In the United States, young people are remanded to psychiatric custody for the institutionalized treatment of mental illness, behavior disorders, and emotional disturbances, and forced to participate in this therapeutic system. Anthropological investigations of therapeutic process have focused on individuals actively seeking and engaging in treatment or a therapeutic process. Does transformation require a person fully accept the therapeutic system? Is a coerced therapeutic process still effective? This article engages with these questions by situating the therapeutic process in psychiatric custody for American adolescents. The youth in treatment accept that transformation and even healing take place but locate the etiology and form of this change differently than the official treatment paradigms. This case study illustrates that transformation and therapeutic process as multifaceted, especially in coercive contexts, and the efficacy of the therapeutic process as shaped by the life stage and political contexts of those engaged in the process.