When Words Fall Short: Healing through Sandtray Therapy After Reproductive Trauma and Loss

Some stories are too painful to speak aloud.

Others haven’t yet found words.

In therapy sessions, this is often the experience when working with clients experiencing reproductive trauma and loss. The grief is real, the emotions are raw, and yet so much goes unsaid. For clients navigating infertility, birth trauma, the NICU, or pregnancy loss, traditional talk therapy sometimes isn’t enough. Therapist and instructor, Lacey Castilleja Fisher, LPC-S, RPT-S, PMH-C, RST-C/T reminds us that that’s where expressive modalities like sandtray therapy can offer something more.

“Sandtray allows the client to visualize what they cannot verbalize or may be too triggering to discuss.” – Lacey Castilleja Fisher, LPC-S, RPT-S, PMH-C, RST-C/T

The Silence Surrounding Reproductive Loss

Though reproductive loss affects many, the experience often remains profoundly isolating. The 2018 documentary Don’t Talk About the Baby shares that 1 in 4 pregnancies end in loss, yet the social scripts around miscarriage, stillbirth, and termination for medical reasons are limited and often harmful. According to Michigan State University’s Department of Public Health, approximately 650,000 birthing people in the US experience perinatal loss each year.

This kind of trauma is often ambiguous, invisible, or medically complex. For many clients, the language to describe it simply doesn’t exist; especially when the pain is layered with personal history, identity-based trauma, or systemic and medical betrayal. Shannon and Wilkinson (2020) describe this as the “ambiguity of perinatal loss,” where the grieving process is often complicated by a lack of social acknowledgment or ritual.

What Is Sandtray Therapy?

Sandtray therapy is a projective, nonverbal intervention where clients select miniature figures to create scenes in a tray of sand. The process may seem simple, but the clinical impact can be profound. It offers a safe container for grief, trauma, identity, and relationship dynamics - especially when words are inaccessible.

Though often associated with play therapy, sandtray is highly adaptable for adult clients working through complex trauma (Garrett, 2013). This expressive intervention allows clients to symbolically represent inner experiences in a protected, three-dimensional space, facilitating exploration of unconscious material through sensory, spatial, and metaphorical elements (Homeyer & Lyles, 2022). Its tactile and symbolic nature engages both hemispheres of the brain, supporting trauma integration through a blend of bottom-up sensory processing and top-down narrative reflection (Webber & Mascari, 2008; Homeyer & Sweeney, 2023).

To hear more about how this nonverbal modality supports grief and trauma processing, listen to Lacey’s interview The Power of Nonverbal Communication in Therapy on the Pregnancy Loss and Motherhood Podcast.

Common Misconceptions about Sandtray Therapy

Although often misunderstood, sandtray therapy is not just for children. Lacey emphasizes:

• It’s highly effective for adults processing grief, trauma, and identity.

• The client is the expert on their experiences and how they represent them in the tray.

• The work unfolds symbolically; the goal isn’t interpretation, but curiosity and presence.

“Stay in the metaphor,” Lacey reminds us. “Let the client decide who or what each figure represents.”

Grief in the Tray: What Clients Show Us

In her work with perinatal clients, Lacey has seen sandtray therapy become a bridge between overwhelm and insight. In one powerful case example, a grieving parent placed a peaceful baby figure in the sand and described him as “the only one that is totally okay and peaceful” (Fisher, 2023, p. 11). This representation brought comfort amid her ongoing pain, offering a visual and emotional anchor for what she could not yet say aloud.

As her work deepened, the client began using the tray to externalize self-blame and complex grief. She surrounded a figure representing her body with barbed wire, later explaining, “My body is a death machine” (p. 13). Through the safety of the tray, she was able to move the baby figure to what she described as a safer place and symbolically knock down the barbed wire fence. Over time, her relationship with the tray mirrored her relationship with herself and her loss. She reflected, “I am starting to enjoy our story again and that good things are coming, which I didn’t feel was possible for a long time” (p. 17).

This layered, symbolic work isn’t just expressive - it’s integrative. The tactile, spatial nature of the sandtray allows clients to interact with and reshape their internal narratives in ways that talk therapy often cannot reach. It invites transformation not just of thoughts, but of felt sense, relational meaning, and personal agency.

More Than a Modality: A Mirror for the Clinician Too

Sandtray also invites the therapist into reflective space. In her training, Storytelling in the Sand, Lacey encourages clinicians to engage experientially - not only to learn how to apply the modality, but also to begin processing their own journeys in parallel.

This dual process can be emotional, but it’s part of what makes the modality so powerful.

Storytelling in the Sand: Using Sandtray Therapy to Cope with Reproductive Trauma and Loss

🗓 September 29, 2025

Learn how sandtray therapy can support healing with clients facing grief, birth trauma, and fertility challenges through case examples and experiential practice.

LEARN MORE AND REGISTER

As Homeyer and Sweeney (2023) emphasize, the therapist’s role as a “witness” is central to the healing potential of sandtray work, particularly when trauma is relational or unspoken.

Making Room for What Can’t Be Said

Whether working with parents navigating TFMR, infertility, NICU trauma, or complicated births, we’re often asked to hold stories that feel too big for words. Sandtray offers another way.

“Sandtray therapy adds levels of trauma and grief processing and integration beyond talk therapy.” – Lacey Castilleja Fisher, LPC-S, RPT-S, PMH-C, RST-C/T

It gives clients something invaluable: a way to externalize the pain, witness it safely, and shape meaning from it.

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References

Fisher, L. (2023). Coping with pregnancy loss through sandtray therapy. World Journal for Sand Therapy Practice®, 1(6). https://doi.org/10.58997/wjstp.v1i6.25

Garrett, K. (2013). Sandtray therapy for adults: An underutilized but valuable tool. Counseling Today. https://ct.counseling.org/2013/10/sandtray-therapy-for-adults-an-underutilized-but-valuable-tool/

Homeyer, L. E., & Lyles, M. N. (2022). Advanced sandtray therapy: Digging deeper into clinical practice. Routledge.

Homeyer, L. E., & Sweeney, D. S. (2023). Sandtray therapy: A practical manual (4th ed.). Routledge.

Michigan State University. (n.d.). Perinatal loss awareness. MSU Public Health. https://publichealth.msu.edu/flint-research

Shannon, E., & Wilkinson, B. D. (2020). The ambiguity of perinatal loss: A dual-purpose approach to grief counseling. Journal of Mental Health Counseling, 42(2), 140–154. https://doi.org/10.17744/mehc.42.2.04

Webber, J. M., & Mascari, J. B. (2008, March). Sand tray therapy and the healing process in trauma and grief counseling. VISTAS Online. http://counselingoutfitters.com/vistas/vistas08/Webber.htm