Affiliation: 3303 Lee Parkway, Suite 220; Dallas, Texas 75219, USA.
Long term inpatient treatment is no longer generally available for adolescents, and young patients whose behavior would have resulted in hospitalization in the past are now by default treated in outpatient settings. In order for outpatient treatment to be successful, some key ingredients are necessary. These include genuine interest and commitment on part of the therapist and the ability to communicate these to the adolescent. In addition, some of what was available in the inpatient milieu needs to be recreated in the context of the therapy, the family, the school and the community. The author draws upon the principles of systems of care, multi-systemic therapy, and his own long experience treating adolescent patients in a variety of settings to illustrate the process of effective psychotherapy of adolescents with severe psychopathology.