Children form a sense of self by watching the responses of significant caregivers. Ideally, children have consistent "good-enough" responsiveness and mirroring from an admiring "Mother." The transitional space between Infant and Mother develops a sense of self and symbol and the first inkling of being and becoming. The child crosses from the world of bodily sensation to a sense of self through imagination, which is an exploration of the real. For reality to be real, it needs to have been filtered through illusion; the individual must have participated in its creation or it will not seem real. The personality is alive between illusion and reality in "potential space". This is where the child plays and uses symbols.
When a traumatic event occurs before a child's ego is formed, the transitional space as potential space is split; there is no place for a solid body-oriented personality to form. Repeated trauma constricts and forecloses transitional space and kills the activity of creative imagination and replaces it with "fantasizing" which, according to British child psychiatrist Donald Winnicott, is a melancholy self-soothing defensive use of imagination in service of anxiety avoidance through self-hypnotic retreat into an undifferentiated state. When a child is raised in an abusive environment, it becomes more important to monitor the moods of the abuser than to be aware of one's own inner state. Children who grow up with the threat of harm or the absence of care, cannot develop the ability to imagine. They must remain vigilant for what has been, for signs, not symbols. The symbol takes a leap, which is only safe if the child feels held by the gaze of an understanding safe observer. This is what the therapist does in therapy. Puppets are used to voice stories that the clients are unable to articulate. The puppets each have their own consistent history and personality with defense mechanisms and virtues.
The puppets can become mirrors for the children and means to activate their imagination. The children observe that the therapist takes the puppet's worries seriously and can tolerate their acting-out behavior. The children see that the puppets can change and learn skills such as anger management and how to express their feelings. Gradually, the children talk to the puppets. Soon the children's stories of abuse come tumbling out. The puppets, the therapist, and the other children respond with positive warmth and acceptance.