Maya, a 9-year-old girl, was referred for therapy due to numerous instances of domestic violence by her father toward her mother (some of which she witnessed), physical abuse by her father, and possible sexual abuse with no specific disclosures. Both parents have extensive histories of substance abuse, including opioid and amphetamine use. Maya’s father is currently incarcerated for drug and violence-related crimes. Her mother was unable to consistently take care of Maya for the past few years due to substance abuse issues so Maya was removed from her care. Maya has two failed foster home placements due to significant aggressive and sexualized behavior. She is currently residing in a stable foster home and has begun to have monitored visits with her biological mother who was recently discharged from a drug rehabilitation program. Maya has attended therapy with this therapist for only a short time and recently, has begun to demonstrate more trauma-related play. This session illustrates how dysregulation and trauma processing can be exhibited in play, sometimes with significant distress for the child with developmental trauma. The critical dilemma involves to what extent the therapist helps a highly traumatized child to manage her distress versus engage in trauma processing.