This chapter is about therapeutic work with families who have a child with a disorder of consciousness or a very profound acquired brain injury (ABI). The therapy is informed by systemic and narrative models of work. The chapter provides a brief overview of what a disorder of consciousness is and the neurorehabilitation process for children and young people. The chapter then outlines some of the dilemmas that families can face when their child sustains such a significant brain injury. An example from practice is then given, which describes some therapeutic work with a parent, that draws on systemic and narrative theory and practice. This includes therapeutic conversations about the impact of the trauma, styles of coping and the changes in family relationships, including with siblings and grandparents. The chapter concludes by providing a reflection on the value of systemic work with families with children with a profound ABI.