Adult survivors of childhood abuse often experience a variety of negative mental health consequences. Sandplay therapy, which has shown promise for use with child survivors of abuse, is a powerful therapeutic tool in which participants place figurines in a tray of sand to create a dialogue between the conscious and the unconscious aspects of the person's psyche. Using a case-study design, we examined the efficacy and perceived efficacy of sandplay therapy for a 52-year-old woman who presented to a university psychology clinic with a range of difficulties stemming from her childhood abuse. Mixed results were found, with some of the client's symptoms reducing (i.e., depression and stress symptoms), other symptoms remaining stable (i.e., posttraumatic stress disorder symptoms, dissociation), and one worsening (i.e., anxiety). Overall, the client's measured psychological well-being increased after sandplay therapy. The client perceived a noticeable positive effect on her life and discussed her perception of the therapeutic approach, which was assessed by thematic analysis. The findings of this study support the theoretical aims of sandplay therapy, and contribute to the field of research on the efficacy of sandplay therapy with adult populations.