Uniquely, as a hybrid therapy, relational psychoanalytic child therapy reconfigures internal object relations of the child while simultaneously ushering changes into their familial and school context by utilising the mutuality established between the child and therapist as a central pivot. Key features of this account include the foundational role of assessment, the ongoing involvement and near-influence of the parents in child psychoanalytic treatment and the compelling mediating role of a puppet as a co-therapist within the analytic space between therapist and patient.