Dyadic coping and mental health in couples: A systematic review.

Globally, one out of three people suffer from a mental health issue during their lifetime. In romantic relationships, impaired mental health does not only affect the individual but also their partner and therefore needs to be coped with dyadically. In this systematic review, we summarize research examining dyadic coping (DC) in the context of mental health and individual and relational outcomes. We searched for peer-reviewed articles published between January 1990 and April 2023 on PsycInfo, Medline, and PSYNDEX on DC and mental health within romantic relationships. A total of 60 qualitative, quantitative, and intervention studies met the inclusion criteria, reporting on 16,394 individuals and 4,945 dyads. To synthesize the studies, we used a narrative synthesis approach. Overall, stress expression and positive DC yielded beneficial individual and relational outcomes, whereas, for negative DC, the opposite was true. Results differed between mental health clusters and context played an important role (e.g., symptom severity, life phase). Due to the great diversity of studies and variables, further research should focus on understudied mental health clusters (e.g., anxiety disorders). Clinicians are advised to view mental health issues as a dyadic rather than an individual phenomenon ("we-disease") and develop tailored couple-centered interventions.

Discrepancies in dyadic coping: associations with distress and quality of life in couples facing early stage dementia.

Objectives: Due to an aging population, the number of persons living with dementia (PWDs) is increasing worldwide. Romantic partners, as informal caregivers (IC) of PWDs, are often adopting additional tasks. The concept of dyadic coping (DC) addresses how couples cope with stress together. For dyadic coping to be successful, efforts of both partners should be equal. The current study examines how discrepancies in PWDs and ICs perspectives on DC relate to distress and quality of life in each partner within couples facing early stage dementia (ESD). Methods: A total of 37 mixed-sex couples including one partner with ESD completed self-report questionnaires. Discrepancies in reciprocity (comparing provided or received levels of DC between partners), equity (each partner balancing own levels received and provided), and congruence (the agreement about levels of DC exchanged between partners) and their covariation with distress and quality of life (QoL) of each partner were measured. Results: Both partners indicated a discrepancy in reciprocity: PWDs reported receiving more DC than ICs reported receiving, which was associated with higher QoL in PWDs and lower QoL in ICs. Inequities were found in ICs only, who reported receiving less DC, than providing. No relation between inequities and distress or QoL was found. ICs reported more incongruencies than PWDs did, which was associated with higher QoL and less depression in partners. Discussion: A redivision of tasks and roles in the early stage of dementia is associated with different experiences and views between partners. Whereas ICs take over most household and care tasks within the couple, their effort was considered less helpful by PWDs than by ICs. A high care burden is associated with a compromised quality of ICs' social life and living conditions. The clinical implications of the results are discussed.

Cognitive behavioural therapy to treat stress and insomnia: A randomized wait list-controlled trial of two online courses.

This randomized, wait list-controlled trial aimed to evaluate the efficacy of the cognitive behavioural therapy-based online e-learning course stressfit for better stress management and the cognitive behavioural therapy for insomnia-based online course SweetDreams for coping with insomniac problems. The course modules offer state of the art psychoeducation and cognitive behavioural strategies concerning different aspects of stress, sleep and insomnia. They provide practice-oriented exercises for self-reflection, as well as a variety of evidence-based methods and measures to increase self-efficacy when dealing with stress or insomnia. Study participants were randomly assigned to the three test conditions stressfit, SweetDreams or a wait list. Participants filled in questionnaires on a wide range of scales relevant to stress and insomnia at three points in time (before, 4 weeks after, and 3 months after the treatment). Of the 588 participants in total, data from 347 participants (59%) were finally included in the data analyses. Data analyses showed that both courses yielded significant positive effects compared with the wait list condition 4 weeks and to some degree 3 months after completion in relation to insomnia symptoms, physical and psychological wellbeing, life satisfaction and general health (General Health Questionnaire), as well as on satisfaction with and effectiveness of coping with stress and sleep disorders. In conclusion, SweetDreams and stressfit proved to be feasible and effective online cognitive behavioural therapy (for insomnia) tools to reduce insomnia and stress symptoms on a broad variety of scales at the 4-weeks measurement point as well as at the 3-months follow-up.

Women's Experiences of Different Types of Orgasms-A Call for Pleasure Literacy?

Background: There is an ongoing controversy about women's sexuality and the existence of different orgasms. The debate is tilted toward anatomical and physiological evidence, which often leaves subjective experiences out of the picture. The aim of the current mixed-methods study was to capture women's accounts of their experiences of orgasmic states. Methods: As part of a larger online survey, 513 women (M = 25.89 years, SD = 5.60) from a community sample filled in open-ended questions on their experience of different kinds of orgasms. Additionally, women rated semantic differentials with bipolar adjectives characterizing vaginal and clitoral orgasms. A sub-sample of n = 257 women (50%) had experienced both, vaginal and clitoral orgasms and rated both separately on the semantic differential. Results: Wilcoxon signed-rank test showed significant differences in that clitoral orgasms were, amongst others, rated as sharper, easier, and more controllable, while vaginal orgasms were rated as wilder, deeper, more pulsating, and extending. In open-ended questions, women talked about various other orgasmic experiences, such as mixed clitoral/vaginal orgasms, whole body, cervical, anal, or mental orgasms. Some women were uncertain about their orgasmic experiences. Conclusion: It is time to integrate anatomical, psychophysiological, and experiential data and conclude that either "all clitoral" or "clitoral and vaginal" falls short to do justice to the complexity of women's orgasms. Understanding and defining these various types of orgasms and allowing for the apparent diversity to have its place in research and in social discourse is a task for future research and pleasure-positive sex education to increase pleasure literacy.

Couples Coping Together: A Scoping Review of the Quantitative and Qualitative Evidence and Conceptual Work Across Three Decades.

Dyadic coping (DC), how couples cope together to deal with a stressor like chronic illness, has received increased attention over the last three decades. The aim of the current study was to summarize the current state of research on DC in couples. We conducted a scoping review of qualitative, quantitative, and mixed-methods studies published between 1990 and 2020, assessing DC in couples during three decades. 5,705 studies were identified in three electronic databases and hand searches. We included 643 sources in this review (with a total of N = 112,923 study participants). Most studies were based in the global North, particularly in the US and Europe. Publication numbers increased constantly over time. A third of study designs were cross-sectional studies followed by qualitative and longitudinal studies. The most prolific DC research areas were related to DC and minor stressors and DC and major physical health stressors. Overall, DC has been established internationally as a highly relevant construct in many disciplines (clinical, social, developmental, personality psychology, social work, nursing etc.). To conclude, the review reveals that future studies should focus on predictors, trajectories, and the importance of very specific DC behaviors for personal and dyadic functioning.

Dyadic Coping in Couples Facing Chronic Physical Illness: A Systematic Review.

Objective: Chronic physical illness affects not only patients but also their partners. Dyadic coping (DC)-the ways couples cope in dealing with a stressor such as chronic illness-has received increased attention over the last three decades. The aim of the current study was to summarize the state of research on DC in couples with chronic physical illnesses. Methods: We conducted a systematic review of qualitative, quantitative, and mixed-methods studies published between 1990 and 2020, assessing DC in couples affected by severe physical illnesses. We used DC and related search terms for the literature search in Psycinfo, Psyndex, and Medline. Five thousand three hundred thirty studies were identified in three electronic databases and 49 of these were included in the review (5,440 individuals reported on 2,820 dyads). We excluded studies on cancer, cardiovascular disease, and multiple sclerosis because of existing reviews in the respective fields. Half of the studies included were on diabetes. Other studies were on arthritis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, human immunodeficiency virus (HIV), Huntington's disease, lupus erythematosus, Parkinson's disease, renal diseases, stroke, and endometriosis. Two raters extracted data using a predefined protocol, including study quality. Results were collated in a narrative synthesis organized by illness and DC operationalization. Results: Overall, DC was associated with beneficial outcomes in physical health, well-being, and relationship satisfaction. Differential effects became apparent for certain chronic conditions potentially depending on certain disease characteristics, such as early-onset, sudden-onset, or life-threatening conditions. Conclusion: Facing challenges together as a couple seemed indispensable for adapting to a diverse range of demands related to chronic illnesses with some specific demands of particular chronic diseases. There is a need for the development of truly dyadic interventions with an eye on the specific challenges of the various chronic conditions.

[Adolescent Drop-Out from Psychodynamic and Cognitive-Behaviour Psychotherapy from the Therapist's Perspective: A Qualitative Interview Study in Germany and Switzerland]. / Therapieabbrüche Jugendlicher in psychodynamischer und kognitiv-verhaltenstherapeutischer Psychotherapie aus Therapeutensicht: Eine qualitative Interviewstudie in Deutschland und der Schweiz.

Therapy drop-outs in adolescence remain a prevalent and complex problem with inconsistent research findings: Although a number of possible predictors have been identified, such as difficult family situations and development-related autonomy efforts, the underlying mechanisms and processes are hardly explained. In this qualitative study, 24 interviews were conducted with resident child and youth psychotherapists. The therapists reported a self-chosen drop-out case from their practice. Additionally, they were asked about their views on what they consider typical for adolescent dropouts. The content analysis yielded factors relating to three topics as reasons for dropouts from the therapist's perspective. The area of therapy included themes such as setting variables or disagreement about therapy goals. The family and environment area included reasons concerning the family, e. g., lack of parental support or parents opposing therapy. Finally, reasons such as therapy being too demanding, lack of motivation or loyalty conflicts were assigned to the adolescents. To conclude, a sensitive handling seems to be necessary when trying to balance the adolescent's striving for autonomy and their therapeutic needs as well as finding the right dosage of parental involvement with parents who are often in need of treatment themselves.

Parents' understanding and motivation to take part in a randomized controlled trial in the field of adolescent mental health: a qualitative study.

BACKGROUND: Little is known about why parents agree to take part in randomized controlled trials for adolescent mental health. This study aimed to investigate parents' perspectives on participating in a trial for psychological treatment of depression. The study explored parents' motivations, understanding of the trial and perspectives on the acceptability of the trial. METHODS: Sixty-five parents took part in this qualitative study. Their adolescent children had been randomly allocated to one of three active psychological treatments for depression as part of the IMPACT trial and were interviewed about their experiences of participating in the study. Semi-structured interviews were analysed using framework analysis. RESULTS: For seven of the sixty-five parents, their experience of taking part in the trial was not covered in their interview so they were excluded from the analysis. The analysis was therefore based on the data from the parents of 58 adolescents taking part in the trial. The most commonly cited motivation for taking part in the study reported by parents was a desire to help others going through similar difficulties. Parents generally reported finding trial participation acceptable, although there were aspects that some reported finding less acceptable, including randomization and the burden of research assessments. Others spoke positively about the experience of trial participation and found it enjoyable or even therapeutic. Importantly, some did not appear to have a good understanding of the trial design, including randomization and treatment allocation. CONCLUSIONS: This study indicates that trial participation can be a positive experience for parents, yet it raises concerns about how trialists can ensure that consent is fully informed, given that some parents appeared to have a poor understanding of the trial. Future studies should seek to explore how communication with trial participants can be improved, to ensure that trial participation is fully informed. Patient and public involvement will be crucial in ensuring this communication is accessible to stakeholders. TRIAL REGISTRATION: ISRCTN registry ISRCTN83033550 . Registered on 15 October 2009.

[Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting]. / Wirksamkeit analytischer Psychotherapie bei Kindern und Jugendlichen mit klinischen Angstsyndromen im naturalistischen Behandlungssetting.

Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting The aim of the study was to evaluate naturalistic out-patient psychoanalytic youth psychotherapy in Germany. The study was a partly controlled effectiveness trial. While the first treatment interval (25 sessions, 6.13 months) was compared with a wait-list control group (5 supportive sessions, 2.94 months), the effects of long-term psychoanalytical treatment were analyzed using a time-series design. 86 children and adolescents (aged 4 to 21 years) and their parents who entered psychoanalytic therapy in private practices participated in this study. The wait-list control group comprised 35 patients. Questionnaires were administered at the beginning and the end of treatment, as well as 6 and 12 month follow-up (FU). Patients received on average 94.04 therapy sessions (range 8 to 300) over 25.70 months. Data analyses were carried out with multilevel mixed linear models on the intention-to-treat (ITT) sample. The patients in the intervention group reported moderate symptom improvements at the end of therapy (d = .57), these effects are stable at the 1-year follow-up and increase from the patient perspective (d = .80). When comparing the first therapy interval with the (minimal treatment) wait-list control group, both groups improved significantly with small effect sizes and no significant group differences. The results suggest that long-term psychoanalytic therapy is successful in alleviating anxiety pathology and improving quality of life for youth with anxiety disorders, and that improvements remain stable across a 1-year follow-up period.

The Association Between Parental Rearing Dimensions and Adolescent Psychopathology: A Cross-Cultural Study.

Research on parental rearing dimensions faced ethnocentric criticism for mainly focusing on adolescents in Western industrialized countries. Over the past decade, the phenomenon of anxious parenting, so called "helicopter parenting", gained attention in popular media as well as scholarly publications in addition to support and psychological control. Whether these parenting dimensions, which were associated with different health outcomes in adolescents, were only occurring in the Western world or are visible cross-culturally, has not been sufficiently studied. Therefore, it is unclear whether these links exist also for adolescents from other parts of the world. Additionally, the involvement of fathers in child rearing continues to be neglected in adolescent psychopathology research. The current cross-cultural study tested the association of maternal and paternal rearing dimensions with youth internalizing and externalizing psychopathology in a sample of 2415 adolescents (56% female, 15.33 years, SD = 0.61) from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey). Hierarchical regression models showed that internalizing symptomatology was associated with mothers' support, psychological control, and anxious rearing as well as fathers' psychological control up and above predictors like country and mother's level of education. For predicting externalizing symptomatology, mother's anxious rearing, mother's psychological control, and father's support as well as father's psychological control were significant up and above adolescents' gender, standard of living, and country. To conclude, across countries, anxious rearing and psychological control experienced from both parents were substantially linked with adolescent mental health.

[Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play?] / Psychopathologie bei Jugendlichen aus sieben Ländern: Welche Bedeutung hat die Kontrolle von Identitätsentwicklung und Familienbeziehungen?

Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play? Abstract. This study analyzed the unique effects of gender and culture on psychopathology in adolescents from seven countries, after controlling for factors that might have contributed to variations in psychopathology. In a sample of 2259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, we assessed identity development, maternal parenting (support, psychological control, anxious rearing), and psychopathology (internalizing, externalizing). Using an analysis of covariance (ANCOVA), we analyzed country, sex, age, and the interaction country x sex as independent variables, while controlling for maternal rearing dimensions and identity development as covariates. This resulted in similar findings for internalizing and externalizing symptoms: Identity rumination and maternal rearing (support, psychological control, anxious rearing) proved to be significant covariates. Further, country, sex, age, and the interaction country x sex were significant. These analyses result in a clearer picture of culture- and gender-specific effects on psychopathology, which is helpful in designing interventions.

Psychoanalytic Psychotherapy for Children and Adolescents with Severe Externalising Psychopathology: An Effectiveness Trial.

OBJECTIVES: This partly waitlist-controlled prospective field study aimed to evaluate the effectiveness of psychoanalytic psychotherapy for children and adolescents with severe externalising symptoms. Externalising symptoms are associated with diagnoses of conduct disorders, hyperkinetic disorders, and disorders of social functioning. METHODS: Participants were 93 children and adolescents in psychoanalytic therapy with a diagnosed psychiatric disorder with externalising symptomatology (intervention group: n = 65; minimal supportive treatment/waitlist control group: n = 28). Data was collected from parents and patients (≥ 11 years) at beginning/end of treatment, 6- and 12-month follow-up. The effects of long-term psychoanalytical treatment were analysed using a longitudinal design. RESULTS: At the end of therapy, externalising symptoms were significantly reduced rated by both parents and patients (parent-rated: d = .69, patient-rated: d = .63). This effect was stable at the 1-year follow-up (parent-rated: d = .77, patient-rated: d = .68). About 70% of the patients may be considered as recovered or improved by the end of therapy. CONCLUSIONS: Psychoanalytic therapy may be successful in alleviating psychiatric disorders with externalising symptoms with effects stable at the 1-year follow-up.

The experience of adolescents participating in a randomised clinical trial in the field of mental health: a qualitative study.

BACKGROUND: This descriptive study aimed to investigate adolescents' motivations for participating in a randomised controlled trial (RCT), to explore the understanding that the young people had regarding a number of aspects of the trial design, to examine whether or not they found participation in the trial to be acceptable and what affected this, and to identify whether and how the young people felt that their participation in the RCT impacted on their experience of therapy and on therapeutic change. METHODS: Seventy-six adolescents who were taking part in a large-scale RCT to evaluate the clinical and cost effectiveness of psychological therapies for depression were interviewed at two time-points after completing therapy. The semi-structured interviews, which included a focus on the young people's experience of the research study, were analysed using framework analysis. RESULTS: The vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of 'conditional altruism'. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process. Although the adolescents were largely positive about their experiences from taking part, the study raises questions about whether clinical outcomes may be influenced by participation in the research elements of the trial. CONCLUSIONS: Although adolescents are under-represented in clinical trials, those who do participate are generally positive about the experience; however, careful thought needs to be given to key elements of the trial design and the potential impact of the research participation on clinical outcomes. TRIAL REGISTRATION: ISRCTN registry, ISRCTN83033550 . Registered on 15 October 2009.

The Experience of Depression: A Qualitative Study of Adolescents With Depression Entering Psychotherapy.

There is a lack of research in health psychology on the subjective experience of adolescents with mental health disorders. The aim of this study was to explore the experience of depression and the journey into therapy of young people (YP) diagnosed with depression. Semi-structured interviews were carried out with six YP (5 female, aged 15-19). Interviews were analyzed using Interpretative Phenomenological Analysis. The following four key themes were identified: "Suffering is experienced as overwhelming," "An experience of loneliness and isolation," "Struggling to understand the suffering," and "Therapy as a last resort." Reasons for a delay in accessing treatment were not knowing what is "normal," the feeling that they have to deal with it by themselves, and/or the lack of a caring adult who supports the YP in getting help. The findings suggest the ongoing importance of reducing stigma and promoting mental health education for YP as well as parents, school staff, and health professionals.

[Operationalized psychodynamic diagnostics in childhood and adolescence (OPD-CA): the axis during psychoanalytic child- and adolescent psychotherapy]. / Operationalisierte Psychodynamische Diagnostik im Kindes- und Jugendalter (OPD-KJ): die Achsen im Verlauf von analytischer Kinder- und Jugendpsychotherapie.

There is evidence for the effectiveness of psychodynamic therapies in terms of symptom reduction. Up to now, there is little evidence to what extend therapy translates to the improvement of core analytical concepts, like psychic structure, interpersonal relatedness, and intrapsychic conflicts. The current study focuses on these concepts over the course of therapy as well as in connection with outcome. The concepts are assessed with the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA). Additionally, the OPD-CA axis prerequisites of treatment is tested as a predictor of outcome. 16 therapists rated 146 participating patients at the beginning and the end of therapy within the framework of a study on the effectiveness of psychoanalytical psychotherapy. Therapists rated the OPD-CA as well as the level of psychosocial impairment. Psychic structure, interpersonal relatedness, and intrapsychic conflicts improved significantly over the course of therapy. Positive outcome was predicted by communicative abilities, positive self-relatedness and an undistinctive intrapsychic conflict at the beginning of therapy as well as the improvement of these during therapy. Among the prerequisites of treatment only the subjective level of mental impairment and the intrapsychic resources were predictive of outcome. Psychoanalytic psychotherapy for children and adolescents improved central psychodynamic concepts like psychic structure, interpersonal relatedness, and intrapsychic conflicts.

Psychometric properties of the Questionnaire for Secondary Traumatization.

BACKGROUND: During the past several years, there has been a growing interest in the negative effects that providing therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. To develop a simple screening tool for secondary traumatization, a quantitative assessment instrument was constructed using a data-driven approach based on qualitative interviews with affected trauma therapists as well as experienced supervisors in trauma therapy. OBJECTIVE: The aim of the current study was to analyze the psychometric properties of the newly developed Questionnaire for Secondary Traumatization (FST) acute and lifetime version and to determine the most appropriate scoring procedure. METHOD: To this end, three independent samples of psychotherapists (n=371), trauma therapists in training (n=80), and refugee counselors (n=197) filled out an online questionnaire battery. Data structure was analyzed using factor analyses, cluster analyses, and reliability analyses. RESULTS: Factor analyses yielded a six-factor structure for both the acute and the lifetime version with only a small number of items loading on differing factors. Cluster analyses suggested a single scale structure of the questionnaire. The FST total score showed good internal consistencies across all three samples, while internal consistency of the six extracted factors was mixed. CONCLUSION: With the FST, a reliable screening instrument for acute and lifetime secondary traumatization is now available which is free of charge and yields a sum score for quick evaluation. The six-factor structure needs to be verified with confirmatory factor analyses.

Psychoanalytic psychotherapy for children and adolescents with severe depressive psychopathology: preliminary results of an effectiveness trial.

This waitlist-controlled field study aimed to evaluate the effectiveness of psychoanalytic short- and long-term psychotherapy for children and adolescents by using a prospective design. The presented analyses focus on the self- and parent-reported levels of depression and the therapists' ratings of the patients' level of functioning. Thirty-five children and adolescents (aged 4-21 years) and their parents who entered psychoanalytic therapy in private practices in northern Germany participated in this ongoing study. At the time of data analysis, the wait-list control group comprised 17 patients. Data were collected from therapists, parents, and from the patients themselves. Questionnaires were administered at the beginning and the end of treatment, as well as up to 5 points in time during therapy. Follow-up took place at 6 and 12 months after therapy. Depression levels were measured with the self- and parent-reported screening questionnaire Child Depression Inventory, and quality of life with the KIDSCREEN. Patients received, on average, 97 sessions of therapy (range: 25-205). Overall, patients showed pronounced impairments at the commencement of outpatient therapy. At the end of therapy, there was a significant reduction in depression in the treatment group (parent report: d = 0.88, p < .001; patient report d = 0.68, p ≤ .003). The wait-list control group, which received minimal treatment, displayed a slight, but not statistically significant, symptom improvement in the patient report (d = 0.07, p ≤ .503), but a significant improvement in the parent report (d = 0.49, p ≤ .008). The results suggest that psychoanalytic therapy is successful in alleviating depressive pathology and improving quality of life for a significant number of depressed children and adolescents.

Health-related quality of life of children and adolescents with mental disorders.

BACKGROUND: The aim was to assess the association of internalising and externalising pathology with the child's health-related quality of life (QoL), and to determine which child and environmental characteristics beyond pathology were related to poor QoL. METHODS: Data was obtained for 120 children and adolescents (aged 6 to 18) commencing outpatient psychotherapy treatment. Parents and children (aged 11 years and older) filled out questionnaires. QoL was measured with the KIDSCREEN-27. RESULTS: QoL was more strongly associated with internalising than externalising pathology according to both self- and parent report. Multiple regression analyses showed that beyond internalising and externalising pathology, gender, age, family functioning, functional impairment, and prior mental health treatment were associated with individual QoL scales. CONCLUSIONS: The data underscored the relationship between mental pathology and impaired QoL even if potential item overlap was controlled for. This stresses the importance of extending therapy goals and outcome measures from mere pathology to measures of QoL in psychotherapy research particularly for patients with internalising pathology.

[Reliability and construct validity of the OPD-CA axes structure and prerequisites for treatment]. / Reliabilität und Konstruktvalidität der OPD-KJ-Achsen Struktur und Behandlungsvoraussetzungen.

As an instrument to assess specific psychodynamic dimensions, the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) is widely used in clinical care and psychotherapeutic training. However, the psychometric validation of its axes is partly still missing. The aim of this study was to test the reliability and construct validity of the axes structure and prerequisites of treatment. 171 children and adolescents (aged 4 to 21 years) with a diagnosed psychiatric disorder who began an analytic psychotherapy were additionally assessed with the OPD-CA by their therapists (n = 25) in the context of naturalistic care in private practice. Therapists were all qualified as analytic child and adolescent psychotherapists and underwent a standardized OPD-CA training. Results indicated conceptually meaningful factor structures for both axes tested. These factor structures predominantly followed the conceptually defined dimensions. Internal consistency was high for the axis structure, modest to low fort he axis prerequisites of treatment. Implications and recommendations for a future revision of the OPD-CA with particular respect of single items and their operationalization are discussed.