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The lava ate my school: The use of group sandplay to reduce anxiety
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JOURNAL r e s e a r c h
OF SANDPLAY
THERAPY ®
Volume 30
Number 2
2021

“the lava ate my school”:

the use of group sandplay
to reduce anxiety and post-traumatic stress
in displaced elementary school students

Lorraine Razzi Freedle, Michael McGee,

Sarah Blechman, John Souza, Jr., Danielle L. Zandbergen

My favorite part of sandplay was you.

Lorraine Razzi
Freedle, Ph.D., CST-T, study participant (age 6)
Teaching Member of
Sandplay Therapists
of America (STA)
and the International
When Kilauea volcano erupted on Hawai’i Island in 2018
Society for Sandplay thousands of people were displaced from their homes and com-
Therapy; Adjunct
Faculty, Southwestern
munities. For three months (May through August) residents in
College in Santa Fe, the lower Puna district watched in fear and reverence as Tutu
New Mexico and the
Trauma Research Pele, Hawaiian goddess of fire and volcanoes, took her lava form
Foundation, Brookline, and consumed their homes, businesses, beaches and gather-
Massachusetts.
ing places (Andrews, 2018; Freedle & Echsner, 2018). Pele
Michael B. McGee,
MSW, LSW, CSAC, destroyed everything in her path. On July 11, 2018 she took Kua
Associate Member of
STA, Adjunct Faculty
O Ka Lā, a public charter elementary school located in Puna and
University of Hawai’i based in Hawaiian cultural traditions and values.
Manoa, Thompson
School of Social Work
Natural disasters such as wildfires, hurricanes and vol-
and Public Health. canic eruptions displace tens of millions of people worldwide
Sarah Blechman, every year (IDMC, 2021). Exposure to natural disasters can
MSSW, LSW, Associate
Member of STA. yield significant increases in psychological stress, anxiety, and
John Souza, Jr., LMFT, post-traumatic stress disorder (PTSD) which are further com-
DMFT, Adjunct Faculty pounded by displacement (Galea et al., 2005; Zahlawi et al.,
Northcentral Univer-
sity, La Jolla, CA and 2019). If left untreated, symptoms of anxiety and PTSD are
University of Hawai’i, likely to worsen and may persist for a lifetime (Bandelow et al.,
Hawai’i Community
College. 2017; McFarlane, 2010). Low to middle income people are five
Danielle L. Zand- times more likely to be displaced by natural disasters with both
bergen, MA, LMHC,
Instructor and Ph.D.
children and indigenous people disproportionately affected
candidate at Oregon (Hernandez-Arthur, 2017; Lai & LaGreca, 2020).
State University in
Human Development
An estimated 175 million children are impacted by natural
and Family Studies. disasters every year (Save the Children UK, 2007). Children
Opposite:
under the age of 8 are particularly at risk for developing mental
The Golden Curtain health problems, including anxiety and PTSD after experiencing

129

Correspondence concerning this article should be addressed to Lorraine Razzi Freedle. E-mail: lrfreedle@gmail.com
130 “the lava ate my school”

a natural disaster (CDC, 2020). The distress they experience can affect their
physical health, relationships, academic performance, and overall quality of
life (CDC, 2020; Dyregrov et al., 2018; Lai & LeGreca, 2020). Providing chil-
dren with mental health services, access to social supports, and opportunities
to share their experiences with trusted adults are ways to help children cope
with natural disasters and may also prevent or reduce post-traumatic symp-
toms (CDC, 2020; Dyregrov et al., 2018; Lai & LeGreca, 2020).
Cultural groups like the Native Hawaiians that reside in volcanically
active regions, share stories about their experiences to build resilience, espe-
cially in times of crisis related to volcanic eruptions (Grattan & Torrence,
2016; Chester & Duncan, 2016). The Hawaiian culture has a rich tradition
of storytelling (National Geographic Society, 2020). Whether Hawaiians are
sharing “mo’olelo” (stories) about their history and mythology or bonding
with each other by “talking story”, storytelling is deeply entrenched in their
culture.
Sandplay therapy is an expressive, cross-cultural therapeutic approach
founded by Dora Kalff that is grounded in the analytical psychology of C. G.
Jung (Kalff, 2020). Sandplay provides children a way to tell their stories and
address their problems through play, an essential activity for emotional and
social development (Brown, 2009). Sandplay is particularly beneficial for
children and adults who have experienced trauma (Freedle, 2017; Freedle
et al. 2015; Freedle et al., 2020; Ramos & da Matta, 2018; Roesler, 2019;
Rousseau et al. 2009; Wiersma et al., 2021; Zoja, 2011). Sandplay activates
the psyche’s natural healing capacities (Kalff, 2020), and provides a nonver-
bal, somatosensory medium to access the unconscious; it allows people who
have been traumatized to release overwhelming emotions and “tell the story
that must be told” (Kalsched & Freedle, 2019, p.30).
Sandplay was used effectively in individual or group settings after the
terrorist attack in New York City in 2001 (Yeh et al., 2015). It has benefitted
victims of numerous natural disasters throughout the world including mud-
slides, earthquakes, volcanic eruptions, and tsunamis (Chenghou & Shen,
2010; Freedle, et al., 2019; Hwang, 2017; Kawai, 2015; Lacroix et al., 2007;
Lee & Jang, 2020; Park, 2018; Zoja, 2011). In addition, group sandplay
and storytelling have been found effective in improving children’s learning
and social development when applied in school settings (Unnsteinsdóttir,
2012). Although there are different ways to conduct group sand work, in
Kalffian-informed group sandplay, the therapist is non-directive and serves
as an empathic witness. Moreover, every effort is made to create a free and
protected space (Kalff, 2020) where each sandplayer works in their own tray
without interference from others (Reece & Ford, 2006; Steinhardt, 2007;
Wiersma et al., 2021).
When Kilauea erupted in 2018, local sandplay therapists (including the
authors of this study) were compelled to bring sandplay to the people who
L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 131

were affected. We asked for donations to create a mobile sandplay collection,

and within three weeks we received hundreds of miniatures, including figures
from therapists in 22 countries. This immense support from our sandplay
friends around the world touched us deeply and was carried forward in our
work.
Throughout the summer and during the eruption, we provided group
sandplay with evacuees at a shelter. We found that by using a group format
we could reach more people in the limited time we had, and that the shared
experience yielded emotional and social benefits for the sandplayers as well as
the volunteer therapists (Freedle & Echsner, 2018; Freedle et al., 2019). With
the start of a new school year, we directed our attention to bringing sandplay
to the students at Kua O Ka Lā elementary school.
The present study focuses on this school outreach effort. We conducted
research to better understand the use of Kalffian-informed group sandplay
with children affected by natural disasters and to share our findings with
others. However, our primary purpose was to join with the community in a
culturally-sensitive and trauma-informed way to meet the needs of the stu-
dents. Working with school administrators we established two goals for the
project:
1. To provide students a means of expression and alleviation of distress
related to trauma, loss, and/or displacement.
2. To support restoration of emotional development and learning.
It was hypothesized that group sandplay could help the students share
their stories and experiences about the event, reduce symptoms of anxiety
and traumatic stress, and access the natural healing capacities of the psyche to
further development.
Method
Participants
Fifteen elementary school students participated in the group sandplay
sessions. These students comprised the entire first grade class of Kua O Ka
Lā. All of the students had lost their school in the eruption. An unknown
number of these students, along with many of the teachers and administra-
tors, had also lost their homes. The intervention took place at the beginning
of the academic year in the school’s new location. The volcano had stopped
erupting, and the community was in the early phase of recovery. One student
moved during the study, and two others were absent when the posttest mea-
sures were administered. The remaining students were the participants in the
study (n=12), including five females and seven males. All were age 6 at the
start of the intervention and two students turned age 7 during the process.
The first grade class was selected because school administrators observed that
132 “the lava ate my school”

emotional, behavioral, and academic challenges were most pronounced in

these students.
The group sandplay project took place as part of a community outreach
and relief project. In this context, demographic information was not collected.
However, the Puna district has some of the highest poverty rates in the state
of Hawai’i and the densest rates of Native Hawaiians (Bay Clinic Inc., 2018).
Measures
The Revised Children’s Manifest Anxiety Scale-Second Edition (RCMAS-2)
Short Form
The RCMAS-2 is a full revision of the Revised Children’s Manifest
Anxiety Scale (RCMAS) developed by Cecil Reynolds and Bert Richmond
Richmond in 1985. It is one of the most widely used self-report question-
naires in children’s anxiety research, including extensive use in cross-cultural
studies (Reynolds and Richmond, 2008). Norms are based on ethnically
diverse samples and the test correlates highly with RCMAS scales (Reynolds
& Richmond, 2008). The Short Form is a brief measure of generalized and
manifest anxiety experienced in children (ages 6-19) and includes the first
10 items of the RCMAS-2. With children responding “yes” or “no” to ques-
tions such as, “I often worry about bad things happening to me,” the Short
Form typically takes 5 minutes to complete. The RCMAS-2 Short Form has
been found to have strong construct validity and reliability with children and
adolescents (Lowe, 2015). Internal consistency reliability estimates for the
RCMAS-2 Short Form scores ranged from α= .76 to .79, with a correlation
of .87 between the RCMAS-2 Short Form scores and the RCMAS-2 Total
Anxiety Scale scores (Lowe, 2015).
The Child Report of Post-Traumatic Symptoms (CROPS)
The CROPS is a low-cost one-page self-report screening measure
that focuses on the full spectrum of post-traumatic stress symptoms and
encompasses a broad definition of trauma, that includes major losses such as
death and displacement (Greenwald, 2005; Greenwald & Rubin, 1999). The
CROPS takes about five minutes to complete and consists of 26 items where
children indicate “how true” each statement feels for them in the past week,
responding with “none” (0), “some” (1), or “lots” (2) (Greenwald, 2005).
Scores for all of the items are added and evaluated against the clinical cutoff
score of 19. Strong psychometric properties were found in multiple studies
indicating good internal consistency (α= .80 - .92), test-retest reliability (r=
.8), criterion validity, convergent and discriminant validity and sensitivity to
change for children ages 7-17 with diverse backgrounds (Greenwald & Rubin,
1999; Greenwald et al., 2002). Although the instrument was not normed on
younger children, the CROPS manual indicates that this screening measure
has utility for children as young as age 6 (Greenwald, 2005).
L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 133

Archetypal Wounding and Healing Themes

Mitchell and Friedman (2017, 2021) developed a systematic method
for analyzing the sandplay therapy process over time using themes. The
themes are related to archetypal patterns that appear in sandplay and were
derived based on years of clinical observation and research. They were cat-
egorized into 20 themes that naturally clustered into 10 wounding themes or
10 healing themes. Wounding themes include chaotic, empty or barren, split
or barricaded, confined, neglected, hidden, prone, injured, threatened, or hin-
dered. Healing themes include bridging, journeying, energized, going deeper,
birthing, nurturing, changed elements, spiritual components, centered,
or integrated trays. Each theme is defined by Mitchell and Friedman with
sandplay examples and possible clinical implications. Although this method
is used in clinical practice to better understand and quantify the sandplay
therapy process, it has not been evaluated for its psychometric properties.
To assess internal changes as reflected in the participants’ sandplay
process, wounding and healing themes for the first and last sandplay scenes
from the 12 participants were analyzed. Two sandplay researchers experi-
enced in the use of this method of theme analysis who were not blind to the
general purpose of the study, independently coded the themes by observing
the presence (score of 1) or absence (score of 0) of each theme. Themes were
scored as “present” only if identified by both researchers. The scores for each
theme were then added, resulting in a composite score ranging from 0 to 12
for each theme, depending on how many participants showed the theme in
their sandplay scene.
Design/Procedures
Pretests for anxiety (RCMAS-2 Short Form) and trauma symptoms
(CROPS) were administered to each participant one week prior to the first
group sandplay session. Posttests were administered immediately following
the final session. The questionnaires were administered by a Licensed and
Board Certified School Psychologist with experience administering these
measures to young children. Although normative data for the RCMAS-2
Short Form included children as young as age 6, it is written to be easily under-
stood by children with a second grade reading level (Reynolds & Richmond,
2008). Likewise, the CROPS manual indicates that younger children may
need help reading the items (Greenwald, 2005). Since the participants in this
study were first graders (age 6-7) who had recently experienced a traumatic
event, adaptations to administration were made for all participants. The ques-
tionnaire was administered orally on an individual basis. Instructions were
given, followed by a brief comprehension check. The students could respond
to each question verbally or by pointing to the options written on index cards
displayed on a table. The students were also advised that they could decline
answering any of the questions. However, all of the students present for the
pre- and posttests answered all of the questions.
134 “the lava ate my school”

Group sandplay sessions were one hour in length and took place every
one to two weeks for a total of five sessions over nine weeks. The first session
started about one month into the school year and about six weeks after the
eruption had ended. The number of group sandplay sessions was determined
by the availability of the volunteer facilitators and the school schedule. Kay
Bradway, founding member of Sandplay Therapists of America (STA) and
the International Society for Sandplay (ISST) asserts that when the sandplay
process is held in a free and protected space even when there is limited time,
“the psyche will rise to the occasion” and move toward healing and wholeness
(personal communication, September 3, 2006).
Prior to the start of the intervention, informed consent regarding the
group sandplay project (including its methods, goals, and evaluation process)
was obtained from the parents. The school personnel, including school
administrators and the students’ first grade teacher received an overview of
the key principles of sandplay therapy and an orientation to the project. A
team of six local volunteer therapists and two interns, all with at least one year
of foundational training and practice in Kalffian sandplay therapy, facilitated
the group sandplay sessions. The therapists lived and worked in the sur-
rounding area where the eruption took place; however, none were of Native
Hawaiian descent. With inspiration from Sandplay Therapy in Vulnerable
Communities: A Jungian Approach (Zoja, 2011) and drawing from her own
experience, a teaching member of STA/ISST designed the intervention,
trained the team in the protocol, and provided on-site supervision during the
sessions. The intention of the project was to provide therapeutic support to
the children in the context of a time-limited community outreach project.
In an effort to establish and maintain a free and protected space (Kalff,
2020) several steps were taken. The students were assigned to a facilitator
who became a consistent, familiar, and welcoming presence. The facilitators
followed Kallfian guidelines for conducting sessions by quietly observing the
process without interference, interpretations, or judgments. The class was
split into two groups so each group consisted of no more than eight students,
each working by themselves in their own sand tray. The group assignments
remained consistent for all sessions. Before each session, the students
reviewed the behavioral expectations in front of a golden curtain (Photo 1).
The curtain, along with a bright-colored sign that read, “Welcome to Sand
Land,” marked the entrance to the space that was arranged for the sandplay
activity. Students gathered in a circle to open the space with a group invoca-
tion, “Aloha magic sand!” Next, they each walked through the curtain into the
sandplay area.
A large, mobile sandplay collection was transported to the school and
set-up by the volunteers each day. The collection of miniatures was displayed
on adjoining tables in the middle of the space (Photo 2). There were four,
long tables surrounding the miniatures with two sand trays placed on each
Photo 1: Golden Curtain

Photo 2: Display of miniatures in group sandplay area

136 “the lava ate my school”

table. In front of each sand tray was a small sign with an image of a starfish and
the student’s name on it. The signs not only designated which tray belonged
to each student, they also helped the students visually track the five group
sessions over time (one session for each ray of the starfish). After moving
through the golden curtain, the students were each introduced to their sand
tray and a basket for gathering miniatures. They created their sandplay worlds
next to their assigned student partner, and across from the facilitator who
observed both students (Figure 1). Two additional facilitators were available
near the miniatures to answer questions and monitor the selection process.
The students were invited to make a picture in their sand tray any way they
liked. They were told they could stop at any time and opt to do artwork
instead. However, none of the students declined to participate in any session.
After the students created their sandplay scenes, they had an opportu-
nity to tell a story about what they made. The attending facilitator and the
student who shared their table listened attentively. The students were told to
leave their trays just as they made it. After they left, the facilitators took pho-
tographs of each sandplay scene. To close the group, the students gathered
near the curtain as each pair finished sharing. Once all of the students came
together, they were invited to take a deep breath and say in unison, “Mahalo
magic sand!” before walking back through the curtain and returning to their
classroom.

Figure 1: Diagram of the Group Sandplay Space.

MINIATURES

MINIATURES

Note: Hearts= sandplay facilitators; smiley faces= students

 L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 137

Results
The Revised Children’s Manifest Anxiety Scale–Second Edition
(RCMAS-2) Short Form
RCMAS-2 pre/post-sandplay ratings were analyzed using a paired
samples t-test. Results indicated on average, all 12 participants reported a
statistically significant reduction in anxiety symptoms (M = 2.75, SD = 1.96,
99% CI [0.99, 4.51], t(11) = 4.86, p < .001) with every participant indicat-
ing a reduction in anxiety scores. On average, anxiety scores moved from the
moderate range of impairment (M = 4.92, SD = 2.68) to the normal range
(M = 2.17, SD = 1.59); these results are displayed in Figure 2. We were also
interested in the extent to which participants’ real world anxiety symptoms
were substantially affected (i.e., effect size). This effect was found to be large
(d = 1.25).

Figure 2

Participants’ Average RCMAS-2 Pre/Post-Sandplay Scores (n = 12)

 138 “the lava ate my school”

The Child Report of Post-traumatic Symptoms (CROPS)

CROPS pre/post-sandplay ratings were also analyzed using a paired
samples t-test. Results indicated on average, all 12 participants reported a
statistically significant reduction in post-traumatic symptoms (M = 11.50, SD
= 5.58, 99% CI [6.49, 16.51], t(11) = 7.13, p < .0001) with every participant
indicating a reduction in post-traumatic symptoms. On average, CROPS
scores moved from above the clinical cutoff (M = 25.33, SD = 9.74) to below
the clinical cutoff (M = 13.83, SD = 6.35); these results are displayed in Figure
3. As with the RCMAS-2, we were also interested in the extent to which par-
ticipants’ real world anxiety symptoms were substantially affected. This effect
was also found to be large (d = 1.40).

Figure 3

Participants’ Average CROPS Pre/Post-Sandplay Scores (n = 12)

L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 139

Evaluating Correlation Between Measures

Because two different measures were used, it was appropriate to
evaluate the reliability of the findings (i.e., whether or not reported changes
were the result of actual changes or the subjectivity of the person applying
the measure). To do this a Pearson correlation was conducted. The results
indicated the presence of a statistically significant, large positive correlation
between improvements reported on the RCMAS-2 and CROPS, r (11) = .69,
p <.05. This suggests that participants’ reported improvements were likely
reliable reports of actual change.
Analysis of Sleep Questions
Due to concerns that students were reporting difficulties sleeping
and “bad dreams,” all questions pertaining to sleep from the RCMAS-2 and
CROPS were examined. Three total sleep questions were identified: “I wake
up scared sometimes”; “It is hard for me to sleep at night”; and “I have bad
dreams or nightmares.” Prima facie visual analysis revealed that no students
reported a worsening of sleep issues and at least half reported improvements
(Table 1).

Table 1

Changes to Participants’ Responses to Sleep Questions on the CROPS and

RCMAS-2 (n =12)

Question Worse No Change Improvement

“I wake up scared sometimes.”* 0% 50% 50%

“It is hard for me to sleep at night.”** 0% 42% 58%

“I have bad dreams or nightmares.”** 0% 33% 67%

Note. * = from the CROPS (Child Report of Post-traumatic Symptoms). ** = from the RCMAS-2 ( Revised Children’s
Manifest Anxiety Scale – Second Edition, Short Form).
140 “the lava ate my school”

Archetypal Wounding and Healing Themes (Mitchell & Friedman, 2017, 2021)
Composite wounding themes comparing the first and final sandplay
scenes of the participants are presented in Figure 4. Results indicated a
marked reduction in the presence of 8 of the 10 wounding themes from first
to last sandplay scenes. The most notable reduction occurred in the theme of
Neglected, which was present in the first sandplay scenes of eight participants
and absent in the final scenes of all twelve participants. According to Mitchell
and Friedman (2021) this pattern may suggest that at the conclusion of the
group sandplay the participants were no longer feeling isolated from support
and protection.
The wounding theme of Threatened remained present, indicating that
most of the participants demonstrated similar feelings of impending threat at
the beginning and the end of the group sandplay intervention. This data coin-
cides with the nature of geology on Hawai’i Island, where volcanic eruptions
remain a facet of everyday living.
Composite healing themes comparing the first and final sandplay scenes
of the participants are presented in Figure 5. Results indicated an increase in
the presence of all 10 healing themes. The themes of Centered and Integrated
were absent for all participants in the initial sandplay scenes and showed
notable increases at the end of the group sandplay intervention. According
to Mitchell and Friedman (2021) this pattern may suggest movement in the
psyche toward greater organization, congruence, and wholeness. In addition,
the themes of Going Deeper, Birthing, and Spiritual Elements also showed
marked increases. According to Mitchell and Friedman (2021) this pattern
may suggest that most of the participants discovered deeper dimensions of
their own internal life, and accessed spiritual resources and new potential for
healing.
The wounding theme of Empty, a lifeless feeling with lack of energy,
was absent in all initial and final sandplay scenes, while the healing theme
of Energized, an alive, focused and intense energy, remained present in first
and last sandplay scenes. This pattern may be explained by the excitement
of participating in the group sandplay process, or by the intense energies sur-
rounding the event itself.
Interviews with School Staff
Interviews were conducted with the two key stakeholders, the vice-
principal and first grade teacher. The vice principal of the school was
responsible for organizing school-wide crisis response and overseeing behav-
ioral interventions and plans. The first grade teacher taught the entire class
and communicated with parents throughout the school year. The interviews
were conducted at the end of the school year, six months after the interven-
tion was completed. The interviews were open-ended and conversational
 Lorraine R. Freedle, Michael McGee, Sarah Blechman, John Souza, Jr., Danielle L. Zandbergen

Figure 4
The Presence of Wounding Themes in First and Last Sandplay Scenes (n=12)

Figure 5
The Presence of Healing Themes in First and Last Sandplay Scenes (n=12)
L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 141

with topics introduced such as what made them interested in bringing the
sandplay intervention to their school, what changes, if any, they may have
noticed in the children during and after the group sandplay sessions, and
anything they wanted to share about their observations and experiences.
The interviews were recorded and transcribed. Two researchers reviewed the
transcripts and themes were extracted by consensus.
Responses revealed five main themes. A list of the themes and key
quotes associated with each theme follows:
Students appeared calmer, less behavioral problems
• They had a lot of energy, sometimes anger and anxiety, I think they came
back [from group sandplay] calmer.
• Along with being calmer, it [group sandplay] helped them be more focused.
So they’re not bouncing off the walls.
• Those serious behavior issues really decreased out of that classroom. I barely
ever get any kind of behavioral referral coming out of that room anymore.
• We noticed that the behaviors in the class started to calm down.
Improved group cohesion and academic performance
• ...we saw a little bit more cohesiveness in the group. The teachers were not
getting as many complaints about [the students] having bad dreams. And it
seems like they were able to work more in the classroom on academic areas.
• We did see some improvement across the board academically, for sure.
• They seem to be working really, really well together...I think it will make a big
difference, not maybe over just this year, but maybe over the course of the next
several years.
Excitement and engagement
• The parents said that their kids loved it and wanted to make sure their kids
were here on that day. The kids definitely loved it, they said it’s ‘better than
recess’...
• The students were really awesome, they loved it, they were really engaged.
They really wanted to be a part of it.
• They [students] were excited. We postponed it the one time, and they were
super bummed about it.
• They were engaged the whole time. I really think that allowed them to give
forth their best effort, which was really awesome. It didn’t seem like there
were any big expectations around it.
142 “the lava ate my school”

Facilitated discussion of the event

• The feedback from the parents, they loved it. They were talking to me about
how their kids were talking to them about it at home. They thought it was
helpful in helping them talk to their kids about the event.
• If anything, it opened the door for them to have a conversation around it. I
think that was really powerful in itself.
• And it really helped them…at the beginning of the sandplay they all wanted
the volcano to put in theirs...they all needed it...and by the end they were all
thinking about other things and working on other projects and had a differ-
ent kinda story. I thought that was really powerful for them.
Future applications
• Climate change is happening around us, and we are probably going to face
more and more natural disasters as we go into the future. I think we need
to be able to just expect that and we need to know what to do to help kids in
that situation, and how to mitigate that trauma... Knowing that and having
the research to help communities and offer that kind of support, it’s not only
powerful here in Hawai’i, but it’s gonna be powerful across the globe.

Discussion
It was hypothesized that group sandplay could help displaced elemen-
tary school students share their stories and experiences surrounding the
volcanic eruption, reduce symptoms of anxiety and post-traumatic stress,
and access the natural healing capacities of the psyche to further emotional
development. As predicted, after the group sandplay sessions, the student
participants reported improved sleep, fewer nightmares, and clinically and
statistically significant reductions in symptoms of anxiety and post-traumatic
symptoms. They participated with marked excitement and energy, and
shared stories in their own way through sandplay images and narratives.
Teachers and parents reported that participation in group sandplay “opened
the door” for increased discussion of the event at home and school. Moreover,
the students were observed to be calmer and more focused following the
­sessions.
Analysis of archetypal sandplay themes (Mitchell & Friedman, 2017,
2021) showed a substantial decrease in wounding themes and a substantial
increase in healing themes over the course of group sandplay. This pattern
suggests that despite the perception of continued threat, the participants dis-
covered new resources and felt less isolated and more connected to support
and protection. They also accessed deeper dimensions of their own internal
life such that movement toward organization, integration, and balance was
evident in their sandplay scenes. These findings are particularly promising, as
L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 143

developing a sense of internal safety, accessing social supports, and integrat-

ing overwhelming emotions are important aspects of trauma treatment (van
der Kolk, 2014).
With alarmingly high numbers of children impacted by natural disas-
ters every year and an anticipated rise in these numbers due to the effects of
climate change (Dyregrov et al., 2018; Save the Children UK, 2007), effec-
tive ways to address the mental health needs of this vulnerable population
need to be developed (Lai & LeGreca, 2020). The results of this research are
consistent with prior studies of Kalffian-informed group sandplay in disaster
relief situations. Sandplay has been shown to have positive effects on recov-
ery and helps children to share their stories, access inner resources, alleviate
a variety of mental health symptoms, and improve resilience (Chenghou &
Shen, 2010; Freedle et al., 2019; Kawai, 2015; Lacroix et al., 2007; Lee & Jang,
2020; Park, 2018; Zoja, 2011).
There are several limitations to this study that center on the pre-post
design, the small sample size, and adaptations related to data collection.
Without a control group we cannot say with certainty that the group sand-
play intervention was solely responsible for the change. Moreover, the small
sample size warrants constraint with generalization of the findings. Although
these limitations exist, this study may offer a valid process for conducting
culturally-sensitive, field-based research. Design and data collection methods
were determined with careful attention to feasibility (Bloom et al., 2009),
particularly with young children and a Hawaiian school community recover-
ing from a natural disaster.
Several other considerations related to validity include the follow-
ing: The researchers who analyzed the themes were not blind to the general
purpose of the study. This may have influenced the findings specific to theme
analysis; however, it had no bearing on the results or analysis of the interviews
or the rating scales. The self-rating measures used seemed to capture that
which they were intended to capture, resulting in high face validity. Attention
was also given to social validity which pertains to tending to the acceptabil-
ity of the interventions for the participants (Carter & Wheeler, 2019). As a
result, the intervention was very well received by students and school staff
alike. Wolf (1978) notes that when social validity is high, participants are
more likely to share information with researchers of dissimilar backgrounds.
The group sandplay sessions also took place in the “real world” setting and
familiarity of their school environment. Therefore, it is likely that ecological
validity was high.
A final consideration in this study is the passing of time. For many
people, within days to weeks after the acute phase of a natural disaster, there
is an expected drop in symptoms of post-traumatic stress (Harwood, 2017).
However, pre-sandplay data, collected after the acute phase had passed,
showed that on average, participants scored in the moderate range for anxiety
144 “the lava ate my school”

and above the clinical cutoff for post-traumatic symptoms. This suggests
some participants were likely on their way to developing PTSD, despite the
passing of time. Moreover, given the fact that children impacted by natural
disasters remain particularly vulnerable to prolonged mental health prob-
lems with 5-43% developing post-traumatic stress disorder (CDC, 2020;
Dyregrov et al., 2018; Lai & LeGreca, 2020), the passing of time alone is an
insufficient explanation for the pattern of symptom reduction evidenced in
the present study.
In conclusion, this mixed-methods research offers group sandplay as
a beneficial and culturally-responsive contribution to relief efforts aimed at
helping children impacted by natural disasters to reduce symptoms of anxiety
and post-traumatic stress and to restore emotional development. The success
of this community outreach project depended on collaboration between local
volunteer sandplay therapists and the school administration. We hope that
this study along with the specific details about how we implemented group
sandplay will provide motivation and practical information to others inter-
ested in this work. More research is warranted on the various applications of
sandplay therapy in communities impacted by natural disasters, particularly
its multicultural applications.
L. Freedle, M. McGee, S. Blechman, J. Souza, Jr., D. Zandbergen 145

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