Self-Destruction and Countertransference Reactions in Adolescent Psychotherapy: A Psychoanalytic Case Report

Self-destruction behaviors in adolescents constitute a serious mental health problem, with approximately 80% of suicidal thoughts and attempts present in adolescents struggling with a psychiatric disorder [1,2]. Depression, substance use, borderline personality traits and dissociative symptoms or disorders have been identified as the major proximal risk factors for selfdestruction behaviors in empirical studies with adolescents [3,4]. In fact, some empirically-tested models propose that although substance use, borderline or dissociative symptoms are used as defenses against painful affects, they eventually facilitate selfdestruction thoughts or acting out through the enhancement of impulsivity, affect dysregulation, splitting of the self and others, numbing of consciousness, depersonalization, and derealization [5].