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The empirical literature offers evidence that loss of a caregiver in childhood is a significant predictor of psychopathology in adolescents and adults. There is a paucity of empirical research exploring the intrapsychic effects of caregiver loss in an at-risk population of hospitalized children. The Social Cognition and Object Relations Scale: Global Rating Method (SCORS-G) was used to analyze Thematic Apperception Test (TAT) narratives for five commonly used TAT cards. Narratives were assessed on eight dimensions, including complexity of representations of people, affective quality of representations, emotional investment in relationships, understanding of social causality, experience and management of aggressive impulses, self-esteem, and identity and coherence of self. Interrater reliability was obtained by using three independent raters. On average, the participants reported a mean age of 13 years and 35 percent were females. Analyses of variance (ANOVAs), correlations, and regression analyses show that age is a significant predictor of self-esteem in children who have experienced caregiver loss (R2 = 0.34, p < .05). Further exploration revealed that depending on how early the loss occurred, IQ was a significant predictor of children's sense of self-esteem (R2 = 0.84, p < .05) and their emotional investment in relationships (R2 = −0.78, p < .01). Implications for treatment of children are discussed.