This paper explores the use of symbolic play in the treatment of mother-child dyads with very disordered relationships. The failure of mothers with rigid, distorted ideas about their children to support emerging symbolic capacities is discussed. These mothers are seen as unable to contemplate their children's inner thoughts and feelings; in turn, they inhibit their youngsters' ability to develop a “theory of mind” about their own and others' mental lives.

It is suggested that parent-infant psychotherapy, a psychoanalytically based intervention, which treats the mother and child as they play together, may serve to facilitate the development of shared mental states: The mother is encouraged to imagine her child's feelings and thoughts as well as to reflect on her own. Clinical case material demonstrates the use of play in parent-infant treatment to help one mother achieve a more empathic, coherent, and balanced view of her toddler's inner world.