This article discusses some of the literature on factors associated with therapeutic change in traumatized children: repetition for mastery, interpretation of affect and experiences, and characteristics of the therapeutic relationship. Additionally, an alternative model of therapy with sexually abused children is proposed. In many cases, the course of therapy with sexually abused children involves a series of cycles in which the child repeatedly returns to three core processes: testing the therapeutic relationship, addressing traumatic experiences, and undoing denial. For many children whose abuse histories are particularly extreme, the course of their therapeutic progress may be better understood, then, as a series of cycles rather than progressive improvement through a number of stages. Two cases are discussed to illustrate the proposed cyclic nature of play with this population of children.
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