The history of the private psychiatric hospital has been characterized by the rise and demise of scores, if not hundreds of facilities. In recent years some well known, long-standing psychiatric hospitals have closed their doors. What has accounted for the ability of some of the private psychiatric hospitals to flourish? Two strategies are proposed: 1) progressive change through a broadened scope and a geographic spread, and 2) staying true to the institution's core mission with clinical and fiscal modifications at the perimeter of that mission. A case example is provided for each adaptation: Sheppard Pratt Health System (Baltimore) for the former; Austen Riggs Center (Stockbridge, Massachusetts) for the latter.