Working Effectively and Developmentally with Traumatized Adolescents in the Juvenile Justice System By Brooke Sheehan, LCSW on 11/2/23 - 8:52 AM

Would you ever want to go back to adolescence? I cringe at the thought. What a torturous time of peer pressure, identity development, and naivete about one’s own mortality. I’m sure there are a few folks out there who would happily re-experience this time in their lives, but my gut tells me it would be a small group. When I reflect on this time in my own development and then consider my experiences working with incarcerated youth, I can’t help but feel immense empathy for what they are going through, knowing they now have this experience of incarceration to contend with that will further impact everything from their self-image and their behavior to their comportment in the world. When you further consider the diagnoses that start to present themselves as these youth ages, it can become gut-wrenching to imagine how they are going to navigate life after incarceration.

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Longing for While Sabotaging Connection

In my work with Zed (fictional name), I’ve seen an adolescent who so desperately wants connection, but is so afraid it won’t last that he rapidly and abusively sabotages his positive relationships. He is profoundly adept at putting on a tough face and acting as if he does not feel lonely, sad, and hurt when this transpires, and he ultimately carries the belief that people always leave, so it is better to strike before being struck. This belief has become a self-fulfilling prophecy of sorts and is heavily characterologically entwined with every facet of his being.

When Zed was younger, he ended up in the foster care system while his parents were struggling with addiction, and inevitably found himself in and out of the juvenile correctional system, transient, and in group home settings. Zed is not without insight — in fact, he frequently states, “I was acting up in those placements; I wanted to be back with my parents.” It’s important to verbalize that although it is true that he may have exhibited self-sabotaging behaviors, Zed’s presentation is directly entangled with the broken attachment and trauma that he experienced, culminating in a recent diagnosis of Borderline Personality Disorder (BPD). This diagnosis has somewhat shocked Zed and he has been persistently reluctant to accept it, and understandably so. As a teenager whose brain is still developing, the idea that your behavior is being pathologized rather than viewed as a response to injustice would be immensely overwhelming. In a session, I once offered Zed the adage, “Hurt people, hurt people.” The idea behind sharing this was to hopefully leave him with a mental nugget to come back to and ponder. However, the response I got from Zed that day was that it’s justifiable for hurt people to hurt people, particularly if it’s someone who has hurt them already. I could feel Zed’s desire for others to feel his pain — it was practically streaming from him, along with the deep injustice he felt he had experienced and the unfairness of it all to such a young person. My inner dialog was saying, “Wow, this person has experienced so much emotional pain, it is practically blinding him and those around him.”

As someone working closely with someone with BPD, it is easy to imagine how other staff members who perhaps do not have much in the way of mental health training could become easily overwhelmed, frustrated, or fearful when working with a teen like him. When Zed perceives injustice, judgement, or simply does not receive the information he would like, he can escalate and become both physically and verbally aggressive. However, the reframe of this, which I have found myself discussing with other staff members, is that he is screaming out to be held, if not literally — which may indeed be true — but figuratively. I’ve found that in instances like this, boundaries are the equivalent of being held, along with unconditional positive regard. When a resident with BPD is actively upset, they are banking on (somewhat unconsciously) the self-fulfilling prophecy of, “I am too much for others. People will always leave me,” becoming fulfilled.

What to do in moments like these, when it would otherwise be so easy to punish and control, is critical not only for their treatment, but as potential lessons of life they can take forward with them. For example, I’ve found that self-injury is often utilized as a method of power and control by someone who is diagnosed with BPD, which in turn, can make clinicians and staff fearful. They then might inadvertently reinforce the self-injurious behavior by acquiescing to what the patient demands just so the self-abusive behavior will cease. This is immensely harmful in the long-term, as the patient will utilize this strategy consistently if it proves fruitful.

When experiencing periods of time where Zed has actively engaged in self-injurious behavior, I approach him with one goal in mind: safety. It is during these periods of crisis when I remind him that I will only be able to do in-depth work with him when he can maintain safety for himself and others. Without this basic element of safety, there is no foundation, and nothing can effectively be accomplished. When I am successful in helping all of those working with Zed in this regard, it becomes much more likely that he will return to a place of equilibrium and avoid harmful behaviors.

Perhaps the biggest challenge I’ve experienced while working with Zed, is maintaining my sense of the “long-game.” Solution focused remedies won’t propel us there, but consistent unconditional positive regard, setting of boundaries, and supporting the therapeutic alliance will. While the gains often feel minimal and fleeting, consistency and determination go a long way in equipping teens like Zed with the tools for a more successful life outside of institutional walls. The most important thing I can do with teens like Zed is to remind myself and others around, that diagnosis is NOT all that these clients are. It is simply a marker and reminder that they have experienced significant and sustained trauma and potentially disrupted attachment, and they can be helped.  


If we tell people there is no hope that they can grow through a diagnosis, we are neglecting to give them all the tools in the toolbox. And as carriers of the toolbox, it is our job to provide those we treat with the proper tools for the task at hand.

Questions for Thought and Discussion
  • What are your impressions of Zed and how this therapist addressed his therapeutic needs?
  • How does your work with clients diagnosed with BPD differ from hers?
  • What might you have done differently with Zed?  

File under: The Art of Psychotherapy, Child & Adolescent Therapy