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Sandtray Therapy Boosts Self-Esteem in Middle-School Girls

Brave.GirlBefore going back to school for psychology, I taught 6th grade English and Social Studies. I remember my girls starting the year as confident and competent young ladies – and then around Winter break, something would shift. Magically cliques would form, the social order would become clear, and my confident girls would suddenly become self-aware teenagers, careful to always be seen doing the right thing with the right people. Suddenly they saw themselves from the constant vantage point of the judgmental observer. As this awareness of their self in the world grew, you could see their self-esteem shrink – and it seemed as if no amount of teambuilding and class empowerment could slow the slide (thus part of my motivation to transition from teaching into psychology!).

I just read a beautiful, fascinating article in the Journal for Specialists in Group Work that suggests group sandtray therapy may be one way to save the self-esteem of early-adolescent girls.

This is an age at which girls’ bodies may outpace their minds. Really, I don’t mean to be at all critical, but at the same time girls are discovering social dynamics and self-awareness, they are likely still in the concrete operational stage of development in which they may lack the language to express the complex emotions they are most definitely feeling. This study used group sandtray therapy as an alternative form of expression. From the article, here’s the rationale: “Group sandtray therapy is physically active and provides children an indirect means to self-disclose material that is painful or uncomfortable. With sandtray, young adolescents can feel a sense of safety and empowerment. Group sandtray therapy offers young adolescent girls an opportunity to build significant relationships with peers, which is an important developmental task for this age.”

It certainly sounds reasonable. And here’s how it worked:

Researchers gathered 37, 7th-grade girls referred by school counselors for concerns about low self-esteem. Seventy percent were identified as academically at-risk. Roughly half of the girls received nine sessions of group sandtray therapy right away, and the other half waited to receive therapy until after the first group finished.

The treatment used humanistic, group sandtray technique, meaning that a therapist moderated but let groups of four girls lead the sandtray creation. Each session was structured around a topic including body image, relationships, social acceptance, friends, etc. “For example, in thefriends’ sandtray session, group members were instructed to build a scene of themselves and their friends,” the paper writes.

Each girl received a round sandtray and had access to figures for use in building a scene. About a third of the session was spent building sandtray scenes and two thirds spent processing the scenes in a supportive group setting.

With testing before and after the intervention, the paper shows that the self-esteem of girls who participated in group sandtray therapy improved compared to the group that hadn’t yet received therapy.

But beneath this overall improvement are even more telling results.

For example the girls indicated that, to them, social acceptance was an especially important component of self-esteem. Interestingly, over the time of the study, the social acceptance component of self-esteem fell about 14 percent in the control group and it rose almost exactly that same amount in the treatment group. “It appears group sandtray therapy may have prevented or protected girls in the treatment group from experiencing the drop in this aspect of self-esteem that is typical for girls in this age group,” the paper writes.

Girls also said that acceptance of their physical appearance was an important piece of their self-esteem. In the session that focused on body image, many girls expressed negative feelings about their bodies; but then they built beautiful sandtrays to represent their bodies. They said these sandtrays represented their personalities as well as their appearance.

“It appears that girls in the treatment group were able to accept themselves better by combining their views of their physical appearance with their views of their inner beauty,” the paper writes, and the girls who had experienced sandtray therapy measured significantly higher in their acceptance of their physical appearance than girls in the control group.

“For example, one girl chose a mirror as a symbol in her sandtray to represent how she felt about her physical appearance. As the therapist focused on her feelings about her body image, other group members encouraged her to focus on her attributes as a person. This feedback appeared to help her accept herself more because the group accepted her physical appearance and valued her strengths as a person. The group’s acceptance appeared to help her improve her self-perception and self-acceptance.”

With the exception of “perception of athletic ability,” the girls who experienced humanistic group sandtray therapy improved on 5 of the 6 subscales of the test used to measure self-esteem. In all, while the control group’s self-esteem fell, girls who used sandtray therapy improved on Scholastic Competence, Social Acceptance, Physical Appearance, Behavioral Conduct and Global Selfworth.

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This image is from by Steven Depolo


Sandtray Therapy Boosts Self-Esteem in Middle-School Girls

Kristi Pikiewicz, Ph.D.

After a first career in teaching, Kristi Pikiewicz earned a PhD in clinical psychology from Pacifica Graduate Institute. She now works half time as a psychologist at the Mackintosh School and half time in private practice in Boulder, CO. She lives with her husband, a pack of labradors, and young kids just outside Boulder.

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APA Reference
Pikiewicz, K. (2014). Sandtray Therapy Boosts Self-Esteem in Middle-School Girls. Psych Central. Retrieved on April 22, 2019, from


Last updated: 15 Aug 2014
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