Psychodynamic Profile in an Early Dropout Case: Comparing Therapist's and External Judges' perspectives

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)

Patterns of change: tracking the therapeutic focus

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)

Propriedades psicométricas do protocolo de sistema diagnóstico Operationalization of Psychodynamic Diagnosis 2 (OPD-2) em pacientes com transtorno mental grave em psicoterapia / Psychometric properties of the Operationalization of Psychodynamic Diagnosis 2 (OPD-2) diagnostic system protocol in patients with severe mental disorder undergoing psychotherapy

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)

Contributions of Operationalized Psychodynamic Diagnosis (OPD-2) in Colombia: training, practice and research

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)

Focos Terapéuticos en un Caso de Abandono Temprano: Perspectivas del Terapeuta y de Jueces Externos / Therapeutic Foci in an Early Dropout Case: Therapist's and External Judges' Perspectives

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

Criterios para evaluar el proceso de supervisión en terapia psicoanalítica: aportes del Diagnóstico Psicodinámico Operacionalizado 2 (Opd-2) / Criteria to assess the psychoanalytical therapy supervision process: contributions of the Operationalized Psychodynamic Diagnostic (OPD-2)

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)

La conceptualización de un caso de trastorno de ansiedad generalizada (TAG) propuesta por terapeutas psicoanalíticos: análisis mediante los criterios del diagnóstico psicodinámico operacionalizado 2 (OPD-2): resultados preliminares / A generalized anxiety disorder (GAD) s case conceptualization proposed by psychoanalytic therapists: analysis through operacionalized psychodynamic diagnostic 2 (OPD-2) s criteria: preliminary Results

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.