Psychologists working with children and adolescents with physical disabilities are confronted with powerful transference and countertransference reactions, as well as projective identifications, vicarious traumatization, and disruptions in their cognitive schemas. Role flexibility, awareness and utilization of countertransference reactions, and sensitivity to developmental and cognitive differences are critical components of the treatment process (Buechler, 2004). Five case examples highlight the complex clinical dilemmas which at times lead to breaking of the therapeutic frame and the rewards of working with this population.