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Beth Castellani-Kelce plans to facilitate a psychoeducational and expressive art group using Sand Tray Therapy for clients with substance use disorders and post-traumatic stress disorder. Sand Tray Therapy allows clients to symbolize their experiences using miniature objects and figurines in trays filled with sand. The therapy helps clients make sense of their inner world, find solutions to problems, and create new behaviors and narratives. The group has rules including sobriety, safety, respect for each other's trays, and punctuality. The therapy also includes psychoeducation on the effects of trauma and substance use on the brain and emphasizes the potential for improvement through Sand Tray therapy. Challenges include managing post-traumatic stress symptoms and ensuring group members collaborate effectively. My name is Beth Castellani-Kelce, and this is my Audio Reflection 9 assignment. The type of group that I will be facilitating is a psychoeducational and expressive art group utilizing Sand Tray Therapy. For my outpatient Sand Tray Group Therapy, I will have 10 clients, ideally referred to by individual counselors who are seeing them within their practice at the treatment agency. My clients will all be over the age of 18 with a substance use disorder. Participants in my group will be people recovering from trauma in childhood, adulthood, or both with co-occurring SUD and post-traumatic stress disorder. Rachel McCormick et al. 2021 explained that Sand Tray Therapy, originating from play therapy, is beneficial for individuals recovering from substance use disorders to process their trauma and emotions while having the control, distance, and safety provided by visually constructing their experience rather than verbally expressing it. Pages 523 through 524. McCormick et al. illustrated how Sand Therapy functions. By using miniature objects and figurines, clients make scenes symbolizing their experiences in 20-inch wide, 30-inch long, and 3-inch deep trays filled with white therapeutic sand. Page 524. Through the development of metaphors and externalizing their account visually to build these scenes, clients make sense of their inner world, find solutions to problems, connect with others, and create new behaviors, schemas, and narratives. McCormick et al. 2021. Page 524. The first rule of my group is that we will come to group free from drugs and alcohol. Rachel McCormick et al. 2021 argued that group members collaborating is integral to the efficacy of group Sand Tray Therapy. Therefore, having a group member under the influence would detract from their ability to support the recovery of their peers. Page 534. My second rule for the group is that we will be safe toward each other with our words, actions, and the use of Sand Trays. If we use our trays to express conflict, we will not depict violence toward another symbolic group member. We can show how the actions of another group member make us feel using metaphor and symbolism. Still, we will not exhibit figurative violence toward a group member in our trays. The trays could be a helpful way for motivated peers to work through conflict. We would still need an alternative plan if the dispute escalates, cannot be sorted using verbal communication, or communication through Sand Tray, and could become toxic or unsafe for the group. This would involve taking physical space from each other. Another rule for my group would emphasize that we do not add, take away, or alter a scene in another person's tray without their permission. This protects the individual's right to control their narrative and discourages viewing the activity as a toy, emphasizing the Sand Tray as a communication and therapeutic device. Just as we wouldn't interrupt another person in the middle of a verbal share, we don't interrupt the process of expressing oneself in the Sand Trays. To prevent interruption of the group process, it would also need to be established that punctual arrival and departure from the group are required. This way, everyone can get set up working on their tray with the assigned topic simultaneously, and clients can focus on introspection and projection of their process without distraction from clients coming and going. A possible way to initiate ideas from group members about what they need to feel safe and comfortable in the group, and establish that as group rules, is to have them construct a Sand Tray on the first day, symbolizing their needs, and then explaining that to the group and the facilitator. This could increase their comfort working with the Sand while also help brainstorming group requirements. Along with using the Sand Trays for processing client experiences, I would also include psychoeducational components in this counseling group. To the client without an understanding of how their trauma and drug use impacted their brain, playing in the Sand may seem like a pointless and infantilizing assignment. Rachel McCormick et al. 2021 explained that both trauma and substance use disorders constrain clients' abilities to verbally express themselves because of the effects on the brain both neurologically and developmentally. McCormick et al. reason that because substance abuse hinders prefrontal cortex development, the part of the brain responsible for speech, impulse control, and decision making, and trauma impairs Broca's area, the part of the brain responsible for speech production, expecting clients with co-occurring trauma and substance use disorder to talk about their trauma and find significant relief from that is unreasonable. Therefore, incorporating a creative or somatic form of treatment is ideal for best results. I would also like to explain to them about neuroplasticity to instill hope that they are not doomed to a lifetime of impairment as a result of the changes to their brain. Sand Tray therapy is one of many methods to improve neurological functioning and mental health after trauma and substance abuse. Sheila McCobb, 2012, explained that Sand Tray therapy affects the neurobiology of a client, allowing the resumption of processing and organizing the sensory experience of the trauma, a process often halted during the initial traumatic experience. Through activation of the left and right hemispheres of the brain and the sensory experience of recounting traumatic experiences visually and metaphorically, the nervous system can process the trauma in ways that cognitive talk therapy cannot. McCobb, 2012, 5 minutes and 46 seconds. In explaining this to clients, I would likely use pictures of the brain to show what a brain impacted by trauma, drugs, and alcohol looks like. I would also like to get an anatomical model of a brain so that I can point out to them where in the brain the trauma and substance use disorder left its mark for clients who may be more interested in a three-dimensional model. The point of the psychoeducational component of my group is to emphasize that the neurophysiological effects of trauma on the brain can be improved. Sand Tray therapy is an accessible way to help clients deal with the trauma that led them to use drugs and the trauma they likely experienced in active addiction. In addition to addressing trauma, Rachel McCormick, et al., 2021, noted that the Sand Tray can be used to manage the aspects of substance use disorder treatment such as forgiveness of self, relapse prevention, improving problem-solving skills, and creating genograms. By asking clients to portray with figurines and symbols the internal barriers to self-absolution, how they feel about relapse, challenges with problem-solving and issues within their family system, and engaging with them to help understand the meaning of their metaphors and symbols, the individual counselors can create more tailored treatment programs and aftercare which will best support the client. Furthermore, the inquiry process by the group facilitator about the client's Sand Tray would allow clients to gain a better understanding of themselves, allowing them to navigate life and recovery better and care for their mental health. I imagine the most significant challenges with this group would be the possible increase in post-traumatic stress symptoms and finding a way for the group to manage violation of group agreement. Through processing trauma and addressing substance use disorder recovery with Sand Trays, an increase in emotional dysregulation and post-traumatic stress symptoms should be accounted for. As Rachel McCormick, et al., 2021, pointed out, people with substance use disorder survive by using drugs and alcohol to cope with the sometimes unimaginable traumas they have experienced. Asking clients to externalize these experiences without a foundation of coping skills and an established period of sobriety could be more harmful than helpful. Therefore, to address this, I would try and select people in the maintaining stage of change for this group with at least six months of sustained sobriety. Additionally, if all group members aren't collaborating, the efficacy of the group process will decrease. Therefore, I will emphasize the importance of prosocial interaction between clients because Rachel McCormick claims this is one of the most healing aspects of using Sand Tray therapy in substance use disorder groups. However, if a group participant is monopolizing the group with either over or under engagement, tardiness, premature departure, and coming to the group intoxicated, I would want to provide group members with a safe way to signal to me that a group rule is being broken. A figurine that symbolizes this, such as a miniature stop sign or a gavel that a judge would use, would be a helpful way that group members could signal that a rule is being broken. As a facilitator, I would have to step in and remove an intoxicated group member or correct the monopolizing behavior. Having figurines that group members can give to each other when a group rule is being violated could also allow them to hold each other accountable in the group process. In conclusion, the proposed group treatment plan integrates psychoeducational and expressive art modalities, specifically utilizing Sand Tray therapy to address the complex needs of individuals recovering from substance use disorders and co-occurring post-traumatic stress disorder. Grounded in the insights of Rachel McCormick and others, the therapeutic approach aims to provide a safe and controlled space for clients to visually construct and externalize their inner experiences, promoting the processing of trauma and emotions. The inclusion of psychoeducation on the neurophysiological effects of trauma and substance use on the brain, coupled with the potential of Sand Tray therapy to enhance neurobiological functioning, adds a crucial dimension to the group process. The group's focus on addressing forgiveness, relapse prevention, problem-solving skills, and family dynamics contributes to a comprehensive treatment approach. Recognizing the potential challenges of emotional dysregulation and PTSD symptoms, the selection of participants in the maintaining stage of change becomes a strategic measure. Additionally, the facilitator's role in managing group dynamics, encouraging pro-social interactions, and addressing rule violations through symbolic communication and addressing rule violations further enhances the therapeutic environment. Ultimately, this group treatment plan seeks to empower clients on their journey to recovery by integrating the therapeutic benefits of Sand Tray therapy with a nuanced understanding of neurobiology, trauma, and substance use.