Where Words Can't Reach: Neuroscience and the Satir Model in the Sand Tray

By Madeleine De Little

The purpose of this book is to help therapists become proficient in Neuroscience and the Satir Model in the Sand Tray (NSST) therapy.  It describes NSST's three components: Neuroscience, the Satir Model (TST), and the Sand Tray.  It explains how to set up an NSST practice and how to use it with children, adults, couples, and families.

In this book you will find examples of our universal life-affirming drive to: Stay safe, stay connected with others, and meet our deepest emotional needs.  You will see illustrations of individual defensive coping behaviours in response to stress, and how these patterns may appear in the Sand Tray.  You will be introduced to the Iceberg Metaphor, which both the Satir and NSST models use to describe an individual's systemic perceptions and responses to his external and internal worlds, and which NSST demonstrates using figurines.  You will get a basic understanding of how to positively and durably transform the current impact of the client's past experiences.  You will better understand the central value of the Neuroscience of both attunement and attachment.  

If you are a practitioner or clinician who is new to the field of using the Sand Tray, I hope this book will entice you to look more deeply into this approach. The research has shown that it is quick, lasting and profoundly transformative. This is because the client can access sequestered embodied experiences through the choice and placement of figurines which go to parts of the implicit memory, where words can't reach!

• Language: English
• Publisher: Madeleine De Little
• Release date: Oct 29, 2020
• ISBN: 9780994086624

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© Madeleine M. De Little 2020

All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

book layout: Joanie Wolfe

ebook conversion: Niels Petersen

ISBN: 978-0-9940866-2-4

Third Edition, available only as an ebook

YinYang

To the children and adults

who have been harmed,

and to all those who support them

on their healing journeys.

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Ultimately, Neuroscience and Satir in the Sand Tray (NSST) is about creating an internal sense of safety for the client. The therapy begins in the sand tray where the client experiences and recognizes the Special Gifts of his/her presenting defensive behaviours and, subsequently, is able to transform these no longer useful defence/coping states into a more integrated/balanced authentic Self.

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Contents

Important Highlights

List of Case Studies

List of Tables

List of Images

Glossary

Acknowledgements

Preface

Author’s Addendum

Chapter 1. Introduction

Why Neuroscience and Satir in the Sand Tray (NSST)?

How I Came to Use TST in My Practice

NSST: The Benefits of Combining Neuroscience with TST

The Purpose of This Book

The Challenge of Personal Presence

Chapter 2. NSST’s Fundamental Concepts and Principles

The Concepts of TST that NSST Embraces

People Are Basically Good

People Do the Best They Can

People Can Learn to Be in Charge of Their Feelings

Human Processes Are Universal

People Inherently Know What They Need

Goals of Therapy

Hope

Life Energy

The Problem Is Not the Problem

Change Is Always Possible

Articulating the Body’s Sensations

Use of the sand tray

Infusion of Neuroscience

People Are Hard-Wired for Safety

The Defence/Coping States

Internal Resources/Special Gifts

Right-Brain to Right-Brain Attunement

The novel metaphor of the Implicit Memory

Therapeutic Attachment

Epigenetics

The Iceberg Metaphor/The Iceberg Model

NSST’s Methods of ExplorationUsing the Iceberg Metaphor

The Defences

Feelings

Feelings about Feelings

Perceptions of Self and the World

Expectations

Yearnings

The Self

The Body Sensations

NSST’s Six Guiding Principles of Therapy

Systemic Principle

Experiential Principle

Principle of Change

Positively Directional Principle

Principle of Authentic Presence

Principle of Staying in the Metaphor

Chapter 3. The Neuroscience of Safety

The Polyvagal Theory of Self-Preservation

The Unconscious Learned Response to Threat

Developmental Effects of Stress

The Five Defence/Coping States

Identifying the Client’s Defence/Coping State(s)

Placating State

Blaming State

Super-Reasonable State

Irrelevant/Distracter State

Frozen/Immobilized State

Attachment and Attunement

The Process of Neural Integration

The Importance of Therapeutic Attachment

Chapter 4. How to Conduct Sessions with Children

Overview of a Session

The Steps for Change in the sand tray

Using Neutral Language in Description

Asking Process Questions

Identifying Energy Spots

Some Words of Caution

Neutral Description of an Energy Spot

Teaching Awareness of the Brain–Body Stress Responses

Description of a Session

Preparing the Playroom

Preparing Yourself

Making Friendly Contact

Listening for the Problem/Goal and Hearing What Makes It a Problem

Asking for a Commitment to Change

Teaching Awareness of the Brain–Body Stress Responses

Inviting the Child to Make a Picture in the sand tray

Stating What You See in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Shifting Perceptions

Shifting Expectations

Helping the Child to Experience the Transformed Sensations in His Body

Anchoring the Transformation

Reflecting on the Session

Appreciating the Child’s Engagement

Performing the Goodbye Ritual

Inviting Parent(s)/Guardian into the Room

Chapter 5. Case Study: Linda Sessions 1 and 2

Session 1

Preparing Myself

Making Friendly Contact

Listening for the Problem/Goal and Hearing What Makes It a Problem

Asking for a Commitment to Change

Teaching Awareness of the Brain–Body Stress Responses

Inviting the Child to Make a Picture in the sand tray

Stating what you see in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Helping the Child to Experience the Transformed Sensations in His Body

Anchoring the Transformation

Session 2

Listening for the Problem/Goal and Hearing What Makes It a Problem

Asking for a Commitment to Change

Describing the External World Portrayed in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Helping the Child to Experience the Transformed Sensations in His Body

Anchoring the Transformation

Performing the Goodbye Ritual

Homework

Conclusion

Chapter 6. Different Kinds of Play

Free Sand Tray Play

Problem-Oriented Sand Tray Play

Therapist-Directed Sand Tray Play

Session 1

Session 2

What if a Client Does Not Want to Play?

How Do Adults Play?

Unusual Kinds of Play

Chapter 7. Complex and Challenging Case Studies

Sam

Steps Followed

Making Friendly Contact

Inviting the Child to Make a Picture in the sand tray

Stating What You See in the sand tray

Asking Process Questions of the Whole sand tray

Asking Process Questions of the Icebergs of the Figurines

Transforming the Defence/Coping States

Helping the Child Experience the Transformed Sensations in His Body

Anchoring the Transformation

Performing the Goodbye Ritual

Inviting Parent(s)/Guardian into the Room and Homework

Clinical Notes

Allan

Steps Followed

Inviting the Child to Make a Picture in the sand tray

Stating what you see in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Helping the Child Experience the Transformed Sensations in His Body

Anchoring the Transformation

Performing the Goodbye Ritual

Inviting Parent(s)/Guardian into the Room and Homework

Clinical Notes

Amy

Steps Followed

Making Friendly Contact

Inviting the Child to Make a Picture in the sand tray

Stating what you see in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Helping the Child Experience the Transformed Sensations in His Body

Anchoring the Transformation

Inviting Parent(s)/Guardian into the Room and Homework

Performing the Goodbye Ritual

Clinical Notes

Barry

Session 1: Steps Followed

Making Friendly Contact

Inviting the Child to Make a Picture in the sand tray

Stating what you see in the sand tray

Asking Process Questions

Transforming the Defence/Coping States

Helping the Child Experience the Transformed Sensations in His Body

Anchoring the Transformation

Clinical Notes

Session 2

Teresa

Colleen

Chapter 8. Meeting the Parent(s)/Guardian

Having the Parent(s)/Guardian Fill in the Intake Questionnaire

Meeting the Parent(s)/Guardian

Creating a Family Map in the sand tray

Setting the Goals for Therapy

Chapter 9. Working with Families

Chapter 10. Creating a Positive Therapy Environment

The Environment

Equipment and Materials

The sand tray

The Sand

The Figurine Collection

Must-Haves

More Figurines

Places to Purchase Figurines

Chapter 11. Final Words

References

Appendix A. Authoring a Report

Appendix B. Process Questions about Figurines in the sand tray

Questions to Begin the Session

Questions to Reflect on the sand tray Picture

Questions to Explore the Client’s Iceberg

Defence/Coping States

Feelings

Feelings about Feelings

Perceptions of Self and Others

Expectations of Self and Others

Yearnings

Transformational Questions

Experiential Questions

Anchoring the Transformation Questions

Other Process Questions

The Wish Candle Sharing

Appendix C. Intake Application Form for Parent(s)/Guardian

Index

Important Highlights

Adult Therapy: It is exciting, and a great privilege, to witness adults as they move away from their stories, create new images of how they want to be different, and change internally. 125 Anchoring the Transformation: (i.e., change) in every part of the child’s Iceberg. Ask questions such as, How will you feel different after you leave today? How will other people know you’re different? How will you be different? 67 Body Sensations: Most children—and many adults—have difficulty in being aware of the sensations in their bodies. It is a crucial part of therapy to teach them to be aware of what their bodies are telling them. 77 Client’s/Therapist’s Jobs: The child is in charge of the content. The job of the therapist is to ask process questions of the figurines, thereby helping rewrite the child’s sense of himself. 72 Complex and Challenging Cases: Sometimes the child will not answer you because he genuinely doesn’t know how he feels or perceives himself and the world. In NSST, the child is able to express his internal world through the choice and placement of the figurines. The work of the therapist is to articulate all the elements of the figurines’ Icebergs, so the child is able to experience himself. 133 Energy Spots: (or hot spots) are the elements in the sand tray where the energy is concentrated, which suggests that something is not right. It is likely that Energy Spots will require the most work—but they are not usually the place for the therapist to begin stating what she sees. 73 Energy Spots: By leaving the Energy Spot to the last, I allow the child to become used to my curiosity and neutral language, and to trust me with his picture. 76 Experiencing the Sand-Tray Change in the Body: The next, and critical, step is to ask the child how he feels now that the figurine is [safe/protected/has friends]. I then ask exactly where in his body it feels different. I invite him to take a few breaths, close his eyes if he wants to, and check in with his body. 88 Experiential Principle: The therapy must be experiential, which means that the client experiences, in his body and in the present, the impact of a past event. 30 Family Sessions: Sharing perceptions of each other through the metaphor of the figurines has an impact on other family members and, hence, upon their contributions to the session. 171 Feeling Free to Play: The placement of just one or two figurines in the sand tray can be an indication of how difficult it is for a child to feel free to simply create and play. 42 Figurine Collection: I look for figurines that can symbolize aspects of a client’s external and internal world. In acquiring figurines, I think of the various parts of the Icebergs as well as change, chaos, cultural icons, positive transformation, and defence/coping states. 181 Frozen/Immobilized State: This is, in some ways, the most powerful source of determination for a client to keep safe. 58 Goodbye Bell: I allow 45 minutes for a session. After 40 minutes, I ring my Goodbye Bell so that the child (who may be still working in the sand tray) knows it is time to start preparing to leave. 69 Internal and External Experiences: The impact of what happened in the past and how the client would like to be different are together in the sand tray—in space and time—along with the defence/coping states that are getting in the way of positive future yearnings. 26 Intuition and Healing: Children intuitively know what they need to heal without talking explicitly about their traumas. 157 Invitation to the Playroom: Decide how to invite the child into the playroom in a positive way—plan ahead. 161 Irrelevant/Distracter State: Generally, a child in this state will create chaos in his play. 54 Meeting the Parent(s)/Guardian: I explain that the child is doing whatever he needs to do to make sense of his experiences and to get what he needs to survive, or avoid, emotional pain. Reframing their perceptions of the child’s behaviour removes the negative judgement of the behaviour and, more importantly, of the child. 160 Mobilized State: In response to a client using mobilized defence/coping state, I consciously use my social engagement system (play state) and make sure to smile at the child, look him in the eye, and offer a calming touch of his shoulder as I help him off with his coat. 134 Neural Integration: The quality of attachment between therapist and client is central to integration. For therapists to have a positive effect on the therapist/client relationship, they must address their own inner integrity/congruence. 62 Neuroscience and Satir in the Sand Tray (NSST): is ultimately about creating an internal sense of safety for the client. The therapy begins in the sand tray where the client experiences and recognizes the Special Gifts of his/her presenting defensive behaviours and, subsequently, is able to transform these no longer useful defence/coping states into a more integrated/balanced authentic Self. 4 Neuroscience: has revealed that the story is not needed for transformational change to occur (Badenoch, 2008, 2018; Cozolino, 2002; De Little, 2015, 2017; Porges, 2011; Schore, 2017). NSST focuses on the exploration and transformation of the defences in the novel metaphor, and the revealing of Special Gifts. 6 NSST: focuses on the Icebergs of the figurines which, in turn, helps the therapist understand the Iceberg of the client, whereas TST focuses only on the Iceberg of the client. 19 NSST Shift: NSST Shift moves the focus from behaviours based on conflict to behaviours based on unconscious implicit responses to trauma (Porges’ Polyvagal Theory, 2011), thereby profoundly changing how we can do therapy. Though we can certainly talk about conflict, we can’t speak directly to unconscious implicit memories. We need another way to access those memories and NSST is a therapy through which this can transpire. 188 NSST Therapy Goal: To discover and transform the client’s defence/coping states. This involves exploring the defence/coping states to show how they have been helpful in keeping him safe, exploring all aspects of the client’s Iceberg through the use of figurines, looking at what is getting in the way of the client experiencing his yearnings, discovering the Special Gifts that arise from the defences which give energy to the transformational process, experiencing the changes in the body, and anchoring the changes internally and externally. 103 NSST-based approach: helps the client to discover and connect to his yearnings, to realize the Special Gifts of his defences, and to become aware of new possibilities and choices beyond the current situation. It automatically creates change from within; it stimulates choice. The act of changing the figurines around in the sand tray metaphorically portrays alternative ways of being for the client and demonstrates the possibility of choice, which he may not have been aware of before. When he reviews the changes he has made in the sand tray, he can imagine new possibilities and make new decisions for himself. 9 Parents: Sometimes parents do not realize that they are part of the problem and therefore must be part of the solution. The majority of children I see from age three onward want something in their lives to be different; thus some careful preparation is also needed for the parents. 159 Playroom Rules: I tell each child that I have only two rules in the playroom: The first is that he can play with and put anything in the sand tray except for my computer and camera; the second is that he is not allowed to put anything away. The children love it when I tell them this! 67 Presence: We cannot change what has happened to the clients we work with—sometimes all we can do is be present for them and create a safe place for them to process their experiences. 66 Process Questions: Express questions in a positive manner when asking about the Icebergs. Be careful not to let the questions, or the play, become mired in the child’s story. As you explore the Icebergs in the sand tray, recall your joint commitment (the therapist’s and child’s) for a positive outcome, and let your questions open an opportunity to celebrate the hopes, yearnings, resources, and Special Gifts of the figurines. 85 Questions about Figurines or Child: Unless the child is spontaneously talking about himself as one of the figurines (i.e., This is me….), I keep the conversation confined to the novel metaphors in the sand tray. 70 Sand Tray Environment: The sand tray allows direct access to parts of the brain that the client has not consciously encountered before. It offers the opportunity to express the disorganized, unconscious, and implicit memories of the right brain (Schore, 2012). This allows the experiences stored in the right hemisphere to become organized and labelled by the left-brain processes of logic and language (Badenoch, 2008). The sand tray helps the client to present his internal world, outwardly, by placing objects as metaphors in the sand. The client can then look at the internal world, as if for the first time, and integrate right- and left-brain processes. 13 Shifting Expectations: Even though the child must return to his life after each session and there are not changes within the family situation, we can still help him to find whatever he yearns for another way—most notably, through accessing the Special Gifts already present in him. 86 Silent Answers: Often the questions I ask about the sand tray are not answered with words—the child simply observes the whole picture and changes some parts of what he sees. 68 Special Gifts: Clients using a Frozen/Immobilized State often develop good acute observation skills of the non-verbal behaviour of others. 55 Super-Reasonable State: Often clients who adopt this state take longer than usual to choose to use the sand tray. 51 Super-Reasonable State: People who use this state are often much more sensitive than their behaviour may suggest. 50 Therapist-Directed Play: If a child has difficulty in choosing figurines or creating a picture, then I suggest that we take turns; I put in one figurine and the child puts in another. I tell him the only rule of this game is that he can move or take out anything of his (or any figurines I have placed in the sand tray), but I cannot touch his figurines. 113 Transforming Reactiveness to Responsiveness: Using figurines to move from a reaction to perceived danger to an increased sense of safety, connection, and love. She moves from external story to the internal world of novel metaphor and, in so doing, she transforms her mobilized state to a more regulated state. 156

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List of Case Studies

Case Study 2.1. Taylor. [Feelings about Feelings] 22 Case Study 2.2. Hannah: I should be able to go to school. [Expectations of Self] 23 Case Study 2.3. Bonnie: Moving from External Story to Personal Iceberg 27 Case Study 2.4. John: A Three-Generational Story and Its Impact on the Child 29 Case Study 3.1. Julia: Moving to Caution too Soon 42 Case Study 3.2 Claire: Stuck in the Middle [Placating State] 46 Case Study 3.3. Walter: Alone on the Roof [Blaming State] 49 Case Study 3.4. Florence: Hides Her Pain [Super-Reasonable State] 51 Case Study 3.5. Madison: Chaos and Danger [Irrelevant/Distracter State] 54 Case Study 3.6. Jennifer: The Chicken and the Dinosaur [Frozen/Immobilized State] 57 Case Study 3.7. Marie: Scared Speechless [Frozen/Immobilized State] 58 Case Study 3.8. Brittany: Giving a Voice to Silent Grief 63 Case Study 4.1. Sue: Teaching Awareness of the Brain–Body Stress Response 79 Case Study 5.1. Linda: Letting Go of Unmet Expectations [Meeting Yearnings in a Different Way] 91 Case Study 6.1. Mary: Free Sand Tray Play 104 Case Study 6.2. Rick: Problem-Oriented Sand Tray Play 110 Case Study 6.3. Jennifer: Therapist-Directed Sand Tray Play 114 Case Study 6.4. Lyla: Therapist-Directed Sand Tray Play (Adult Client) 116 Case Study 6.5. Cindi: Therapist-Directed Sand Tray Play (Estranged Ten-year-old) 118 Case Study 6.6. Jim: Therapist-Directed Sand Tray Play in Processing Overwhelming Grief 123 Case Study 6.7. Dale: Making Sense of Fear (Adult Client) 125 Case Study 7.1. Sam: Chaos in the Sand Tray 134 Case Study 7.2. Allan: Constant Chaotic Sand Tray Play 138 Case Study 7.3. Amy: Asking for Help 142 Case Study 7.4. Barry: They need a safe home. [Chronic Trauma] 145 Case Study 7.5. Teresa: My dad’s a mean beast. [Moving from External Story to the Internal World of novel metaphor] 152 Case Study 7.6. Colleen: Sexual Abuse in the novel metaphor 156 Case Study 8.1. Marcia: A Parent’s Sense of Her Child 161 Case Study 8.2. Father’s Natural-Family: The Chameleon and the Gumby 163 Case Study 8.3. Family Dynamics: The Moose and the Lighthouse 165 Case Study 9.1. Parental Alienation of a Child 168 Case Study 9.2. Divorced-Family: Triplet Children (Marc, Adam, and David) 171

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List of Tables

Table 5.1. Linda’s Iceberg before Session 1 and after Session 2. p.99 Table 6.1. Mary’s Iceberg before and after Session 1. p.107 Table 7.1. Barry’s Iceberg before Session 1 and after Session 3. p.149

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List of Images

Image 1.1. Kevin: Does the guy know that there are snakes behind him? 2 Image 1.2 . Kevin: Maybe the guy feels helpless and the snakes are going to hurt him? 3 Image 1.3. Kevin: So now this guy can protect himself from the snakes? 3 Image 2.1. NSST Iceberg Metaphor. Based on Figure 2 by J. Banmen (1999) in Fostering Personal Growth for Counsellors through Transformative Pedagogy and the Learning of an Experiential Play-Based Therapy , Simon Fraser University Ph.D. thesis by M. De Little 2017, p. 48. Copyright 2017 by M. M. De Little. 20 Image 2.2. Taylor: This is my jealousy, and this is my sadness about how jealous I am, and this is how confused I am about feeling so jealous. [Feelings about Feelings] 23 Image 2.3. Hannah: In my head I know I should be able to go to school. [Expectations] 24 Image 2.4. Bonnie: What current life is like and a yearning for it to be like the past again. [Yearnings] 28 Image 2.5. Bonnie: The external reality of what her family is like. The beginning of the grieving process. [Systemic Principle in the metaphor] 28 Image 2.6. John: The impact of multi-generational abuse. [Systemic Principle in the metaphor] 30 Image 3.1. Julia: I feel like I am always about to fall off the horse. [What does the rider need to feel safe?] [Moving out of Frozen/Immobilized State] 43 Image 3.2. Spiderman in Satir’s classic caricature pose of the placater showing that, in this stance, we give our power to others. [Placating State] 47 Image 3.3. Claire: The sad egg in the middle, trying to make everyone else happy. [Placating State] 47 Image 3.4. Claire: Transforming the sad face to a happy face. [Transformation in the metaphor] 48 Image 3.5. Spiderman pointing his finger at others. [Blaming State] 49 Image 3.6. Walter: A very angry child, all on his own, attacking everything in the sand tray. [Blaming State] 50 Image 3.7. Spiderman follows the rules of logic. [Super-Reasonable State] 51 Image 3.8. Florence: I placed the figurines in the sand tray, checking to see if they were OK with her. She never touched the sand. [Super-Reasonable State] 53 Image 3.9. Spiderman is always moving, never stopping. [Irrelevant/Distracter State] 54 Image 3.10. Madison: A child who creates chaos in the sand tray. [Irrelevant/Distracter State] 55 Image 3.11. Spiderman keeps himself safe by not doing or responding to anything. [Frozen/Immobilized State] 56 Image 3.12. Jennifer is the chicken and the dinosaur is the world. [Frozen/Immobilized State perceptions] 58 Image 3.13. Marie: The little girl is safe in the tree. [Creating safety in the metaphor] 59 Image 3.14. Brittany: Giving a voice to silent grief. [Therapist being