234 GREENSPAN, HATLEBERG, AND CULLANDER The_profile assesses personality functioning sequentially, going from a broad, encompassing perspective to specific eval- uation in detail. The initial categories focus on the.overall in- tactny and flexibility of the ego, while the later categories consider specific ego functions, superego, Obj lations, af- fects, defenses, and drives. The profile is constructed to take into account th the individual. Impressions are base? ~~ ~ ~~ age-expected developmental accon reensgon, S level of development. In order to arr fe a knowledge of developmental stage The co code of | is necessary. The theoretical struct Vv Hy presented, followed by a case illustre *’ Wwe EvA, Introduction to the Profile Narrative accounts of evaluation interviews, and auxiliary data such as psychological testing and school reports, should be followed by a metapsychological assessment of the person’s functioning in the format presented here. In this format the interviewer first describes the individ- ual’s functioning in each category. Following this, he is to rate his impressions from “good” to “inadequate.” Whether ratings can be applied to the descriptions is an open question and should be attempted with this in mind. Ratings are indicated by a check in the appropriate box. If the area of functioning falls between two of the descriptions, e.g., fair to good, a check is placed on the line between the two relevant boxes. In addition, confidence in the accuracy of the rating is indicated on a scale of 1 to 3, with 3 indicating relative confidence and | indicating relative lack of confidence. Systematic descriptions in each category have been devel- oped to help orient the interviewer toward a systematic report of his impressions. ‘The descriptions are not intended to be comprehensive but rather to give the flavor of those areas of functioning that are to be assessed. It should be emphasized that the style and structure of the session with the individual is to be one’s own, independent of this outline. It is to be ex- Greewr_pepanwSYSTEMATIC PERSONALITY ASSESSMENT 235 pected that it may not be possible to gain impressions of all the listed areas. For ready reference and visibility a rating sheet appears as Figure 1. Category 1: Ego Intactness (vs. Ego Defects) Included in this the general basic integrity of the ego—an overall evaluation of ego apparatuses and fui tions. ‘a: Ego apparatus. Thi des the basic organic category integrity of the €go: the perceptual, visual, auditory, and motor ap, apparatuses that coordinate these (perceptual- motor); diher similar apparatuses, such as memory, that have to do with the integrity of the mental apparatus. b. Basic ego functians. This category includes only the basic overall functions of the ego (e.g., reality testing, predominance of secondary process thinking, presence of ego boundaries). Special atte! Id be paid 10 the more subtle aspects of these functions that will give the interviewer clues about, well- hidden_borderline tions, for example, the predomi- nance of magical thinking, exireme impulsiveness, and avoid- ance and withdrawal covering up a subtle ego defect. In evaluating this category, attention must be paid to what would be considered age-appropriate levels of development in ego functioning. The r € attainment of reality testing, second- ng, and ego boundaries mu he evahirated in table developmental accomplishments : u 2nd exe functions are basically age-appropriate. Interference from neurouc for- mations, developmenial lags, or_organie-dysfunctions are minimal to none. 2. Fair. Physical or psychologicalfactors, e.g., neurological dys- functions, ego defects, neurotic or characterological con- strictions, moderately impair the ego’s capacity for age- appropriate functioning. - 3. Marginal. Same as above, only there is marked interference with the ego’s age-appropriate capacities. as follows:, 1. Good. The organic ego appar236 GREENSPAN, HATLEBERG, AND CULLANDER Figure 1. Metapsychological assessment profile. Categories Good Fair Mar- ginal Inade| quate Conti. dence of Rating 1-3 Scale Ego Intactness a. Ego apparatus b. Basic ego functions Ego Flexibility a.’ Adaptive capaci (1) Relationships (2) Education; learning; work (3) Play b. Intrapsychic experience maladaptive tendencies (1) Organized disturbance (2) Relinquishing area of experi- (3) Unmodified discharge (4) Tendency for fragmentation c. Overall ego flexibility cific Ego Functions Related to Autono- mous and Conflict-free Spheres of the Ego Relationship Potential Superego Functioning Affects Defenses Drive Organization Reality Considerations 10, Intuitive Impressions 1 Capacities for Further Growth 12. RecommendationsSYSTEMATIC PI 237 4. Inadequate. Physical or psychological factors severely inter- fere with the ego’s capacity,¢.g., severe neurological dy function or ego defects result in psychotic processes. Category 2: Ego Flexibility (Adaptive Capacities of the oe Personality) Under this category is assessed the ego's flexibility—its ca- pacity to utilize a variety of finely discriminated operations. At the lower end of this scale would be found a rigid ego with only a few poorly discriminated operations at its disposal. Included in this category are age-appropriate capacities to tolerate in- ternal or external tension and to form and tolerate conf and a variety of affects. The presence of these capacities stands in contrast 16 “Signs Of arrested ego development, severe ego constrictions, below age-appropriate externalizations of inner tensions, and altered or restricted modes of drive gratification. In addition, the individual's capacity to develop transient symp- toms, affective states, or behaviors in response to internal or external ‘stress, which do not interfere with developmentally relevant ego functioning, should be contrasted with the devel- opment of symptoms, affective states, or behaviors which com- promise developmentally relevant ego functions and jead to restrictions in a capacity for further development (c.g., with- drawal). In this category, behavior should be described and rated from two perspectives: (1) flexibility of adaptation .to-devel- opment and phase-expected tasks; and (2) flexibility of the ego in dealing with “intrapsychic” experience. Note: these capacities are separated here for purely conceptual and descriptive pur- poses. a, Adaptive capacities. Under this heading is assessed the individual's ability 6 engage in'@ broad range of life experiences in the major arenas of relationships, work, learning, and play. ‘These experiences may be scored quantitatively by con: the variety and richness of available choices; the dep oO: perience; and the degree of differentiation and appropriate- ness.238 GREENSPAN, HATLEBERG, AND CULLANDER 1. Relationships a. Good. Has full and satisfying age-appropriate relation- ships; e.g., has intimate continuing relatior significant other persons; has friends; feels loved cted in close relationships; €.g., relationships repeatedly get neurotically tangled and/or yield little sat- isfaction. c. Marginal. Severely restricted in close relationships; lim- ited in capacity for maintaining reladonships in general or deriving satisfaction from them. d. Inadequate. Incapable of relationships. ork, Ce cation, or Learning Experiences a. “Good. Works and/or learns at full creative, productive b. Fair. Productivity or satisfaction from work and/or learn- ing limited_or ed: oe c. Marginal. jeverely mited in learning activities and/or work; é.g., major characterological interferences result in frequent self-defeating behavior in home, school,.or career; gets little satisfaction from above. d. Inadequate. Totally unable to maintain work or learning experience or to derive satisfaction fromit.. 3. Play a. Good. Has capacity to relax, experience | enjoy a variety of age-appropriate experiences. 6. Fair. Mild limitations in pflicted about having pleasure. © Marginal. Moderate to severe limitations in capacity for relaxation and pleasure; ¢.g., must always be “ser (studying or working) and, when not, is sleeping; other conflicts often interfere with pleasure. d. Inadequate. No capacity at all for play activities, due to inhibition or interference. ~ 6. Intrapsychic experience. Here is assessed the capacity to form, perceive, and tolerate conflict and to remain in touch with thoughts and feelings (no matter how unpleasant or in- tense) concerning the important issues confronting the individ- ual at the time. Implied is the ability to use these thoughts andSYSTEMATIC PERSONALITY ASSESSMENT, 239 feelings to work out adaptive life solutions. Deviations from this most desirable position may be represented by four tendencies: 1. Tendency toward formation of an age- and phase-appropriate or- ganized disturbance in part of the ego, which condenses, with great economy many other conflicts “and issues and allows the remainder of the ego to i mai short-term, temporary affective Tintusbonces or other states, yet leaves the person still able to involve himself in most life endeavors and to experience a wide range of thought, feel- or. other age-appropriate internal experiences. dency to relinquish age- and phase-appropriate areas of expe- rience by walling off or preventing access to certain types of behaviors, thoughts, or affects, e.g.) limited capacity to ex- perience anger, love, sadness, anxiety, sexual feelings and fantasies, etc. The expectable range of thoughts and affects is limited by certain of these being walled off by the ego; the ‘ego ives up flexibility through avoidance of the expectable ‘range of inner experience. The ego may also relinquish areas of behavior to protect itself, e.g., avoidance of intimate het- erosexual relationships or intimate friendships, avoidance of accomplishment in work, avoidance of all human rela- tionships, etc. In this category the ego may be dominated by an 6verwhelming defensive operation. This would include many character disorders, chronic affective disorders, and developmental arrests. 3. Tendency toward unmodified discharge of drives or expression of affects, e.g., impulsive, aggressive, or sexual behaviors; extreme affect states (€.g., manic states); may include sexual perversions. 4. Tendency toward fragmentation of age- and phase-expected levels of ego organization under stress, ¢.g., in_an older child or adult, compromise in basic ego functions such as reality test- ing, integration of thought and affect, cohesion of sense of self and sense of other (feelings of depersonalization, de- realization), loss of attention to outer world (total withdrawal, acute psychotic phenomena). This fragmentation may be240 GREENSPAN, HATLEBERG, AND CULLANDER encouraged by the use of primitive defenses, such as. pro- jection or denial, Standards for rating each style of ego flexibility 1. Tendency toward formation of an organized disturbance a. Good. Tendency to form organized disturbance is tran- sient, appearing when person is under stress (e.g., tran- sient phobia). 6. Fair. Organized disturbance pearing with only minor stress. Marginal. Organized. disturbance is chronic and severe. While in part protecting the other areas of ego function, it is quite painful, ¢.g., severe obsessive-compulsive symptoms such as hand washing, chronic doubting, etc. Inadequate. Organized disturbance. i and potentially debi more continuous, ap- awn sexuality that keeps person awake at night. Com- extremely painful. 2. Tendency to relinquish areas of experience ood. Tendency t relinquish axcas. of feeling. thought, or experience is minor sient and related to in- ternal or external stress, es .. Mild withdrawal after a ionship breaks up. , b. Fair. Te eee relinquish areas of feeling, thought, or experience ig moré continuous, though only ir limited life areas, e.g., moderate, continuous avoidance of competition. e. Marginal. Tendency to relinguish, areas of feeling, thought, or éxperience is “shows itself in major life areas, e.g., avoidance Iintimacy. d. Inadequate. Tendency to relinquish areas of feeling, ought, or experience is chronic and shows itsel sO. many areas of life as to be debilitating, e.g.) Wi chidrawval from all human relationships. a rendency toward unmodified discharge Good. Occasional—in relationship to stress. Fair. More continuous, but.xelatively minor incidents, e.g., regular mild tempertantrums.SYSTEMATIC PERSONALITY ASSESSMENT 241 Marginal. Chronic and severe, ¢.g., sexual perversion. many potentially aS 4.7 Tendency t toward fragmentation . Good. Very occasional episodes of fragmentation under very extreme stréss and Of Iowéred capacity for integra- tion, ©. occasional depersonaliz tion, when getting to sleep, working very hard, or under extreme psycholog- ical stress. Fair. Occasional episodes of fragmentation in the context of moderate internal or external stress, e.g., feelings of derealization when very angry. ° ¢. Marginal. Frequent episodes of fragmentation, e.g., fre- quently féeling’ tinreal, illusionary experiences, misper- ception of reality, e.g., paranoid fantasies, dissociation of paris of self (object and self-object splitting), etc. d. Inadequate. Total experience of fragmentation, psychotic delusions, €.g., bodily dehisions, hallucinations, perse- cutory delusions, total disintegration of affect regulation and/or tolerance (completely flat affect), etc. c. Overall ego flexibility. This category includes both intrap- sychic and reality-adaptive aspects. of ego flexibility. 1. Good. The ego demonstrates age-appropriate flexibility in its response tO internal or external stress. ‘Developmental in- terferences and Conflicts, neurotic conflicts, and neurotic formations only minimally interfere with this flexibility. Either no impairment or very mild i flex- ibility, e.g., a mild Organized disturbance such as some pho- bic tendencie: 2. Fair. The ego is somewhat rigid in terms of age-expected capacities, but along with this rigidity there is a capacity to tolerate internal or external stress of varying degrees without marked disruptions in age-appropriate ego functioning. May have #1 tendency to mild organized disturbance, e.g., pho- bia; may have some minor #2 tendency to relinquish areas, e.g., tends to deny anger at authority or to avoid competition242 GREENSPAN, HATLEBERG, AND CULLANDER, with authority; mild use of #3 unmodified discharge, e.g., mood swings under stress; very rare use of #4 fragmenta- tion, and only under extreme stress, €.g., occasional deper- sonalization. 3. Marginal. The ego tends to be quite rigid in regard to age- expected capacities. Internal and/or or external stress “jn age-appropriate égo functioning: e.g., in a latency child _there are occasional losses of age-appr6priate reality testing, “severe states of inhibition, or markedly impaired impulse regulation. Moderate to severe use of #2 relinquishing areas, “e.g., the very passive individual who avoids almost all ex- periences of rage, expression of anger, or assertion; or the narcissistic individual who avoids any intimacy and cannot experience balanced empathy; moderate use of #3 unmod- ified discharge, e.g., severe-mood swings, some perversions, impulsiveness; moderate use of #4 fragmentation,.e-g.,. loss of reality testing under stress, depersonalization, etc. The ego is severely limited in its age-appropriate inated operations (defenses) to cover more basic earlier structural defects (as is seen in psychotic or borderline organization). Where the ego is in its carly formative stages, it is severely limited in its capacity to to further its own development, Severe use of #2 relinquishing areas, and of #3 unmodified discharge and/or fragmentation, e.g. psychotic character disorder, extreme lability of affect, per- versions, and psychotic phenomena. For a more differentiated assessment, the interviewer may also rate the person’s ego flexibility for each style of ego in- flexibility and for overall ego flexibility in each of these life areas: (1. Relationships a. relationship with one or a few individuals b. _ friendship—telationships in general 2. Work 3. PlaySYSTEMATIC PERSONALITY ASSESSMENT. 243 4. Intrapsychic phenomena Category 3: Ego Functions Related to Autonomous and Conflict-Free Spheres of the Ego This section of the profile, which is related to ego intactness and ego flexibility, should include a description of the individ- ual’s age-appropriate precursors or capacities for (a) self-ob- servation; (b) regression | in the service of the ego; (c) ability to learn; (d) intelligence; (e) creativity; () curiosity; and (g) syn- and integration. In addition, déscribé aily other assets or ‘liabilities that would facilitate or hinder adaptation and the capacity for further differentiation These abilities or capacities are to be looked at from two points of view: their polential utility and their current functional utility (the degree to which current stress or conflict may or will Continue to interfere with their functioning). .; 1. Good. Autonomous functions are age-appropriate and ca- pable of being used to integrate new experiences and facil- itate development. 2. Fair. Age: appropriate autonomous functions are slightly re- stricted by internal or external stress and/or are mildly im- paired due to other factors (genetic endowment, cultural background). 3. Marginal. Age-appropriate autonomous functions are mark- edly restricted by developme develop- mental or neurotic conflicts, neurosis, and ego constrict ns, and/or aré relatively deficient due to other fact 4. Inadequate. Functions usually considered autonomous are not. Instead they are severely restricted, below age expec- tations, and used mainly in the service of developmentally early drive gratifications or to cover up early ego defects. Where the ego is still in its early formative stages, these functions are not used in the service of further ega devel- opment Category 4: Relationship Potential (Object Relationships) , This section should include an. assessment of the individ- pacity for relationships.with others. The history of éarly ual’s244 GREENSPAN, HATLEBERG, AND CULLANDER object relationships, growing relationship patterns, current pat- terns, and thé quality of affect and relatedness in the assessment situation should be used as indicators. Predominant aspects of relationship patterns should be assessed: autistic, narcissistic, anaclitic, symbiotic, sadistic, masochistic, phallic, sharing, lov- ing, etc. Special attention should be paid to age-expected ac- complishments. For example, in a latency child attention should genital dyadic patterns versus the degree 1 to which they rep- resent, an integration and_resolution of triangular oedipal patterns and movement on to age-expecied peer rélauonships. In a preoedipal child of 27%, where one inantly dyadic pate ns based on preger should be paid to in relative attainmiéiit oF movement toward object constancy in the context of age expectations s| ed (i.e. it should be achiéved by 3 years of age) 1. Good. Relationship patterns reflect age-appropriate capaci- ties for intimacy and lity as well as age-appropriate ca- pacities. for frustration, and Tage. Earlier than age-expe ected lousy, and anger the preads scent there is a significant “chum” relation: . 2. Fair. Relationship patterns reflect age-appropriate capacities but are mildly compromised by earlier unresolved issues. 3. Marginal. There are relationships, but these are predomi- nantly characterized by developmentally earlierpatterns. For example, in a disturbed latency child, relationships may be markedly unstable and based on preoedipal concerns. 4. Inadequate. Relationships, if they occur, are-markedly below age-appropriate expectations. For example, in a severely disturbed latency child, rélationships either might not occur as such or would be based on anaclitic « or symbiotic patterns. Ina severely disturbed 2-year-old patterns might_be prominent.SYSTEMATIC PERSONALITY AS SSMENT 245 Category 5: Superego Functioning This may be rewarding and productive of self: punitive and productive of guilt and depression. This section should include an assessment of the degree to which the su- perego or its precursors have achieved and maintained an age- appropriate level of functioning: (1) Consider the degree of age-expected structuralization (e.g., in a late latency child the superego should be relatively internal and organized). (2) Con- sider the degree to which the age-appropriate superego pro- cesses or its precursors are smoothly integrated with ego and id and the degree to which there is finely discriminated regu- lation in the context of a relatively stable.esteem system and y for pleasure, This would include an assessment of the character and consistency of either the figures for identification ‘or established introjéctions and their relationship to the devel- oping identity, sense of self, and attitudes toward predominant types of age-appropriate drive discharge éxpression._ At the other extreme, this category should include an as- sessment of (1) the degree to which the superego or its pre- cursors are bel perienced as separate | and in conflict with the ego; (2) the. degree of incon- Sistency in age-expectéd relation (e.g., in a latency child super- ego lacunae or overgeneralized strictness and punitiveness —everything is bad); and (3) the degree of instability in the age- expected esteem maintenance and capacity for age-appropriate pleasures. At this extreme, consider how the character and con- sistency of figures for identification. or established _introjects may interfere with identity forma: 1 complete or negative sense of self),_an on (e.g., aberrant, inhibited). Because the superego is continually forming during child- hood and adolescence (and even t and is only relatively organized knowledge of age expectations is ‘particularly important in as- sessing this category. The two extremes presented above have definite implications for pathology only where a relatively com- plete superego organization is expected. In the preoedipal child, for example, inconsistency is to be expected. Assessment246 GREENSPAN, HATLEBERG, AND CULLANDER of the superego precursors of the very young child will of ne- cessity be more speculative and depend in part on assessments of aspects of his early drive and ego organization and his family. 1. Good. The superego or its precursors are age-appropriate and in balance, and provide for a reasonable amount of age- appropriate drive gratification and self-esteem while exert- ing age-appropriate regulation. 2. Fair. The superego or its precursors are relatively age-ap- propriate, but there are mild compromises in age-appro- priate drive gratification, self-esteem. maintenance, and impulse regulation. priate drive gratification and self-esteem maintenance are markedly impaired. 4. Inadequate. The superego or its precursors are significantly below age-appropriate. expectations. ‘The structures dealing with age-appropriate impulse regulation, drive and self-esteem maintenance are either defective, develop- ing improperly, or_not developing at all. Category 6: Affects ‘These may be multiple, flexible, and developmentally ap- Figid, and developmentally retarded. This section should include an assessment of: 1. The types of. affects (those that predominate and those that emerge under stress). 2. Their developmental level i developmental level based ample, in a 5-year-old pred6minant affects of indtional hunger, fear, rage, jealousy, and envy may represent de- velopmentally immature affects, while some capacities for sharing and loving together with the former may represent an age-appropriate pattern. For a 2-year-old, however, the former pattern would be age-appropriate. 3. Their flexibility and selectivity. For example, are there aSYSTEMATIC PERSONALITY ASSESSMENT 247 number of expected affects potentially available, some of which can be selectively called forth in the appropriate sit- uation (fear and rage in one situation, love and concern in another)? Alternatively, there may be only a few, below age- expected affects (fear and rage or pseudowarmth) which are used in most situations. Special attention should be paid to the type of anxiety manifested: 1. Is it related to integrated, internal structural conflict it signal anxiety? ed to a combination of internal and external con- cerns, €.g., partial projection of fears onto the external world or poorly integrated internal conflicts, e.g., fear of the in- stincts? 2. ; fear of loss of love, fear tion by of castration, punishment of separation, fear of object loss, or fear of annihi 1. Good. There is an age-appropriate variety of affects which can be used selectively in response to external, or internal stimuli as well as conflict. Anxiety is age-appropriate. For example, in the postoedipal child anxiety is related to inter- nal, integrated structural conflict (signal anxiety), whereas, in the 3-year-old, anxiety is in part related to a fear of loss of love from the mothering figure. 2. Fair. There is city for age-appropriate affects when jiot under siress. Anniety is also age appropriate-butregres- SiOTS Of r under stress. 3. Marginal. A few affects | elow..age expectations predominate. For example, in a latency child there are pre- dominantly feelings of emptiness, sadness, rage, envy, avd pseudowarmth. Anxiety is below age expectations; for ex- ample, in the oédipal child the anxiety is predominantly related to fear of the instincts and/or concerns over sepa- ration and annihilation. 4. Inadequate. The affect system is si; nificantly | below age ex-248 GREENSPAN, HATLEBERG, AND CULLANDER pectations, to a degr incompletely develope inappropriate affect. An: that it is either inappropr his her flat priate ego devaleeee a and ey merisres ég., intense fear of self- or object destru Category 7: Defenses These may be age-appropriate, stable, flexible, selective, and effective or developmentally retarded, unstable, rigid, overly generalized, and ineffective. This section should include an assessment of the general defensive styles and specific types of defenses or groups of defenses used both ordinarily and under stress; Included should be an assessment 6 ich has projection, “ienial, and in- trojection vs. developmentally more appropriate defenses such as repression, reaction-formation, sublimation, and be- ginning capacities for intellectualization). . Their stability (what happens under stress). Their flexibility (now well they adapt to new situations). . Their selectivity.(can_the most effective defense be called forth in a given situation?). Their effeetiveness-(do- they- protect-vital, age-appropriate ego functions?). — avn * Because this is an important category that often reflects general personality functioning, a number of defenses will be listed, and the rater is asked to evaluate the relative roles of these and others: avoidanc “denial, blocking, pro- jection, introjection, som: tion, undoing, acting Out, dis- placement, repression, identification, isolation, excessive use of affects (affectualization and magical thinking), the turning of emotions into their opposites, reaction-| “formation, sublimation, rationalization, intellectualization, and regression. 1. Good. Defenses are age-appropriate and organized. TheySYSTEMATIC PERSONALITY ASSESSMENT 249 tend to protect the ego without significantly hampering age- appropriate functions. For example, in a latency child de- fenses only minimally interfere with memory (repressed memoties), age-appropriate reality testing, and ego flexibil- ity. 2. Fair. Defenses are mixtures of age-appropriate and imma- ture defenses. The immature defenses are sed mainly in response to stress. Age-appropriate ego functions are com- promised only under stress. 3. Marginal. Defenses are_below age expectation. They hamper age-appropriate ego function constricting, them (phobias), impairing their regulatory ca- pacity (impulsive behaviors), leaving them open to severe “ranges of affect (anxi d cases of unusual stress, allowing disruptions in age-appro- priate reality testing. 4. Inadequate. Defenses are significantly below age expectations, e.g., the predon srojection, and denial in a latency child. They are unselective, and severely hamper aj propriate ego functions (reality ‘testing). At best they serv only"a fragile defense against psychotic processes. Category 8: Drive Organization This section should include as complete a description as possible of the person’s current level of drive organization. It should (1) assess the degree to which the drives (both libidinal and aggressive) are age-appropriatcly fused and have pro- sed to age-appropriate levels of organi: , have the s fused and progressed to a phallic-oedipal level of or- ganization in a 5-year-old?); and (2) determine whether aspects of drive organization which are below age expectation rend to reflect major fixations or potential regressions to. fixation points, States intermediate between age-appropriate drive orga- nizations and earlier levels of drive or; should be sessed in terms of (1) guantity (how much is still tied to thé position anc uch has progressed to the age-appropriate250 GREENSPAN, HATLEBERG, AND CULLANDER, position?) and (2) quality (how rigidly is it tied at the next positio tions—secondary gains, severe conflicts 1. Good. Drive organization is predomi Regressions are temporary. they represent FEgFEWIONS to fixation points. 2. Fair. Drive organization represents.a-mixture of age-appro- priate levels and earlier developmental levels. 3. Marginal. Drive organization is predominantly below age expecfations. This is due to arrested development, major fixations, or marked regressions. 4. Inadequate. Drive organization is significantly below age ex- pectations. Drives are primitive and disorganized to such a degree that activa 1 routine stresses, result: gan zation. Here should be assessed the reality circumstances of the individual and/or his family as these might effect the imple- menitation of potential recommenda status, and capacity to understand and fully support treatment and, in the case of a child, to establish a productive working relationship with a therapist should be considered. The reality situation may be regarded 2 1. Good 2. Fair 3. Marginal _ 4. Inadequate. Category 10: Intuitive Imy Here may be included any impr that are not captured by the preceding cate liabilities of the individual, or feelings based on the interviewer's experience, although not eas i for. mulated in metapsychological texans, should be.descxibed,. This category is also to be rated “good” to“ ” based onESSMENT 251 SYSTEMATIC PERSONALITY ASS the implications of these intuitive impressions for the individ- ual’s capacity for current coping and further growth. ~ Good. Special assets or liabilities and inwuitive impressions considerably strengthen the estimate of the individual’s po- tential for further growth. ‘air. Special assets and liabilities and intuitive impressions neither strengthen nor weaken the estimate of the individ- ual’s capacity for coping or further growth. Marginal. Special liabilities and intuitive impressions weaken the estimation of the individual’s capacity for coping and further growth. 4, Inadequate. Special liabilities and intuitive impressions weaken considerably the ‘estimation of the individual’s capacity for coping and further growth. Category 11: Capacities for Further Growth and Development in an Average Expectable Environment or in the Current Environment _ Include h¢ a description of the capacities for further development in terms of the categories previously outlined (ego, superego functioning, drive organization, defenses, af- fects, etc.) and anticipated special prob! For example, does the current evaluation of the individ go structure forecast difficulties in ‘schoolwork or peer relationships? Is treatment necessary or will it become necessary? If so, what kind? In this section it is especially important to present the interviewer's evaluations in narrative form so that the basis for these impres- sions will be clear. 1. Good. Capable of optimal. development; should be arelatiyely itegrated, happy person. 2. Fair. Capable of relatively healthy further development, but may encounter some difficulties of minor to moderate pro- portions and may need some therapeutic intervention. 3. Marginal. Does not appear to be capable of further healthy development without some.major intervention. Without in- tervention it is expected he will have, or continue to have, significant problems in major life areas.252 GREENSPAN, HATLEBERG, AND CULLANDER, 4. Inadequate. Expected to have or continues to haye significant difficulties in most major life areas. Even with major inter- ventions, development will likely be compromised. Category 12: Recommendations Justify recommendations in the context of the total assess- ment. . Assessment of a 6-Year-Old Boy Sessions with Parents Session 1: First parental visit. Bryan, 6 years old, was pre- sented by his parents, an attractive couple in their mid-thirties, as having numerous problems. Among these was his refusal, from the time he was trained, to defecate regularly, sometimes withholding for as long as 2 weeks. Occasionally he would soil himself. He was stubborn, had temper tantrums, and was un- able to make a choice and be happy with it. He would cry hysterically when his mother left him at school. Bryan’s playtimes with his parents would end disastrously. With his mother, the sessions would result in mutual irritation and bickering. With his father this was less likely. Rather, Bryan would jump and wrestle long after his father felt it was time to stop, and the play would come to an unhappy end with Bryan being scolded and pushed away, whereupon Bryan would sulk. Bryan, they both implied, never knew when enough was enough. At the same time, they were saying, he had “an ex- traordinary ability to get under your skin, and he also knows how far he can go.” The mother thought Bryan’s problems stemmed from the time of his brother's birth. She had been hospitalized for 10 days, and Bryan had been cared for by a “witch” of a nurse, a rigid, depriving woman who was fired immediately upon the mother’s return home. Up to that time Bryan, like his brother Robert now, was characterized as a happy-go-lucky child. As difficult as Bryan has been, he has apparently gotten on well with his younger brother, now 3. From the very beginning he wanted to see and hold the baby and was never hostile towardcapitulo 7 La entrevist> clinica de diagnéstico Nakeol, V. Tearnce de le con adolescentes eatiorists con edolecete EA Pox, Wexce En Ia evaluacidn, asesorfa y tratamiento de los adolescentes se requiere hacer entrevistas e intervenciones directas con el adolescente. La entre- vista sistematizada con adolescentes se ha desarrollado recientemente y ha aumentado debido a que se ha visto que hay muchos sintomas o esta- dos subjetivos para Jos cuales solamente los propios adolescentes pueden dar un recuento valido. Los padres pueden estar totalmente inconscientes de los sentimien- tos de sus hijos, tales como: culpas, obsesiones, afectos reprimidos, pro- blemas de autoestima, creencias delirantes, preocupaciones suicidas anstosas, alucinaciones y otros s{ntomas. Por otra parte, los padres pue- den proveer informacién valiosa acerca de cémo se ha afectado la vida familiar a causa de la problematica de su hijo adolescente y ademés son mejores informantes acerca de las dreas del desarrollo y de la historia médico-psicolégica familiar. - Para algunos y, especialmente para quienes se inician apenas en su entrenamiento como entrevistadores y psicoterapeutas de adolescentes, la evaluacién y la entrevista con adolescentes puede ser abrumadora ¢ intimidante. Esto quiere decir que, en-ocasiones, el entrevistador puede encontrarse con la dificultad de mantener la neutralidad al trabajar con esta poblacién. En esta fase de la entrevista se deben formular hipétesis, no formular afirmaciones ni ¢jecutar soluciones para el adolescente, En una entrevis- ta clinica de diagnéstico con un adolescente se necesitan responder al menos las siguientes preguntas: + gBladolescente estd suftiendo problemas emocionales y mentales por los cuales requiera psicoterapia? Mm