A growing number of adolescents arrive in the therapist's office beyond adult control. Their behavior is outrageous, they use drugs heavily, and their moods fluctuate wildly. Nothing seems to work. If they stay in treatment, they make a shambles of the process. If they terminate prematurely, therapists may feel they never really got hold of the case; worse, they are not sure how they could have done so. Therapists looking at their interactions with patients will usually notice distinct patterns. The out-of-control patient usually shows a preference for one of five pathological patterns: narcissism, masochism, the paranoid stance, the schizoid defense, and affective lability. This book studies the five patterns of interaction typical of out-of-control adolescents, showing therapists how to recognize each and introducing interventions to interrupt them. When patients are forced into new, less comfortable experiences of themselves and their therapists, more honest exchanges become possible and more conventional treatment approaches become feasible.