In this article I describe a clinical approach to meeting the needs of a group of children with complex disorders and their families in a day unit setting. These children have both psychiatric disorders and learning disabilities. I propose a way of conceptualizing the complex aetiological factors involved, the diversity of need, and the fit with possible therapeutic provision, which has the potential to function as a model for services to this group of children and their families. This model represents a multifaceted approach which encompasses biological, behavioural, pharmacological, psychoanalytic and systemic principles of assessment and intervention.