The therapist at play and the patient who begins to play

This paper addresses the therapeutic challenge presented in the initial phase of therapy by patients who have trouble playing and dreaming, that is, patients who use action-discharge and concrete communication and who show a relative lack of derivative, symbolic communication. An approach is described which conceptualizes therapy as taking place in an intermediate area between inner and outer reality, and in which playing, dreaming and interpretable transference, the vehicles of therapeutic work, can be facilitated. There can be advantages, in some cases, of using such an approach in family sessions. Clinical material is presented from the treatment of an adolescent in her family.