Self-destructiveness in adolescence: psychotherapeutic issues.

In sum, then, the psychotherapy of self-destructive adolescents involves an assessment of the degree to which the patient's behavior is dominated by a negative ideal. If that seems like a central mechanism, than the therapist must seek ways to bring this to awareness, to confront the patient with the presence and the activity of such a component of the self, to sensitize the patient to the way this expresses itself in his everyday behavior, and to rally the patient to the twin tasks of facing this and consciously opposing it, and of working to discern its origins and what happened to introduce it into his life. Generally speaking this is an aspect of personality that patients tend to repress and to maintain in repression. They may do this by denial, evasion, or hyper-emotionality, by regarding this part of the self as a source of pleasurable excitement, or by using its effects to drive away the therapist or to convert the therapy into yet another site for the attainment of pain, frustration and failure.