ABSTRACT
Jack is a 13-year-old Caucasian male in a residential treatment program because of his angry outburst and physical threats to his mother and stepfather. After a short course of residential treatment, which included individual and family therapy, Jack’s relationship with his family not only did not improve but actually worsened. The treatment staff was baffled. Individual sessions with Jack were planned to focus on anger management skills, while family sessions were to focus initially on Jack’s sadness and anger at his parent’s divorce and his mother’s subsequent remarriage. Although this treatment plan and intervention strategies had been quite successful with many other acting-out adolescents in this residential program, they appeared to be a poor “fit” with Jack and his family. Interestingly, Jack’s three siblings were not initially involved in the treatment process. This case scenario, which will be revisited later, serves to illustrates how “standard” treatment plans and interventions that are not based on a clinically useful case conceptualization are less likely to achieve expected treatment outcomes because they ignore key dynamics in the case. On the other hand, when these key dynamics are understood and incorporated into a tailored treatment plan, the likelihood of positive treatment outcomes is much greater.
