Concurrent substance and psychiatric problems have been shown to significantly reduce the probability of successful treatment outcomes while increasing vulnerability to a range of troubles including homelessness, incarceration, physical health problems, and criminal victimization. This article presents an ethnographic analysis of treatment processes in a residential social model treatment program specifically designed for individuals with dual diagnoses in an effort to inform current debates with empirically grounded knowledge regarding therapeutic practice itself. The article focuses on four fundamental themes bearing on therapeutic practice in this residential program: social model treatment; the formulation of clinical identities; recovery, personal responsibility, and authority; and the measurement of therapeutic success. In conclusion, the article suggests that the central role played by program residents in the therapeutic process deserves particular attention and makes recommendations regarding mental health services delivery that, if followed, might invigorate treatment efficacy.