A not unusual clinical presentation is of an adolescent female who voices self-destructive sentiments, is angry, oppositional, and at odds with her parents. Cutting, suicidal or parasuicidal (suicidal like) behavior are often very alarming and the presenting problem. Oftentimes, the client has replaced family relationships with peer relations or a boyfriend. The boyfriend may be older, slightly delinquent and introducing the teen too early to adult vices. Such teens may have an oppositional or depressed tone. Oftentimes they are diagnosed as borderline, depressed, or  having a cyclothymic or bipolar disorder and medicated as such by medical providers. There is often a developmental aspect to it. They may seem prematurely pseudo-mature, or have come to loggerheads with parents, often interpreting discipline as punishment or criticism. An essential goal is to re-establish positive relations with the parents, and encourage discipline that does not appear punitive.  Generally, these teens have good prognosis. They have a sociable quality, tend to be open to therapy, and, once the depression and mood is regulated do well. I have seen hundreds of this prototype. A first goal is evaluating for suicide or self-destructive thoughts, and providing some outlet for their feelings which are often experienced as toxic and mixed. Repairing the relationships with parents is essential. Helping find ways to de-escalate toxic emotions other than unwise relationships and self-mutilation is another goal.