[OPD in the hospital: an algorithm for structuring the diagnostic process with the Operationalized Psychodynamic Diagnostics OPD-2]. / OPD in der klinik: ein algorithmus für die therapieplanung mit der Operationalisierten Psychodynamischen Diagnostik (OPD-2).

OBJECTIVES: Operationalized psychodynamic diagnostics OPD-2 is a diagnostic procedure that has proven to be valuable for psychotherapy. However, to date there has been only little discussion about the application context and any necessary adaptations to various clinical fields. METHODS AND RESULTS: The working group "Implementation of OPD in Clinical Practice" proposes an algorithm for the sequential and adapted use of OPD depending on the clinical context. CONCLUSION: Especially for patients who are primarily not open to receiving psychotherapy, e.g., in psychiatric hospitals or general hospitals, OPD can be an important basis for structuring motivating interventions. A stepwise procedure is proposed which is adapted to the usage of OPD in such contexts. Furthermore, also for these contexts, simplified ratings are proposed and discussed for the axes relationships, conflicts and structure. However, complete OPD remains recommended when determining the focus of a psychotherapeutic treatment.

Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients.

The Working Alliance Inventory-Short Revised (WAI-SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI-SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI-SR in German outpatients (N = 88) and inpatients (N = 243). In both samples reliability (alpha > 0.80) and convergent validity with the Helping Alliance Questionnaire were good (r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond-Task-Goal model in both samples. Multi-group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI-SR can be recommended for alliance assessment in both settings.

Therapist effects on outcome and alliance in inpatient psychotherapy.

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.