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The rise of technology has transformed countless aspects of daily life, including utilization in therapy via telehealth services. Video games, a ubiquitous and increasingly popular medium among children and adolescents, present a unique opportunity for integration into psychotherapy. This qualitative study explores the perspectives of clinicians who utilize video games in therapy with children and adolescents, focusing on the benefits, challenges, and practical considerations of this approach. The six participants included in this study highlight how video games can strengthen therapeutic rapport, provide real-time insights into emotional dysregulation, and serve as a platform for teaching adaptive coping strategies. Additionally, video games offer a promising avenue for enhancing telehealth services, particularly in the context of the COVID-19 pandemic, where remote therapy modalities became essential. However, the incorporation of video games also presents ethical, logistical, and training specific challenges, such as maintaining client confidentiality and navigating the engagement of parents. This study underscores the importance of intentional utilization of video games as an intervention and notes that success depends on both clinician familiarity with video games and identifying ways to balance game play with previously established techniques and approaches. By addressing these considerations, mental health professionals can harness the potential of video games to engage children and adolescents in meaningful and effective therapy. Recommendations for future research are discussed and include investigating the longitudinal outcomes of video game-based therapy, expanding training programs, and developing clinical guidelines to optimize this modality for diverse populations to further legitimize utilization of video games as an effective intervention in therapeutic practice.