The psychoanalysis of an 8-year-old boy who does not play is presented to illustrate the centrality of the “state of playing” for meaning-making and communication in treatment. Developmental research links affect regulation, narcissistic balance, and the capacity for make-believe to the early intersubjective exchange between mother and infant. The intersubjective dialogue between patient and analyst in the “state of playing” is a crucial component of child analysis and its absence both reflects and compounds ego vulnerability in the child and presents a daunting technical challenge to the analyst.