A Case Study of Sand Drawing Therapy, Norio Seki

Ⅰ.  Introduction

In my previous paper, "Sand Drawing Therapy: A New Approach to Art Therapy," I discussed the characteristics and significance of using sand drawing as a form of therapy, as well as the procedures and precautions for its implementation, citing relevant literature.

In this paper, I would like to introduce the practice and specific methods of sand drawing therapy through a case study.

The therapist (hereafter Th) stands facing the client (hereafter Cl) and is responsible for recording the sand drawing process as it is woven from the Cl's fingertips, and for photographing the completed picture.

With this technique, the process and the transformation of the image can be observed as if you were holding it in your hands, but with this technique on paper, you can only infer from still images.

Nevertheless, the development of many images through sand drawing over the course of a single hour and a half session is likely to be of great help in understanding the characteristics of this technique.

Ⅱ.  Case Study

A 38-year-old man. He had previously participated in a one-day art therapy group and, remembering the moving experience, signed up for a private session. His mother, who had experienced the author's art therapy on another occasion, also strongly recommended it. He had not previously visited a mental health clinic, but had previously received short-term private counseling. Therefore, he was not undergoing medication.

The patient's main complaint was trouble with interpersonal relationships (with a religious group) at work, and the associated anxiety and irritability. He worked as a mannequin painter, but one day, on his way home from a year-end party, he was approached by a company executive for a religious-like solicitation. After this, he developed paranoia, which ultimately led him to quit his job. He currently feels constantly watched, even when he goes out, and as if people are taking his picture with their cell phone on the train.

He continued his job search during this time.

Sessions were held once a month as 90-minute private art therapy.

Sand drawing was introduced in the second session.

This technique, which has a strong projective inclination, was adopted early in the sessions because, although he had persecutory ideation, it was not an acute breakdown, and his ego state was otherwise intact. Therefore, it was judged that by reducing the image to a silhouette, the client would not be overwhelmed by the color and vividness; and it was thought that by freely changing the image, a sense of control would be achieved.

Sand drawing was introduced in the second session (July) of the 90-minute individual art therapy held once a month from June of year X to March of the following year.

The duration of the work of sand drawing at this time was just over an hour.

As the focus was on production, the Cl. was asked to say "done" once the image had taken shape. Then the Th. quickly photographed the image from the other side of the table and focused on writing down any comments made by Cl. at the time. Once Th. had finished taking the photos, Cl. would erase the drawing and, once again, touch the sand freely with his hands and give shapes to the next image that had arisen.

The photos taken were used for verbal sharing in the next session.

In the next session, Cl. gave his association to Th. on what he had made last time, looking at printouts of each.

Here Th. got two comments of the Cl.

One was what he said on creating the drawings, and the other one was what he said in the next session looking at the printed out images at a distance.

.

III. The Actual Process

1. Warm-up

First, with the lights on in the room, Cl. placed an appropriate amount of sand on the lightboard. Then, as a warm-up, Cl. touched the sand with both hands, enjoying the sensation for a while.

As Cl. touched the sand, he remarked that it reminded him of his training trip to Okinawa, describing it as "the happiest time."

2. Turning on the lightboard and starting drawing

After the warm-up, Cl. gathered the sand in the center of the lightboard and Th. dimmed the room lights and lit the lightboard from below. Next, Cl. began to freely shape the images that came to mind while touching the sand.

〇 Comments from the first session 

At this point, the client let out a small cry of surprise, "Wow!" He then timidly touched the sand with both hands, allowing his hands to dictate the visual image.

Five images quickly unfolded here, but since this is still a warm-up session, I'll just present them together as illustrations. Japan's topography (coastline) (figure 1) → Powerful typhoon-like winds (figure 2) → Gathering winds (figure 3)

The whole thing took about 10 minutes.

〇 Reflection in the next session

figure 1： "Sea creatures...jellyfish." "Just floating around." "Not a very good feeling."

figure 2： "It feels like the previous thing exploded." "Its shape suddenly collapses, and clouds appear."

figure 3： "It feels like it's turned back into a jellyfish, and now it has legs."

Th："What does it feel like to be a jellyfish?”

Cl："It moves toward the surface, breathes air, and floats up."

"I feel like it's relaxing and resting."

3. The Fruit (figure 4)

〇 Comments from the first session

It shaped into three clusters, and became a fruit.

Cl： "It gives me a round, warm image.”

〇 Reflection in the next session

Th：“Does it remind you of anything?”

Cl：" It's a male genitalia, or a female uterus."

4. Landscape with Clouds, Mountains, and a Road (figure 5)

〇 Comments from the first session

He drew a landscape of a road leading up to a cloud-covered mountain.

No particular comments were made.

〇 Reflection in the next session

 Cl："A landscape with few people. I'm looking at it from the bottom left of the screen. It looks like there's still rain in the clouds. The road of the left side is cut off."

5. Big Tree (figure 6)

〇 Comments from the first session

Cl："It's a tree. A big tree. It stands in a grassy area." "It feels expansive."

〇 Reflection in the next session

Cl："The clouds become leaves. The trunk is growing." "It looks like a brain." 

6. Clouds over the mountains (figure 7)

〇 Comments from the first session

Cl："Clouds are gathering over the mountains."

　  "It feels like it's about to rain."

〇 Reflection in the next session

Th： "It's back to the clouds in the previous scene. It's like a close-up.”

 "It looks like two pairs of legs are interlocking."

7. Devil  (figure 8)

〇 Comments from the first session

Cl：“It looks like a devil.”

 "The arms don't seem to spread out like wings."

 "At first, it felt unpleasant, but once I added the hands, it didn't look so bad."

〇 Reflection in the next session

Cl："Angry bat"

　　"It spreads its wings to look bigger, and it's trying to fly."

"It's trying to show strength," he said. "This may be related to the need to look big for job

hunting," he added, but commented, "It doesn't look very strong."

8. Traces of the Devil's Passage (figure 9)

〇 Comments from the First Session

Cl："These are the traces of the devil's trampling through the earth. But there's a little hope," he

 　 commented. "This side is a mirage."

〇 Reflection in the Next Session

Cl："The circle looks like a human head. It's as if it's pleading with me."

　　"It's as if it's asking for help, or apologizing."

Here, he shares memories of being sickly as a kindergartener, being in and out of the hospital frequently, and feeling lonely because his parents couldn't stay over.

9, Triangular-Roofed House (Figure 10)

〇 Comments from the First Session

"A house. A big house. A solid, sturdy house that seems like it would protect me. We have animals. We even had a cat from before." He reminisces, "Something unpleasant happened when I was in the first year of junior high. It wasn't quite bullying, but there was a time when all the girls wouldn't talk to me."

〇 Reflection in the next session

Cl："I'd like to add more windows."

　　"I imagine it as someone else. Maybe it's my future family."

Th：When you look at this house, does anyone in your family come to mind?

Cl："It's my father."

Th："What kind of image is that?”

Cl："He gives the impression of being calm and composed."

　  "He always seemed tired from work, but he was kind when I was in elementary school."

10. Towering Mountain (figure 11)

〇 First Session Creation and Impressions

As he drew a triangular mountain with clouds floating in the sky, he said, "This is a mountain. I want to climb this mountain."

The mountain's shape was angled to match the roof of the large house he had drawn earlier.

〇 Reflection in the Next Session

"This mountain evokes an image of towering, obstructive presence. Do you have similar associations?"

"In my second year of high school, I insisted on studying social studies while working a part-time job, but my parents strongly opposed it, and I became depressed."

"Also, in my third year of high school, I suffered a pneumothorax, which collapsed one of my lungs and ruined my entire summer vacation. I was depressed ever since. I still remember it."

11. The Sun Rising from a Broken Mountain (figure 12)

〇 Impressions from the First Session

The mountain's peak crumbles, and after a while, a large sun appears. The clouds shrink and disappear behind the sun.

"I yawped in my head and split the mountain in two with all my might," he later explained.

〇 Reflection and Work in the Next Session

Cl："As I looked at the mountain, I felt like splitting it."

Th："Not climbing the mountain, but splitting it? What does it mean to split a mountain?”

Cl："I want to break through my current situation. That mountain may represent my current situation."

Th：I associate it with the birth scene. Was it actually like this?

Cl："I heard I was big and the delivery was tough and difficult."

Th：“Now, try posing like that mountain.”

He stands up and makes an M pose with both hands.

Th：“What does it feel like?”

Cl："I am floating in the air. Even though I don't want to, I feel like flying through the air and into the space."

Th：“What does it feel like to stretch your arms up in a W shape?”

Cl：“It's better to stretch my arms up. It feels like I'm lifting them up.”

Th：“What are you lifting?”

Cl："They're balls. I'm holding one large ball in each hand. They're not very heavy, so they're easy to balance."

Th：“Now, try balancing them.”

Cl：“...It's even easier if I hold the balls where they overlap."

Th：“What does the ball in your right hand symbolize?”

Cl："It symbolizes masculinity."

Th：“What does the ball in your left hand symbolize?”

Cl：" Femininity. It's a small animal, like a cat. It feels like a baby."

Th：Use your imagination and talk to the baby.

Cl：“The message says it wants to be a tiger or a lion when it grows up.”

Th：“When will it come out?”

　　“How will it come out?”

“Ask it if it knows how to be born.”

“Ask it if it knows how to split a mountain.”

- A brief silence -

Cl：“...Hang up !!!”

“I will change my cell phone and cut ties with old religious acquaintances!”

After a brief pause, the client declared firmly.

12. Giant Sun (figure 13)

〇 Comments from the first session

A landscape lit by sunlight. The sun is so large that its heat seems to be drying up the earth.

Cl："It's somewhere between a desert and a grassland, and new shoots are sprouting."

〇 Reflection in the next session

Cl："The clouds have been blown away by the sun. It feels a little hot."

13. The moon emerges as night falls (figure 14)

〇 Comments from the first session

Cl："A peaceful city." "The sun from earlier has calmed down as night falls." "The moon emerges, as if regaining its energy."

〇 Reflection in the next session

Cl："This is an image of night."

14. An image of dawn (figure 15)

〇 Comments from the first session

Cl："The city area has grown, and dawn is visiting over the city."

　  "This is the end."

〇 Reflection in the next session

Cl："Peace has returned to the city, and a new day is about to begin."

In subsequent sessions, art therapy sessions using drawing, collage, and paint were conducted.

However, the themes embedded in the images and symbols that emerged during the sand drawing continued to recur in subsequent sessions.

Conversely, by appropriately incorporating themes that emerged in the sand drawings into the artwork being produced at the time, the clients was able to delve deeper into the themes they were concerned with and developed them further.

The sessions concluded with the client's main complaint, including his persecution complexes, being resolved and his finding a full-time position at a hotel.

Looking back, the sand drawing work hinted at the flow of the series of sessions that would follow, and there is a resemblance to what is called “Initial Dream” in Jungian psychoanalysis. (J. Jacobee 3）

IV. Review of the Series of Sessions

In this sand drawing experience, a total of 16 images were produced in one session.

During the initial warm-up, the images that emerged were still atypical, but they eventually took on concrete forms, evolving as if watching the unfolding frames of a picture-story show or manga.

The initial atypical forms gradually became more concrete, and transformed into more structured images.

Furthermore, the changes in composition and recurring symbols throughout the series of sand drawings were interpreted as visual messages from the unconscious.

This also provided important clues for understanding the Cl.'s internal conflict and then, the place of transformation.

The process of creation began with the client touching the sand with both hands, eliciting images through the sensation of touch. This seems similar to the effect of sand in sandplay therapy.

For example, in figure 3, the shape described as a "fruit" that appeared in the drawting later transformed into a cloud. (figures 5 and 7). At first, the cloud is seen in the distance of a road, then becomes a huge cloud hanging over a low mountain (hill), and then reveals its true form as a demonic image.

As the landscape transitioned from a low mountain to a towering one, the cloud receded into the background again as a small, bright cloud (figure11). When the mountain split in two and the sun emerged, it became even smaller (figure12). This movement, observed through a series of frames, was like a cloud transforming into a sun.

The shape of the "fruit" is also reminiscent of a phallic shape. In that sense, a connection with the leaves of the large tree (figure 6) is also suspected. In fact, some illustrations from alchemical texts cited by Jung (1968) depict the male genitalia as a single tree ４). This seems to represent the image of a man literally standing on his own feet.

However, the lone tree in the grassland is obscured by a huge cloud that spreads and a demon that appears there tramples on the earth.

Next appears a house with a triangular roof. The next image, a large conical mountain, has the same slope as the house's roof, suggesting that the house and mountain may share the same symbolic content.

Asari (2004), a long-time researcher of children's drawings, has stated that triangular-roofed houses in children's drawings represent fathers, and similarly, pointed triangular mountain .1)

Cl's father had passed away several years earlier, and it is speculated that his unfulfilled desire for fatherhood, his desire to depend on and be protected in a fatherless household, was rejected by the towering mountain that symbolizes fatherhood, leading to paranoia and ultimately to his loss of job. The tree also seems to represent Cl's own ego state as he strives for independence.

By splitting the mountain in two, the rising sun evokes a scene of childbirth. Seki (2011) discusses the relationship between solar representations and ego states, and this sun could be symbolically described as the birth of a new ego 6).

11. In the work Cl. did in the M-shaped split mountain pose, expressing a "hanging image." I noticed a strong resemblance to the devil pose Cl. had created earlier (figure 8). Understanding it in this way, I can see that the devil pose, which at first appears threatening, actually harbors feelings of victimization.

At first, it was a huge, manic sun that tormented the surrounding area with drought, but then night came, and the moon calmed its heat. The final image he created was a serene landscape with a moderate sun floating above, illuminating the houses of the town with its dawn light and watching over them.

 V. Discussion

This sand drawing therapy session begins with the creation of a sand drawing using the Cl.'s fingers while touching the sand. A few days later, the Cl. and the Th. engage in verbal interaction while looking at a printed image of the sand drawing. Thus, the sessions are composed of two phases: the first half, art production, and the latter half, verbal sharing with the therapist.

This directly corresponds to the two therapeutic pillars of art therapy: art as therapy (session 1) and art psychotherapy (session 2). The former sees therapeutic opportunities in the creation of artwork in art therapy, while the latter is the stage in which verbal interaction between the client and therapist takes place based on the completed artwork. 7)

The sand drawing session on Day 1 involves several important expressive transitions. First, as a warm-up, the client engages in a process of enjoying the touch of the sand with all ten fingers. Here, the focus is purely on the sense of touch. Next, the room is darkened and the light table is turned on, shifting the process from the tactile process of touching the sand to the visual process of viewing the silhouette of the sand.

This shift from the tactile experience of the sand to the visual image of its silhouette is reminiscent of the myth of the creation of the universe, in which a shape gradually emerges from chaos. This expressed image should be understood not as the product of conscious thought, but as an unconscious image taking on a recognizable form. In other words, there is a shift from the  experiencing ego in touching the sand to the observational ego in observing the silhouette from a distance.

Another distinctive feature of sand drawing is that the completed image can be freely recreated as many times as desired, facilitating processes of transformation such as destruction and creation.

The next stage of sand drawing therapy is the verbal sharing with Th.

No actual art making takes place in this session. Rather, Cl. looks at printed images, sharing his impressions and associations with Th..This is also the stage where they can expand the images if necessary.

Here, the focus is on the other therapeutic pillar of art therapy：the aspect of art psychotherapy through the observing ego. Keeping a distance from the images he has created and confirming his experience with Th. as a witness leads to awareness within a protected and safe framework.

In the therapeutic process described above, let us consider how the structure of sand drawing therapy contributed to the healing changes within the Cl. in this paper.

As mentioned above, in sand drawing, after the tactile experience of handling the sand, a light is turned on from below, and the result of that experience appears before the viewer's eyes as a "shadow." At this moment, Cl let out a soft cry of surprise, as the tactile spatial experience was re-experienced visually from the outside as a shadow. The effect of the reversal of perspective up to this point, including the utterance of the comment, can be called the first-phase effect. For example, in the work presented in 11) (Figure 12), there is a verbalization of the dramatic tactile effect of hollowing out a mountain and then splitting it apart "with sheer force."

In the next session, the client and the therapist shared the photographs from the first session and engaged in a dialogue. Here, the photograph's "documentary" nature came into play, allowing the client to connect the tactile effect he had produced to the past situation when his symptoms first arose. In other words, his work reminded him of the pressure he had been under. The words that emerged were, "...cut it !!!" These words could be described as a second-phase effect, excited when the experience was placed within interpersonal verbal activity. This "cutting" was a verbalization linked to a real-world action: severing one's relationship with an oppressive, pseudo-paternal religion. This kind of severance is a self-healing act that is difficult to achieve, even if one desires it. The sand drawings combined structural constraints such as "front and back" and "inside and outside," achieving a spatial effect of "severing" light and language within Cl on two occasions. As a result, the sun and moon subsequently parted ways, as if to acknowledge each other, and gently illuminated the earth's surface, suggesting a creation myth.

In this way, sand drawing therapy appears to be an excellent approach for engaging in the dialogue between consciousness and the unconscious, giving form to the unconscious, and then reconstructing it.

Ⅵ. Conclusion

I would like to conclude this paper by comparing this healing transformation with the effects of shadow puppet theatre.

The change toward healing in the Cl. can be seen as being brought about by what might be called the "shadow puppetization of inner perception."

One of the origins of my artistic endeavors is shadow puppetry. In my twenties, I briefly joined a theater troupe led by Seiji Fujishiro 2), performing it in several stages or elementary schools.

One day, after a performance, the lights were turned on and a group of curious children came timidly to peer backstage of the screen. I will never forget the vibrant, shining faces of the children at that moment.

But I have never seen my own shadow play. This is true in any of this kind, that actors are destined to not be able to observe their own performance from the side of the audience.

However, with sand drawing, we can watch the silhouette transform into various shapes and  take them in videos or photos, later reflecting on them with the Th. This can be said to be a collaborative effort between consciousness and the unconscious.

In art therapy, Art as Therapy and Art Psychotherapy seem to correspond to the functions of the experiencing ego and the observing ego. And in the latter process, diverse standpoints in psychology of the Th. seems to make various psychological approaches possible.

The shadow, which is the central focus here, is said to represent, psychologically, the unconscious realm untouched by consciousness or the ego.5)  From the perspective of depth psychology, this approach of dealing with the shadow itself seems to contain many implications. I would be delighted if this paper inspires even a few people to take an interest in this technique, try it out, and incorporate it into their own clinical practice.

Acknowledgments: I would like to express my gratitude to Mr. S. for his kind consent to write this paper.

Seven years have passed since I first submitted this paper, but after receiving an inquiry from the editorial committee about the status, I was finally able to take up my pen again. I would like to take this opportunity to express my deepest gratitude.

References

1) Atsushi Asari, Hideo Watanabe (eds.): Asari-Style Painting Diagnosis Dictionary, Cosmo Two One, vol. 141, 2004.

2) Seiji Fujishiro: Let There Be Light, Let There Be Shadow: 65 Years of Creative Activity, Bijutsu Shuppansha, 2008. Seiji Fujishiro Museum of Art. https://fujishiro-seiji-museum.jp

3) Jacoby, J.: First Dream, Man and Symbols: The World of the Unconscious, Vol. 2, 214, Kawade Shobo Shinsha, 1986

4) Jung, C.G.: Psychology and Alchemy II. Translated by Koichi Ikeda and Michio Kamada, Jinbun Shoin, 197

5) Jung, C.G.: Analytical Psychology, Translated by Katsuyuki Ogawa, pp. 41-43, Misuzu Shobo, 1976

6) Seki, Norio: The Symbol of ☉ / Seeing, Touching, Hearing: On the Origin of the Ego and Central Sensation, Journal of the Japanese Society of Art Therapy, 42(1), 25, 2011

7) Wadeson, H.: The Nature of Art Therapy, Clinical Drawing Research III, pp. 151-159, Kongo Publishing, 1988

Norio Seki, Clinical Art Therapist norioseki571@gmail.com