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Window to an ill youngster's world: Therapy with miniatures and sand goes beyond child's play

Knai Bridges, 13, creates a sandplay assemblage as Ruth McKay, medical family therapist looks on. (PHOTOS BY SUSAN KAHN)

Knai Bridges, 13, creates a sandplay assemblage as Ruth McKay, medical family therapist looks on. (PHOTOS BY SUSAN KAHN)


A box of sand and an assortment of  miniatures helps young patients portray their world, and perhaps make sense of it, at the Waters Center for Children's Cancer and Blood Disorders and the Pediatric Hematology-Oncology unit at the Upstate Golisano Children's Hospital.

Sandplay therapy, as it is called, allows the children to process their feelings and thoughts about their diagnoses and treatment for life-threatening illnesses and the impact of treatment on their daily lives.

"The box of sand offers a safe place to express some of the intense experiences that can come with treatment for life-threatening illnesses," says medical family therapist Ruth McKay. "Children engaged in sandplay therapy may not consciously understand or be able to speak about what they are going through, but they can explore their experience nonverbally with the miniatures in the sand."

The box, or sandtray, measures about 28¼ inches by 18¼ inches, often with a blue interior to represent water or the sky. The patient selects from hundreds of miniature people, animals, toys, cars, household items -- almost anything you might find in the real world, including the world of medical treatment, including hospital beds and IV poles.

McKay, who is certified as a sandplay practitioner by the Sandplay Therapists of America, adds that sandplay tends to be a part of therapy, not the only therapy a child does. A patient and his or her family may also be engaged in family therapy, or a child may be learning skills to reduce post-traumatic stress symptoms.

Among what she has seen in sandtrays, McKay cites:

-- a child adjusting to having his port accessed and blood drawn by his nurses places witches watching over sleeping children in the sand.  Later he decides that he likes the nurses, because even though they do scary things, they are trying to help him get better.

-- another patient leaves just a handprint in the sand like a signature, saying "I am here.".

-- a boy creates a "car family," consisting of a mommy car, a daddy car, a child car -- and a car being transported inside an ambulance, much like his experience of his first treatment.

-- a dying boy whose family was reluctant to talk openly about his impending death repeatedly hides a coffin containing a skeleton in different spots in McKay's office, indicating that death was present, but not out in the open.

-- a girl who usually made animals run around endlessly one day places them by the water for a "spa day," at about the same time her family was no longer feeling in crisis mode, but getting use to the new normal of treatment.

McKay makes sandplay therapy available in her office, or she wheels a well-stocked cart to patients who can't come to her.

Knai Bridges, 13, of Syracuse, is being treated for sickle cell disease at the Waters Center and enjoys her time with sandplay. "It's like a box of sand where you can put your toys and special friends," she says, adding, "it's like doing a video."

Among the miniatures she has used are a bride and groom, various animals, hearts, a shell, a dancer and a hospital bed with an IV pole. McKay notes that Knai uses sandplay to help her to hold on to the whole of her life, not just the times when she is receiving treatment. The eighth-grader used to be in the hospital frequently and appreciates sandplay.

"She loves it. She talks about it all the time," Knai's mother, Nailah Beyah, says of the sandplay.

Most of the children McKay sees will have one or maybe two sandplay sessions, sometimes  spaced several months apart while some may engage in sandplay therapy for months. She follows a strict hospital protocol for cleaning the figures and changing the sand.

Bridges Knai_McKay Ruth_231

Sandtrays, the boxes that hold sand and miniature figures and other objects, can be arranged any way a person likes. This sandtray scene was one created by Knai.

What is sandplay?

Sandplay is a therapy in which a person, usually a child, expresses thoughts or feelings by creating a scene with miniature objects in a box of sand (called a sandtray), which often has a blue interior to represent water or the sky. The therapist quietly witnesses the creative process and photographs the finished scene to observe themes developing over time. Developed by Dora Kalff a follower of Swiss psychiatrist Carl Jung, sandplay therapy can work for people of any age.

How is it possible?

If you contribute to Paige's Butterfly Run or related events such as Pedaling for Paige or the Pajamarama, your donation helps make sandplay possible at Upstate. Sandplay therapy is offered to pediatric hematology-oncology patients free of charge, thanks to a grant from Paige's Butterfly Run.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.