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Acting out is viewed as a form of experimental recollection and a more primitive type of problem solving than play. It is the unconscious repetition of a conflict and differs from action, the conscious solution of a conflict. Stages of mental development are described, progressing from action without delay through play action, pure fantasy, play acting, to reality oriented secondary process thinking. The need for action is progressively given up in this mental development. In treatment, whatever the patient produces, acts out, plays out, or talks out is his way of communicating his unconscious conflicts to the therapist.
A case report of an adolescent boy demonstrates how unconscious conflicts were not re-enacted by way of play but in actuality. This boy had little capacity for verbal communications or free associations in the form of play but communicated by acting out and play acting through much of his intensive treatment. A very 'active' type of treatment was utilized wherein the therapist entered into the patient's fantasy life and play-acted parts with him in a very imaginative manner. From time to time the patient could not maintain play acting but regressed to delinquent acting out. As he mastered his anxiety he moved from acting out to playing out a problem, to talking it out, and finally to resolving it in a reality oriented manner. The more mature the ego organization and the more neutralized energy available, the less tendency there is to acting out as a method of communication and of problem solving. The therapist must avoid 'counteracting out' with the patient.
The authors differentiate play action and play acting. In play action the patient unconsciously repeats the original conflict. In play acting he tries to master the problem by cue taking, imitation, and pretending and attempts to modify a past identification in an effort to adapt and grow. Perhaps the difference between play action and play acting could be more simply demonstrated by