Difficulties in the expression of aggression, control of impulses, resolution of loss, depression, and self-concept require deep exploration in the abused child, both interpersonally and intrapsychically, because they are central issues to be resolved. As the therapist deals with current reality, not only repressed memories or fantasies, focus is less on achieving catharsis than on containment, on becoming aware of and learning to tolerate potentially overwhelming affect, and ambivalence. These issues occur and recur in play and are clarified and interpreted. A case illustration portrays a child with severe problems in the expression of aggression, identification with the aggressor, poor impulse control, low self-esteem, and dealing with parental loss. The case shows how the interplay of situational factors affects the course of treatment. Fifty-nine references are provided.