The psychological management of behaviour that challenges, following paediatric brain injury, is a new and evolving field. This chapter details a narrative approach with ‘James’, who was the inspiration for this book. It guides the reader through psychological formulation (based on narrative ideas and the international classification of function), the therapy process and outcome measurement. Aged 10, James survived surgery and chemoradiotherapy to prevent a cancerous brain tumour spreading. The treatment resulted in several life-changing medical illnesses, creating a problem-saturated life story and identity. They made him measure his fluid input and output, use a wheelchair, over-eat and feed the depression with ruminative thoughts. This trauma led to actions that challenged his family and services, such as frequent demands for food, shouting and threats to end his life. The narrative approach led to consolidating and extending new stories, where James “traded Hunger for fruit”, walked unaided without fear, toileted independently, was linked into a mainstream school and reported no depression. Techniques which externalise the problems, identify exceptions and thicken preferred stories can empower a child’s adoption of preferred identities and actions, as experts of change in their lives. Children and networks can re-author their life stories and re-write their future scripts.