First of all, Dr. Ellman doesn't know Justin, so that is quite a leap. And second of all, Justin was making so much progress in season 4 towards loving himself and letting others in. Not to say he didn't have his moments of weakness when Clay lashed out at him or Jessica Davis (Alisha Boe) started dating someone else, or when he turned back to drinking at a party, but for the most part he was doing better. He went to rehab and was putting in the work at meetings. He was prioritizing his sobriety. He was excited to go to college. He told Jessica that he wasn't sure what came next for him in life but he was focused on "trying not to die" and staying out of jail.