How to Document Sandtray Therapy Sessions

Why Sandtray Documentation Is Different from Standard Talk Therapy Notes

Most progress note formats were designed for verbal therapy. The therapist and client talk, the therapist tracks what was said, what themes emerged, how the client responded, and what the plan is going forward. SOAP, DAP, and BIRP notes all assume that the primary clinical event is a conversation.

Sandtray therapy (also called sand tray therapy or, in its Jungian-rooted form, sandplay therapy) does not work that way. The primary clinical event is a scene created in a tray of sand using miniature figures. The client selects objects, arranges them spatially, and constructs a world that may or may not be explained verbally. The therapeutic process unfolds through the nonverbal, symbolic, and spatial. The clinician observes, bears witness, and may or may not intervene with directive prompts depending on the theoretical orientation.

Documenting that process in a standard note format creates problems. "Client used the sand tray today and expressed emotions" communicates almost nothing clinically. It does not capture what was created, which figures were selected, how the scene was structured, what themes emerged, or how the session connects to the treatment plan. If an auditor reviews that note, or if a supervisor needs to understand the clinical direction, or if you need to transfer this client to another clinician, the chart is essentially empty.

The documentation challenge is real, and it goes deeper than just being thorough. Sandtray work is inherently nonverbal, and the instinct of many clinicians trained in expressive modalities is to let the work "speak for itself." But your chart cannot speak. Your chart has to translate a three-dimensional, symbolic, emotionally loaded scene into written language that demonstrates clinical reasoning, treatment progress, and medical necessity. This guide walks through how to do that well.

The Two Main Orientations and What They Mean for Your Notes

Understanding which theoretical framework you are working within shapes what you document and why.

Jungian sandplay follows the nondirective, depth psychology tradition established by Dora Kalff. The therapist creates what Kalff called a "free and protected space" in which the client creates the tray without prompts, direction, or interpretation during the session itself. The therapist does not comment on or analyze the tray with the client. Processing happens through the creation itself, and verbal integration, if it occurs, follows naturally. Documentation in this orientation focuses heavily on observational data: what figures were chosen, how the scene was arranged, what shifts occurred, and how the tray relates to previous trays in the series. Clinical interpretation lives in your private process notes, not in the session record shared with insurers.

Directive sandtray therapy (associated with practitioners like Homeyer and Sweeney) uses the tray as an active therapeutic tool within a broader treatment framework. The therapist may give specific directives ("Build a scene showing your family"), use the tray to work on identified treatment goals, and engage the client in verbal processing of what they created. Documentation in this orientation tracks both the tray content and the verbal exchange, and connects both more directly to stated treatment objectives.

Many clinicians work somewhere between these poles, adapting their approach to the client and the session. Whatever your orientation, your notes need to reflect it consistently so that the chart tells a coherent clinical story.

The Four Core Elements to Document in Every Sandtray Session

Regardless of orientation, four elements should appear in every sandtray session note.

1. Scene Description

A scene description is a written record of what the client built. It should be specific, observable, and behaviorally written, not interpretive. Include:

• The overall arrangement (one unified scene, multiple separate zones, a chaotic scatter, an organized landscape)
• Geographic or spatial structure (figures on one side vs the other, burial, hiding, walls, fences, pathways)
• Named miniatures used, described concretely ("a brown bear figurine placed at the upper left corner of the tray," not "bear energy in the north")
• Movement, if any, during construction (figures picked up and put down, scenes changed mid-session)
• Sand work: was the sand shaped, smoothed, buried under, piled, wetted?

The goal is that another clinician reading your note could reconstruct the tray well enough to understand its clinical significance. You are not writing poetry about it. You are writing a factual record.

Fictional example. Mia is an 8-year-old referred for trauma-focused work following parental divorce and reports of emotional dysregulation at school. In session 7, her therapist Dr. Reyes writes:

"Client constructed a divided scene with a fence bisecting the tray. Left side contained a small female figure, a horse, and a farmhouse placed close together. Right side contained several large animal figures (wolf, two bears) placed at a distance from one another, with no shelter. Client buried one of the bears under the sand near the fence line before ending the session. Sand on the left side was smoothed and level; right side sand was disturbed and uneven."

That note gives any subsequent reader a clear picture of what happened in the tray, without any interpretive overlay.

2. Miniature Selection

Miniature selection refers to which objects the client chose from the collection, how many, whether certain categories were favored, and whether selection patterns have changed across sessions.

Track: the categories chosen (animals, people figures, structures, vehicles, fantasy/mythological figures, natural elements, objects representing danger or safety), figures that were explicitly rejected or put back, figures that reappear across multiple sessions, and any verbal comments the client made about particular figures.

Repeated figures across sessions are clinically significant and should be noted longitudinally. If a client consistently selects a specific figure over eight sessions, that is a pattern worth naming.

3. Process Observations

Process observations capture how the client worked, not just what they produced. This is especially important for demonstrating clinical reasoning and therapeutic response.

Include: pacing (quick and certain, slow and deliberate, hesitant), visible affect during construction (calm, distressed, focused, dissociated-appearing), body language (proximity to tray, posture, facial expression), verbal behavior (silence, narration, emotional commentary, questions), and any significant shifts during the session (a moment of visible emotional release, a sudden change in the scene, a pause before placing a figure).

These observations connect the tray to the client's internal state and demonstrate that you are tracking therapeutic process, not just recording an activity.

4. Themes and Symbolic Content

This is where your clinical interpretation lives. Thematic content refers to the psychological or symbolic patterns you observe: conflict between figures, movement toward or away from safety, isolation, destruction, repair, connection, protection, boundary-related imagery, and so on.

Write themes in clinical language that links to your treatment plan. Avoid mystical or esoteric framing unless it directly serves clinical communication. "Scene reflected themes of isolation and unavailability of protective figures, consistent with client's attachment history and presenting concerns" is auditable. "Client's tray revealed activation of the shadow archetype" is meaningful within Jungian supervision but will not survive an insurance audit.

You can hold both. The clinical record uses translatable language. Your private process notes or supervision notes can be as theoretically deep as the work requires.

Connecting the Tray to Your Treatment Plan

This is the piece most sandtray notes are missing. A scene description without a connection to the treatment plan is an activity log, not a progress note.

For each session note, explicitly state how the tray content connects to at least one treatment goal. This can be direct or inferential, but it must be present.

For directive sandtray: The connection is usually explicit. If a goal is "client will identify and express feelings related to family conflict," and the directive was "show how your family feels right now," then the note documents the tray content and then states directly how it addressed the goal.

For nondirective Jungian sandplay: The connection requires more clinical reasoning but is equally important. If a treatment goal is "reduce trauma-related emotional dysregulation," and the client's tray shows progressive movement toward scenes with more protective figures and clearer structure across sessions, you document that longitudinal shift and link it to the goal.

Example treatment goal language for sandtray work:

• "Client will demonstrate increased capacity to symbolically represent and contain distressing internal states (assessed through evolving tray scenes)"
• "Client will show reduced fragmentation and increased integration of self-representation in expressive modalities"
• "Client will identify and communicate core relational themes that contribute to current presenting concerns"

These are measurable in the context of the modality, which is what medical necessity requires.

Writing for Medical Necessity

Insurance reviewers are not trained in sandplay theory. Your job is to translate the clinical significance of the work into language they can evaluate.

Medical necessity for sandtray rests on three pillars. First, the client has a diagnosed condition (depression, PTSD, anxiety, adjustment disorder, attachment difficulties) that the treatment is addressing. Second, the treatment approach is clinically indicated given the client's presentation. Third, progress is occurring and is documented.

Where sandtray practitioners lose medical necessity arguments is almost always on the third pillar. If your notes consistently describe tray scenes without tying them to measurable movement on treatment goals, a reviewer cannot determine whether the client is getting better or whether the sessions are appropriate to continue.

Progress language for sandtray should include:

• Longitudinal comparisons ("This session's tray showed markedly increased protective structure compared to session 2, when all figures were either buried or isolated")
• Functional correlates ("Client's mother reports improved sleep and reduced nighttime distress since beginning treatment; current tray work reflects reduced threat imagery compared to initial sessions")
• Verbal integration ("Client verbally identified the divided tray as representing her experience at home, demonstrating increased capacity for symbolic awareness and self-reflection")

You do not need to prove that sandplay caused the improvement. You need to show that treatment is progressing and that you are tracking it.

A Full DAP Note Example

Here is a complete fictional session note using the DAP (Data, Assessment, Plan) format for a directive sandtray session.

Client: "Tomás," 34-year-old male, diagnosis F43.10 (PTSD, chronic). Referred following a workplace accident. Currently in session 11.

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Data

Directive given: "Build a scene using figures that represent your life before the accident and your life now."

Client worked for approximately 18 minutes. He selected two distinct areas of the tray, placing a house, a truck, a male figure, and two child figures on the left side ("before"). He described this side briefly as "everything normal." On the right side, he placed the same male figure separated from the house, with a large pile of sand between the figure and the house. He added a wolf figure near the sand pile and stated it represented "the thing that's always watching." Client attempted to place the truck on the right side, held it for approximately 30 seconds, then put it back on the shelf without placing it. He stated: "I can't put that there." Visible distress during this moment; client reported SUD 7/10 (subjective units of distress).

Client ended the session by smoothing the sand pile slightly, reducing its height by approximately half, before stopping. He stated the pile was "a little smaller than last time."

Assessment

Session addressed treatment goal 2 (reduce avoidance of trauma-related cues and develop approach-oriented coping). Client's commentary and figurine choice demonstrate continued avoidance of the accident-associated stimulus (truck) and active trauma-related threat perception (wolf figure), consistent with PTSD symptom cluster. However, client's spontaneous modulation of the sand barrier and verbal acknowledgment that it is "smaller" suggests incremental progress in approaching trauma-related material. SUD rating of 7/10, down from 9/10 in session 8, consistent with gradual desensitization pattern. Client tolerated distress without dissociation and was able to use the tray to communicate symbolically rather than verbally, a significant shift from initial sessions when he was unable to address the accident directly in any format.

Plan

Continue directive sandtray targeting PTSD symptom cluster, with emphasis on graduated approach to avoided stimuli. Next session will revisit the "now" side of the tray and invite client to place one figure he avoided today if tolerable. Coordinate with treating physician regarding current PTSD symptom severity per scheduled quarterly check-in.

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This note captures scene description, miniature selection, process observations, symbolic content, medical necessity, and measurable progress in a format that any reviewer or clinical supervisor can follow.

Documenting Jungian Sandplay: Special Considerations

Jungian sandplay therapy has additional documentation considerations because the nondirective stance and depth psychology framing create a wider gap between what happens clinically and what belongs in an auditable record.

The most important principle: your clinical record and your process or supervision notes serve different purposes. The clinical record needs to be translatable into medical necessity language. Your private process notes can hold the archetypal interpretation, the Jungian thematic analysis, and the theoretical depth that informs your clinical judgment.

In the clinical record, document the scene and process factually, then write a brief but specific statement linking observable elements to treatment goals and diagnostic presentation. You do not need to explain Jungian theory to an insurance reviewer. You do need to show that the session was clinically indicated and that progress is being tracked.

Photograph documentation: Many sandplay clinicians photograph trays as a longitudinal visual record. If you do this, document it in your notes ("Tray photographed per standard practice with verbal client consent, stored in secure clinical record"), and store photographs in a location subject to the same confidentiality standards as written records. Photographs are part of the clinical record and need to be treated accordingly.

Sandplay series tracking: The Jungian model considers the series of trays, not individual sessions, as the unit of clinical meaning. Your documentation should reflect this by including periodic longitudinal summaries: brief notes written every four to six sessions that describe how the tray work has evolved, what thematic shifts have occurred, and how those shifts relate to treatment goals. These summaries support medical necessity arguments and create an auditable through-line in the chart.

Seven Common Documentation Mistakes

1. Scene descriptions that are too vague. "Client made a nature scene" tells you nothing. Name the specific figures, their placement, and notable spatial relationships.

2. Interpretation without observation. Writing "client explored abandonment themes" without describing what in the tray led to that interpretation. Always anchor your interpretation to observable scene elements.

3. No connection to treatment goals. Activity documentation without clinical purpose. Every session note should explicitly tie the tray work to at least one stated treatment goal.

4. Progress not tracked longitudinally. Sandtray documentation works cumulatively. If you are not referencing how the current session compares to earlier sessions, you are not demonstrating treatment progress.

5. Using theory-specific language as the only clinical explanation. Jargon from sandplay theory or analytical psychology is appropriate in supervision or process notes, not in a clinical record that needs to be legible to insurance reviewers and other providers.

6. Omitting process observations. The scene is what the client built. How they built it, and how they responded emotionally during construction, is equally important clinical data and should be in every note.

7. Failing to document consent for expressive modalities. Many clients are unfamiliar with sandtray when they enter treatment. Your chart should include documentation that sandtray was explained, that the client understood it, and that they agreed to participate. This is especially important for children, where caregiver consent documentation should be specific.

Session Note Checklist for Sandtray Therapy

Before Each Session

• Treatment plan includes at least one goal that sandtray can address and measure
• Client (and caregiver, if applicable) has signed informed consent specific to expressive modality use
• Photograph storage protocol is established if photographing trays

For Every Session Note

• Scene description: overall arrangement, spatial structure, named miniatures, sand work
• Miniature selection: categories used, repeated figures noted, figures explicitly rejected
• Process observations: pacing, affect, body language, verbal behavior during construction
• Thematic content: observable symbolic patterns linked to treatment goals in translatable language
• At least one explicit connection between the session's tray work and a treatment goal
• Client's subjective response or verbal commentary (if any)
• SUD or other distress/progress measure if applicable to your treatment approach
• Clinician intervention (or nondirective stance clearly noted)
• Plan for next session

Periodically (Every 4 to 6 Sessions)

• Longitudinal summary comparing current tray themes to earlier sessions
• Progress note against each active treatment goal
• Medical necessity statement documenting that continued treatment is indicated

For Jungian Sandplay Specifically

• Tray photograph documented and stored per confidentiality standards
• Separation between clinical record language and process/supervision notes maintained
• Sandplay series summary at regular intervals

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Sandtray and sandplay therapy work involves a level of clinical observation that can feel difficult to translate into written notes. The temptation is either to over-explain the theory or to write so little that the chart becomes clinically useless. Neither extreme serves your clients or your practice.

The goal is specific, observable language that captures what happened, links it to treatment goals, and demonstrates that you are tracking progress. A tool like NotuDocs can help if your documentation burden across a full caseload is creating friction: you build a template structured around your sandtray note format once, and fill it from your session observations each time. The work still requires your clinical eye. The template handles the structure.

For related documentation guidance, see how to document EMDR therapy sessions, how to document therapy sessions using standardized outcome measures, and how to document person-centered therapy sessions.