Seizures in the Body, Stories in the Sand: A Case Study in Psychosomatic Healing

Abstract

This case study examines three years of trauma-informed sand tray therapy with a 38-year-old client (referred to as Liam) diagnosed with psychogenic nonepileptic seizures (PNES). Sand tray therapy served as the primary modality for encouraging nervous system regulation, while simultaneously providing symbolic containment and psychological distance from traumatic material rooted in early institutional neglect and abuse. This dual function of regulation paired with containment supported Liam's capacity to engage with previously overwhelming experiences in a tolerable and integrative manner, rather than retraumatizing him.Liam endured more than 200 hospitalizations, multiple cardiac procedures, and trials of numerous medications before discovering that the cause of his seizures was psychosomatic rather than biological. Although PNES events do not involve the characteristic electrical disturbances observed in epileptic seizures, they are subjectively experienced as equally distressing and physiologically overwhelming (Cleveland Clinic, 2025) and are widely understood to be connected to unresolved emotional conflict, chronic stress, and trauma. This diagnostic clarification marked a pivotal shift in treatment, decreasing Liam's feelings of helplessness and hopelessness and facilitating a transition to more somatic-focused interventions.Over the course of treatment, Liam moved from being unable to tolerate depth in the tray to a semi-directive, self-paced approach that allowed him to externalize internal experiences, create therapeutic distance from past events, and share his story within a witnessing and attuned therapeutic relationship. This structured yet flexible framework supported symbolic expression, improved affect regulation, and facilitated engagement with implicit trauma narratives, resulting in meaningful insight and extended periods free of seizure activity, though gains were nonlinear and closely tied to environmental stability and pacing. This case illustrates both the promise and the limits of sand tray as a bottom-up intervention for PNES and offers clinicians a model for titrating symbolic trauma work against a client's physiological capacity.