This study examined the relationship between communication patterns and retention among families (n = 18) receiving family therapy. Those that attended 12 sessions were labeled completers (n = 6), 4–8 sessions were middle dropouts (n = 6), and 1–3 sessions were early dropouts (n = 6). Audiotape recordings of the first therapy session were transcribed. The content (positive or negative) and total percentage of communications by the parent, adolescent, and therapist were coded. Completer and middle dropout parents (but not adolescents) showed higher talk time proportions than parents in the early dropout group. Completer families had higher percentages of therapist-to-parent communications, while early dropout families had higher percentages of therapist-to-adolescent communications. There were no significant differences between middle dropouts and completers in either content or total communications. These findings demonstrate the potential utility of examining within-session communication patterns and suggest that within-session processes may determine therapy retention.