The class teacher brought Gaga, a student in the first grade of high school, to a psychologist because of self-injury, with the consent of the student's mother. Her parents were divorced, her mother was her legal representative (guardian). She had visible scars from cutting her hands on the inner sides of both forearms. Gaga told the psychologist that her mother believes that this is an attempt to draw attention to her problems, and even a suicide attempt. Gaga does not accept that. The assessment, as part of the initial phase, was made during the first two sessions. Together with Gaga, the psychologist made a formulation of her mental difficulties. In short, in interpersonal situations that provoke a drop in her self-esteem, Gaga experiences a strong unpleasant tension, which she resolves by self-injury. The fragility of her self-esteem is conditioned by her negative IWMs. The work took place in the school psychologist's office. It was agreed that Gaga would come once a week until the end of the semester for an interview with a psychologist lasting 45 minutes, but also whenever she experiences tension that causes her to self-injury.

There was a plan to resolve the crisis, which included, among other things, that when Gaga felt tension, she should turn to the first available important person: a psychologist, a class teacher, her best friend or her mother. Informal psychoeducation was carried out in all phases of work with Gaga, mainly by observing and naming Gaga's psychological phenomena in accordance with psychology as a science, then they were connected to the circumstances in which they occurred, as well as to the consequences they led to. With Gaga's consent, the psychologist collaborated with Gaga's mother, for the purpose of psychoeducation about communication, trust and closeness in the relationship with her daughter. The aim of working with Gaga was to control unpleasant impulses and emotions, so that self-injuring stops. This aim has been achieved through three tasks: 1) that Gaga, in the relationship with the psychologist, builds her IWMs as positive, so that she can see herself as a person who is worthy of the love and support of close people; 2) to develop a stable capacity for mentalization; 3) to apply the acquired skills listed under points 1) and 2) in the interpretation of her affective experiences.

The mentalizing approach in working with Gaga included an attitude of emotional warmth, acceptance and authentic interest in her inner world. Young people who have negative expectations and feelings about themselves usually believe that others will think the same. The mentalizing approach enables Gaga to manifest such experiences. The main phase of work lasted 2 months, a total of 8 sessions. Gaga shared episodes from her life that caused her strong distress, weakened her mentalizing capacity and provoked self-injury. The psychologist used the following techniques: support and empathy, clarification, elaboration and challenge, basic mentalizing, mentalizing the relationship between the psychologist and adolescent. Providing support and empathy included validating the feelings she was talking about. Validation of feelings consisted of reflection – i.e. the psychologist's answers as to how he understood Gaga's narrative, then checking to what extent Gaga agreed with it. Here's an example:

Psychologist: “I see you have a bandage on your hand, your class teacher told me that you cut yourself again. When and where did it happen?” Gaga: “In the apartment, yesterday” (the student lived in a rented apartment with a roommate). Psychologist: “What did you feel then, just before you cut yourself?” Gaga: “I felt a strong tension, I told you about that tension last time.” Psychologist: “I would very much like to know more about that event. What caused that tension, what were you doing that day just before you cut yourself?” Gaga: “I don't know. Nothing, I guess. It just comes to me that way. When I feel tension I cut myself.” Here, Gaga's teleological mode of explanation was seen – self-cutting was used as representation of extreme mental pain, and it was an indicator of completely broken mentalization [1,8]. The psychologist patiently maintained the mentalizing approach: Psychologist: “Please, slow down. I'm really interested in how that tension arises. Is there anything you remember doing right before that event?” Gaga: “I was thinking about talking to my friend. We were walking in the park. We talked. She told me - yesterday my boyfriend went out to Caffee Monroe with a girl from our school”.

Psychologist: “How did you feel when you found out?” Gaga: “I'm not interested in him anymore. That is not the reason why I am doing this on my hands... When I see that someone is not for me, I leave him” (she was very tense while speaking). Psychologist: “You want to break up? ” Gaga: “He cheated on me. My friends saw him in Monroe drinking coffee with a girl, and this was repeated with some other girls from our school. I didn't know anything about that. You know what goes after a drink. Makes a monkey out of me.”

Gaga's narrative was not balanced in terms of verbal and non-verbal cues, affect was separated from actions. Instead of mentalizing, Gaga had one of the prementalizing modes of thinking - the pretend mode, in which mental reality seems to be separated from the happenings in the environment [1,8]. There was pseudomentalizing in which the wrong forms of inference are not expressed in full: “my boyfriend is having a drink together in a cafe because he is cheating on me; the motive of his cheating is my worthlessness”. It was crucial at that moment to weaken or eliminate pseudomentalization by treating the current event:

Psychologist: “It seems to me that this tension in you is mental pain... Did you feel that kind of unpleasant feeling?” Gaga: “I'm not sure... Sometimes I'm just angry with myself. I don't know how I can't do it. Others find it easy to be with someone. Some anger, some hatred builds up in me.” Psychologist: “To whom is this hatred directed? Gaga: “I can't stand myself sometimes. I hate myself.”

As the level of her negative arousal increased, which was triggered by negative ideas about the relationship with a close person, in this case with a boyfriend, pseudomentalization arose. Then it happened that she unconsciously slipped deeper into the teleological mode of thinking as an even more severe disturbance of the understanding of her own experience, after which self-injury occurs as a solution to unbearable mental pain.

Psychologist: “It's clear to me that when you start thinking about how a boyfriend cheated on you, you feel worthless and hate yourself. Let's see something else. Would your best friend say that you are a less valuable person if you told her that a boyfriend cheated on you?” Gaga: “She would not. She would say he is trash, not me.” Psychologist: “I agree that you are a person worthy of respect.” Clarification referred to asking questions in order to gain better insight into certain events, behaviours and experiences. Clarification revealed details that indicated that strong, negative “tension” is actually self-hatred. Clarification enabled elaboration, which referred to the consideration of the layers of Gaga's feelings, while the challenge as a procedure included offering an alternative interpretation of her experience, in which Gaga is worthy of respect. Basic mentalizing included procedures for focusing on a part of Gaga's narrative when a decline or lack of mentalization is observed: “stop and pause” (e.g. the psychologist says “let's stop now at that moment.”), the procedure “rewind” (e.g. a psychologist says: “let's rewind, what happened when.”). The mentalizing of the relationship between the psychologist and Gaga referred to the consideration of the motives of their immediate interaction in situations where the psychologist did not understand or misunderstood Gaga, which caused her strong emotions that hindered her potential to mentalize. When Gaga said sentences like: “You don't understand me”, the psychologist said that he was sincerely sorry that it was so and tried to improve his understanding: “I am very sorry. Help me understand you better and tell me what I misunderstood”. After two months, i.e. after the 10th session with the psychologist, Gaga stopped self-injuring. The final phase included the following 4 sessions. In this phase, Gaga talked about her experiences from her significant interpersonal relationships. The psychologist helped her continue to successfully control her emotions and have positive IWMs. The agreement was that there is no strict time when treatment stops, but that she can come when she needs to talk. The psychologist, in cooperation with the class teacher, monitored Gaga's achievement and behaviour at school until the end of her first grade.