The BIOMED international outcome study on childhood depression offered a unique opportunity for the systematic treatment of children and families with major depression using systemic psychotherapy. This paper describes the experiences of clinicians working with the families referred and the theoretical and clinical models that evolved during the treatment process. The concept of 'keeping company with hope and despair' emerged as an overarching framework for thinking about the quality of the therapeutic relationship in this developing area of clinical practice. We illustrate our systemically informed interventions with case examples and discuss the role played by therapists' 'use of self' in engaging and fostering change in families gripped by depression.\ud \ud \ud \ud \u
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