What kinds of change occur in adolescents using Sandtray in counselling? An exploration of autonomy, causality and change in relation to counselling young people

  • Kirsty Bilski

    Student thesis: Doctoral Thesis


    This research aimed to increase understanding of adolescent therapeutic change through the use of sandtray in counselling. Three Hermeneutic Single Case Efficacy Design studies (HSCED) (Elliot 2002), were completed with three adolescent girls aged 15 to 16 years. The cases of Amber, Beth and Chloe. Although HSCED has been used extensively with adult clients, it has been rarely used with young people. These studies highlight ethical considerations around working with young client participants, striving to achieve a balance between obtaining a rich data record and the recognised research vulnerabilities of this client group. These studies also consider the nuances of the causal relationship between therapy and evidence of therapeutic change, considering both in-therapy causal factors and extra therapy events. The study focuses on the intricate processes which occur in sandtray therapy, along with the relationship between autonomy, causality and therapeutic change. Sandtray therapy research very often comprises of case reports, this study aimed to achieve something different through an adjudicative approach. Thus reducing the impact of researcher bias through robust hermeneutic analysis and external review by a panel of judges. Outcomes for each case were scrutinised by the panel who provided feedback on whether therapeutic change had occurred, and to what extent therapy was responsible for those changes.

    Strengths of the study include the challenging methodology, an alternative approach to traditional case reports, whilst also raising awareness around the ethical position of adolescents in research. The study design enables insight into the intricate nature of sandtray process, along with an appreciation for adolescent autonomy and the many causal factors which may impact therapeutic outcomes. Challenges included the outcome measures selected for the rich data record and subsequent data analysis, along with difficulties experienced by the judging panel.

    Findings indicate many, and varied, types of change occur in the use of sandtray with adolescent clients. Autonomy and causal factors were extensively considered throughout. There is a need for further research into the use of HSCED methodology with adolescent clients. Expanding awareness around the balance of ethical research practise whilst not underestimating, or compromising, what is possible to achieve in a study of this nature. Study findings are explored in relation to training, contribution to professional practice and future research.
    Date of Award2023
    Original languageEnglish
    SupervisorDeborah Lancastle (Supervisor) & Steve Smith (Supervisor)

    Cite this