Operationalized Psychodynamic Diagnosis OPD-2
1. Auflage 2008
ISBN: 978-1-61676-353-4
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
Manual of Diagnosis and Treatment Planning
E-Book, Englisch, 431 Seiten
ISBN: 978-1-61676-353-4
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
OPD-2 – a new edition of the multiaxial diagnostic system for psychodynamically oriented therapists and psychiatrists, now with practical tools and procedures for treatment planning and for measuring change.
Operationalized Psychodynamic Diagnosis (OPD) is a form of multiaxial diagnostic and classification system based on psychodynamic principles, analogous to those based on other principles such as DSM-IV and ICD-10. The OPD is based on five axes: I = experience of illness and prerequisites for treatment, II = interpersonal relations, III = conflict, IV = structure, and V = mental and psychosomatic disorders (in line with Chapter V (F) of the ICD-10). After an initial interview lasting 1–2 hours, the clinician (or researcher) can evaluate the patient’s psychodynamics according to these axes and enter them in the checklists and evaluation forms provided. The new version, OPD-2, has been developed from a purely diagnostic system to include a set of tools and procedures for treatment planning and for measuring change, as well as for determining the appropriate main focuses of treatment and developing appropriate treatment strategies.
Fachgebiete
Weitere Infos & Material
1;Foreword;6
2;Table of Contents – Overview;8
3;Preface;10
4;Table of Contents;14
5;OPD Task Force;24
6;Theoretical Background;26
6.1;From OPD- 1 to OPD- 2;26
6.2;Aims of the OPD Task Force;30
6.3;The Concept of the Operationalized Psychodynamic Diagnosis (OPD);33
6.4;Fundamental Considerations on a Multiaxial Diagnosis;34
6.5;On the Operationalization of Psychoanalytic Constructs;36
6.6;Past Approaches of Operationalization of Psychodynamic Constructs;39
6.7;Limits of the OPD;42
7;Experiences and Empirical Findings with OPD- 1;44
7.1;Quality Criteria of OPD- 1;45
7.2;Axis I: “Experience of Illness and Prerequisites for Treatment”;47
7.3;Axis II: “Interpersonal Relations”;48
7.4;Axis III: “Conflict”;50
7.5;Axis IV: “Structure”;52
7.6;Conclusion;54
8;Operationalization of the Axes According to OPD-2;56
8.1;Axis I – Experience of Illness and Prerequisites for Treatment;56
8.2;Axis II – Interpersonal Relations;74
8.3;Axis III – Conflict;85
8.4;Axis IV – Structure;101
8.5;Axis V – Mental and Psychosomatic Disorders;110
8.6;Conceptual Cross-References and Interactions Between the Axes;118
9;Manualization of the Axes According to OPD-2;130
9.1;Axis I – Experience of Illness and Prerequisites for Treatment;130
9.2;Axis II – Interpersonal Relations;166
9.3;Axis III – Conflict;182
9.4;Axis IV – Structure;224
10;The OPD Interview;248
10.1;The Theory of the Psychodynamic Interview;248
10.2;Carrying out the OPD Interview;254
11;Case Example: “Driven out from Paradise”;268
11.1;Interview Vignette;268
11.2;Case Evaluation and Documentation;271
11.3;Comments on the Evaluation;276
12;Focus Selection and Treatment Planning;286
12.1;Establishing the Indication for Treatment on the Basis of OPD Axis I;286
12.2;Determination of Foci on the Basis of OPD Axes II–IV;290
12.3;Principles of Focus Selection;293
12.4;Component Parts of the Foci;294
12.5;Treatment Planning and Therapeutic Aims;295
12.6;Peculiarities of the Psychodynamic Work on Dysfunctional Relationship Patterns;306
12.7;Concluding Remarks;309
13;Change Measurement with OPD;310
13.1;OPD and Change Measurement: Basic Considerations;310
13.2;Model of an OPD- based Change Measurement;311
13.3;Reliability and Validity;313
13.4;Clinical Application;314
14;Areas of Application and Quality Assurance;316
14.1;Quality Assurance in Psychotherapy and the Law;316
14.2;Quality Assurance in Psychodynamic Psychotherapies (QPP);317
14.3;OPD in the Expert Assessment Procedure of the German Psychotherapy Guidelines;319
14.4;OPD in Inpatient Treatment in Psychosomatic-Psychotherapeutic Hospitals;321
14.5;OPD in the Psychosomatic Rehabilitation Treatment;322
14.6;Training, Continuing Education, and Post-Graduate Study;323
14.7;OPD and Expert Opinion;324
15;Continuing Education and Post-Graduate Study (with a List of Addresses of Training Centres);328
15.1;Interests and Needs;328
15.2;The Organization of OPD Training and Post-Graduate Training Seminars;329
15.3;The Contents of the Training Seminars, and Main Emphasis;330
15.4;Certification;331
15.5;Experiences Gained in the Training Seminars;332
15.6;Outlook;332
15.7;Training Centers;333
16;References;340
17;Author Addresses;360
18;Tools for Working with OPD;366
18.1;Axis I – Forensic Module;366
18.2;Axis II;368
18.3;OPD- 2 Conflict Checklist;370
18.4;The OPD- 2 Structure Checklist;385
18.5;Heidelberg Structural Change Scale;393
18.6;Interview Tools;393
18.7;Operationalized Psychodynamic Diagnosis (OPD- 2) Data Evaluation Forms;417
18.8;Data Evaluation Sheet Forensic Module;423
18.9;Data Evaluation Sheet Focus Selection;425
19;Additional Modules;428
19.1;The GAF (Global Assessment of Functioning) Scale;428
19.2;EQ-5D;429
19.3;List of Defence Mechanisms;430
2 Experiences and Empirical Findings with OPD-1 (p. 19-20)
OPD serves not only state- but also process-diagnostic purposes. OPD, with its diagnostic categories and their operationalizations, is a considerable enrichment on the diagnostic horizon, precisely because it contributes to making psychodynamic constructs measurable which are relevant for therapy and change. It thus can be put to use in the planning and evaluation of therapy as well. In clinical practice, a thorough assessment using OPD can provide helpful hints for decisions and actions within the framework of treatment planning. The rating results from Axis I, for example, reflect relevant aspects of how a patient experiences illness, of his concepts of illness, and his motivation for change. On this basis the clinician is able to decide whether, at that point in time, the patient would benefit from a specific psychotherapeutic measure or whether more basic interventions are indicated to stabilize the patient first, perhaps gradually leading him towards psychotherapy. The OPD rating results from the other axes can reveal the patient’s core problem areas, which may assist with the formulation of treatment aims, as well as with the development of therapeutic interventions. Such core problem areas can be dysfunctional relationship patterns (Axis II), life-determining conflicts (Axis III), or “critical” structural characteristics (Axis IV) which describe particular vulnerabilities or limitations of the patient. These problem areas, which are laid down in the categories of the OPD, can be the foci that guide psychotherapeutic treatment. Moreover, the assessment of the patient’s structural level is per se an important piece of information about whether a more structure-oriented psychotherapeutic procedure is indicated, or rather an interpretative- disclosing intervention, which focuses on the dysfunctional handling of unconscious conflicts (Rudolf, 2004b).
An OPD-based model for the determination of therapy foci and therapy aims was developed during the course of a long-term analytical therapy practice study, or, in its German original, “Praxisstudie Analytische Langzeittherapie” (Grande et al., 2004b; Leising et al., 2003; Rudolf et al., 2001a; Rudolf et al., 2002a). It has proved its worth in in-patient and out-patient settings as clinically practicable and usable for the scientific evaluation of psychodynamically-oriented therapies. This model uses the so-called Heidelberg Structural Change Scale (HSCS) as an instrument to measure change by tracking the progress in the patient’s ability to deal with problem areas that are to be restructured through therapy (Grande, 2005; Grande et al., 2001; Grande et al., 2003; Rudolf et al., 2000; cf. Chapter 8 of this book). In addition, the formulation of a focus in terms of relationship dynamics has been helpful in in-patient treatment in order to promote a patientcentered attitude within the team (Stasch, 2003; Stasch & Cierpka, 2006).
2.1 Quality Criteria of OPD-1
With the publication of the OPD manual (Arbeitskreis OPD, 1996) a phase of intensive research began. The first reliability studies were quite satisfactory and had already been incorporated into the first OPD manual (Freyberger et al., 1996a). Consequent to this, interrater reliabilities were collected for the Axes II to IV on the basis of videotaped initial clinical interviews in the area of in-patient treatment. Experience gained from teaching the system and from its application has shown that not only the training, but also the quality of the material examined, and the clinical training and professional experience of the raters, play an important role in the quality of the ratings.
A study by the OPD-1 working group (cf. Cierpka et al., 2001) recruited 269 patients from 6 clinics for psychosomatic medicine to test the reliabilities of Axes I to IV. As the rating conditions in the various clinics differed along important parameters, the experimenters were able simultaneously to look at what conditions improved or worsened the reliability of the assessments. The measure they used was the weighted kappa (Cohen, 1968), which in contrast to the intraclass correlation coefficient (ICC) makes no parametric demands and was thus better suited to the data than the latter. To determine the weights, the intervals on the rating scales, which each contained four subscales, were assumed to be equidistant for the Axes I, III, and IV; this leads to a kappa that can be interpreted similarly to a Pearson correlation coefficient (Fleiss/Cohen, 1973). On Axis II “interpersonal relations”, the experimenters also calculated the weighted kappa. The procedure in this case corresponded to the standard procedure used in the Structural Analysis of Social Behavior (SASB, Benjamin, 1974); in this, deviation weights in kappa are adjusted to the logic of the circumplex model of interpersonal behavior with a method described by Grawe-Gerber and Benjamin (1989).
