I provide comments to Roblek, Detweiler, Fearing, and Albano's (1999) presentation of child and adolescent cases of trichotillomania in this case conference series. I focus particularly on the authors' attitude when it comes to conceptualizing and treatment planning, and I present an alternative attitude, a pragmatic attitude. A pragmatic attitude begins with concrete problems of specific human beings in particular contexts, and in beginning with concrete problems of specific human beings in particular contexts the pragmatist recognizes the myriad of problems that might arise, and perhaps even more importantly, that different problems may require different solutions. I then illustrate how a pragmatic therapist might have considered the need to consider various contextual factors, including developmental factors, which would have led to modifying the behavioral conceptualization and treatment when working with an adolescent.