Relational dialectics theory (RDT) provides a framework for understanding the dialectical tensions families experience when talking about pediatric chronic illness. One place where families may express these tensions is during clinical art therapy sessions, where therapists encourage child patients and their family members to use the creative process of art to tell stories while engaged in art making. Subsequently, we studied one clinical art therapy program for families with chronically ill hospitalized children. We examined the naturally occurring conversations during the art making process. Family members’ talk enumerated three primary dialectical tensions describing the pediatric illness experience. Findings and implications are discussed to explain how RDT may inform art therapists’ sensitivity to addressing these specific dualities verbally expressed by families.