Children’s clinical symptoms can often only be understood within their individual and family contexts. However, contemporary research has pointed to the importance of also working with children’s social identities and macrosystem environment when attempting to understand and treat clinical problems. The case of a 10-year-old Dominican-American girl who presented with a significant trauma history, oppositional behavior, and difficulties interacting with her peers is examined using a developmental ecological framework. Attachment theory, cognitive behavioral therapy, narrative therapy, and multicultural family systems therapy, with a focus on trauma responses, are integrated when exploring the case. Additionally, the benefits of exploring the influence of social identities (race, ethnicity, immigration status/perceived immigration status, and class) are explored via an approach that focus on transformation and healing from oppressive systems by integrating sociopolitical realities in therapy.