The Use of A Psychodynamic Semi-Structured Personality Assessment Interview in School Settings

Abstract

Background and goals: Research on adolescent personality development has been limited and of- ten bases its premises on studies of adult behavior. Growing awareness of the vicissitudes of adolescent de- velopment details the developmental pathway between childhood and adulthood and recognizes its unique dimensions. There has been a five-fold increase in empirical studies examining borderline personality disor- der (BPD) in adolescents over the last ten years with BPD cited as a general factor of personality pathology. There is a need for practical assessment tools that can measure personality functioning and pathology and can be used by practicing clinicians. Since DSM utilizes adult criteria for the assessment of personality during adolescence it fails to recognize the specific developmental characteristics of PDs, because observable behav- iors quickly change while the personality organization could remain more stable or arrested. Recently, a con- sistent effort has been made in promoting a psychodynamic oriented assessment of PDs even during adoles- cence, stressing the difference between personality organization and PD considering three domains which have also a neurobiological relevance (1) identity formation, (2) interpersonal relations (3) affect regulation.
Method: This article describes the use of a semi-structured interview, the Interview of Personality Organiza- tion Processes in Adolescence (IPOP-A), in the school setting. We present a series of case vignettes to illus- trate how it can be employed to assess personality functioning, and also how it can be used to help promote self-reflection in adolescents.
Conclusions: The IPOP-A offers a valid and reliable psychoanalytically oriented empirical instrument high- lighting the stages and tasks of adolescence. It addresses functioning in three essential contexts: home (fam- ily), peers (social, interpersonal), and school. The interview has proven valuable both with clinical and normal subjects. This article emphasizes adolescence as a second opportunity for self-other development emphasizing change in perspective and behavior. Not all adolescents are the same and the multiple processes of develop- ment during this period focus on increasing awareness of self-other, self-regulation and self-determination. The IPOP-A seems to be a promising tool useful in the clinical assessment and in-take sessions with adoles- cence with emerging patterns of personality pathology and in the field of adolescent personality development research.

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The Use of A Psychodynamic Semi-Structured Personality
Assessment Interview In School Settings
Audrey J. Clarkin*, Massimo Ammaniti and Andrea Fontana
New York, USA
Abstract: Background and goals: Research on adolescent personality development has been limited and of-
ten bases its premises on studies of adult behavior. Growing awareness of the vicissitudes of adolescent de-
velopment details the developmental pathway between childhood and adulthood and recognizes its unique
dimensions. There has been a five-fold increase in empirical studies examining borderline personality disor-
der (BPD) in adolescents over the last ten years with BPD cited as a general factor of personality pathology.
There is a need for practical assessment tools that can measure personality functioning and pathology and can
be used by practicing clinicians. Since DSM utilizes adult criteria for the assessment of personality during
adolescence it fails to recognize the specific developmental characteristics of PDs, because observable behav-
iors quickly change while the personality organization could remain more stable or arrested. Recently, a con-
sistent effort has been made in promoting a psychodynamic oriented assessment of PDs even during adoles-
cence, stressing the difference between personality organization and PD considering three domains which
have also a neurobiological relevance (1) identity formation, (2) interpersonal relations (3) affect regulation.
Method: This article describes the use of a semi-structured interview, the Interview of Personality Organiza-
tion Processes in Adolescence (IPOP-A), in the school setting. We present a series of case vignettes to illus-
trate how it can be employed to assess personality functioning, and also how it can be used to help promote
self-reflection in adolescents.
Conclusions: The IPOP-A offers a valid and reliable psychoanalytically oriented empirical instrument high-
lighting the stages and tasks of adolescence. It addresses functioning in three essential contexts: home (fam-
ily), peers (social, interpersonal), and school. The interview has proven valuable both with clinical and normal
subjects. This article emphasizes adolescence as a second opportunity for self-other development emphasizing
change in perspective and behavior. Not all adolescents are the same and the multiple processes of develop-
ment during this period focus on increasing awareness of self-other, self-regulation and self-determination.
The IPOP-A seems to be a promising tool useful in the clinical assessment and in-take sessions with adoles-
cence with emerging patterns of personality pathology and in the field of adolescent personality development
research.
Keywords: Adolescence, development, personality disorder, psychodynamic foundations, reflective func-
tioning, stages and tasks of adolescence.
INTRODUCTION
Adolescence provides a second opportunity for
personal development and growth. It is a period of
reorganization of self and other representations.
However, it is also a period in which prior devel-
opmental risk factors begin to emerge with symp-
tomatic features of anxiety, depression, and per-
sonality dysfunction (Bornovalova, Hicks, Iacono,
& McGue; 2008; Casey, Jones, & Somerville,
2011; Cicchetti, & Crick, 2009; Shiner, 2009;
*Address correspondence to this author at New York, USA ;
Tel/Fax: ????????????; E-mail: ajclarkin@hotmail.com
Westin, Betan, & DeFife, 2011). Early identifica-
tion of problems and timely intervention is crucial
for positive outcome (Chanin & McCutcheon,
2013). The most critical period for adolescents has
been described as between ages 14 and 17.
As we have pointed out, assessment must go
beyond identification of symptoms and confirming
or ruling out DSM diagnoses (Ammaniti et al.,
2012). The key features of the assessment proce-
dure with adolescents should take into account the
crucial importance of differentiating between nor-
mal identity crisis and identity diffusion, the qual-
ity of object relations, the capacity to modulate

2 Adolescent Psychiatry, 2015, Vol. 5, No. 4 Clarkin et al.
affective experience, with particular importance
given to the modulation of aggression, the devel-
opment of a healthy moral values system, reality
testing, and finally, defensive functioning (O.
Kernberg, 1998; P. Kernberg, Weiner, & Barden-
stein, 2000). There is a pressing need to develop
clinically sounded and empirically grounded tools
for the assessment of personality development in
adolescence. The need for such assessment meth-
ods, while important in all clinical settings, is par-
ticularly acute in school settings, where evalua-
tions determine what services are provided and
even if the student can remain in the school. The
students cited in this article were all referred to the
counseling center. Three of the five subjects ex-
hibit profiles on our semi-structured interview
called the IPOP-A similar to the norms for clinical
subjects at the first interview. Six to nine months
later, there was improvement due to prescribed
intervention.
Schools offer a long-range view of students
over time and encompass developmental changes
(DeFruyt & DeClercq, 2014). It should be noted
that schools in the United States provide a wide
representation of services as they depend on local
tax funds. Some districts provide maximum re-
sources, while others struggle with supplying basic
textbooks, adequate staff and attention to students’
critical needs, e.g., food, shelter, adult supervision.
Optimally, schools can provide a consistent, struc-
tured environment and daily contact with signifi-
cant adults and a variety of peers. Ideally, expecta-
tions for achievement and behavior are made clear,
and the adolescent who is reducing parental de-
pendence finds support in the school setting. The
school system is a setting in which both growth
and dysfunction emerge beyond the boundaries of
the nuclear family.
Certainly, there are students at risk within
schools who present a daily challenge to school
staff. The school system with its professional per-
sonnel can provide a setting in which early detec-
tion and intervention can occur. It is an important
judgment call when the school decides to alert
family and/or parents. Imminent danger regarding
self and others necessitates such a response.
Abuse, neglect and significant deviation from the
normal developmental paths prompt school offi-
cials to alert family and request parental permis-
sion to pursue the problem. Intervention might in-
volve individual assessment, special academic
programming and/or individual or group counsel-
ing. There is a critical need for valid and reliable
methods of assessment that can be used in school
settings to identify the risk of aberrant develop-
ment and guide interventions to promote a trajec-
tory of healthy growth. An assessment tool that
involves the adolescent in thinking about himself
has the potential to be useful not only for evalua-
tion but also for promoting reflective thinking. The
IPOP-A shows promise as such a tool; it has been
successfully utilized in a school setting and offers
a valuable assessment tool that can direct further
clarification based on the individual’s responses.
The IPOP-A addresses the critical tasks of adoles-
cence in the context of identity, relationships to
self and other, affect regulation, and moral sense.
THE IPOP-A
The IPOP-A1 is a semi-structured interview that
can be administered to students in a variety of set-
tings, including schools. It provides an initial pic-
ture of adolescents as they develop through the
years from 12 to 19. The IPOP-A is a sensitive in-
strument that can elicit current feelings, thoughts,
and reactions and pursue their origin and change
during the past year. It allows the interviewer to
ask questions for clarification and elaboration
without posing a threat to the individual.
Colleagues from the Unites States and Italy
(Ammaniti, Fontana, Kernberg, J. Clarkin, & A.
Clarkin, 2011) developed the IPOP-A based on
psychodynamic clinical and theoretical founda-
tions with reliability and validity research. The
IPOP-A has shown inter-rater reliability with reli-
ability scores ranging from .89 for object relations
inside the family to .96 for risky behaviors. The
major IPOP-A domains also demonstrate internal
consistency with Cronbach’s Alpha ranging from
object relations inside the family (.93) to risky be-
haviors (.77). Estimates of concurrent validity
were obtained by correlations with the Millon
Adolescent Clinical Inventory (MACI) (Millon,
Davies, & Millon, 1993) and with the DERS
(Weinberg, Klonsky, 2009). For example, Identity
Disturbance on the IPOP-A is significantly corre-
lated with Borderline Tendencies (.66), Avoidant
(.60) and Schizoid (.43) Personality Pattern scores
on the MACI. As theoretically expected, identity
1 The instrument can be obtained upon request from Dr. Andrea
Fontana at: andreafontanaweb@gmail.com

The Use of A Psychodynamic Semi-Structured Personality Adolescent Psychiatry, 2015, Vol. 5, No. 4 3
problems in adolescence are associated with per-
sonality disorders (Kernberg, P., Weiner, Barden-
stein, 2000). Difficulties in object relations with
peers on the IPOP-A are significantly correlated
with peer insecurity (.43) scores on the MACI,
while difficulties in object relations inside the
family are significantly correlated with child abuse
(.47) scores on the MACI. Futhermore, Affect Re-
gulation on the IPOP-A is significantly correlated
with emotional non acceptance (.33) and lack of
strategy (.44) in dealing with emotions, measured
by the DERS. The IPOP-A has been used to dis-
criminate between nonreferred adolescents and
adolescents referred to a clinical setting, with all
the IPOP-A scores significantly higher in clinical
adolescents (see Table 1). We have described in
detail the evolution and development of this in-
strument in an earlier article (Ammaniti, Fontana,
J. F. Clarkin, A. Clarkin, Nicolais, & Kernberg,
2012) and reported on its clinical and theoretical
implications elsewhere (Ammaniti, Fontana, &
Nicolais, 2015).
Although the IPOP-A derives from the Struc-
tured Interview for Personality Organization
(STIPO) (Stern, Caligor, Clarkin, et al., 2010) the
IPOP-A emphasis is on the developmental proc-
esses rather than on the structure of personality.
The IPOP-A requires 45 minutes to administer to
an individual adolescent and explores the adoles-
cent’s perception via affective experiences of eve-
ryday life that they are asked to consider: they are
asked to describe how they would experience and
react to various situations.
The IPOP-A can detect differences in self-
representation (identity and self-description) and
quality of object relations so that interpersonal fac-
tors (empathy and intimacy) emerge regarding self
and other. The IPOP-A focuses on personality and
is growth oriented rather than on symptoms and
pathology. It provides a valuable tool for discrimi-
nating issues and problems and can offer a first
step in determining the need for further
tests/evaluations. It addresses three adolescent de-
velopmental stages (early, ages 12-14, middle, 15-
16, and late, 17-19) and provides specific scoring
on identity, quality of peer relations, affect regula-
tion and moral development at each level.
Whereas the IPOP-A is a semi-structured inter-
view, many of the questions are open-ended
enough to allow the adolescent to reveal his/her
own perspective on every day issues of friendship,
involvement, and goals.
A critical value of the IPOP-A is its attention to
self-definition as it transforms from early adoles-
cence to the integration of bodily, sexual changes
in a realistic and mature body image with the ca-
pacity to invest in school activities, friendships,
hobby and future goals. Throughout adolescence it
is the self-sameness that is critical to adolescent
development. Adolescence is characterized by an
intense need for peers, satisfaction of bodily and
sexual pleasures and an underdeveloped control
center (Casey, 2011). Healthy adolescents reflect
on various relationships as opposed to activating
an immediate behavioral response, the latter typi-
cal of asocial behavior. This reflective capacity
with its diversity of interpersonal relationships
prompts revision of former attachment models al-
lowing parent/adult influences to diminish and in-
creasing peer influence. Adolescents diagnosed
with a personality disorder tend to be high on
negative affect and rejection sensitivity and low on
effortful control.
Table 1. Five Domain IPOP-A Scores For Each Ado lescent.
Identity
Object Relations Family
Object Relations Peers
Affect Regulation
Risky Behavior
Non-clinic subjects
.25
.25
.27
.25
.08
Clinic subjects
1.12
1.08
.92
.96
.58
Anna (17 year old female)
1.33
1.71
1.00
1.31
.00
Joseph (17 year old male)
1.56
1.14
1.00
1.31
1.33
Ted (16 year old male)
1.44
1.29
1.22
.63
.67
Louise (15 year old female)
.56
1.14
.78
.88
.33
Jim (16 year old male)
.78
.13
.78
.63
1.00

4 Adolescent Psychiatry, 2015, Vol. 5, No. 4 Clarkin et al.
Adolescent responses on the IPOP-A are also
indicators of their ability to regulate affect. Affect
regulation is a sensitive index of the healthy per-
sonality and its dysregulation constitutes one of
the main characteristics of borderline personality
(Fonagy, Bateman, 2008). Healthy subjects tend to
respond with their personal affective reactions
while more disturbed subjects reply incoherently,
changing topics, avoiding affect and responding
negatively. Significant gender differences exist;
females tend to have personality profiles that are
more emotionally dysregulated, while males’ pro-
files are more externalizing and behaviorally ag-
gressive.
The following case vignettes with responses to
the IPOP-A present a descriptive spectrum of ado-
lescent developmental pathways and the valuable
information that was derived from each one as evi-
denced by their responses to the IPOP-A within
the school setting. All students were Caucasian
and belonged to economically stable families. The
interviewer’s questions are in italics, and followed
by the adolescent’s responses.
In order to further inform the reader concerning
the subjects, each adolescent’s scores on the five
major domains of the IPOP-A as compared with
non-referred and referred clinical subjects norms
are presented in Table 1.
CASE VIGNETTES
Louise
Louise is 15 years of age and in the 10th grade.
She entered ninth grade and attached herself to
two depressed non-functioning boys with whom
she spent most of her time, helping them with
school work, listening to their problems while ne-
glecting her own school responsibilities and for-
mer friends. She went from being an A student to
getting C to C- grades. Louise participated in a
weekly school social group, and she slowly real-
ized her situation and resolved to reconnect with
school, classes and previous friends. The follow-
ing year in grade 10 she is happier and more satis-
fied with self. Louise realizes her role as helper
was hurtful to self.
What are you like as a person? Give exam-
ples of positive and negative. Well, I’m
more like I used to be. Last year was differ-
ent for me – new, bigger school, no close
friends in my classes, impersonal teachers,
well it was just hard.
How did you handle all that? Not well. I
became overinvolved with two boys, not
romantically, but more as a super helper,
always available, cheerful and giving.
And were you happy with that role? At first,
yes, it was nice to be needed but then it be-
came too much! It got to me, my grades suf-
fered and I wasn’t having fun. My best
friend all through school hardly talked to me
and I missed her.
So what happened? I learned more about
what I wanted and now I’m back to my
music, my old friends and getting good
grades.
Do you regret that you left those two boys?
No, it wasn’t good for me or them. I still say
“Hi” but don’t spend my time with them.
Do you have a best friend? Yes, the one
I’ve had since elementary school. We’re
alike, have fun together and spend time at
each other’s houses, or we’re on the phone
or computer with each other. It’s great!
Jim
Now in his second year (10th grade) of high
school at age 15, Jim can look back to last year
and verbalize his problematic transition to high
school. He missed his old friends, neglected aca-
demics, experienced strong conflict with his father
over his school behavior and failing grades and
had angry, even physical exchanges with his fa-
ther. Jim attended a rigorous summer sports camp
and in his words, “grew up.” Now he has appro-
priate friends, is succeeding at academics and
sports, and has some friends who are girls. His re-
lationship with his father has improved and he
states that he’s in a better place now. His scores on
the IPOP-A dimensions of Identity, Self-
Regulation and Relationships with Peers now fall
within the normal range.
Jim, you make it sound as if you’re a different
person. Well, in lots of ways I am. I don’t know
what you call it but I grew up. I can now talk to
my parents about all kinds of things and they’re
helping me to make summer plans to go to sports

The Use of A Psychodynamic Semi-Structured Personality Adolescent Psychiatry, 2015, Vol. 5, No. 4 5
camp and visit my older cousin in Carolina. It’s so
much better.
Ted
Ted is 16 years of age and in grade 11. The
family had moved frequently due to his father’s
job. Before his parents divorced last year, he and
his 12 year-old brother witnessed intense negative
parental physical and emotional exchanges. Ted
now lives with his mother and brother and seldom
sees his father who moved to a different state.
He’s reconnected with some friends and is on a
sports team and involved in school activities.
Ted’s acting out and aggressive behavior became
known to the school psychologist in ninth grade.
He was seen individually on a weekly basis by the
school psychologist during that year and sessions
continued in the following year in tenth grade. The
counselor encouraged him to think aloud about
where he was and where he wanted to be. At first,
he resented this contact but gradually formed a
more positive self-image and now is willing to
admit it helped.
Ted, describe yourself now so I get a good
picture of what you like and what you don’t
like about you. Well, Right now, I’m not
sure about a lot of things. I don’t even like
myself sometimes but it’s better. I have
some friends and I’ve joined the debating
team and the “midnight run” team.
What’s that one?
Once a month a whole group of my class-
mates stay late after school, make sand-
wiches and prepare snacks for homeless
people in the Bronx. Most kids don’t want
to go down there but I’ve done it. It’s an eye
opener. I never knew people could be so
poor and live on the street. It makes me feel
like I’m helping.
And in the future, do you have any ideas?
Well, I’ll go to college and maybe study law
so I can help poor people.
Joseph
Joseph came to the school district in fifth grade.
He is an only child with divorced parents and a
mother who is “all giving.” In middle school, Jo-
seph failed several subjects and was connected to a
negative peer group. He did begin individual ther-
apy outside of school but stopped, claiming “it was
no help,” “I didn’t like the woman.” Joseph is im-
pulsive, a risk-taker, and likeable but irresponsible.
Now 17, he is in the 11th grade in high school. He
has been caught stealing, showing no remorse. Jo-
seph has gotten involved with drugs and frequently
is truant from classes and from his counseling
group in the school. He did join a theatre group
that he likes. However last month, he assaulted a
shopkeeper, was suspended from school and rec-
ommended to an alternative program. When asked
about his future, Joseph states he plans to leave
school before graduation and doesn’t know what
he will do.
Joseph, sounds as if you get into a lot of trou-
ble? What’s the payoff for you? Is it exciting?
Yeah, I guess so. I jump into things. Some work
but others give me more trouble. Right now, I’m
in big trouble. My parents had to go with me to
the police station. I took a sports hat from the
store and the owner saw me. I hit him as I was
running out of the shop. I have to go a different
school because of that but they haven’t found a
place for me. Maybe I’ll just quit school. I never
liked it.
Then what? I’ll get a job.
Think that will be easy? Well, I can try.
Anna
As early as age 7, Anna exhibited rage reac-
tions, fluctuating moods, and was overattached to
her mother and resentful toward her father, and
had minimal peer relationships. She showed a lack
of consistency in her studies and seemed unable to
form meaningful friendships. Hannah often
dresses in a conspicuous fashion.
Anna often projects her negative self-image on
to others with a critical view of what is wrong
with everyone. Although she is of above average
intelligence, Anna performs below expectation in
all areas – academic, social, athletic. She has re-
fused all types of school help whether it was Re-
source Center for academics, or group and indi-
vidual counseling. Over the years, her parents
have provided a private tutor and an individual
psychotherapist. At age 17 in the 12th grade,
Anna was interviewed with the IPOP-A on a cold,
winter day. She was wearing very short black

6 Adolescent Psychiatry, 2015, Vol. 5, No. 4 Clarkin et al.
shorts, black stockings and a T shirt. She had
pink hair which she admitted doing “to be differ-
ent.” Based on her history alone, one can predict
long-term impairment with the possibility of self-
harm.
How would you describe yourself? What are
you like as a person? I don’t know, I can’t.
It’s complicated. I want my own way.
Sometimes I act funny, you know silly so
people will like me.
And other times? I don’t care what others
think of me. It means I don’t care if people
think I’m different. Well, no one else in this
school has pink hair and dresses like me. I
don’t care. I just don’t belong.
Have you friends? I hang out in the guid-
ance office. There are always other kids
there.
What about the lunch room? I never go
there.
What about after school and weekends? I
don’t see other kids. I’m usually on the
computer with my cousin.
Do you have a boyfriend? No, never. I used
to play with boys in my neighborhood but
they don’t even say hello now.
Would you say you have a best friend? My
mother is my best friend. She knows me
best and helps me.
Since you’re in your last year, what do you
want after high school? I don’t know. I
guess college like everybody else in this
school.
What do you want to study? I don’t know.
The first year, you don’t have to decide.
And after that? Maybe I’ll do art.
So if you need help, do you think about talk-
ing to your brothers, or friends at school?
Do you compare youself to others? No, they
wouldn’t help. I don’t care, I don’t belong.
No, my brothers are always busy with
sports. I don’t have close school friends. I
don’t care. I don’t belong. My cousin is my
friend and I often am with her.
DISCUSSION
Louise, now in her second year of high school,
was able to reflect on her obsessive attachment to
two needy male students and her wish to help
them. She was able to evaluate the damage this
caused her, was able to integrate both care for oth-
ers and for her self. She seems to be back on track
in terms of reconnecting to old friends, success at
her studies, and happier with the way she is now.
No intervention is indicated.
Jim had a positive summer experience at an in-
tensive sports camp with positive role models and
has returned to high school and to family, espe-
cially his father with a positive attitude. The
school will monitor Jim during the next year. He
acknowledges that he is maturing.
Ted has a history of family stress and conflict.
He seeks help within the school and should con-
tinue contact with the school psychologist either
bi-weekly or monthly.
Joseph continues to be impulsive, action ori-
ented, an externalizer who lacks self-reflection. He
will be attending an alternative program in a more
supervised setting and will require close monitor-
ing.
Anna who has a history from age 7 of temper
tantrums and willful behavior has refused all
school help over the years. Her parents recognized
her problems and have ongoing contact with the
school counselor and have provided her with pri-
vate tutoring and psychotherapy. Her affect dys-
regulation interferes with interpersonal relation-
ships. She is at high risk for self-harm and future
difficulties.
GENERALIZATIONS ABOUT THE INDI-
VIDUAL VIGNETTES
One can make generalizations about these case
vignettes, as they illustrate both aspects that are
unique to the individual adolescent, but also pro-
vide comparisons of success or failure in meeting
challenges of adolescent development. Although
some of these adolescents might meet criteria for
specific psychiatric diagnoses, this is not the intent
of the IPOP-A. Rather, as the vignettes illustrate,
the IPOP-A provides a description of the adoles-
cent’s individual progress on essential develop-
mental tasks common to all adolescents, and pro-

The Use of A Psychodynamic Semi-Structured Personality Adolescent Psychiatry, 2015, Vol. 5, No. 4 7
vides a marker of how the individual adolescent
compares to others of the same gender and age.
SUMMARY AND CONCLUSION
In evaluating the most significant IPOP-A items
the following provided a reliable measure of
adolescent development and differentiates their
strengths and limitations regarding identity, object
relationships, affect regulation and moral stance.
The IPOP-A offers an in-depth description of indi-
vidual personality, it is growth-oriented not
pathologically directed. The IPOP-A elucidates
significant factors that interfere with normal ado-
lescent development, i.e. cognitive deficits, inter-
mittent loss of reality testing, poor stress tolerance,
inability to manage stress and episodic behavioral
dsycontrol.
The IPOP-A is a theory driven semi-structured
interview that can be effectively used in a variety
of settings (Ammaniti, Fontana, & Nicolais, 2015)
to provide a rapid assessment of the individual
adolescent’s progress on universal developmental
tasks. This article describes the effective use of the
IPOP-A in a high school setting. The school set-
ting provides a consistent, long-term setting for the
observation and potential correction of the adoles-
cents’ developmental pathway through grade and
high school years. Vignettes of individual adoles-
cents demonstrate the positive reception of the in-
terview by adolescents and illustrate how the in-
terview captures the developmental trajectory of
the individual, which can be used as a basis for
communication with school personnel and parents
and guide corrective action.
Bornovalova and colleagues (2008) based on
their research on borderline personality disorder in
adolescents, state that the critical risk period for
BPD characteristics is between 14 and 17 years of
age. This is the period during which symptoms are
at their peak. Some adolescents get off track, learn
from the experience and get back on track. Others
do not. When an adolescent has difficulties both
with self-definition and accurate representation of
others, it is more serious. The ability to learn and
correct a deviant path is relevant to positive devel-
opment. The IPOP-A offers an invitation to the
adolescent to reflect on a growing sense of iden-
tity. It provides a scaffolding for the adolescent to
think about different aspects of self and to synthe-
size a more positive self image and a stronger con-
nection with others. The IPOP-A is a valuable in-
strument for school personnel to derive a sense of
the adolescents’ strengths, needs, and issues and to
move on to provide positive help. Assessment,
counseling, family involvement can all be avail-
able to help the adolescent find a positive self im-
age.
This article serves as an introduction to adoles-
cent pathways of development, both normal and
deviant. It does not address long term self harm
actions such as successful suicide, serious drug
usage, repetitive bodily harm to self and others.
School personnel must recognize these serious
conditions in their efforts to help the teenager de-
velop greater emotional regulation. Adolescent
pathology requires that those who work with this
age group must be optimistic, knowledgeable, and
open to different approaches to behavioral im-
provement.
Not all high school students have a smooth, un-
eventful development. Challenges exist based on
temperament, family support, and positive per-
sonal qualities. Peers can also play an important
role in the adolescent transformation. Of the five
students described in this study, three presented
with profiles encompassing the five domains as
more similar to clinic subjects. Because adoles-
cence is a learning experience, some teenagers can
grow in self awareness and become more positive
in their personal and career choices while others
require supervised direction and support.
ABOUT THE AUTHORS
Massimo Ammaniti, M.D., is a psychoanalyst,
a member of the International Psychoanalytical
Association, Professor of Developmental Psycho-
pathology at the Training School for Clinical Psy-
chologists at the Sapienza University of Rome,
former member of the Board of Directors of the
World Association of Infant Mental Health, and
Honorary Professor at the University of Rome.
Audrey Clarkin, Ph.D., is a Consultant Psy-
chologist to Scarsdale High School; in Private
Practice in Larchmont, N.Y and former Director of
Psychology for the Scarsdale, New York School
District.
Andrea Fontana, Ph.D., is Adjunct Professor
of Psychological Assessment at Libera Università
Maria Ss. Assunta (LUMSA) University, Rome.

8 Adolescent Psychiatry, 2015, Vol. 5, No. 4 Clarkin et al.
CONFLICT OF INTEREST
The authors confirm that this article content has
no conflict of interest.
ACKNOWLEDGEMENT
Declared none.
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Received: October 27, 2015 Revised: December 17, 2015 Accepted: January 17, 2015