Self-reflection is a developmental competence that fully emerges in adolescence. In this paper, self-reflection development is explored from the perspectives of developmental psychology, resilience studies, and developmental psychopathology as a way to deepen clinicians' understanding of the clinical relevance of self-reflection development. Literature on narrative identity formation in normative adolescence is reviewed, and research on self-reflection in narratives of high-risk adolescents participating in a 30+ year ongoing longitudinal study of adolescent developmental psychology and psychopathology is presented. A theoretical synthesis is proposed to account for the relations between self-reflection, competence and resilient outcome.