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Within the context of family therapy a discursive social constructionist approach was utilized. This illustrated how parents drew upon culturally understood notions of mental health in order to situate the family’s issues within the identified child. Three core analytic issues were identified. First, it was found that parents attributed blame with the identified child. Second, they made direct appeals to the truthfulness of their accounts. Third, the therapist worked to reframe the difficulties as family problems. Thus, through an application of the discursive action model of Edwards and Potter (1992) the social actions and performative nature of family interactions were bound up with parental accountability and therapists moved to refocus the family in a way that maintained therapeutic alliances by offering praise, empathizing, and talking about “feelings.” In this way, a social constructionist, discursive account provided a mechanism for exploring how families interact within the therapeutic space and how child mental health is better understood as a negotiated, rather than fixed concept.