This chapter illustrates the triumphs, failures, and complexities of providing mental health treatment to traumatized children and youth who spend time in the foster care system. The elements described in it are fundamental to the building of any therapeutic relationship. The success of the therapeutic relationship is, in large measure, influenced by its environment. Success for the sake of the therapist runs counter to the tenets of Relationship-Based Therapists (RBT) because it has shifted the focus of the therapy from the emotional life of the client to that of the therapist. Clinicians may also work in sites that require that all staff adhere to a particular theoretical orientation or rely only on interventions that are clearly and succinctly outlined and supported by traditional experimental outcome research. Peggy's therapy described in vividly demonstrates the importance of attending to the evidence the client bring to the therapy about his or her changing state of mind and need for distance or engagement.