<p>Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective, evidence-based treatment for youth experiencing post-traumatic stress symptoms (PTSS) following trauma. The current study expanded on previous research on client satisfaction with TF-CBT by (1) descriptively examining caregivers’ and youths’ quantitative and qualitative views of TF-CBT treatment and, for the first time, (2) exploring the associations between caregiver- and youth-reported satisfaction and youth PTSS outcomes, including non-response to treatment. Data were drawn from youth, aged 8–18 years (<i>M</i>_age = 13.19 years) and their caregivers (<i>n</i> = 360), who were receiving TF-CBT from clinicians (<i>n</i> = 179) participating in one of five Learning Collaboratives in the Southeastern United States between 2017 and 2021. Both caregivers and youth reported high satisfaction with TF-CBT. Skill acquisition, the therapeutic relationship, and discussion of the trauma were cited as the most helpful aspects of treatment. Using a multi-informant approach, caregiver-reported satisfaction with TF-CBT was associated with lower youth-reported PTSS, and youth-reported satisfaction with TF-CBT was associated with lower caregiver-reported youth PTSS. TF-CBT responders also had significantly greater satisfaction with treatment compared to non-responders. Even among non-responders, satisfaction with TF-CBT was quite high, and while significant, the magnitude of the association between satisfaction and PTSS outcomes was small. Results suggest that satisfaction is related to, but not sufficient for, TF-CBT treatment success. Future research should consider other predictors of variability in TF-CBT treatment outcomes, the directionality of the satisfaction and clinical outcome association, and whether satisfaction is associated with other treatment metrics.</p>