You'll have to excuse me because I am highly annoyed with psychiatric thinking... I know you are well read but my thoughts kind of just flow out when i come here...but interesting discussion to me since I have issues in this area too.

If it comes more from long ingrained traits, I strongly feel that psychoanalytic therapy is good for that. Your first therapist, if I recall correctly, wasn't that skilled in managing his transferences and worked in a way that resulted in therapy becoming about the relationship with that T. Too bad you ran into him.

Although outdated and oversimplified, I found the concept of id, ego, and superego to be one of the most helpful things in understanding how my brain works. Psychoanalytic therapy, although it takes years to realize impact, eventually retrains your ego to regulate id and superego due to the emphasis on defense work. That's one reason I support that therapy-it's one of the few things that leads to permanent change, although it's risky to do that therapy. Despite having a severe trauma history and attachment problems, it's not all about the relationship imo.

I have self destructive behavior too but think mine is more related to trauma and introjection. Was that after you had issues with bullying? You might have some introjection too, where the trauma sort of melts/binds with your internal processes and sense of self.

The behavioral part, I think, can have an impact as not waiting for motivation to do things can ingrain a new habit over time. It is easier said than done I know. Self sabotage can be so many things.. Have you ever considered Intensive short-term dynamic psychotherapy (ISTDP)?

Afterthought-it might be worth a try to seek an analyst 70+ who does both analytic therapy and psychiatry.