Trauma Informed Directed Sandplay

Patricia Mary Sherwood

• Publisher: Sophia College
• Year: 2020
• ISBN:
  9780987614384
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Current research in the field of trauma has alerted us to how deeply embedded truamais in the physical body cells and how it runs the individual’s life from below the floorboards, in the unconscious. Spontaneous sandplay is powerful in making conscious, the unconscious in a manner that is com­passionate, soulful and transforming but it can take extended periods of time. This book elucidates directed sandplay sequences that are concise, focused and transformative using repeatable sequences developed for a range of truamatic clinical presentations including anorexia, OCD, body dysmorphia, self-harm through cutting, traumatic mutism, addiction, divorce recovery and suicide ideation. These processes facilitate the processing, releaseand transfromation of trauma and promote mental health recovery for clients with traumatic experiences.

CHAPTER 1

Self harm through cutting

“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.”

Laurell K. Hamilton (2019)

Non-suicidal self-injury (NSSI) is of epidemic proportions among adolescents in the western world and the most common form of self-injury is cutting but may also include burning, bruising, hair pulling or hitting oneself. Each year, one in five females and one in seven males engage in self-injury. It is a popular peer group dysfunctional behaviour to manage unresolved trauma and stress. Adolescent peers share techniques and photos, and develop a sub-culture of cutting in many schools. Over sixty per cent of cutters are females. Research has shown that fifty percent of those who self-injure are sexual abuse victims (Gluck, 2012). The prevalence of trauma among self harm cutters includes abuse in childhood, addiction, PTSD, and depression. It is often triggered by a recent difficult life event such as the breakup of a relationship, conflict with parental figures, particularly the mother, school failures, bullying, and recent episodes of violence or rejection by significant others. (https://www.lifeline.org.au/get-help/topics/self-harm). Cutting is most prevalent among female adolescents in Australia and an online survey (Murray, Warm & Fox 2005) reveals a profile of an adolescent who is female with a history of sexual and or physical abuse and who often has an eating disorder as well. She cuts her arms and legs on a daily or weekly basis. This person usually hides cutting implements, scars and bleeding from significant others such as carers, parents and other authority figures. However, she may publically display it through photographs to selected peers who also cut.

When working with clients that self harm the following explanations are common. “Cutting helps me get rid of bad blood and bad family history”, “it releases my anxiety or tension”, “relieves my feelings of loneliness and rejection”, “relieves my negative feelings of failure” or “fear of failure”, “helps me cope with self-blame and hopelessness” and “gives me a feeling of control over these overwhelming feelings”. It is common to hear that “Cutting also helps me focus on the pain in my body and forget the pain of all the negative bad feelings in my life”. Adolescent cutters also state that they find camaraderie, support and acceptance with other cutters who understand them and their problems in a way that the adults and people around them do not. Unfortunately however, cutting is a negative strategy for expressing negative emotions and forms a body-mind pathway that reinforces it as a way of relieving emotional stress. This relief circuit becomes harder and harder to break the more frequently cutting is used as the means to release tension and trauma (Hemmen, 2019).

Cutting should be perceived as a coping strategy masking much deeper traumatic experiences. It is adopted by teens in particular, as they often lack the skills and experience to develop better coping mechanisms and their family, community and/or school environments fail to model and educate alternative ways for coping with stress, disappointment and perceived failures. Usually when the adolescents present in therapy for cutting themselves, it has come to the notice of the school or parents despite the secretiveness of most cutters around concerned adults. By the time that it comes to a concerned adult’s attention, it is usually a habitual pattern of dealing with overwhelming negative feelings, so it is challenging for the therapist and client especially if the client believes it is the best and only way to deal with their stressors and adults simply don’t understand. Once the therapist has established rapport with the adolescent through some spontaneous, undirected sandplays and conversations, one can begin to introduce directed sandplay sequences. The first of these directed sequences is an orientation sequence to facilitate the client’s understanding of the stages of the cutting process.

1. Sandtray sequence for exposing the client’s experiential process of cutting

Although adolescents talk a great deal about their cutting escapades to each other, photograph it and circulate it via their mobile phones, they do not have an in depth understanding as to what drives the process, nor its costs to their health, nor interventions that they could make to prevent themselves engaging in the process. This first exercise is directed at exposing the negative cognitive distortions that drive the process.

The client is invited to choose objects from a diverse variety of figurines, both positive and negative, and place them from left to right along the horizontal middle line of the sandtray as follows:

Step 1

•Ask the client to choose a piece to represent their feelings when they have the first thoughts about wanting to cut and then to place it in the sand tray. For example: “I am bad and a failure because I failed the maths test today”. It is placed in the middle of the tray on the far left and labelled, “The “unhappy powerless one” or “sad or bad one” based on client’s choice.

Step 2

•Invite the client to choose a piece for the sand tray which represents how they feel and think when they are preparing to cut: for example “I am hopeless and I feel anxious”. It is placed in the tray next to the last piece going across the tray from left to right and labelled, the “anxious one” or whatever they have said they are feeling.

Step 3

•Ask the client to choose a piece that represents how they feel at the moment of cutting: It is placed in the tray next to the last piece going across the tray and labelled by the client. Usually they choose something like “I am powerful” or “I am in control”.

Step 4

•Ask the client to choose a piece that represents how they feel immediately after cutting. It is placed in the tray next to the last piece going across the tray and labelled by the client. Usually they choose something like “I am relieved” or “I feel calm.”

Step 5

•Invite the client to choose a piece to represent how they feel in the longer term after cutting. It is placed in the tray next to the last piece going across the tray and labelled by the client. Usually they choose something like “I regret it” or “I feel ashamed” or “I will be in trouble.”

Step 6

•Invite the client to reflect their feelings and thoughts at each of the points above. Work with the presenting trigger and the thoughts at each stage to elucidate with the client the cognitions and emotions that run that phase. After completion of the above steps, provide the client with insights which facilitate the client reframing their experiences during the process, into a positive way of thinking that moves them from victim to agent of change, from self-condemnation to self-compassion.

Reflection:

Spend time with the client reflecting on the steps of the cutting sequence and create a conversational space for the client if they wish to share experiences, or comment on the above. Once a trusting nonjudgmental relationship is established with the client who is cutting, they are usually quite keen to share their experiences of cutting. Out of this conversation usually the second directed sandplay sequence will arise either in the same or next counselling session.

2. Sequence exposing the experiences that move the sad/bad and anxious one to cutting

Step 1

•Ask the client to write down all the bad feelings they have about themselves when feeling bad/ sad or anxious and before they resort to cutting.

Step 2:

•Select further pieces to represent the sad/bad one and the anxious one.

Step 3:

•Select pieces to represent these feelings and place around the sad/ bad one and the anxious one.

•Label each piece so easily identifiable.

Reflections

In reflection with client help them to identify the trigger incidents in the client’s experience that lead to each of these feelings. Work with the trigger incidents individually over as many sessions as required to explore further in sandplays how each one of these trigger feelings operate in the client’s life. Use a range of additional techniques to transform these negative feelings based upon one’s particular clinical therapeutic model.

Interventions:

As a holistic somatic therapist, (Sherwood, 2010) I would undertake the following process for each of the negative qualities they have placed in the above sandplay:

1.Find where precisely in their body they feel the tension when speaking about a specific exper...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Acknowledgements
• Contents
• Introduction
• Chapter 1: Self-harm through cutting
• Chapter 2: Anorexia
• Chapter 3: Obsessive Compulsive Disorder (OCD)
• Chapter 4: Traumatic Mutism
• Chapter 5: Body Dysmorphia Disorder (BDD)
• Chapter 6: Addiction
• Chapter 7: Suicide Ideation
• Chapter 8: Divorce
• Conclusion