Although parents are typically involved in initiating and planning mental health treatment for their children, the parent and child may not agree on what needs to be addressed in treatment. This may result in a situation known as the “therapist’s dilemma”: the therapist must side with either the parent or child to develop a treatment plan. Past literature has investigated the likelihood of parent-youth-therapist treatment goal agreement. However, no study to our knowledge has addressed whether differences in stakeholders’ cultural orientations influence parent-youth-therapist treatment goal agreement. The present study investigated the relationship between differences in parent, child, and/or therapist cultural orientations and parent-youth-therapist agreement on treatment goals in a sample of 270 cases of outpatient mental health service-using children aged 12-17 years and their parents and therapists. Cultural orientations were measured using the American Cultural Orientation (ACO) and Other Culture Orientation (OCO) subscales from the Pan-Acculturation Scale. Dyadic cultural differences were operationalized by calculating the absolute difference between the informants’ subscale scores. Triadic cultural differences were operationalized by summing all three dyadic cultural difference subscale scores. Treatment goals were measured by coding responses to an open-ended prompt regarding treatment/counseling goals using a system based upon items from the Child Behavior Checklist and Youth Self-Report that can be placed into broader treatment goal categories and domains. Treatment goal agreement was determined by stakeholder co-endorsement of a treatment goal within the same category/domain. Logistic regression models were conducted to investigate the relationship between differences in stakeholders’ cultural orientation and treatment goal agreement. Each model included a dyadic/triadic cultural disagreement score as a predictor variable. ACO and OCO differences were not associated with treatment goal agreement across all types of informant cultural differences examined and across both category-based and domain-based treatment goal agreement. Findings indicated that stakeholders’ cultural differences, as operationalized by this study, were not associated with the likelihood of triadic treatment goal agreement. Implications and limitations are discussed. Future studies should consider investigating cultural similarity using approaches including categorical match, cultural differences in specific cultural domains, agreement on specific types of problems, and sampling other regions and communities.