When Treatment Isn’t Working: Transitioning an Adolescent From Individual to Family Therapy

This case report illustrates the difficulty of deciding when to shift therapeutic focus for a 12-year-old girl who presented with depression, self-harm behaviors, and suicidality. Routine outcomes monitoring (i.e., weekly risk assessments and biweekly self-report measures) revealed a progressive worsening of symptoms during the first episode of care as well as ongoing issues with substance use, prompting a timely transition from individual to family therapy. The change highlighted how patient characteristics, treatment components, and delivery methods interact to influence progress, and demonstrated the critical role of systematic outcome tracking in detecting early deterioration. Framing the intervention within the family system brought to light underlying dynamics that were pivotal to resolving the adolescent’s difficulties, thereby strengthening the therapeutic alliance and quickening progress towards a successful treatment outcome. The case underscores the necessity for clinicians working with adolescents to establish clear expectations and boundaries around patient and family confidentiality and to routinely evaluate suicidal ideation and health-risk behaviors, using structured outcome data to guide timely treatment adjustments.