Current theories of therapeutic action place the nexus of change in the intersubjective experiences of the therapeutic dyad. Where does this leave us when a child patient's social skills are so limited as to impede an experience of “usness”? How do we work at repairing early ruptures in relating when a child is not attuned to our social, facial responses to their pain? When a patient is so self-involved that being in their presence is felt as deadening in some basic respects, how do we “use” this countertransference? How do we develop room for play when the child is at a loss on the playground?