Play therapy is widely used with children, including children who experienced sexual abuse. This longitudinal study examined whether more pretend play completion (PPC) at Time 1 predicted fewer child difficulties when this was assessed 3 years later at Time 2. Participants were 91 children (aged 3-8 at Time 1), including 51 children who experienced sexual abuse (child sexual abuse CSA). Play was coded with the Children's Play Therapy Instrument, and child psychological difficulties were assessed with the Child Behavior Checklist. More PPC at Time 1 predicted fewer child psychological difficulties 3 years later at Time 2. This was the case in children who had experienced CSA as well as the comparison group, showing that PPC is predicts better psychological adjustment in both abused and nonabused children. The study provides the first longitudinal evidence of the important role of pretend play narrative completion in predicting less internalizing and externalizing difficulties. The findings have important clinical implications for play therapists. It suggests that interventions that encourage children to elaborate and complete their play narratives could facilitate agency and psychological adjustment, as well as recovery after trauma. This is in line with the idea that through play children discover that they can "play with reality" and gain control over how they tell their stories.