In general, the attempt to include, and even systematize, a relatively wide biopsychosocial context in diagnosing and treating youngsters seems fine to me, and far too rare in the current American climate of underdiagnosing and undertreating and extruding troublesome youngsters. MST, to its great credit, does not just medicate symptoms. Also, to its great credit, it tries to create a system without the usual abandoning of many difficult children to the streets, the courts, the prisons, or the cracks in our systems. On the other hand, MST still falls short of encompassing as much of the biopsychosocial reality as it implies it does, and this will probably be a problem for the authors’ wish to extend MST to younger children and to other mental illness diagnoses, where its usefulness is still less clear than it is with antisocial teenagers. MST selectively omits some areas in the biological and social realms, but the most striking omissions, as in many more purely behaviorist programs, seem to be in the psychological realm. Psychoanalytic as well as psychiatric, child guidance, pediatric, educational, and commonsense experience suggests that there will be great cost to mostly or totally ignoring such areas as feelings, conflicts, resistance, the unconscious, the irrational, the importance of relationships, eclectic and dynamic psychotherapy, and even wisdom. Can one build more of that into the already complex protocols of MST? Much more research, and not just by insiders, will be needed to study the long-term costs and benefits of such omissions in the protocols of MST, as in more traditional cognitive behavior therapy and behaviorism in general.