When you come to think about the core ingredients of successful pain management for children and youth, one needs to consider the central role clinicians play in shaping the clinical encounter. Arguably our ability to effectively assess and manage pain rests on effective communication between clinicians and children and their families. As a self-appraisal condition that rests on memory, beliefs about the origins of pain, recall bias and an understanding of the role of everyday life context, management of child pain encompasses an ongoing and unpredictable iterative process between the child/family and clinician that has potential to both positively and negatively shape the therapeutic outcome. We can be well trained, well read, and thoughtful about our use of analgesics, but if we fail to appreciate our central role as clinicians in making the encounter therapeutic, we stand to only add to child and family suffering. The key question we face is how clinicians can ‘give agency’ to the encounter. In this session Oberlander will address this question by defining the nature of a clinical child pain encounter. Then drawing from an emerging literature describing the impact of ‘placebo by proxy’ appreciate the role of clinician communication, identify characteristics of what makes the encounter therapeutic, barriers to therapeutic success and approaches about how to navigate away from being therapeutically stuck.