Cancer Care – Tom Baker Cancer Centre Department of Psychosocial Resources Helping You Live Well With Cancer Education Research Clinical Care Exploring Sand Tray Therapy in the Tapestry Retreat Experience for Oncology Patients Kristylea M. Brosz, BSc, BSW, RSW Clinical MSW Practicum Student, Faculty of Social Work, University of Calgary Dr. J. Steven A. Simpson, BSc, PhD, MD, FRCPC Associate Professor, Departments of Psychiatry & Oncology, Faculty of Medicine, University of Calgary
Transcript
Cancer Care – Tom Baker Cancer Centre
Department of Psychosocial Resources Helping You Live Well With Cancer
Education Research
Clinical Care
Exploring Sand Tray Therapy in the Tapestry Retreat Experience
for Oncology Patients Kristylea M. Brosz, BSc, BSW, RSW
Clinical MSW Practicum Student, Faculty of Social Work, University of Calgary
Dr. J. Steven A. Simpson, BSc, PhD, MD, FRCPC
Associate Professor, Departments of Psychiatry & Oncology, Faculty of Medicine, University of Calgary
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Support for use of sandtray therapy in Tapestry from literature surveyed
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Implications for use of sandtray therapy in Tapestry
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Overview of Tapestry Retreat Program
• Holistic five day residential retreat in rural setting
• Aimed at creating community and providing whole-person care.
• Focus on exploring existential and spiritual aspects of the cancer journey.
• Multi-modal retreat with variety of choices to suit needs of each individual patient.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Implications for use of sandtray therapy in Tapestry
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
2: Overview of Sandtray Therapy • Sandtray therapy involves a ritual of creation of scenes in a
tray of sand using minatures/icons.
• Utilized in a wide variety of contexts for children, adults, and groups in which traditional verbal therapeutic modalities may limit exploration of patient’s experiences.
“Sandtray opens a whole new dimension to the therapeutic process….the world built in the sand tray stands as an actual physical creation which can be touched, viewed, pondered, discussed, emotionally experienced, and photographed…it often becomes
a joint expression of the intellect, the soul, the heart, and the body of a human being” (DeDomenico, 1995, p. 4)
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
2: Overview of Sandtray Therapy
Area of
Comparison
Lowenfeld
(Lowenfeld, 2011)
Kalff
(Kalff, 2007)
Weinrib
(Weinrib, 1983)
De Domenico
(De Domenico, 2005)
Purpose of the Sandtray The client will be able to demonstrate his/her own mental state at any particular moment in time.
To create a three-dimensional unconscious aspect of the client’s psyche.
To execute a symbolic and creative act/symbolic ritual.
To assist the client in making the unconscious more conscious.
Use and Interpretation of Symbols
The meaning of symbols of focused on the meaning the client attributes to objects as the sandtray is created.
Symbols are to be interpreted by the therapist.
Symbols are evaluated by the therapist in light of Jungian interpretation of symbols.
The symbolic nature of items within the sandtray are determined by the client.
Interpretations of sandtray It is essential that no interpretation be given by the therapist, rather that the client is able to describe their own interpretation. The value in the sandtray process is to allow the creator to experience it, rather than have the therapist confront the client about the world they have created.
The therapists interprets the sandtray and it is not necessary for the therapist’s insight to be communicated to the client.
The therapist evaluates based on Jungian symbols, but there is no interpretation during the session.
Interpretations by the therapist are not helpful to the client and hinder the creative and healing process of the sandtray.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
2: Overview of Sandtray Therapy Strengths within the Sandtray Process: - Allows for the expression of emotional issues without requiring a specific
creative/artistic abilities or strong verbal skills.
- Provides a sensory, kinesthetic, and tactile experience with potential to be therapeutic in itself.
- Allows for defenses to diminish through a non-threatening setting.
- Creates a necessary therapeutic distance for clients.
- Provides an inclusive experience with a level playing field for each participant.
- Provides a unique setting for the emergence of metaphors.
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Implications for use of sandtray therapy in Tapestry
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3: Use of Sandtray Therapy in Tapestry
A. Set-up
B. Rituals for introduction of activity
C. Witnessing the creation of scenes in the sand
D. Group sharing
E. Photographing scenes
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3A: Set up of the Sandtray Room
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3A: Set up of the Sandtray Room Selection of Icons:
• People
• Animals
• Buildings
• Transportation
• Vegetation
• Fences/Gates/Signs
• Natural items
• Fantasy
• Spiritual/Mystical
• Landscape
• Medical Items
• Miscellaneous Items
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3B: Rituals Around Introducing the Sandtray Process
• Rituals around ensuring mystery of sandtray within the retreat activities.
• Introduction and instructions for process in separate room from sandtrays.
• Process of choosing icons.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre 3C: Witnessing the Creation of Scenes in the Sand
• Importance of witnessing and observing the process of creating the scenes.
“Witnessing and observing the entire sand tray process is absolutely essential. Only then can anyone appreciate the richness of each and every world created by the
client.” (De Domenico, 1995, p. 42-43).
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre 3C: Witnessing the Creation of Scenes in the Sand
• Layers of witnessing that can include multiple levels of perception:
- Visual
- Multisensory
- Physiological Metabolic
- Emotional
- Imagining
- Secondary Thinking
- Spiritual
- Reflective-Integrative
- Factual
(DeDomenico, 1995)
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3D: Group Sharing of Scenes Created • Invited to share in turn reasoning for icon choices, what they
mean to the client, and what it represents within their life.
“ No observer can judge the right or wrong way of expressing their images as they belong to the imaginable realm of the [client] who experiences them according to
their nature, lived experience, and own sense of correctness. The images simply are what they are to the person who owns them” (DeDomenico, 1995, p. 4)
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3D: Group Sharing of Scenes Created • Removal of barriers to reveal
shared scenes.
• Invited to walk around sand tables and honour each other’s scenes.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3D: Group Sharing of Scenes Created
“Group sandtray is more powerful than individual sandtray…patterns emerge in the
sandtray which help people recongize that their pain, their suffering may not be random, chaotic, and meaningless. Meaning emerges that has the potential for
powerful unique healing” (Remen, 1995, p. 49).
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
3E: Photographing Scenes
• Provides a final ritual of honouring the scenes created.
• Allows for clients to capture the moment in time.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Implications for use of sandtray therapy in Tapestry
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
4: Summary of Literature Surveyed
• 63 sources reviewed from social work, medicine, psychology and nursing databases current within last 20 years.
• Key word searches (singularly or in combination): sandtray, sandplay, therapeutic relationship, group sandtray, chronic illness, oncology, psychosocial oncology.
• Sources generally focused around individual case studies with few rigorous large scale studies.
• 2 key studies to inform use of sandtray within the Tapestry Retreat experience.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
4: Summary of Literature Surveyed • Use in Chronic Illness: Lagutina, Sperlinger, and Esterhuyzen (2011).
• Grounded theory study with 9 therapists who presented 23 case vignettes from clients experiencing life-threatening illness.
• Findings indicated sandtray beneficial in expressing their lived experience related to:
– Significant features of the patient’s histories
– Symbolic reflections of inner world experiences
– Movement towards restoring wholeness & recovery
– Preparation for death
– Inner changes manifesting in the external world
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
4: Summary of Literature Surveyed • Use in Breast and Ovarian Cancer: Sparling PhD Dissertation (2002).
• Involved ten therapy sessions for 1 ovarian and 5 breast cancer patients.
• Findings suggested that sandtray was an effective therapeutic modality in oncology as it is able to:
– Promote self-reliance by solidifying the patient’s commitment to their own healing process.
– Assist in aiding the patient to confront their guilt and possible depression related to their illness.
– Promote acceptance of illness through conscious integration of unconscious material.
– Facilitate healing process by integrating spiritual dimensions.
– Providing opportunity for healing into death, or healing into life, as appropriate based on prognosis.
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Agenda
1. Summary of Tapestry Retreat Program
2. Overview of Sandtray Therapy
3. Use of Sandtray Therapy in Tapestry Retreat Program
4. Summary of Literature Surveyed
5. Implications for use of sandtray therapy in Tapestry
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
5: Implications for Sandtray Therapy in Tapestry
• Support from literature for use of Sandtrays in Tapestry: - Healing impact through the release of unconscious in sand play.
- Importance of rituals and witnessing sandtray process.
- Potential for additional healing power in group sandtray experience.
- Importance of client interpreting own sandtray
- Emerging potential for use in chronic illness and oncology
• Future Directions and use for psychosocial oncology - Areas for future research
- Use for meaning making within psychosocial oncology
Department of Psychosocial Resources
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
Helping You Live Well with Cancer Cancer Care – Tom Baker Cancer Centre
References
Armstrong, S. A. (2008). Sandtray therapy: A humanistic approach. Dallas, TX: Ludic Press.
Carey, L. (1999). Sandplay Therapy With Children and Families Published by Jason Aronson, New Jersey.
De Domenico, G. (1995). Sand Tray World Play, A Comprehensive Guide to the Use of Sand Tray in Psychotherapeutic Transformational Settings. Vision Quest Images: Oakland, CA.
Homeyer, L. & Sweeney, D. (2011). Sandtray Therapy: A practical Manual. Taylor & Francis Group. NewYork, NY.
Hughes, S. (2004). The group sand tray: A case study. Doctoral dissertation, Union Institute & University.
Kalff, M. (2007). Twenty-One points to be considered in the interpretation of sandplay. The Journal of Sandplay Therapy. 17(1), 51-73.
Labovitz, B., Goodwin, A. (2000). Sandplay Therapy: A Step-By-Step Manual for Psychotherapists of Various Orientations , Norton Press, New York, NY.
Lagutina, L., Sperlinger, D., Esterhuyzen, A. (2011). Addressing psychological aspects of physical problems through sandplay: A grounded theory study of therapists’ views. Psychology and Psychotherapy: Theory, Research, and Practice. 55, 1-20.
Lowenfeld,M., (2011). Lowenfeld’s Contribution to the Understanding of Trauma in Sandplay. Transpersonal Sandplay Therapy Center. Available at: http://www.sandplay.net/preschool.htm. Accessed on November 4, 2011.
Remen, R. (1995). Tradecraft of the Commonweal Cancer Help Program: A Series of Interviews and Discussions with Program Staff. Bolinas, California. Pages 36-56.
Sparling, W. (2002). From healing into life to healing into death: The Sandplay Project. A clinical study utilizing Jungian psychology complement conventional breast or ovarian cancer treatment. PhD Dissertation. Union Institute and University.
