Play is a central aspect of psychotherapeutic technique that can facilitate learning, intimacy, and personal growth. Nevertheless, little has been written about how play can be used when working with patients experiencing psychosis, which risks undermining the possibility of connection and meaning-making and reinforcing stigma. In this article, barriers to play are explored, including both the patient's contributions such as concrete thinking, metacognitive challenges, and paranoia, and the therapist's contributions, including fears of exploring psychotic thoughts, an attitude of excessive seriousness, and the riskiness of play. After exploring impediments to play, there is a discussion about how to assess the patient's readiness for play and how therapists can foster play by embodying an attitude of improvisation and curiosity and trusting their mind and irrational associations. Finally, the authors explore how to play with different psychotic presentations, including delusions and negative symptoms.