Sara's treatment history illustrates an adolescent's tumultuous growth from childhood to maturity. It clearly mirrors some basic tenets of psychiatric intervention and appropriate residential treatment. Unable to cope with ineffectual parents and a split family, Sara "acted out" in classic form, becoming a compulsive drug user and frequent runaway. At fourteen, she was hospitalized on a locked adolescent psychiatric unit. A clinically sound treatment, consistently implemented, was adapted to Sara's specific needs. A sensitive and creative child, Sara initiated some of her own treatment innovations. While there were dramatic regressions, a tenacious commitment to care provided the atmosphere in which Sara was able to explore her inner world and adjust her sights in the here and now. Once the baseline was established, the difficult passage from disturbed adolescence to adult understanding was accomplished at an accelerated pace.