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In the last two decades, several working groups in the international psychoanalytic community have been interested in the development of systematic tools for psychodynamic diagnosis, case formulation and treatment planning. Such psychodynamic diagnostic manuals are efforts to systematically integrate an enormous and rich amount of historically partialized and dispersed information, but which constitute the substantial contribution of psychoanalysis to the field of mental health. The aim of the present article is to provide an updated review on this kind of systematic tools for diagnosis, case formulation and therapeutic planning, designed for the field of psychodynamic approaches. To this end, we describe the aims and structure of: 1) the Psychodynamic Diagnostic Manual 2 (PDM-2), 2) the Operationalized Psychodynamic Diagnosis (OPD-2/OPD-3) and 3) the Operationalized Psychodynamic Diagnosis for Children and adolescents 2 (OPD-CA-2). The contributions of these current tools to clinical practice and empirical research are discussed, as well as the need to disseminate these types of instruments in our regional context.

En las últimas dos décadas, diversos grupos de trabajo de la comunidad psicoanalítica internacional se han interesado por el desarrollo de herramientas sistemáticas para el diagnóstico, la formulación de los casos y la planificación del tratamiento psicodinámico. Este tipo de manuales diagnósticos psicodinámicos son esfuerzos de integración sistemática de una enorme y rica cantidad de información históricamente parcializada y dispersa, pero que constituye el aporte sustancial del psicoanálisis al campo de la salud mental. El objetivo del presente artículo es ofrecer una revisión actualizada sobre esta clase de herramientas sistemáticas de diagnóstico, formulación del caso y planificación terapéutica, diseñadas para el campo de los abordajes psicodinámicos. A estos fines, se describe la estructura y los objetivos de: 1) el Manual Diagnóstico Psicodinámico 2 (PDM-2), 2) el Diagnóstico Psicodinámico Operacionalizado (OPD-2/OPD-3) y 3) el Diagnóstico Psicodinámico Operacionalizado Infanto-Juvenil 2 (OPD-IJ-2).Se discuten las contribuciones de estas herramientas actuales para la práctica clínica y la investigación empírica, así como la necesidad de difundir este tipo de instrumentos en nuestro contexto regional.

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Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.

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The 3-Level Model (3-LM) is proposed as a guide or heuristic for observing and describing patient change. Used since 2011 in the context of the International Psychoanalytic Association (IPA), its trustworthiness as a model still needs to be studied. OBJECTIVES AND METHODS: This study aimed to assess the trustworthiness of the 3-LM by comparing the output of three groups of IPA-certified analysts (Europe, North America and South America). The comparison was made using process and outcome measures as analytical tools. This objective was divided into specific objectives presented in two articles. Each group belonged to a different geographical region of the IPA. They all worked on the same clinical case and their output was analysed using the same structured qualitative methodology. To analyse levels 1 and 3 of the model, the Consensual Qualitative Research (CQR) method was used. For level 2, the Operationalised Psychodynamic Diagnosis (OPD-2) was used. RESULTS AND DISCUSSION: There was a predominance of convergence between each of the groups for each of the levels analysed, with some points of divergence. The implications of these results for the trustworthiness of the model, clinical practice, training and research in psychoanalysis are discussed.

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In this paper we summarize some experiences with Operationalized Psychodynamic Diagnosis (OPD-2) in the colombian context, and put into perspective other possibilities for its implementation grounded on our teaching and clinical practice. Given OPD-2 develops as a modular system for diagnosis and treatment planning, it has been used in different areas of both clinical practice and empirical research. Based on this, we have chosen different application scenarios to illustrate OPD-2'susefulness, focusing on different axes or modules of the instrument, reharding Colombia's interculturality, clinical work at the general hospital, teaching and practice integration, and OPD-2's contributions to dynamic psychology. The possibilities of OPD-2 related to each application area are discussed and gathered into a final conclusion.(AU)

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INTRODUCTION: contemporary psychodynamic therapy research supports combining clinical judgment with empirical evidences. Recent studies suggest that systematically analyzing single cases may contribute to such efforts. Also, current criteria for evidence-based case studies recommend different perspectives on therapeutic process and outcome, such as therapist's and external judges' ratings. Finally, client's dropout conforms a challenge for psychotherapy research. AIMS & METHODS: as part of a SPR Small Research Grant, this study analyzed and compared the psychodynamic profile proposed both by therapist and two external judges, for the same case of early dropout from focused psychodynamic psychotherapy, consisting of two diagnostic interviews and five subsequent sessions, in a patient with an emotional disorder. Being blind to the rating process of the counterpart, Operationalized Psychodynamic Diagnosis (OPD-2) was used by therapist and judges to generate a psychodynamic profile including five therapeutic foci. External judges rating was achieved through consensus, following CQR's guidelines. RESULTS & DISCUSSION: similarities and differences among therapist's and judges' psychodynamic profiles were found. Result's contributions to the understanding of case's early dropout are discussed, along with OPD-2's usefulness for psychodynamic practice-oriented research.(AU)

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INTRODUCTION: Brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity, focalization must be accomplished. The work on focus consolidates the material, abbreviates psychotherapy, and is considered to be a change mechanism. Operationalized Psychodynamic Diagnosis OPD-2 proposes a concept of focus as the specific problem areas that are significant for patient's psychodynamics, in terms of relational pattern, inner conflicts, and structural vulnerabilities. The study on foci becomes a research and clinical imperative, where change on foci must be considered. AIMS & METHODS: This study aimed to (1) identify foci in change episodes and (2) establish the relationship between them during the process. A multiple single-subject design was used, considering the analysis of 13 outpatient psychotherapies done as treatment as usual (average of 18 sessions each process). OPD-2and Level of Presence of Foci were used to identify foci worked by therapist and patient during change episodes, already codified in a previous research usign the list of Generic Change Indicators. RESULTS & DISCUSSION: 208 change episodes were analysed. Conflict focus relates inversely with structural focus at the initial phase, and the latter appears to increase during the process. Some focus relates to different levels of patients change. Results are discussed in their clinical relevance. (AU)

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INTRODUCTION: In order to expand the descriptive classification of symptoms in mental disorders, and to bring empirical consistency to psychodynamic/psychoanalytic models, a multiaxial instrument called Operationalized Psychodynamic Diagnosis (OPD-2) has been developed, allowing psychotherapy research to encompass the complexity of the relationships between conditions and factors that determine the phenomena of mental pathologies, from a psychodynamic point of view. METHODOLOGY: Longitudinal naturalistic study with 80 outpatients with severe mental disorders, who were treated with a) psychodynamic psychotherapy, b) interpersonal psychotherapy and c) cognitive behavioral psychotherapy. All patients were interviewed at baseline and after six months, according to OPD-2's criteria. They all also completed two self-report measures (WHOQOL-BREF and SCL-90R) to evaluate symptoms and quality of life at each assessment point. RESULTS: According to OPD-2's axis I, better personal resources, psychosocial support, and introspective capacity significantly correlated with fewer symptoms in the BDI's and SCL-90's measures. Also, symptoms' reduction and quality of life's domains significantly correlated with items that assessed OPD-2's "desire for care versus autarchy" and "identity" conflicts. There was also a significant correlation between all items that evaluate structural functioning according to OPD-2 and the SCL-90R's psychotic index. Regarding predictive validity analysis, we observed mean differences in the structural functioning of patients with a history of suicide attempt and previous history of hospitalization. DISCUSSION: results support that OPD-2's criteria significantly correlates with data from validated self-report measures. When administered by trained raters, OPD-2 displayed good quality in assessing patients' conflicts and structural issues. This evidence suggests that the Brazilian version of OPD-2 is a valid and reliable instrument in evaluating psychodynamic properties and can be a useful tool within the clinical and research contexts. (AU)

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BACKGROUND: Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care. METHODS: 26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions. RESULTS: The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data. CONCLUSION: The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.

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Introducción: es necesario mayor estudio de la experiencia de abandono terapéutico temprano. Indagar sistemáticamente casos únicos puede conformar una respuesta orgánica a este desafío. Objetivos y métodos: se analizó y comparó la evolución de focos terapéuticos, planteados por el terapeuta tratante y por dos juezas externas, para un caso de abandono temprano de psicoterapia psicodinámica focalizada de un trastorno emocional. Ciegos a la codificación de la contraparte, terapeuta y juezas utilizaron el Diagnóstico Psicodinámico Operacionalizado-2 (OPD-2) para generar un perfil psicodinámico y establecer focos de tratamiento. Para cada foco, aplicaron la Escala de Presencia de Foco y la Escala de Cambio Estructural de Heidelberg. Resultados y discusión: se observaron puntos de convergencia y divergencia entre las perspectivas de terapeuta y juezas externas. Se discute la utilidad de dichos puntos para la comprensión del abandono temprano del paciente, así como las implicancias del OPD-2 como herramienta de investigación orientada a la práctica

Introduction: more study on the experience of therapeutic early dropout is needed. The systematic study of psychodynamic single cases can conform an organic response to this challenge. Aims & Methods: therapeutic foci's evolution, proposed by both treating therapist and two external judges, for the same early dropout case of a focused psychodynamic psychotherapy for an emotional disorder, were analyzed and compared. Blind to the counterpart's rating process, therapist and judges employed Operationalized Psychodynamic Diagnosis (OPD-2) in order to generate a psychodynamic profile and establish therapeutic foci. For each focus, they applied the Focus Presence Scale and the Heidelberg Structural Change Scale. Results & Discussion: specific convergences' and discrepancies' points between therapist's and judges' perspectives were observed. Such points' usefulness for the understanding of patient's early dropout, together with OPD-2' implications as a practice-oriented research tool, are discussed

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OBJECTIVE: To compare male and female patients with regard to the Operationalized Psychodynamic Diagnosis (OPD-2) system, treatment variables, and outcome after multimodal psychodynamic inpatient psychotherapy. METHODS: At the beginning and at the end of inpatient treatment in a multimodal psychodynamic setting, patients were examined with the OPD-2 systemas well as with three self-assessment questionnaires addressing interpersonal problems (Inventory of Interpersonal Problems, IIP), and psychopathology: Brief SymptomInventory (BSI) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Data of 850 patients (238 males, 28%), 612 females, 72%) were available for analysis. There were differences between men and women in the main diagnoses, with a higher proportion of eating disorders and a longer treatment duration among the women. Therapy discontinuation rates were low and did not differ between the sexes. Women scored higher on psychopathology at admission on the BSIGlobal Score, IIP and anxiety; the pattern of reported interpersonal problems was consistent with sex roles. While the level of structural integration was similar in both sexes, the distribution of the two main conflicts and the level of improvement of awareness and dealing with the psychodynamic foci showed significant differences. Overall, at the end of inpatient psychotherapy, there was a mean improvement in both men and women, with no significant differences between them. Because of higher scores at the start of psychotherapy, the effect sizes for improvement were higher for women. CONCLUSIONS: On the whole, both sexes seem to benefit equally from psychodynamic inpatient psychotherapy in terms of symptom improvement.

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A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. METHODS: In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). RESULTS: 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. DISCUSSION: It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

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Introducción: la terapia psicoanalítica contemporánea suscribe una planificación y evaluación del proceso que combine juicio clínico con evidencias empíricas (Barber y Sharpless, 2015; Juan y Pozzi, 2016). Objetivos y estructura: este artículo presenta una organización de criterios para evaluar el proceso de supervisión en terapia psicoanalítica. Se combinan aspectos clásicos con aportes del Diagnóstico Psicodinámico Operacionalizado 2 (OPD-2) (Grupo de Trabajo OPD, 2006/2008). Se ofrecen guías para sistematizar la descripción del caso, su evolución, y los motivos y expectativas del terapeuta para supervisar. El OPD-2 es utilizado para operacionalizar el diagnóstico del paciente supervisado y evaluar el progreso durante el tratamiento. Los parámetros ofrecidos se ejemplifican mediante un material clínico. Discusión: se analiza la utilidad de los criterios presentados como recurso para la actividad de supervisión y la práctica clínica. También se discuten sus implicancias para la investigación empírica que evalúe mecanismos de cambio en terapia psicoanalítica. (AU)

Introduction: contemporary psychoanalytic therapy goes through a planning and evaluation process that combines clinical judgment and empirical evidence (Barber and Sharpless, 2015; John and Pozzi, 2016). Objectives and structure: this article presents a body of criteria applied to assess the supervision process in psychoanalytic therapy. Classical aspects are combined to contributions from the Operationalized Psychodynamic Diagnostic 2 (OPD-2) (OPD Work Group, 2006 / 2008). Guidelines are offered to systematize the description of the case, its evolution, as well as the motives and expectations of the therapist regarding supervision The OPD-2 is applied to operationalize the diagnosis of the supervised patient and assess progress during treatment. The parameters offered are exemplified by means of clinical material. Discussion: the contributions of the criteria presented as a resource for the supervising activity and clinical practice are discussed. Their implication for empirical research assessing change mechanisms in psychoanalytic therapy are also discussed. (AU)

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Otopalatodigital spectrum disorders (OPDSD) include OPD syndromes types 1 and type 2 (OPD1, OPD2), Melnick-Needles syndrome (MNS), and frontometaphyseal dysplasia (FMD). These conditions are clinically characterized by variable skeletal dysplasia associated in males, with extra-skeletal features including brain malformations, cleft palate, cardiac anomalies, omphalocele and obstructive uropathy. Mutations in the FLNA gene have been reported in most FMD and OPD2 cases and in all instances of typical OPD1 and MNS. Here, we report a series of 10 fetuses and a neonatally deceased newborn displaying a multiple congenital anomalies syndrome suggestive of OPDSD and in whom we performed FLNA analysis. We found a global mutation rate of 44%. This series allows expanding the clinical and FLNA mutational spectrum in OPDSD. However, we emphasize difficulties to correctly discriminate OPDSD based on clinical criteria in fetuses due to the major overlap between these conditions. Molecular analyses may help pathologists to refine clinical diagnosis according to the type and the location of FLNA mutations. Discriminating the type of OPDSD is of importance in order to improve the genetic counseling to provide to families.

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La siguiente investigación clasificó la conceptualización de un caso de TAG, realizada por terapeutas psicoanalíticos, utilizando los criterios del Diagnóstico Psicodinámico Operacionalizado 2 (OPD-2). Se re-analizó información proveniente de la tesis doctoral en curso del primer autor, donde 30 psicoterapeutas (15 psicoanalíticos y 15 cognitivos), en una entrevista individual, propusieron inferencias pronósticas y una conceptualización del caso para un paciente TAG. El objetivo del presente estudio fue la utilización de los criterios OPD-2 para un análisis secundario de las 15 entrevistas ya conducidas con los participantes psicoanalíticos. Se describen la justificación, los procedimientos y preguntas centrales de esta investigación. Se presenta el OPD-2 como instrumento de análisis. Según resultados preliminares, los ejes OPD-2 III y IV predominaron en la identificación del problema principal del paciente, los ejes IV y V en su diagnóstico tentativo, y el eje II en las expectativas inferidas del paciente respecto del tratamiento. Se discuten implicancias de esta investigación para la práctica clínica psicoanalítica.

The present study classified a GAD´s case conceptualization made by psychoanalytic therapists using Operationalized Psychodynamic Diagnostic 2 (OPD-2) criteria. Information from the first author´s ongoing dissertation research was re-analyzed. In that study, 30 psychotherapists (15 psychoanalytic and 15 cognitive) proposed prognostic inferences and a case conceptualization for a GAD patient. The aim of the present study was to use OPD-2´s criteria for a secondary analysis of the 15 interviews already conducted with the psychoanalytic participants. The present study`s rationale, procedures and central research questions are described. OPD-2 is presented as a data analysis` instrument. According to preliminary results, OPD-2´s axis III and IV were predominant in the patient´s main problem identification, axis IV and V were used to describe patient´s preliminary diagnosis, and axis II was observed in the patient´s inferred treatment expectations. Implications for psychoanalytic clinical practice are discussed.

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La siguiente investigación clasificó la conceptualización de un caso de TAG, realizada por terapeutas psicoanalíticos, utilizando los criterios del Diagnóstico Psicodinámico Operacionalizado 2 (OPD-2). Se re-analizó información proveniente de la tesis doctoral en curso del primer autor, donde 30 psicoterapeutas (15 psicoanalíticos y 15 cognitivos), en una entrevista individual, propusieron inferencias pronósticas y una conceptualización del caso para un paciente TAG. El objetivo del presente estudio fue la utilización de los criterios OPD-2 para un análisis secundario de las 15 entrevistas ya conducidas con los participantes psicoanalíticos. Se describen la justificación, los procedimientos y preguntas centrales de esta investigación. Se presenta el OPD-2 como instrumento de análisis. Según resultados preliminares, los ejes OPD-2 III y IV predominaron en la identificación del problema principal del paciente, los ejes IV y V en su diagnóstico tentativo, y el eje II en las expectativas inferidas del paciente respecto del tratamiento. Se discuten implicancias de esta investigación para la práctica clínica psicoanalítica. (AU)

The present study classified a GAD´s case conceptualization made by psychoanalytic therapists using Operationalized Psychodynamic Diagnostic 2 (OPD-2) criteria. Information from the first author´s ongoing dissertation research was re-analyzed. In that study, 30 psychotherapists (15 psychoanalytic and 15 cognitive) proposed prognostic inferences and a case conceptualization for a GAD patient. The aim of the present study was to use OPD-2´s criteria for a secondary analysis of the 15 interviews already conducted with the psychoanalytic participants. The present study`s rationale, procedures and central research questions are described. OPD-2 is presented as a data analysis` instrument. According to preliminary results, OPD-2´s axis III and IV were predominant in the patient´s main problem identification, axis IV and V were used to describe patient´s preliminary diagnosis, and axis II was observed in the patient´s inferred treatment expectations. Implications for psychoanalytic clinical practice are discussed. (AU)

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The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to "remember, repeat, and work through" concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved it corresponds to neuronal transformation. Individualized neuro-imaging requires controlling and measuring of variables that must be defined. Two main methodological problems can be distinguished: the design problem addresses the issue of how to account for functionally related variables in an experimentally independent way. The translation problem raises the question of how to bridge the gaps between different levels of the concepts presupposed in individualized neuro-imaging (e.g., the personal level of the therapist and the client, the neural level of the brain). An overview of individualized paradigms, which have been used until now is given, including Operationalized Psychodynamic Diagnosis (OPD-2) and the Maladaptive Interpersonal Patterns Q-Start (MIPQS). The development of a new paradigm that will be used in fMRI experiments, the "Interpersonal Relationship Picture Set" (IRPS), is described. Further perspectives and limitations of this new approach concerning the design and the translation problem are discussed.