This chapter discusses a complex life situation of a school-age inner-city African American girl seen for mental health services. Liza is an 11 year old African American girl. Despite the many presented and interpreted clinical issues, the main therapeutic crisis discussed in this chapter revolves around sex. A structural analysis of selected clinical points raised in Liza's case will, Mary believes, add an important dimension to Gretchen's climb. As therapists working with clients, and as educators working with prospective therapists, we have generally been insufficiently aware of the contextual or surrounding extra-psychological factors. The interpersonal skills she needs to develop in order to meet these survival and safety requirements are not likely to include conventional dominant culture social skills. Instead her coping and relational survival skills included strategic withdrawal and bartering with neighborhood males for protection/affection in exchange for sexualized attention.