 This is St. Tech, Hawaii. Community matters here. Welcome to Shrinkwrap, Hawaii. My name is Stephen Phillip Katz. I'm a licensed marriage and family therapist here on Oahu. And today I have a guest that flew here this morning from sunny Hilo to be with us and rainy Oahu today. But it's well worth it, I hope, because she wears so many hats. We'll get into that later, but please welcome to our show Dr. Lorraine Friedle. It's good to be here. Welcome. So, some of the folks out there may have noticed that we have this tray in front of us. What is this? Tell us about this. Well, today I'm here to talk about this is a Jungian-oriented sand plate therapy. And Sam... Jung as in Carl Jung. Carl Jung, yes, correct. Yeah, there's many ways that therapists use sand and miniatures or toys. And today I wanted to talk about sand plate, which is a depth-oriented model. So there are three routes to sand plate, a lot of people don't know that. But one of the routes is plate therapy, which is common. Another route has to do with the Jungian-depth psychology, this understanding of using symbols and myth and telling one's story to get it unconscious materials and to integrate one's personality. And then the third route is Buddhism. And it's in service to the idea of interconnectedness and stilling the mind and getting connected with what's inside, finding what's sacred inside and what we share with others. And so those are the routes of sand plate. How did you first decide to become a sand plate therapist? Why? Well, nearly 30 years ago, I was in a training actually with an art therapist who exposed us to sand plate. And I just was very, you know, she asked for a volunteer to try it in front of the group and I said, I'll try it. And I couldn't believe what happened when I put these miniatures in sand and what it revealed to me in terms of what it gave back. And so I was sold in that moment and wanted to share this with others and learn as much as I can about it, found out that it's a long road. So you say what it revealed to me. Tell me more about that. So we're innocently in sand plate. What you do is imagine that there are two trays of sand. One is typically wet, one is dry, and there's a room full of miniatures and little objects like this. And one goes in following their own inter-prompting and chooses from amongst the shelves and creates an image in the sand. That sounds very highfalutin, their own inter-prompting. Right. And it turns late to, oh, I think I'll take that one. Yeah, exactly. Right. So with kids, they don't need any introduction, right? They see the toys and they make the sand. With adults, sometimes we have too many minds. We wonder, what's this about? And so sand plate can be particularly useful for people that intellectualize. So rather than talking about what's going on, they're actually making what's happening. You mean consciously making a story? They may, or they may make anything they want. So in the beginning, you're following a whole series. So sometimes you come to sand plate therapy for only one session, but often you come for a whole process. And what that means is that you're creating something every week or each time you come and it follows a sequence of development of how your psyche is changing over time. So if I come in every Wednesday at two, next Wednesday when I come at two, will I get a blank tray of sand or will the one that I did last week be there for me to fool around with? Well, actually, you get a new canvas every week and the sand is your canvas. And the way that it works, though, is that you'll sit and we'll talk about what's going on in your life, maybe go into the sand with an intention or none at all. So before we start playing with the sand, I might come and tell you that my dog is just running amok. Right. You may have something that's really affecting you in your life that you would like to talk about or maybe celebrate something. And then what happens is you go into the sand and create a scene and often we're surprised. That's what happened to me. I went thinking I was creating one thing and then suddenly I realized that maybe this person doesn't need to be in my life or, wow, maybe I have a passion about this thing that I didn't even know about that was so glaring. And so sand play can uncover passions and potentialities as well as conflicts that we may or may not be fully aware of. Do you make interpretations? Like, do you see something and you go, oh, it looks like you've got a thing about your mother over here? Well, actually, in Jungian-oriented sand play, and Dora Kahlp is the founder. She was a Swiss psychoanalyst. And we don't interpret at the time that the sand play is made. However, there's a sense that suppose you created the scene and you made it and we would sit and just fully realize what it might mean for you. And so sometimes that sitting in silence together, connected, sometimes it's you noticing how big, how much attention you spent on a certain area and then making some connections in your life. Wow, I am spending an awful lot of time and attention on this issue and having an increased appreciation about that. So let's pretend for a moment that I created this one. You actually created this one, right? Yes. I brought some of my portable sand tray. Why don't we switch it since we don't have to make believe you created this one. So you be the patient, I'll be the therapist, right? So I noticed, Lorraine, that there's a lot of time symbols here. Is that, would I say something like that? Right. You can share a reflection, you know, something that you notice, but mostly we allow the person who created it to just share as little or as much as they would like. So I would say, tell me about what you made today. And I might say, gosh, I noticed that I put this time symbol in there and another symbol of time. And I really do feel pressure about time and I might begin to talk about that. Or in sand play, which is difficult, it's different than verbal therapy in that we want the symbols to stay in the psyche until they're brought to consciousness. When you say psyche, what do you mean? So I'm a neuropsychologist and also a sand play teacher. And so we have the brain, which is the physical mechanism. And then we have the psyche, which is the soul or that mystical aspect of who we are as human beings. And so often, therapies can be very mechanistic or we're going to talk about this particular way you're thinking. And if you change that thinking, your life will change. A cognitive behavioral therapy. Right. And although there's a place for those kinds of therapies, I think as humans, we're looking for something deeper. We want to understand more about who we are in our center and how we fit into this world. What is our purpose? And so by connecting to more unconscious material, like dreams and symbols, which is what sand play helps us connect to, we can get in touch with deeper layers of our psyche and realize our full potential. So how do you know when it's working? Well, there are right now over 30 studies of sand play therapy out there. A lot of the studies are being done in Japan, Korea, China. About half of those studies are randomized controlled trials. And so we're finding that sand play is effective in treating anxiety, depression. I have a particular research interest in trauma because sand play acts at the level of the unconscious. Often trauma is stored very deep in our brains. When we try to access trauma material, which is implicit memories, we overreact, we get explicit. Right. You can re-traumatize somebody. And in sand play, we can access those things at a deep level and gradually bring them to consciousness and rework them over time. And so it's very powerful in trauma. And from a neuropsych perspective, we've been studying about four aspects of sand play that are particularly relevant in the treatment of trauma. One is the relational safety. There is no trauma treatment we know without safety. We have to... So a relationship with the therapist? Absolutely. The therapist creates what Dorakoff called the free and protected space. So you come in, there is no judgment. You can create whatever aggressions, whatever pain, whatever excitement you're feeling that day, whatever calls to you. And then you sit with that. The second piece is you're actually using your hands. And so there's a somatosensory, a connection to your body. You're actually making something which triggers activation across multiple brain systems, including deeper centers of the brain and connection to our bodies, which sometimes we can get pretty heady and disconnected and talk about things but never really live them. Experience it. So this is experiencing through effective action. And then the other piece is we get to tell the story in symbols. And telling our trauma story can be very difficult. And yet stories are important to share and to heal. And then the last piece is we get to be mindful. A mindful participation of very carefully just stealing ourselves, taking a break from everyday life and going into ourselves becomes really important. So mindfulness is the fourth component that brings about this sense of balance and neural integration. So you mentioned that a lot of your research has been with brain trauma? Yeah, different kinds of trauma. So the first research I did was with folks with traumatic brain injury. And wanted to know some of these have severe aphasia. My dad... Aphasia can't speak. Yes, cannot speak. Different kinds of difficulties with motor. Inverbal therapies, they were perseverating, which means they would get stuck on these concepts. They lacked awareness of their deficits. And by giving them the opportunity to choose and create... Choose the pieces. Mold the sand any way they wanted and construct something. They had a sense of mastery and they were able to communicate in ways that they were not able to verbally. And in doing so, they were able to get at the underlying issues, which were often grief, trauma, a sense of feeling they needed normalcy in their life after their traumatic brain injury. So really powerful stuff that... Does that include people who have suffered a stroke? Yes. Some of the research participants, in fact, one suffered a stroke as well. So we live in an island surrounded by sand beaches. Do you need a tray? Yeah, well, we all have some memory of playing in the sand. Sandboxes. Yeah. And Jung himself, Carl Jung, sat on the lakes in Switzerland creating in the sand there. And found he could do so much through play that he couldn't do with his thinking mind. And so he was a fan of sand play and told Dora Koff actually. She did her analysis with Emma Jung, his wife, the founder of sand play. And he told her to go use sand play and apply his methods to her work so that this, the Jungian world could reach children. And so that's part of our roots in sand play. I mean, kids, and not just kids, I mean, it seems like everybody loves to play in the sand, except we're told that we're not a kid anymore. It's not. Cool. But I mean, I notice I live right next to a beach and you bring some toys down to a beach and give it to people. They're never bored. Right. They can just play and play and play. In play, we're safe, we're spontaneous. Our neural pathways are open to change and possibility, novelty, creativity. There's a lot of research on how play itself stimulates creativity. That's why the corporate America is interested in play and what that does for people and making sure that employees have opportunities for play because it expands our mind and our capacities to create and get in what what's called our flow. It seems there's a big difference between this kind of play and playing a video game. Exactly. I mean, is that the tactile aspect about it that's different because in video games, you're just hitting keys and playing with a mouse. Yes. And with sand play, there's an intention of going in. It's a ritualized space. So the same thing you come in, you get centered in the sand. So there's often people will use their hands this way. There's bilateral stimulation, a calming effect when we put our hands in the sand and we just start molding and centering ourselves and then open opening ourselves to possibilities. So Carl Jung used a lot of his philosophy in psychotherapy. A lot of people ask, well, how does he do psychotherapy? I had that question when I did my research. How does Carl Jung do psychotherapy? And one of the things I learned is that he believes in this idea of generous attention that if the therapist can give the client generous attention, then their wholeness of their personality will come forward. They will be who they really can be. But trauma can disrupt that opportunity to be whole and different complexes can disrupt that. And so sometimes we need that attention from another individual, right? So play, safety, relationship, all those things come together in sand play. Speaking about general attention, I just got a little message in my ear. We have to give some generous attention to a 60-second break. We'll be right back. Don't touch that mouse. Aloha. I'm Winston Welch. And every other Monday at 3 p.m., you can join me at Out and About, a show where we explore a variety of topics, organizations, events, and the people who fuel them in our city, state, country, and world. So please join us every other Monday at 3. And we'll see you then. Aloha. Aloha, I'm Richard Concepcion, the host of Hispanic Hawaii. You can watch my show every other Tuesday at 2 p.m. We will bring you entertainment, educational, and also we'll tell you what is happening right here within our community. Think Tech Hawaii. Aloha. But grandmother, what big eyes you have. She said, what are you doing? Research says reading from birth accelerates our baby's brain development. Push. Read aloud 15 minutes. Every child, every parent, every day. Welcome back to Shrink Rap Hawaii. I'm still with Lorraine Friedl, and we're talking right now about sand play. So what kind of patience, what demographic, age range are appropriate for sand play? And who do you work with? Well, often people will see the sand and the toys, and they say, oh, this is for children. Or do you have a cat? Or they'll look at all the toys. Do you collect things? But in reality, sand play is a wonderful modality with children and adults alike. And I particularly spend time doing sand play with therapists that are interested in doing their own personal work, as well as at Pacific Quest, I'm the clinical director, and we use sand play with adolescents and young adults in the context of a holistic healing environment. Tell us more, what is Pacific Quest? So Pacific Quest is an outdoor behavioral health program for adolescents and young adults. We serve kids 14 to 24 on the big island of Hawaii. And the kids come to us from all over with a lot of different issues, mostly depression, anxiety, unable to adjust maybe to high school or the transition to college, maybe spending too much time in their dorm rooms, on gaming or social media, and losing track of what's important to them in school, other forms of addiction that they might pick up along the way. And so they come to Pacific Quest. We have horticultural therapy. They eat perfectly portioned whole food, anti-inflammatory diets, so they're looking at making sure they're unplugged, eating right, sleeping with the cycles of the sun. They don't have cell phones with them. We absolutely don't allow cell phones or electronics. It's a chance for them to reset, to get connected to nature, to eat right, and then to really delve into the reasons that they're there individually and with their families. How do they get chosen to be part of Pacific Quest? Well, their circumstances in life make it where their families usually are the ones who are saying it's not working anymore. You need to get some help. And through that process, they choose us as opposed to perhaps other programs. Sometimes being in Hawaii helps. Sometimes the fact that they get to be outside in the gardens. How long is the program? About 10 weeks to 12 weeks, depending, and they live with us. And they're in camps with each other. And they go through a rites of passage experience. There's a lot of different components. And sand play is one of those things that they do. And we have an outdoor sand play holly in one of the camps, which brings sand play to them outside. And then in the young adult program, we have an indoor sand play room. What does it look like? You say camps. I went to a sleepaway camp as a kid. Yeah. And imagine all of these different gardens and vegetables and fruit trees deep in Hawaii on the mountainside in Ka'u. We have different camps for the kids. And they have a kitchen, outdoor kitchen, and little hollies, little places where they can have some quiet time alone. And... Who runs it? So Pacific West is privately run. Our owners are Suzanne and Mike McKinney. And I serve in the role of clinical director there. And we have a medical director, Dr. Brita Zimmer. And we have integrative psychiatry. It's a very comprehensive program for young people. I just got distracted. I don't know what they said in my ear. That happens. I'm hearing voice. It must be expensive. I mean, does insurance pay for this? No, but insurance pays for some of it. And so folks will come up with the funds ahead of time, and then we give them super bills for them to then bill the insurance at a different time. So kids... You mentioned kids that have various addictions, alcohol, drugs, can those be referred there? Yeah. And actually, usually the primary is depression or anxiety or some sort of trauma, adjustment issues. And then the kids pick up alcohol and drugs sometimes along the way. So it's just not unusual to have comorbid alcohol or drug issues. And in fact, a while back in 2015, out of the University of New Mexico, I did some research on sand play with young people that had opioid dependence and co-occurring trauma. And in that research, we put together based on this opioid... There's a whole epidemic going on. And the government at that time said, we want pilot projects. We want something to help reach these young people. And so we took evidence-based substance abuse, which the kids were calling workbook therapy, where they would come in a couple nights a week and do worksheets. And we added all of these experiential modalities, including sand play. And in the end, we saw tremendous results in terms of improvements in their well-being, jobs, family relationships, reduction or abstinence from drugs and alcohol. And then they found the surprise finding. And that's when these young people asked, what made the difference for them in their program? Overwhelmingly, they responded that it was sand play therapy. Oh, wow. And it surprised me, because I put it in there thinking, well, maybe this would help. But the program was based on other modalities. And so we learned a lot from them in focus groups. They talked about how they could tell their stories. Nobody was saying it for them. They could just see what was going on for themselves. They had privacy and chances for reflection. And so they were the ones who talked about sand play. And we concluded that maybe, that if we incorporate sand play in residential programs, in outpatient programs with substance abuse, treatment of trauma, that maybe we would improve treatment engagement. Because this is a huge issue with young people, especially traumatized or folks that are addicted, is engagement. Do they stay in treatment long enough for it to benefit? And this particular research showed that sand play helped with that engagement. So after they graduate, if I learned how to do sand play with you, could I, again, get my own tray, take it home, and just play on my own every night? Some of our students will say, oh, I got a little sand tray, and they'll make a meditation tray at home. But the whole process of sand play is relational. So it is involved with a therapist. If you had a sand tray and you were making some things, we would think that be a form of meditation. But the addition of the therapist as witness there to help you process, to monitor, creates the therapeutic environment. I'm glad you said that, because a lot of what I see doing talk therapy with patients, I mean it seems that every study that's done about the different modalities of therapy always comes down to, it's about the relationship. Is there a transference between the patient and the therapist? Absolutely. And so I find that, like you found it surprising that they said the sand play was the best, and I thought, well, that's not relational, it's only relational to the objects. But no, you're saying there's also a relationship to the therapist in the room. Yes, absolutely. And as a neuropsychologist, I'm particularly interested in the exchange that's happening in this intracyclic field, brain to brain, person to person. And some of the neuroimaging studies being done now are talking about how a synchrony develops between the sand player and the therapist during the sand play. And so... Even if the therapist is not saying anything. Right, I am exhausted in a sand play session. I am generously tuning into what's going on and channeling this kind of energy and being as fully present, noticing everything that's happened, the sequence. So I can share, I know exactly, for example, that once they put something difficult in, then they followed it with something, maybe a resource, and I'm watching the conflict and defense system in action. I'm being fully present. So wait, you lost me there. Wow. Which of these are difficult, and which would be a resource? Well, so if I were creating this, well, I created this tray, right? So here's this lovely little egg with gold inside. But in front of it, we have Cerberus, the three-headed dog, and we have this two-headed snake with fangs and these four little rabbits there in danger. Those are scary. There's a mask. And so it seems to get to this gold and this potential in the egg, there are some forces that need to be dealt with. And I have resources. You know, I have spiritual resources I see in the tray. We've got Yoda here. Got some flowers. You know, and you can see here a place of loss and grieving. Wait. What's the place of loss? Well, there's some tombstones there. And this is a weeping Yoda. So there was an expression of loss there. There's a treasure. And so there's these different energy spots in a sand play that become really important to just take in. And if the person wants to talk about it, if they're ready, they'll talk about it and gain insight. But we're not worried about that as sand play therapists. We want the image to stay in the psyche in the unconscious until it's ready. And in that process, neurologically, we're holding images all the time. Sounds like dreams. Exactly. In fact, one of my research participants said sand play is like dreaming with toys. And there's not many places where we're able to give our unconscious attention. And so what happens in this day and age is we spend our lives distracting ourselves and repressing energies that then become destructive in the form of addiction, violence, and in sand play, we give a place for those energies to come forward and be expressed. It's particularly important for young men. We found it a research on aggression with young men, giving them a place to express it and work through it is really important. I work a lot with couples. Does anybody do sand play with couples? Yes, I do. And others in the traditional coffee and sand play, it's traditionally an individual method. However, it's been expanded for use with couples with groups. We have some rules if we use sand play with couples and that, you know, to honor what the other person made to not make fun or question. But it can be a really intimate experience to create something your partner's present and then to share and talk on the way home about what you experienced brings people closer together. Because again, these surprises come up when we allow ourselves to create. Yeah, I would think you could see a whole different side to your partner. Very vulnerable and needs to be held. Yeah. So how could somebody, how could somebody find you if they wanted to do that? They could find me at PacificQuest or at my website PacificQuest.com PacificQuest.org. As well as LorraineFriedle.com. And you recommend it for all ages? Yes, sand play is a very, as you can see, it brings up a lot of defenses in people sometimes. What is that? Is it research based? It seems really weird. However, you know, in the right hands and with the people that are, I would say, moved to do it. It's a very, very powerful modality. Well, Lorraine Friedle, thank you so much for coming on our show today. Thank you for talking about sand play. I appreciate it. It's really great. Thank you so much. All right, bye-bye. Tune in next time to shrink wrap Hawaii aloha.