This chapter builds on the learning from previous chapters about what is known about common and complex mental health difficulties in young people and provides a developmentally focused framework for understanding how to effectively engage young people in trusting and therapeutic communication, for the purpose of helping them with their mental health needs. Working with children and young people who experience complex mental health needs can feel daunting and overwhelming. There can be understandable worries about causing further harm by saying the wrong thing and making their situation feel worse and whether you have the right knowledge and skills to help them. Yet contemporary research increasingly demonstrates that the most important influence on safety and positive mental health outcomes for children and young people (CYP) is the availability of high-quality, supportive therapeutic relationships with adults in their everyday life. The chapter begins by outlining why relationships with adults are so important and the key developmental issues that need to be held in mind when approaching young people to talk about potentially sensitive issues related to their mental health. The importance of self-awareness, reflection and understanding young people within their family context is discussed. Practical guidance on how to engage young people, in order to enter into supportive discussions that enable individuals, and their family members is provided, with a focus on promoting agency, collaboration and openness to intervention that will ultimately support their emotional well-being and timely access to more specialist help where needed.