One of us worked with a 13-year-old boy named Joe for 2 months after Joe’s mother requested that he receive counseling. She and her husband, Joe’s stepfather, were concerned about Joe’s poor school performance, his acting out, his group of delinquent friends, and his alternately hostile and completely withdrawn behavior at home. Joe’s stepfather was a machine operator who provided severe yet inconsistent discipline. Joe disliked his stepfather, and he reported that the dislike was mutual. He described his mother as nicer but complained that she did not permit him to do what he wanted. His mother was primarily a homemaker, but occasionally she did temporary office work. She frequently placated her husband so that he would not get angry with Joe. She felt Joe needed to change, however, and believed that counseling might fix him. Joe’s parents refused to come in for counseling as a family because they insisted that Joe was the problem. Joe spent a great deal of time with his friends both during and after school. He reported smoking marijuana and cigarettes fairly regularly. Shortly after our first counseling session, he was arrested for possession of drug paraphernalia. His parents refused to let him see any of his friends after the arrest. Joe’s school performance and effort were poor. Joe probably had a mild learning disability, but a recent psychoeducational evaluation had been inconclusive. Joe’s primary problem at school was his acting out. Unfortunately, when Joe got into trouble with a teacher, he was inadvertently rewarded for his disruption. He could effectively avoid the schoolwork that he found so difficult and distasteful by sitting in the assistant principal’s office listening to stupid stories. Joe was doing so poorly at school and misbehaving with such frequency that his stepfather threatened to send him to a strict boarding school unless his behavior improved. Joe said that would be fine with him because he had heard that the work was easier there. His stepfather’s threat to cut his hair short was the only consequence he seemed concerned about. Joe primarily used marijuana, which did not change during the 2 months he was in counseling. We don’t know whether Joe experimented with more powerful substances because he showed a great deal of resistance to coming to counseling and seemed very disinterested in changing himself, although he did want his stepfather to move out. Joe was a frustrated and angry adolescent who resented his parents and received little direction or consistent structure from them. He was unsure of their expectations, hated school, felt isolated from his friends, and could see no solution to his problems. He directed his anxiety and poor self-esteem inward and acted out by skipping school, talking back to his teachers, or roaming the streets with his friends. Like many other young people, Joe faced difficult challenges in life and had few resources for coping with them. He had never learned to delay gratification, he did not know how to relate to others in a healthy and positive way, he received no consistent discipline and failed to develop a sense of responsibility for his actions, and he felt mistreated and betrayed by the school and by his parents. Drug use was simply a means for Joe to escape from the problems that troubled him so much. Joe’s parents did not accept that his difficulties might be symptomatic of larger family problems. They refused to enter family therapy and eventually withdrew Joe from counseling.