Sand tray therapy, like other therapeutic modalities, can have limitations. Within some communities or cultures, this technique might be viewed as time-consuming, confusing, frustrating, intrusive, or too dependent on the clinical expertise of the therapist. Adults may be resistant to this visually expressive approach because they believe they lack creativity or sufficient artistic skills for the treatment to be effective.

Additionally, the interpretation of sand pictures remains a debated topic within the mental health community. At times, the interpretation of symbols, figures, or entire scenes by either the therapist and/or the person in therapy may be vague or ambiguous, with such interpretations sometimes contributing to the neglect of alternative explanations. While the use of sand tray therapy is grounded in theoretical support and considerable clinical evidence, few studies have been conducted to provide concrete scientific validation for the approach.