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By Birgit Wolz, Ph.D.
1. EXPERIENCES WITH ANOTHER PSYCHODYNAMIC DIAGNOSTIC SYSTEM
European psychotherapists and psychoanalysts have reacted to the DSM and the ICD with skepticism because of these manuals’ emphasis on reliability while clinging to phenemenological and biological concepts. This approach results in very low validity, especially in respect to treatment planning. The European clinicians point out that many psychotherapists evaluate the personality development, intrapsychic and interpersonal conflicts, the subjective experience of illness, and processes of coping with the disorder when they plan therapy, areas that are not considered in these classification systems (Schneider, Freyberger, Muhs, & Schuessler, 1993). They also believe that the use of the DSM and the ICD is unsatisfactory because they define the nature and the structure of the therapist-patient relationship as well as the process of treatment in a manner that is counterproductive to psychodynamic theory. For example the patient/client is defined as being a passive object of the diagnostic process.
Based mainly on the work of German researchers and therapists, a research team developed an operationalized psychodynamic diagnostic system (OPD), which they believed would be better suited to understanding psychotherapeutic processes. The aim was to create a set of uniform and precise concepts that were clearly formulated within a usable terminology that was independent of any particular psychoanalytic or psychotherapeutic school, in order to be acceptable to different psychotherapeutic approaches. The first impetus of this approach benefited from the experiences of the ICD-10 field trials. Later the development and use of the new diagnostic model was coordinated with the work of the international ICD group. The German version of the OPD was published in 1996 (OPD Working Group, 1996) and the English version in 2000 (OPD Working Group, 2000).
The OPD was designed to do the following:
These purposes should provide clearer baselines about the course of illness, testing for indication of therapy and differential indication and for examining the efficiency and effectiveness of treatments. (Schneider et al., 2004)
The OPD defines five diagnostic axes:
Axis I: Experience of Illness and Prerequisites of Treatment
Axis II: Relational Issues
Axis III: Conflict
Axis IV: Structure
Axis V: Syndrome diagnostics according to Chapter V (F) of the ICD-10
Even though the OPD is structured differently than the PDM, the goals and the basic content of this European diagnostic system resemble the American psychodynamic diagnostic manual to a degree that similar benefits for the field of psychotherapy can be expected.
Since 1996, many working groups have done research involving the OPD at multiple sites. They were able to demonstrate a satisfying interrater reliability for raters well trained in OPD diagnostics. Validity studies showed positive results in the areas of clinical validity, construct validity and predictive or treatment validity. (Schneider et al., 2004).
Recently, the OPD was translated into many languages, including French, Hungarian, Spanish, and Italian. The manual has been used extensively for treatment decisions: to clarify whether individual, couples, family, group therapy, psychodynamic, cognitive, or cognitive approaches are most appropriate for an individual client. Therefore clinicians from different theoretical orientations make use of OPD (Schneider & Freyberger, 2000).
The creators of the OPD were surprised about the large number of psychotherapists from several European countries who participated in OPD training seminars.
“The acceptance of OPD in German-speaking countries is very high and represents a qualitative development in psychodynamic psychotherapy. This fact reflects, on the one hand, the need in the field of psychotherapy to control and evaluate the clinical work. On the other hand, it might be an expression of the dissatisfaction of many of psychodynamic or psychoanalytic psychotherapists with the widely noncommittal or unscientific status of psychoanalytic-psychodynamic theory and practice.” (Schneider et al., 2004, p. 197)
The PDM is expected to become at least as popular as the OPD. ” … few experts doubt that there is an appetite for a guidebook that adds to the D.S.M.” (Carey, 2006). Another indication about its popularity can be seen in the fact that the number of pre-ordered copies on Web sites of Internet booksellers jumped dramatically after an article in the New York Times announced the manual’s publication in January 2006.
2. CONCLUSION
In most general terms, the PDM is a welcome addition to the DSM and ICD. The new manual’s most important contribution is its effort to go beyond viewing people as sums of their symptoms. That is, the PDM is striving to understand people in broader and more meaningful ways in term of their internal experience of themselves, others and the world around them. This allows the manual to present treatment implications.
Two questions need to be posed. Will the PDM face the same problem with reliability and clinical utility as other manuals, even though the new manual is based on current neuroscience, treatment outcome research, and other empirical investigations? And secondly, will the manual’s self-imposed limitation, to focus on analytic theory and practice, limit its utility, in spite of the fact that the PDM is designed not only for psychoanalysts but also for clinicians who use other therapies, which address the full range of human functioning?
While writing this course, I started using the PDM in my clinical work and I came to find it invaluable. It expanded my understanding of my clients’ personalities, the meaning, extent and the roots of their suffering, as well as appropriate treatment approaches.