This chapter presents an approach to working with families of young children with behavior problems that emphasizes accountability as a way of clarifying the roles of therapist, parents, and, most importantly, children. Historically family therapists and child therapists alike have been nonplussed by the idea of including young children in family therapy. J. J. Zilbach pointed this out when she found so few references to this work in the family therapy literature. Children’s repertoires of accountability expand as they grow older. Obedience, responsiveness, and affection are early expectable levels of accountability. As children and parents evolve, their mutual accountabilities change, the nature of generational boundaries change, and so does the management of behavior problems. The responsibility of physicians, therapists, and healers is a subject of philosophical differences. Extremes of difference are represented on one side by the rules of obligation to treat suggested by codes of ethics, such as the Hippocratic Oath.