With services available to pre-teens and adolescents, it is possible to change course before patterns become further entrenched. For therapists at Centered Ground, this can be such a rewarding process to impact and witness such significant shifts, even when clients have already been struggling for extended periods. Although individual sessions are emphasized in some cases, given clinical indications or barriers to parent participation, family involvement is generally considered an essential part of this process, including family skills training and parent training. This usually includes contingency management guidance regarding reinforcement and consequences, working closely with parents to create and maintain a structure uniquely tailored to each family for effectiveness. Coaching is also available between sessions to our pre-teen and adolescent clients and their parents to intervene when it may be most needed and most beneficial for change to implement skillful alternatives when situations are occurring.