Resch / Romer / Schmeck OPD-CA-2 Operationalized Psychodynamic Diagnosis in Childhood and Adolescence

Theoretical Basis and User Manual
2017
ISBN: 978-1-61334-489-7
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 334 Seiten

Following the success of the Operationalized Psychodynamic Diagnosis for Adults (OPD-2), this multiaxial diagnostic and classification system based on psychodynamic principles has now been adapted for children and adolescents by combining psychodynamic, developmental, and clinical psychiatric perspectives.
The OPD-CA-2 is based on four axes that are aligned with the new dimensional approach in the DSM-5: I = interpersonal relations, II = conflict, III = structure, and IV = prerequisites for treatment. After an initial interview, the clinician (or researcher) can evaluate the patient’s psychodynamics according to these axes to get a comprehensive psychodynamic view of the patient. Easy-to-use checklists and evaluation forms are provided. The set of tools and procedures the OPD-CA-2 manual provides have been widely used
for assessing indications for therapy, treatment planning, and measuring change, as well as providing information for parental work.

Autoren/Hrsg.

Resch, Franz

Romer, Georg

Schmeck, Klaus

Seiffge-Krenke, Inge

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Kinder- und Jugendlichenpsychotherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Medizinische Diagnose und Diagnostik
• Sozialwissenschaften Psychologie Allgemeine Psychologie Differentielle Psychologie, Persönlichkeitspsychologie Psychologische Diagnostik, Testpsychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Kinder- & Jugendpsychiatrie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychodynamische Psychotherapie

Leseproben

|3|1. Introduction
Beginning in 1992, the Operationalisierte Psychodynamische Diagnostik (in English Operationalized Psychodynamic Diagnostics, OPD) for adults was developed for German-speaking countries (Arbeitskreis OPD, 1996) and then later revised (Arbeitskreis OPD, 2006). The English versions of the Manual were published a bit later (OPD Task Force, 2001, 2008). The OPD is a system with psychodynamically based diagnostic axes for supplementing and expanding nosological classification schemes (such as DSM-5 in the USA, American Psychiatric Association, 2015; ICD-10 in Europe, World Health Organisation, 1992). The result is an instrument that both takes into account psychodynamic theory and attempts to improve interrater reliability in the psychodynamic assessment of mental states. This instrument is intended to remedy the fuzziness of psychoanalytic concepts – often criticised by other therapy approaches – through definitional principles. Of course, the reduction of fuzziness and ambiguity necessarily entails a curtailment of some theoretical models, which is appropriate given the practical diagnostic and therapeutic considerations. From the outset, the OPD and the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence (OPD-CA; in German Operationalisierte Psychodynamische Diagnostik im Kindes- und Jugendalter [OPD-KJ]; Arbeitskreis OPD-KJ, 2007) aimed at complementing the categorical approach (in terms of diagnoses) with a dimensional view of mental disorders in terms of ratings of severity along different axes (or dimensions). This approach to the classification of mental disorders has proven to be forward-thinking and ground-breaking, as the current developments in the new DSM-5 show, in which dimensional perspectives and assessments of severity have now been integrated into the categorical system of psychiatric diagnoses (APA, 2015). In the case of children and adolescents, the continued development of the ICD-8 and ICD-9 very early on led to a multiaxial nosological |4|framework (Remschmidt & Mattejat, 1994; Remschmidt, Schmidt & Poustka, 2008; Rutter, Shaffer, & Sturge, 1975). This allowed diagnostics on several levels: Along the first axis the clinical-psychiatric syndrome is described, while the second axis allows coding of developmental disorders, the third records intelligence, and the fourth diagnostically classifies physical illnesses as well as disabilities. The fifth axis captures associated abnormal psychosocial circumstances, and a sixth axis ascertains the level of psychosocial functioning. A task force was established in 1996 with the aim of developing a German instrument for the Operationalisierte Psychodynamische Diagnostik im Kindes- und Jugendalter (OPD-KJ; Arbeitskreis OPD-KJ, 2003, 2007; Operationalized Psychodynamic Diagnostics in Childhood and Adolescence [OPD-CA] in English). The aim was to capture, similar to the adult version, psychodynamic aspects of childhood and adolescence, extending beyond the multiaxial classification system, as an aid to appropriate treatment planning. Based on the OPD instrument for adults, profound modifications were necessary for childhood and adolescence. The central issue was the influence of developmental processes on the psychodynamics. The second edition of the German classification system OPD-KJ-2 combines psychodynamic, developmental, and clinical psychiatric perspectives (Resch & Koch, 2012; Resch, Schulte-Markwort, & Bürgin, 1998; Windaus, 2012). Multidimensional models of the origins of mental disorders are included (Herpertz-Dahlmann, Resch, Schulte-Markwort, & Warnke, 2008) and integrated in an overall biopsychosocial model open to dynamic perspectives (see Chapter 2 Developmental Concepts and Ages). The OPD-CA-2 should accordingly take into account the following special therapeutic considerations: It should allow a good differential indication for therapy and treatment planning given psychodynamic considerations, as well as provide information for a relationship-based foundation for parental work, and, for practical purposes, maintain a sufficiently high level of differentiation and comprehensibility despite the high level of complexity. The psychodynamic approach to the child indeed requires correspondingly complex, multidimensional, and development-oriented diagnostics, and may not remain at the level of nosological assessment. The identification of specific psychiatric disorders through questionnaires and interviews has a long clinical tradition, with increasing |5|attention in recent years to developmental aspects and resources in childhood and adolescence. The diagnostic approach in the OPD-CA goes beyond an integration of developmental diagnostics on the one hand and psychiatric classification on the other hand. The OPD-CA aims at a complex identification of psychodynamic processes that takes into account the child’s or adolescent’s subjectivity and attempts to render the symptoms also hermeneutically accessible and understandable in a developmental context. The developmental perspective is central to all aspects of the diagnostic process, from the type of assessment and selection of relevant diagnostic categories to the process of assessment along various substantive dimensions – where, at the end of the process, a recommendation for treatment can be made integrating psychiatric symptomatology, level of development, and psychodynamic aspects. In the OPD-CA too we specify, as an orientation aid, certain age groups in which developmental adjustment or maladjustment as well as structural resources become visible. Although compared with adults, children still seem incompletely structured, since at certain ages they cannot fully perceive the causal relationships in the world, some insights and background information remain hidden to them, and their affect regulation depends on significant attachment figures, each child at any given age will possess an optimal structure. At each age, a person has available to him or her a repertoire of experiential and behavioral capacities that also takes into account internal conflicts and allows the active formation of relationships. The view of children as generally not optimally adjusted to their environment or as immature according to some adult ideal is inappropriate. Dysfunctional types of behavior and fantasies always need to be compared against age-appropriate requirements. A child is not an incomplete adult. In order to identify psychodynamic disorders in children of different ages, mentally impaired children have to be compared with healthy children of the same age (Resch & Koch, 2012). The developmental aspect is relevant at all levels of the diagnostic process. The collection itself of diagnostically relevant information, i.e., the settings the persons are interviewed in as well as the different levels at which information is obtained (play, observation, dialog, scenic understanding) was adapted to the different developmental stages. The collection of relevant psychodynamic information along the axes of in|6|terpersonal relations, conflict, structure, and prerequisites for treatment is differentiated according to the levels of development. As development is always considered contextually, developmentally relevant areas such as family, play, school, peer group, etc., need to be included as well. The numerous experiences from trainings and information from empirical studies of the German instrument informed the development of the OPD-KJ into the OPD-KJ-2. An English version of the first edition of the Manual was not published so we shall henceforth refer to the second edition as the OPD-CA-2 but use the abbreviation OPD-CA to refer to the the original German version or to the instrument generally. Items and definitions that had proven to be insufficiently clear and selective were revised or even removed. The thorough revision of the axes and their dimensions also incorporated factor-analytic findings, so that significantly improved reliability and construct validity can be expected compared with the original OPD-KJ Manual. The partially new nomenclature of the conflicts is intended to increase comprehensibility of the key conflict themes. The structure axis now shows similarities with the alternative model for personality disorders in Section III of the DSM-5 (American Psychiatric Association, 2015), which incorporates a scale for the level of personality functioning on four dimensions: identity, self-direction, empathy, and intimacy. This has significant similarities with the four dimensions of the structure axis of the OPD-CA-2: identity, control, interpersonality, and attachment. The basic concern of the OPD to reduce the fuzziness and ambiguity of some...