This paper discusses the results of a study that investigated the progress of 51 children receiving long-term dynamically-oriented therapy at a naturalistic "real world" clinic. The orientation of the Outpatient Clinic of the Yale Child Study Center is primarily long-term, psychodynamic treatment. Parents and clinicians completed measures before initiation of treatment and at termination. Results indicated the children improved in their functioning as rated by parents and clinicians. In addition, parents reported improved family management practices and a decrease in social isolation from the beginning to the end of treatment. The paper discusses the difficulties inherent in evaluating effectiveness in naturalistic settings where clinicians are less motivated to adhere to research designs, especially those involving the administration of post measures. The need to conduct more outcome studies is urged. Findings for the study suggest that reliable and positive results can be achieved for those families and therapists in "real world" clinics who remain committed and accountable to the therapeutic process. (Contains 19 references.) (CR)