Michael Stasch

The operationalized psychodynamic diagnostics system : Clinical relevance, reliability and validity

In this paper, we present a multiaxial system for psychodynamic diagnosis, which has attained wide usage in Germany in the last 10 years. First we will discuss the 4 operationalized psychodynamic diagnostics (OPD) axes: illness experience and treatment assumptions, relationships, mental conflicts, and structure, then clinical applications will be outlined. Focus psychodynamic formulations can be employed both with inpatients and with outpatients. Studies show good reliability in a research context and acceptable reliability for clinical purposes. Validity will be separately summarized as content, criterion, and construct validity. Validity studies indicate good validity for the individual axes. Numerous studies on the OPD indicate areas of possible improvement, for example for clinical purposes the OPD should be more practically formulated.

Individualized and Clinically Derived Stimuli Activate Limbic Structures in Depression: An fMRI Study

Objectives In the search for neurobiological correlates of depression, a major finding is hyperactivity in limbic-paralimbic regions. However, results so far have been inconsistent, and the stimuli used are often unspecific to depression. This study explored hemodynamic responses of the brain in patients with depression while processing individualized and clinically derived stimuli. Methods Eighteen unmedicated patients with recurrent major depressive disorder and 17 never-depressed control subjects took part in standardized clinical interviews from which individualized formulations of core interpersonal dysfunction were derived. In the patient group such formulations reflected core themes relating to the onset and maintenance of depression. In controls, formulations reflected a major source of distress. This material was thereafter presented to subjects during functional magnetic resonance imaging (fMRI) assessment. Results Increased hemodynamic responses in the anterior cingulate cortex, medial frontal gyrus, fusiform gyrus and occipital lobe were observed in both patients and controls when viewing individualized stimuli. Relative to control subjects, patients with depression showed increased hemodynamic responses in limbic-paralimbic and subcortical regions (e.g. amygdala and basal ganglia) but no signal decrease in prefrontal regions. Conclusions This study provides the first evidence that individualized stimuli derived from standardized clinical interviewing can lead to hemodynamic responses in regions associated with self-referential and emotional processing in both groups and limbic-paralimbic and subcortical structures in individuals with depression. Although the regions with increased responses in patients have been previously reported, this study enhances the ecological value of fMRI findings by applying stimuli that are of personal relevance to each individuals depression.

Operationalized psychodynamic diagnosis as an instrument to transfer psychodynamic constructs into neuroscience

This theoretical article makes a contribution to the field of “psychoanalytically informed neuroscience”. First, central characteristics of psychoanalysis and neuroscience are briefly described leading into three epistemic dichotomies. Neuroscience versus psychoanalysis display almost opposing methodological approaches (reduction vs. expansion), test quality emphases (reliability vs. validity) and meaning of results (correlation vs. explanation). The critical point is to reach an intermediate level: in neuroscience an adequate position integrating both aspects—objective and subjective—of dual-aspect monism, and in psychoanalysis the appropriate level for the scientific investigation of its central concepts. As a suggestion to reach that level in both fields the system of Operationalized Psychodynamic Diagnosis (OPD; OPD Task Force, 2008) is presented. Combining aspects of both fields areas, expansion and reduction as well as reliability and validity, OPD could be a fruitful tool to transfer psychodynamic constructs into neuroscience. The article closes with a short description of recent applications of OPD in neuroscience.

El sistema Diagnóstico Psicodinámico Operacionalizado (OPD): Concepto, confiabilidad y validez

This paper presents the system “Operationalized Psychodynamic Diagnosis (OPD), which has been applied in the German speaking countries very successfully duri...

Changes in the mental representations of relational behavior in depressive patients

Abstract In this study the mental representations of interpersonal relations in depressive patients were assessed using the axis relationships of the operationalized psychodynamic diagnostics (OPD) system. The data were obtained at the beginning and at the end of inpatient psychotherapy. Although a link was assumed to exist between the severity of the symptoms and the variability of the mental representation of relational behavior, this was not proven. Also, contrary to expectations, an increase in the variability of the mental representations of the patients’ own relational behavior was not observed on completion of therapy. However, patients’ mental representation of their social partners’ relational behavior tends to become more variable. A shift in the focus of relationships was also observed.

Seiffge-Krenke I, Dietrich H, Adler-Cormann P et al. (2014) Die Konfliktachse der OPD-KJ-2. Ein Fallbuch für die klinische Arbeit

Es kommt als ein relativ kleines Büchlein daher, verglichen mit dem aktuellen, seitenstarken Grundlagenwerk der OperationalisiertenPsychodynamischen Diagnostik im Kindesund Jugendalter (OPD-KJ-2). Das handliche Format lädt zum „Hineinlesen“ ein, und man stellt schnell fest, wie interessant und fesselnd der klinische Blick durch die „Brille“ der OPD-KJ-2-Konfliktachse sein kann. Der Autorengruppe um Inge Seiffge-Krenke ist es gelungen, den Behandlungsalltag mit Kindernund Jugendlichen lebendig und facettenreich abzubilden. Die Vignetten entstammen den unterschiedlichsten klinischen Bereichen und reichen von der Arbeit mit Babys und Kleinkindern über analytische Langzeitbehandlungen von jungen Patienten verschiedenerAltersstufen, Elternarbeit, Jugendhilfe, tagesklinische Behandlung bis hin zu Supervision und Antragstellung. Die Fallberichte werden durch kurze theoretische bzw. forschungsbezogene Kapitel ergänzt, die grundlegende Fragen der diagnostischen Arbeit mit der Konfliktachsebehandeln.DamitwirdLeserinnen und Lesern, die sich vielleicht noch nicht so intensiv mit derOPD-KJ-2 beschäftigt bzw. ein entsprechendes Trainingsseminarbesuchthaben,derEinstieg leicht gemacht. In einer deutlichen Erweiterung des Altersspektrums der Anwendung des Instruments (imVergleich zumOPD-KJ-2Grundlagenbuch) wird die interessante Frage beantwortet, ob man beispielsweise Babys „therapieren“ bzw. Vorläufer unbewusster Konflikte bereits im ersten Lebensjahr diagnostizieren kann. Dabei werden die Ansätze der psychoanalytischen Säugling-Kleinkind-Eltern-Psychotherapie (SKEPT) aufgegriffen und um eine OPD-basierte, kindzentrierte diagnostische Perspektive erweitert. Der empirisch oft vernachlässigten Fragestellung, ob oder inwieweit symptomatische unauffällige Kinder und Jugendliche auch entwicklungshemmende Konflikte aufweisen, wird anhand von Daten aus einem groß angelegten Projekt im Auftrag des Deutschen Jugendinstituts nachgegangen. Behandlungstechnisch sehr relevant ist das Erkennen von sich im Verlauf der Behandlung verändernden Konfliktdynamiken bei jungen Patienten. In Fortführung einer Vignette aus dem OPD-KJ-2-Manual (eine damals 6-jährige Patientin mit einem Unterwerfungvs.-Kontrolle-Konflikt im aktiven Modus) wird die Verschiebung desKonflikts zur ödipalen Dynamik unter der laufenden Behandlung beschrieben. Die Erweiterung des individuumzentrierten Blicks auf Aspekte der Elternarbeit und somit auch auf die transgenerationale Weitergabe vonKonfliktdynamikenwird immer wieder vorgenommen, nicht nur in einem eigenen Kapitel, sondern auch in den Fallberichten und schließlich in den Überlegungen zu superbzw. intervisorischer Fallarbeit. Persönlich hat mich der Fall „Jeremy“ aus der kinderund jugendpsychiatrischenPraxisammeistenbewegt.Geschildert wird der Werdegang des Patienten vom 6. Lebensjahr an: drogenabhängige Eltern, Heimunterbringung, Familienhilfe, Förderschule, stationäreBehandlung, Pflegestelle. Das sind die Stationen eines Lebens, das schon von Anfang an starkbelastetwar, undmanmag resignieren, angesichts der vielfältigen strukturellen Defizite, die der junge Patient mit-

Focus-Oriented Psychotherapy of Parents with Infants and Toddlers

Donald W. Winnicott (The maturational processes and the facilitating environment. Studies in the theory of emotional development. Karnac, London, 1990) once said “There is no such thing as a baby.” By this he meant that wherever there is an infant, there is also a mother or parent caring for the infant. From the outset, the infant is involved in a lively exchange with the world and its primary caregivers, which it is constantly introjecting and projecting onto. For this reason, in psychoanalytically oriented psychotherapy, the quality of relationship regulation between parent and infant plays a central role. In order to establish the focus of treatment, one must answer the question of whether—and perhaps also in what way—is the emotional-interactional exchange between parents and infant impaired.