Attrition or loss of cases poses a significant problem in the evaluation and delivery of children's psychiatric services (Garfield, 1986; Howard, Krause, & Orlinsky, 1986; Stark, 1992). From 28% to 59% of children and families drop out from treatment (Gould, Shaffer, & Kaplan, 1985). Since two-thirds of children in need of mental health intervention already fail to receive this service (US Congress, 1986, 1991), attrition exacerbates the problem of too few services to children in need of care. Furthermore, and inextricably related, attrition is a major problem in treatment research (Kazdin, 1988). Loss of subjects prohibits drawing valid inferences from the aspect of treatment under study. The problem of attrition can be addressed from conceptual, methodological, clinical, and fiscal perspectives. From a conceptual standpoint, the loss of cases raises questions about the factors that relate to attendance and participation in mental health services. Characteristics of the patients, therapists, and interventions have yet to be considered in ways that would augment our understanding of the processes and mechanisms underlying dropping out of treatment. In the context of psychotherapy, the conceptual tasks require consideration of the special features of children and adolescents. Specifically, youth usually do not seek service to begin with, nor do they see their behavior as problematic. Consequently, they may lack some of the usual motivation evident with adult patients.