In this chapter, the main sources of psychological strain on children and families in PICU are outlined. For children, these are potentially traumatising experiences, difficulty recalling or understanding what is happening to them and disturbing experiences which can occur in relation to delirium. Parents have difficulty assimilating complex and, for them highly emotionally loaded, information in a protracted state of high anxiety. Illustrative examples of casework by a psychologist working in this setting are provided, along with information about models of working with acute stress in medical settings, which may be helpful to keep in mind for other health professionals. Finally, research on longer term psychological outcomes and how the majority of families normally recover psychologically is given, together with information relating the treatment requirements of particular at risk groups.