Image description



The picture which we have adopted as the CUSTTAD image (as seen above and on the Home page) was produced by a boy from Royston Primary School

Paul (not his real name) had been having bad dreams in which the main protagonists were Dracula and Freddie Krueger

As he began to talk about the dreams and other concerns at home and at school he added Superman and declared that he would not be watching any more scary videos




CUSTTAD is an acronym derived from the two core procedures of the approach which are called Talk and Draw and Making a Tray. More exactly it is taken from the words the Combined Use of Sand Trays and Talk And Draw

The name was devised in 1996 to assist with the write up of an evaluation of its use in a clinic setting




During a period of several years in Canada I had a number of experiences in education which proved to be relevant to the work I am commenting on here

They included teaching Guidance in Olds, Alberta, a year as a Grade 7 class teacher in Masset, Haida Gwaii, British Columbia and fifteen months in a nursery school in the nearby village of Old Massett


They were experiences which influenced my decision, on returning to Scotland, to take up a position in one of Glasgow’s two Primary Day Units for children who were considered to have emotional and behavioral difficulties

There, for seven years, along with other colleagues, I was run ragged dealing with children whose underlying difficulties were rarely understood or addressed


During a year out on a Special Educational Needs Course at Jordanhill Training College Glasgow (where again the focus was more on how to modify behaviour than to understand what was causing it) I accidentally discovered the existence of sand trays

This led to the writing of a dissertation on the development and use of small toys in making therapeutic contact with young children


On returning to the unit I introduced sand trays into a classroom already well resourced with creative materials

The change of emphasis in how I wanted to work was supported by the Principal Educational Psychologist in Strathclyde with the proviso that it did not interfere with my duties as an Assistant Head Teacher


The materials proved to be a catalyst in the gradual transformation of the classroom into a ‘special’ facility which subsequently became a resource available to all the children in the unit


The whole school population was usually no more than twenty four and consisted of four classes with five or six children in each. That facility was the fore-runner of the one in which the practice of CUSTTAD now takes place


That entire phase of the work’s development lasted about eight years during which practices and procedures were modified in deference to the task which slowly emerged as being central to the children’s needs


The nature of the task and its perceived relevance to CUSTTAD will be commented on later Almost everything that was made, said and done during that period was recorded in words and photographs


And, alongside an extensive reading program, it was to these records I continually returned to appraise the applicability of various theories and ideas to the children’s work


By the end of that time I had taken the work as far as I could and on leaving the unit I wrote an account of my experiences there The purpose was twofold; to make my own sense of all that had happened and as a means of explaining the work to others


That explanation became a book entitled BALANCING THE REQUEST TO BE GOOD: an account of a visit to the outskirts of child psychotherapy And it comes with a caution. The approach has gone through numerous changes, from slight adjustments, to the total discarding of some practices and, whilst a reading of the book can contribute to an understanding of where CUSTTAD came from, it can be a hindrance to understanding what CUSTTAD now is


Concurrent with writing the book, a facility, based on the one in the unit, was set up in Royston Primary School, Glasgow, ScotlandFrom its earliest days those of us who have been involved in the work have been convinced of its potential usefulness for children in a mainstream primary school setting


Also, over the various stages of the work’s development I had given several presentations to small groups of clinicians in the Department of Child and Family Psychiatry, Yorkhill Hospital, Glasgow Following the publication of the book and a further presentation to the Department’s Academic Research team, it was decided, in the spring of 1996, to try out the work in one of their community-based clinics


With an initial budget of £500 I was asked to set up and resource a facility in a clinic in the north west of Glasgow Based closely on those which had been established in the unit and in Royston Primary School there was however a major change in how it was used Whereas in the unit I had worked mostly with groups of children and only occasionally with individuals, I moved to seeing children on an individual basis only.


During the next four years I met with over two hundred children in the clinic for assessment and treatment purposes An internal evaluation of the work, covering issues of treatment, assessment and transferability was carried out by a Consultant Clinical Psychologist and one of her assistants And the outcome was predominantly positive.


A number of clinicians tried out the approach in their own practice and, drawing on this experience, the foundations of a Custtad training program were established. This was subsequently developed further in co-operation between the Department of Child and Family Psychiatry and South Lanarkshire Education Authority


South Lanarkshire has played an important role in the development of the work and by the end of this year fifteen CUSTTAD facilities will be in use in the region and thirty four CUSTTAD workers will have been trained  The approach now functions as an integral component in the authority's special educational needs provision.


During that four year period I also spent one day each week working, on a voluntary basis, with children in the facility in Royston Primary School The head teacher had by this time taken part in the Introductory Training Course and a senior teacher from the school had completed the full CUSTTAD training As she began to work with the children in the school I moved to a more supervisory role  Two other teachers from the school were later trained in the approach.


In April 2000, the CUSTTAD facility in Royston Primary School was reconstituted incorporating the materials which had been employed in the clinic and the training program began to be administered from the school.




To explain why CUSTTAD is seen as relevant to children within a mainstream primary school setting I need to return to the unit to comment on what I found out during my time there


What occurred with the introduction of the sand tray materials had not been anticipated  As I see it now we had inadvertently created conditions which were conducive to the children sharing many of the concerns they had. And for some children they were concerns which they had been holding on to for years.


They also varied from the relatively easy to sort out, which could be managed within the unit (usually with the help of their class teacher) to the very complex, which would require the assistance of their parents, carers and/or workers from other agencies


The concerns also had certain common features; a major one being the difficulty the children had in sharing them And a significant factor in the not sharing was the fear of the consequences. Those fears ranged from being seen or thought of as bad to the expectation that they, or someone in their family, would be killed if the concerns were spoken of to another person.


The concerns were also in what might be described as an unmanageable state i.e. they were pressing for some sort of resolution or expression whilst the children did not have the appropriate means or strategies to do either  And the more inappropriate responses they adopted included making strange noises, shouting, swearing, being aggressive, sitting on fences, climbing on roofs - and all the other ingenious ways children find to let it be known that something is bothering them


And although many of the concerns were available for conscious recall there was a noticeable deficit in the children’s ability to find the words they needed to give them verbal expression  This was however an ability which - we contend - can be nurtured through the use of materials which are provided in a CUSTTAD facility  And particularly helpful in this respect was Talk and Draw, a procedure which began to take shape in the unit and which has been increasingly formalized during all subsequent stages of the work


That these concerns were capable of being talked about distinguished them from those which were expressed mainly through the sand tray materials -a widely accepted and excellent medium for nonverbal symbolic expression.


This form of expression also plays a crucial role in the CUSTTAD work, both in its own right and through its inter-related use with Talk and Draw The employment of the sand tray materials has also been formalized into a procedure which serves our particular purposes We refer to it as Making a Tray


Talk and Draw and Making a Tray are the two core procedures of the approach.


One other issue requires mention This is not the place to comment on the subject in any detail but many of the concerns which were in need of being shared could be encompassed within a broad definition of trauma Included in such a definition would be any incident or event which a child had experienced as painful, scary or horrible, and whose ‘impact’ had remained with them in a decidedly discomforting way


And once such concerns had been shared (apart from the immediate relief which was often observed) there was usually a reduction in acting out behaviour  Children became more settled and showed both an increased ability to respond to the challenges of the school curriculum and an improvement in their relationships with members of staff and other children  On a more general level, in the unit overall, the atmosphere was much calmer.


I have been placing an emphasis here on those behaviours which manifest themselves in ways which are usually difficult to ignore, but the facility is set up to be just as accommodating of children who internalize their upset in ways which are likely to make them withdrawn or depressed or ill  And obviously it is just as important to be alert and responsive to the child whose difficulties are of a less demonstrative kind


As to the prevalence of ‘traumatic concerns’: I am not suggesting that the experience in the unit in which I worked would pertain to the population of all such establishments  But it was noted, at one particular review, that 20 of the 24 children attending the unit, had brought, or were in the process of bringing, such concerns to the facility.


Their longer term impact also requires mention.


Much has been written about the degree to which unintegrated and unresolved traumatic experiences can become permanently established to form the basis of adult psychopathology  CUSTTAD’s claim to be an effective preventative mental health measure is based on its capacity to provide an on-going onsite means of helping children to deal with such concerns




To return to the task, mentioned earlier, as being central to the children’s needs; in our view this is to provide and maintain the conditions in which they feel as supported and comfortable as possible about sharing any concerns they might have - if and when they feel able or inclined to share them


BUT there is an important qualification: if children on a visit to a CUSTTAD facility choose merely to explore their ideas and concerns without sharing anything then that would also be an acceptable outcome - with whatever gains the child might make being theirs alone to contemplate  The bottom line in this work has always been to provide children with an opportunity to be constructively creative in a pleasant, well resourced and ordered environment


I need to say more about that qualification  It may seem like just a difference in emphasis but it is much more a difference in ethos  The aim and purpose of the facility is NOT to probe or press to access any concerns a child may have but to CREATE A SETTING in which things can be shared if the child is so minded


When considering which children could benefit from using a CUSTTAD facility this approach is not being presented as an answer to all the difficulties which might be encountered  There will be those children for whom traumatic concerns may be an issue but who are also in need of some very basic training and nurturing. CUSTTAD is being used alongside a Nurture Group in several schools inSouth Lanarkshire. There is now also a Nurture Group in Royston Primary School


CUSTTAD is also unlikely to provide enough for the child who has been struggling within the system for far too long, for whom disruptive and anti-social behaviour has become more of a way of life than a means of expression and who, in every aspect of their life, is being overwhelmed by the negatives


But even with the most troubled child there is always the possibility of making some gains, not perhaps in any significant life changing way but at least relieving some of their more acute difficulties And, based on my own experience, unexpected and very positive outcomes can not be totally ruled out


As for those children who present a much more complex picture involving specific learning difficulties and constitutional or genetic factors; this does not preclude them from having the same kind of concerns as those identified here or exclude them

from the possible benefits of obtaining some assistance with them



On the subject of nurturing; in the unit, issues relating to food and feeding were an important consideration and they are viewed as no less important in a mainstream school setting. But they can be effectively incorporated into a whole school policy and taken up in relation to occasions like the morning break and lunch times


Our position on this is indicated on the page on this site where, on the page entitled CUSTTAD WITH MILK OR WATER OR JUICE, it is suggested that the benefits of giving out and sharing food in companionable circumstances should not be underestimated




CUSTTAD is intended to be an integral on-site, self-staffed resource Children, ideally, should become gradually familiar with the existence of the facility within the school and be as comfortable about the prospect of spending time there as they would be about going to the dining room for lunch  For some children, just knowing that there is a facility which they can use if they choose to do so, can in itself be a settling influence.


Each school, within certain criteria, works out its own particular way of informing the children and involving staff, parents/carers and all other agencies of the intention to set up a CUSTTAD facility and how they plan to use it  The criteria, and working out a PLAN OF ACTION as regards all aspects of the work’s implementation, are covered in detail in the training program


Describing how a CUSTTAD facility functions within a school or what exactly occurs inside a facility is a subject for another kind of presentation  However, the manner in which the room is presented to the child is representative of the overall character of the work and a few comments will hopefully be illustrative of this


First it should be made clear that no child would be using the facility without their parents'/carers' agreement  After a brief explanation of the facility (and the words for this and for introducing the various procedures in the room have been carefully worked out) a child is invited to try out the room, to decide whether or not they think it might be useful to them


Secondly, the room is purposely set up to be as attractive as possible, to assist the child’s engagement, but it is entirely their decision whether or not they take up the offer  A child is never told that they will be going to the facility or will have to go there or should go there  And the offer or invitation is never presented in the form of a bribe, an enticement, a reward or as a response to the child being upset


But supposing a child were to listen to one’s explanation of the facility and decline the offer, or get as far as the door, look in and decline the offer, all would not be lost  The child would have understood something of what the room was about, noted the terms on which the offer was being made, and know, if they felt inclined to use it at some future time, it would be made available to them


And, if a child should take up the offer, and if they did have concerns with which they required assistance, then this would be provided with as much of their involvement as possible  There would also be no hesitation in drawing on the services of anyone or any agency able to assist and this would be managed as speedily and effectively as possible.




There are many claims made for rooms which employ similar kinds of materials and procedures as those used in the CUSTTAD approach, and we accept those similarities exist, but in the way this method of working is now structured there are also distinct differences  We speak of THE LIMITED AIMS OF CUSTTAD because we are content to concentrate on those issues of concern which I have identified here and which in my experience frequently reveal themselves to be implicated in the kind of acting out behaviours which are difficult to manage in any setting


By focusing on those concerns which can be talked about we are not reluctant to accept that other gains might be achieved through the believable if unproven benefits which are claimed for symbolic play, in safe protected spaces, with an appropriately skilled worker But if they are we would consider them a bonus


As to what might be expected from having a CUSTTAD facility in a school: at the least this would be an increased understanding of some of the more unsettled children and an improved prospect of making informed changes in what the curriculum, in the widest sense, should have on offer


Too often it is still the children, in spite of the extreme problems with which some of them have to deal, who are expected to make the adjustments


As regards counteracting the negatives - an essential element of this work- what more positive message can there be for a whole school community than to witness a very unsettled child begin to take control of their concerns and find a constructive focus for their energy and creativity


It is towards such an outcome that CUSTTAD aims to make a contribution


Sheila K. Cameron