only the abstract was read.

Dora Kalff and the Jungian development

The International Society for Sandplay Therapy (ISST) describes Dora Maria Kalff (1904 to 1990) as a Jungian psychologist and a student of Lowenfeld who worked within C. G. Jung's depth psychology and studied Zen Buddhism, Tibetan Buddhism and Taoism. The 2024 practitioner account says Kalff studied with Lowenfeld at the urging of her neighbour Jung, and that the two agreed in the late 1950s that Lowenfeld's method would be called sandtray and Kalff's sandplay.

These statements come from sandplay organisations and teachers. Independent historical scholarship on the relationship between Lowenfeld and Kalff was not located for this draft, so the dates and the naming agreement rest on tradition-internal accounts.

Societies and regional spread

ISST says it was founded on 13 August 1985 at Kalff's home in Zollikon, Switzerland, by fourteen founding members from five countries, including three professors from Japan. Sandplay Therapists of America, a member society of ISST, gives its founding date as 28 February 1987.

A 2003 historical article in Transcultural Psychiatry describes how Jungians in Japan built a following through cultural critique and therapeutic practices such as sandplay therapy. It offers one regional account of transmission and does not describe the method's history elsewhere.

Sandplay, sandtray and the World Technique

The 2024 practitioner account separates the two terms. It says that sandplay embraces Jungian theory and Eastern contemplative traditions and is nondirective, with clients given no instruction beyond an invitation to make whatever they like in the sand, whereas the method that kept Lowenfeld's name is called sandtray. Many clinicians and researchers use 'sand tray' more loosely for any therapy involving a tray of sand and miniatures.

A 2026 narrative review of sand-based therapy in children draws a similar line, describing the therapist's role in sandtray as actively guiding the play and in sandplay as passive and non-directing. Only one of its eight included studies explicitly used sandtray. The sources reviewed do not show how consistently the two terms are applied in clinical or research practice.

Kalffian vocabulary

The practitioner account lists four principles of the Kalffian tradition. The free and protected space is the freedom and protection to express oneself in the sand as needed. A contemplative orientation draws on Eastern spiritual practices of inner stillness. Delayed interpretation means none is offered until the sand process is finished. Kalff's definition of transference is protection of the client. These are concepts of one tradition, not measured constructs.

Professional titles

ISST and its member societies use titles such as Certified Sandplay Therapist, abbreviated CST, and Teaching Member, abbreviated CST-T. Sandplay Therapists of America also has a Registered Sandplay Practitioner level. These are credentials issued by those societies and are separate from a state or national licence to practise psychotherapy.

The tray, the miniatures and the therapist's role

In the Kalffian description, sand trays are rectangular, about 19.5 by 28.5 by 3 inches, painted blue inside and half-filled with sand. Small figures, regarded as symbols that can hold several meanings, are kept on open shelves, and water is available to add to the sand. The client builds a scene in the tray, and the therapist is described as 'being with' the client and not 'doing to' the client, accepting each image and delaying interpretation.

Protocols used in research

Trial protocols vary. In the 12 randomised trials of sandplay for autistic children, sessions lasted 45 to 60 minutes, were held once or twice a week, and ran for 10.5 to 30 weeks, in individual or group formats. The review noted that therapist qualifications and training were not consistently reported.

In a three-arm trial in Jordan, qualified therapists at a children's centre delivered sandplay in 30 to 40 minute sessions once a week for 12 weeks. Children built sand pictures with miniatures and could then share narratives. These are research protocols and cannot be assumed to match training in the Kalffian tradition.

Claims made within the tradition

The 2024 practitioner account states that sandplay works at a preverbal or nonverbal level, that conscious verbal insight is not needed for change to occur, and that premature interpretation can disrupt the client's creative process. The same account describes the method as an evidence-based practice, citing a 2022 article in the Journal of Sandplay Therapy that was not opened for this draft. These are the position of one practitioner tradition, and the evidence sections below assess what controlled studies show.

Populations and problems studied

Published studies have mostly involved children. The 2026 narrative review included trials in immigrant and refugee children, children with behaviour problems, children living in shelters, children with leukaemia or kidney disease, adolescents with systemic lupus erythematosus, and children with autism spectrum disorder. A 2026 trial in Jordan studied Syrian refugee children with PTSD, and a 2026 systematic review pooled trials in autistic children.

Listing a use here records that it has been studied or claimed, not that sandplay is an established treatment for it. The sources reviewed contained no systematic review of sandplay in adults.

Autism spectrum disorder: a 2026 meta-analysis

A systematic review and meta-analysis searched PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure from 2005 to June 2025 and included 12 randomised trials with 819 children with autism spectrum disorder, all conducted in China. Comparators included conventional rehabilitation, medication, social behaviour interventions, waitlist or no intervention, and treatment as usual. The pooled standardised mean difference favoured sandplay for language (-2.63, 95% confidence interval -3.69 to -1.56) and social communication (-6.83, -8.01 to -5.65).

Heterogeneity was very high, with I-squared above 90% in every subgroup, and allocation concealment and blinding were at high or unclear risk of bias in all trials. The authors said the lack of blinding may have led to overestimation, called the findings preliminary supportive evidence and did not grade the certainty of the evidence. No adverse events were reported in any included trial.

Trauma in young children

A 2026 systematic review in Clinical Psychology Review assessed 12 psychological treatments for trauma-exposed children aged 12 or under, with 127 studies and 5,689 children in the narrative synthesis. Supplementary meta-analyses of controlled studies found a large effect for sandplay from three studies, against a moderate-to-large effect for trauma-focused cognitive behavioural therapy from 24 studies. The authors concluded that trauma-focused cognitive behavioural therapy is currently the best-supported treatment and noted that study quality varied considerably. Only the abstract was available for this draft.

The Jordan trial randomised 102 Syrian refugee children aged 5 to 13 with diagnosed PTSD to sandplay (32), art therapy (42) or standard counselling (28), weekly for 12 weeks. Trauma questionnaire scores fell by 22.4 points with sandplay, 10.8 with art therapy and 2.1 with counselling. The authors reported the trial was unblinded, severe PTSD was more common at baseline in the sandplay group (40.6%), only one outcome was measured and there was no long-term follow-up.

A 2026 narrative review of pediatric studies

A narrative review following PRISMA reporting guidance identified 130 articles on sand-based therapy in children published from 2005 to 2025, of which eight met inclusion criteria. All eight traditional sand-based studies reported significant improvements in the experimental groups. The authors listed small samples, a lack of between-group comparisons, dropout of up to 40% in some studies and a lack of objective outcome measures, and concluded that these limitations constrain interpretation. They found no studies of digital sand therapy.

Shared weaknesses in the trial literature

Across the sources reviewed, blinding was not possible or not achieved, outcomes were frequently reported by parents, teachers or the clinicians delivering the treatment, comparators varied widely, and follow-up was short or absent. Both reviews and the Jordan trial reported no adverse events, which describes what was reported and does not show that none occurred.

What the evidence does not cover

Most evidence concerns children, and the largest pooled analysis is restricted to autism trials from one country. Therapist training was not consistently reported, so results cannot be attributed to the Kalffian method as taught by ISST societies. PubMed searches run on 2026-10-05 for sandplay and sand tray found 84 records in titles and abstracts and 21 title records that included review or trial terms. No systematic review in adults was identified, and other databases were not searched.

Reported harms

No adverse events were reported in the 12 autism trials, the eight studies in the narrative review or the Jordan trial, which obtained ethics approval and parental consent with child assent. The reviews do not say how harms were monitored, and no source reviewed documented specific risks or contraindications of sandplay, so none are listed here.

Care boundaries

The trauma review's conclusion that trauma-focused cognitive behavioural therapy is the best-supported treatment for children aged 12 or under means the evidence for sandplay is thinner, based on three controlled studies in its meta-analysis. This does not show that sandplay is ineffective. Persistent distress, thoughts of self-harm or safety concerns call for assessment by a qualified clinician, and sandplay should not delay or replace necessary care.

Training and professional standards

To become an ISST Certified Individual Member, a person needs a personal sandplay process, at least 100 hours of theoretical training in Kalff's tradition and Jungian psychology, at least 80 hours of supervision, two symbol papers and a final case study read by three ISST case readers. Sandplay Therapists of America also requires a post-graduate degree, licensure in a mental health field and malpractice insurance as pre-qualifications.

The ISST Code of Ethics, ratified in 2007, says members must hold clients' best interests paramount, avoid harming them, practise within their competence, state the treatment method, session length and fees before therapy starts, and obtain written permission before presenting or publishing client material. These are professional-body standards. Requirements differ by country, and this draft did not review statutory regulation.