Children in Western countries are being referred for therapy at increased rates. There is, however, a lack of research that explores how social workers, in the role of therapist, engage children and their caregivers to determine the ‘presenting concerns’ for therapy. This study uses a Critical Discourse analysis of therapy transcripts to investigate if and how children are afforded the right to name the issues they may face. The study examines the politics of knowledge production in the therapeutic triad between the therapist, child and caregiver. The messy realities of child-centred practice are shown. The findings reveal the complex operations of power in therapy interactions and the influence of behavioural discourses in framing children's mental health issues, positioning children as therapeutic subjects. Findings underscore the need for social workers to find socio-political ways to conceptualize, with children, the issues that impact on their lives, using externalizing practices and therapeutic resources.