Psychoanalytic opinion continues to be dichotomized in regard to the role of trauma versus intrapsychic conflict as contributing to pathogenesis. This paper emphasizes the importance of conflict in both the experience and processing of trauma, so that problems in talking about it and processing it verbally are taken as evidence of conflict and defense. Cumulative trauma and its analysis in children are emphasized. While children in analysis find remembering and talking about their traumas difficult, they can know such experiences and modulate the anxiety of knowing when they do so in play. A clinical vignette is presented to demonstrate this way of using play to promote more advanced mentalization or insightfulness.