OPD-CA-2 Operationalized Psychodynamic Diagnosis in Childhood and Adolescence: Theoretical Basis and User Manual

Psychodynamic concepts are important and useful frames to understand mental health problems in children and adolescents. The understanding can inform us about treatment approaches and plans for this group of clients. Yet often, psychodynamic concepts can be unclear, ambiguous, and difficult to lay down; validity and reliability of these diagnoses also remains challenging to clinicians.

The second edition of “OPD-CA-2 Operationalized Psychodynamic Diagnosis in Childhood and Adolescence”, originally published in German, has now been translated into English. It is a dimensional manualised instrument that aims to decrease the confusion and ambiguity of some psychoanalytic concepts and constructs through operationalisation. In this manner, it also aspires to improve and optimise communication between different therapists about psychodynamic perspectives and other treatment approaches.

Developmental concepts and frames are important considerations that underlie the whole OPD-CA-2. There are 4 axes in this instrument, namely interpersonal relationships, conflict, structure, and prerequisites for treatment. In each axis, there are different axis-specific aspects to be explored through questioning and behavioural observation / internal resonance; a rating can be given afterwards in these axis- specific aspects.

Take the conflict axis for instance, axis-specific aspects to be explored include closeness versus distance, submission versus control, taking care of oneself versus being cared for, self-worth conflict, guilt conflict, Oedipal conflict, identity conflict, and severe stress in life. For instance, in the closeness versus distance axis-specific aspect, exploratory questions include: ‘Imagine you encounter some children or adolescents you don’t yet know and you’d like to play with. How do you make contact with them? How do you feel when you’re alone? Do you like being together with other children or adolescents? Why?’ Behavioural observation / internal resonance include: ‘Does the patient offer closeness and contact in the interview situation or rather keep his / her distance? Do I feel like accepting this patient into therapy, or would I rather have nothing to do with him her?’ For these assessments, a rating of 0 means absent in this area, 1 means present but insignificant, 2 means present and significant, and 3 means present and very significant.

The editors emphasise that the strength of the OPD- CA-2 lies in the possibility of a diagnostic investigation of structure and conflict as a supplement to the multiaxial classification system, in the capturing of relationship patterns and in the possibility of assessing the prerequisites of treatment. In addition, the structural and conflicting foci can be formulated for treatment planning and the progress and outcome of treatment can be described. As with other manualised instruments, they emphasise the importance of training before using it.

If you are looking for a manualised instrument to make a psychodynamic diagnosis in children and adolescents, this is a book that will be of interest.

Lai-yin Chow, MBChB (CUHK), MRCPsych, FHKCPsych, FHKAM (Psychiatry), Grad. Dip. Child P.S. (Monash)
(email: cly487@ha.org.hk)
Department of Psychiatry
Prince of Wales Hospital
Hong Kong SAR
China

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