Operationalized psychodynamic diagnostics

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The Operationalized psychodynamic diagnostics (OPD) is a psycho dynamic diagnostic system which mainly for psychoanalytisch and sound psychodynamically working Psychotherapy is designed.

It is a semi-structured interview with the corresponding theoretical psychodynamic background constructs, in which, among other things, different areas of life, the course of the illness and self-assessments are queried. The questions are asked as openly as possible and no possible answers are given.

The diagnostic manual was developed as an alternative to the existing psychiatric diagnostic manuals. This is intended to supplement the purely descriptive phenomenology in the ICD-10 and DSM-5 with a reliable and valid diagnostic instrument that takes psychodynamic aspects into account.

Through the process of operationalization , the essential variables in psychodynamic theories should be made measurable, such as transference patterns , internal conflict constellations and structural conditions . The OPD tries to achieve a better objectivity , reliability and validity of the diagnoses and to meet the quality criteria of psychodiagnostic procedures .

history

Operationalized Psychodynamic Diagnostics was developed in the early 1990s and the first diagnostic manual was published in 1996. Since then, well over a hundred publications have appeared in specialist books and journals. Around 40 clinicians and researchers are working on the further development of the diagnostic instruments. In 2006 a largely revised and supplemented manual with the designation OPD-2 was published. This version also provides tools for planning psychotherapy . The working group is currently also working on the areas of forensics , rehabilitation , addiction syndrome and others.

Involved

Authors

Markus Burgmer, Manfred Cierpka, Reiner W. Dahlbender, Stephan Doering, Matthias Franz, Harald J. Freyberger, Tilman Grande, Karsten Hake, Gereon Heuft, Sven Olaf Hoffmann, Thorsten Jakobsen, Paul L. Janssen, Marianne Junghan, Joachim Küchenhoff, Reinholde Kriebel, Elmar Mans, Claudia Oberbracht, Doris Pouget-Schors, Gerd Rudolf, Henning Schauenburg, Gudrun Schneider, Wolfgang Schneider, Gerhard Schüßler, Michael Stasch, Matthias von der Tann.

Speakers and contact persons

  • Axis I: Wolfgang Schneider , Rostock
  • Axis II: Manfred Cierpka , Heidelberg
  • Axis III: Gerhard Schüßler , Innsbruck
  • Axis IV: Gerd Rudolf , Heidelberg
  • Axis V: Harald J. Freyberger , Greifswald
  • Forensics working group: Matthias von der Tann , London
  • Rehabilitation work group: Reiner W. Dahlbender , Bad Säckingen
  • Working group on addiction: Thorsten Jakobsen , Basel

Classification of diagnostics

The diagnostic manual enables the individual mental constitution of the patient to be described and assessed on five different axes. For this purpose, questionnaires are made available for each axis, on which the diagnostician can assess given items. For example item 17 on axis I:
patient's personal resources = nonexistent (0) | = low (1) | = medium (2) | = high (3) | = cannot be assessed (9)
The questionnaires contain a total of over 40 such assessment scales and fields that can be freely formulated.

  • Axis I covers the experience of illness and the prerequisites for treatment.
  • Axis II covers relationship diagnostics, with the focus on episodes of relationships being analyzed in addition to the transference and countertransference between therapist and patient.
  • Axis III covers life-determining unconscious inner conflicts of the patient.
  • Axis IV covers the structural level , that is, the basic abilities of psychological functioning.
  • Axis V records mental and psychosomatic disorders in relation to the established descriptive-phenomenological diagnostics ( ICD-10 , DSM-IV )

Axis I - disease experience and treatment requirements

Axis I consists of a basic module that can be interlinked with specific additional modules as required.

  1. Current severity of the disorder / problem
    1.1 Severity of the symptoms
    1.2 GAF scale
    1.3 EQ-5D sum
  2. Duration of the fault / problem
    2.1 Duration of the disruption
    2.2 Age at first onset of the disorder
  3. Disease experience and presentation
    3.1 Psychological stress
    3.2 Presentation of physical complaints and problems
    3.3 Presentation of psychological complaints and problems
    3.4 Presentation of social problems
  4. Patient's disease concepts
    4.1 Disease concept based on somatic factors
    4.2 Illness concept based on psychological factors
    4.3 Disease concept based on social factors
  5. Change concepts of the patient
    5.1 Desired form of treatment: physical treatment
    5.2 Desired form of treatment: psychotherapeutic treatment
    5.3 Desired form of treatment: social area
  6. Change resources
    6.1 Personal resources
    6.2 (Psycho-) social support
  7. Barriers to change
    7.1 External barriers to change
    7.2 Internal barriers to change

There is also a separate psychotherapy module.

Axis II - relationship

With the help of an item list, each of the following four experience perspectives is assigned a position in a circumplex model. Each of the 16 items is based on a circumplex model of interpersonal behavior that is based on Benjamin (1974; 1993).

Perspective A: The patient's experience
The patient experiences himself Patient experiences others
Perspective B: The experience of others (including the examiner)
Others experience the patient Others experience each other

Relationship dynamic formulation

... as the patient experiences others again and again:

... how he reacts to it in his experience:

... what kind of relationship he (unconsciously) makes others with this reaction:

... which answer he (unconsciously) suggests to others:

... as the patient experiences when others answer as suggested to them:

See also: Cyclic Maladaptive Patterns

Axis III - conflict

Questions to clarify the prerequisites for conflict assessment

A) Conflicts are not advisable, diagnostic certainty is lacking.

B) Due to the low level of structural integration, it was not a question of distinct [...] conflict patterns [...] but rather of conflict schemes.

C) Cannot be assessed because of averted perception of conflict and feelings [...].

D) […] (actual conflict) without significant dysfunctional repetitive conflict patterns.

Repetitive dysfunctional conflicts:

  1. Individuation versus dependency
  2. Submission versus control
  3. Supply versus self-sufficiency
  4. Self-esteem conflict
  5. Conflict of guilt
  6. Oedipal conflict
  7. Identity conflict

In clinical use, the two most important life-determining conflicts are highlighted. The time window is the last year, whereby the focus should be on the actual update.

Main conflict:

Second most important conflict:

Main conflict processing mode:

(1) predominantly active (2) mixed (3) mixed rather passive (4) predominantly passive (9) cannot be assessed

Axis IV - structure

"Structure can [...] be described in four dimensions, each of which distinguishes the relation to the self and the relation to the objects." (P. 118)

Relation to self Relation to the object
1a self-awareness 1b object perception
2a self-regulation 2b Regulation of the property reference
3a internal communication 3b external communication
4a attachment to inner objects 4b attachment to external objects
5 structure overall

Axis V - Mental and psychosomatic disorders

Va: mental disorders

Vb: personality disorders

Which disorder is clinically in the foreground? (Axis Va or Vb)

Vc: Physical illness

Additional Information

In addition, demographic data of patient and diagnostician is collected and given a code instead of the name due to data protection .

Patient: code, age, gender, survey date

Diagnostician: code, age, gender, center

OPD in psychotherapeutic practice

In 2018 there were 45 clinical institutions working with this diagnostic tool, 40 of them at clinics and polyclinics in Germany, two each in Austria and Switzerland and one at the Portman Clinic in London.

In principle, the OPD is also a valuable diagnostic and therapeutic instrument for outpatient psychotherapeutic practice. However, from the point of view of some established psychotherapists, the complete OPD is too time-consuming to be routinely widely used. On the other hand, nowadays in Germany a number of training institutes for depth psychology-based psychotherapy teach the OPD as a standard to formulate psychodynamics in the prescribed report to the expert for health insurance applications for psychotherapy. In practice, the entire OPD is usually not carried out, but rather only the conflict and structural axes are used, in particular for the formulation of psychodynamics in the expert application. Taking into account the time possibilities of outpatient psychotherapy practice, Udo Boessmann and Arno Remmers developed a simplified questionnaire-based psychodynamic diagnosis and therapy planning concept that is based on the OPD, but which can be used with much less time and without the special, complex training that the OPD requires can.

See also

literature

  • Working group OPD: Operationalized Psychodynamic Diagnostics OPD-2. The manual for diagnosis and therapy planning. Huber, Bern 2009, ISBN 978-3-456-84753-5 .
  • Jaeggi, E. / Gödde, G. / Hegener, W. / Möller, H .: Teaching depth psychology - learning depth psychology . Klett-Cotta Stuttgart 2003, ISBN 978-3608940602 .
  • Leichsenring, Falk (editor): Textbook of Psychotherapy, Vol. 2 Psychoanalytic and depth psychological therapy. 2004, ISBN 3-932096-32-0 .
  • Gerd Rudolf, Hildegard Horn: Structure-related psychotherapy. Guide to the psychodynamic therapy of structural disorders . Schattauer, Stuttgart 2004, third edition 2013, ISBN 978-3-7945-2857-8 .

Web links

  • OPD online - project website with training seminars

Individual evidence

  1. ^ Rolf Adler (2003): Psychosomatic Medicine. Urban and Fischer, Munich. ISBN 978-3-437-21830-9 . (Chapter 24, Critical Statement on the Use of the International Diagnostic Keys, Paragraph 6, Page 394.)
  2. ^ Working group OPD (ed.). (1996). Operationalized psychodynamic diagnostics. Basics and manual. Bern: Huber.
  3. ↑ Operationalized Psychodynamic Diagnostics OPD-2. The manual for diagnostics and therapy planning by the OPD working group von Huber, Bern 2006
  4. ↑ Operationalized Psychodynamic Diagnostics (OPD-2) questionnaire as a PDF file ( Memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.verlag-hanshuber.com
  5. ↑ OPD-2 sheet for focus selection. Hogrefe Verlag, accessed February 18, 2018 .
  6. ^ A b John F. Clarkin, Eve Caligor, Barry Stern & Otto F. Kernberg: Structured Interview on Personality Organization - German Version - STIPO-D. English original edition: Clarkin, Caligor, Stern & Kernberg: Structured Interview for Personality Organization (STIPO) , Personality Disorders Institute, Weill Medical College of Cornell University, New York, 2004, November 27, 2007 (PDF, 106 pages, 612 kB, ( Archive) ).
  7. ↑ a b c d e working group OPD (2006): Operationalized Psychodynamische Diagnostik OPD-2. The manual for diagnosis and therapy planning . Huber Verlag, ISBN 978-3456842851 .
  8. ↑ Links to cooperating institutions. (No longer available online.) Working group Operationalized Psychodynamic Diagnostics (OPD), archived from the original on April 16, 2018 ; accessed on April 15, 2018 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.opd-online.net
  9. ↑ Udo Bössmann, Arno Remmers: The initial interview , Bonn: German psychologists Verlag, 2011
  10. ↑ Udo Boessmann, Arno Remmers: Treatment focus , Bonn: Deutscher Psychologen Verlag, 2008