Letter to participants - C. G. Jung Institut Zürich

Seminar 183
Tuesday June 26, 2012
14:05‐15:50/16:05‐17:50
Dear participants,
Letter to participants
Operationalized Psychodynamic Diagnosis (OPD‐2)
Holger Himmighoffen, MD
June 6, 2012
First, I would like to thank you for your interest in this seminar, which will be an introduction to the
Operationalized Psychodynamic Diagnosis (OPD‐2) in the C.G. Jung Institute Zurich.
The OPD working group was founded in Germany in 1990 with the idea to develop a diagnostic tool
to comprehend psychodynamic dimensions of patients in an operationalized way. It was also thought
to be an addition to the merely descriptive and phenomenological‐oriented psychiatric diagnostic
systems like the DSM‐IV or the ICD‐10. Since that time the OPD has been quite successful concerning
its main intentions and been widely used within the clinical and scientific field of psychodynamic
psychotherapy. It has also gone through a lot of further developments with a revised second version
in 2008, the OPD‐2. In addition to a psychodynamic diagnosis the OPD‐2 makes it possible to assess
relevant dimensions for the planning and evaluation of a psychotherapeutic treatment.
In my seminar I will start to give you an overview about the OPD concerning its development,
theoretical background, composition, dimensions, definitions and practical application. Usually, it
takes a whole weekend seminar to learn the OPD. For a sufficient knowledge to use the OPD at least
2‐3 weekend seminars are necessary (plus a regular clinical experience with it over the time). So, my
seminar can only give you a first introduction to the OPD. After giving you a theorectical
introduction in the first part of the seminar (including brief clinical examples), I would like to be the
second part more practical by doing a brief OPD interview of 30 minutes (usually an OPD interview
takes about 1 hour) followed by an individual assessment of some of the OPD dimensions and a
group discussion about it.
As I don’t have a video‐taped OPD interview in English I will need to have one of the participants to
be my interview partner and I ask you to think about it.
In my email I attached some written information and material with respect to the OPD:
‐ a list of OPD literature in English
‐ a book review by Horst Kächele about the OPD‐2 manual. This book and manual is the main
reference for the OPD‐2:
OPD Task‐Force (Ed.). (2008). Operationalized Psychodynamic Diagnosis (OPD‐2). Manual of
Diagnosis and Treatment Planning. Kirkland: Hogrefe & Huber
‐ Itemlist and checklists for the OPD‐Axes II, III and IV
‐ the rating forms for the OPD and the HSCS (Heidelberg Structural Change Scale)
‐ Interview tools for the OPD
The OPD working group has a Website, where you can get some more information about the OPD:
http://www.opd‐online.net/
I look forward to meeting you in the seminar!
Best wishes
Holger Himmighoffen
Holger Himmighoffen, MD
Psychiatric University Hospital Zurich
Lenggstrasse 31, 8032 Zurich, Switzerland
Phone: +41 44 384 2364
Email: holger.himmighoffen@puk.zh.ch

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A book review by Horst Kächele
Book Title: Operationalized Psychodynamic Diagnostics OPD-2. Manual of Diagnosis and
Treatment Planning
Book Authors (full names): OPD Task Force (Eds.)
Publisher: Hogrefe & Huber Publishers
Place of publication: Cambridge, MA
Publication year: 2008
Pages in book: 407
Freud's diagnostic explorations served to exclude somatic illness or psychosis. The founder
of psychoanalysis never hesitated to take on seriously ill patients. As soon as the elementary
preconditions had been satisfied and questions of payment and appointments were settled,
the fundamental rule was explained and the analysis began. Then as now, general
psychosocial factors such as education, age, and motivation were highly relevant. Freud did
not take a detailed history until the first phase of treatment; his preliminary interview usually
was brief. The problem of diagnosis and resulting selection first arose when demand began
to outstrip supply, as Fenichel reported about the clinic of the Berlin Institute.
However, by and large the psychoanalytic profession only reluctantly dealt with issues of
elaborated diagnostics, even when over the years the nosologic system was adopted from
psychiatry. On the other hand, the influences of psychodynamic thinking on psychiatry were
perceptible as early as the 1930s. The individual steps have been traced by Gill, whose
important contribution is the definition of the psychodynamic interview technique. They
contrast the traditional psychiatric exploration with the “dynamic interview”. In the course of
the 1950s, numerous different psychodynamically oriented interview strategies were
developed by psychoanalysts working within dynamic psychiatry.
Kernberg's "structural interview" from 1981 was a good example of the second
generation of psychoanalytically oriented psychiatric initial interviews following in the tradition
of psychodynamic interviewing. He relates the history of the patient's personal illness and his
general psychic functioning directly to his interaction with the diagnostician. The main goal is
clarification of the integration of ego identity or identity diffusion, the quality of the defense
mechanisms, and the presence or absence of the capacity for reality testing. This permits the
differentiation of personality structure into neuroses, borderline personalities, functional
(endogenous) psychoses, and organically determined psychoses. He is particularly
concerned to appraise the patients' motivation, their capacity for introspection, their ability to
work together with the therapist, their potential for acting out, and the danger of psychotic
decompensation. From the patients' reactions, conclusions can be drawn which help the
therapist decide on further diagnostic and therapeutic measures.
The interviewer's structuring activity naturally affects the interaction. A certain restriction
of freedom in the way the relationship between patient and therapist begins to form is
1

accepted, in order to gain the information necessary for differential diagnosis. The structural
interview is nevertheless a balanced blend of psychopathologic description and relationship
analysis, and meets the diagnostic, therapeutic, and prognostic demands placed on the initial
consultation.
A third generation of structured psychodynamic interviewing that claims to meet the
necessities of research and clinical work arose within the creation of a new psychodynamically
oriented system, the Operationalized Psychodynamic Diagnosis (OPD), which
had been developed by a group of German academically trained psychoanalysts and which
was first published in German in 1996. Meanwhile translations into other languages have
appeared (English, Italian, Spanish, and Hungarian). Recently a second edition of the
English version has been published (OPD-2).
Operationalized Psychodynamic Diagnosis is a multiaxial diagnostic and classification
system based on psychodynamic principles.
After an initial interview lasting 1–2 hours, clinicians (or researchers) can evaluate the
patient’s psychodynamics according several axes (see below) and enter them in the
checklists and evaluation forms provided. The new version, OPD-2, has been developed
from a purely diagnostic system to include a set of tools and procedures for treatment
planning and for measuring change, as well as for determining the appropriate main focuses
of treatment and developing appropriate treatment strategies.
Quite similar to its US-American counterpart, the Psychodynamic Diagnostic Manual
– PDM, developed by a Task Force of psychoanalytic organisations, the OPD-2 covers five
axes: I = experience of illness and prerequisites for treatment, II = interpersonal relations, III
= conflict, IV = structure, and V = mental and psychosomatic disorders (in line with Chapter V
(F) of the ICD-10).
It is easy to agree with the foreword from Kernberg and Clarkin in which they state
that the OPD-2 is „a diagnostic system that successfully attempts a synthesis between
descriptive and dynamic features, and respects the interaction between biological,
psychodynamic, and psychosocial determinants of illness“.
The OPD system has been applied in numerous research projects. The German
study group has provided a fair number of studies on aspects of reliability and validity that
are summarized in this volume too. The Studies show good reliability in a research context
and acceptable reliability for clinical purposes. Validity studies indicate good content,
criterion, and construct validity for the individual axes. Alas most of the studies reported are
(not yet) available in English publications. This is one definite limitation of this volume
translated from German. The bulk of the quoted literature reveals how intensive in the
2

German psychotherapeutic world the issues of adequate diagnostics have been dealt with
since long, but to an English speaking audience these may not be accessible.
Apart from research-oriented status diagnostics, the most important target area of the
OPD system lies in the clinical and therapeutic field. More than 4,000 therapists have been
trained in the different training centres in German-speaking countries. In many psychiatric
and psychosomatic hospitals, in institutions working with addictive patients, at university
departments for psychotherapy and psychosomatics and others, the OPD is used in day-today
routine.
The OPD findings can supply the clinician with information helping him to decide on
differential therapy indication and treatment planning from a psychodynamic point of view.
Axis I can help to clarify the patients’ basic assumptions regarding their problems and
eventual motivation for psychotherapy. The assessment of basic ego function on the
structure axis (axis IV) is decisive for the choice of suitable psychotherapeutic approaches,
i.e. the alternative of providing more supportive vs. conflict-oriented or expressive
psychotherapy, as well as in particular circumstances for deciding between in- or outpatient
psychotherapy.
The axis on interpersonal relations allows, similar to the CCRT (Luborsky), the
formulation of typical dysfunctional relationship pattern within the interpersonal circumplex. A
key advantage of this formulation over descriptive diagnoses is that it may be used to predict
how an individual might respond in certain therapeutic situations. In the sense of pathogenic
beliefs these patterns require special therapeutic attention and interventions so that therapy
does not fail due to complications in the therapeutic relationship.
By stressing the most prominent conflicts (axis III) and/or the most prominent structural
deficiencies which illuminate vulnerability and available resources to be taken into account,
therapy goals can be identified and therapeutic planning can be derived on the basis of the
assessment. The OPD system allows a more structured and dynamic understanding of how
different pathogenic factors operate and interrelate with each other and it can indicate the
foci to be worked on in psychotherapy:
From the foreword by Kernberg and Clarkin we also learn that the international systems for
classification of diseases, ICD-10 as well as the DSM-IV, „in their effort to simplify and thus
facilitate communication and research have reduced the richness and clinically appropriate
level of diagnosis in psychiatry“ (p. V). They rightly point out that the long time prevailing
devaluation of diagnosis by psychoanalytic clinicians is not useful to the clinician, and
„denies the progress as has been achieved both in the biological and the psychodynamic
realm“(p. V).
3

The Operationalized Psychodynamic Diagnosis bridges the gap between descriptive clarity
and precision on the one hand, and clinical sophistication and appropriate individualized
differentiation on the other.
What is remarkable of the „OPD-enterprise“ - under the strong leadership of Manfred
Cierpka – a former student of mine - that it has caught the interest of many young clinicians
in several countries around the world. A recent translation into Chinese demonstrates its
utility for newcomers and its cross-cultural applicability. The new toolbox provided with the
second edition – e.g. a conflict checklist, a structure checklist, a structural change scale and
special interview tools for each of the axes- obviously responds to a need of practitioners in
the age of Evidence Based Medicine. Therefore it is now increasingly used by many for the
Expert Assessment Procedures of the German Psychotherapy Guidelines.
The concern of experienced therapists that working with the OPD undermines the
preciously guarded “evenly hovering attention” and does not do justice to patient’s individual
concerns will remain an issue. To summarize: OPD can be an important stimulus for
structuring ones thinking about patient´s problems. Many years ago, at the international
Psychoanalytic Process Research Conference in Ulm 1985 the late Hans Strupp proclaimed
the necessity for „problem-treatment-outcome-congruence“. Clearly with OPD-2 we are
moving in this direction.
Horst Kächele, Germany
4

Basic OPD literature
OPD Task‐Force (Ed.). (2008). Operationalized Psychodynamic Diagnosis (OPD‐2). Manual of Diagnosis
and Treatment Planning. Kirkland: Hogrefe & Huber.
(This is the up‐to‐date OPD manual and reference book for the OPD)
Cierpka, M., Rudolf, G., Grande, T., Stasch, M. & Task Force OPD (2007). Operationalised Psychodynamic
Diagnostics (OPD). Clinical relevance, reliability and validity. Psychopathology, 40, 209‐220.
(Good introduction into the principles of the OPD, but referring to the first version of the OPD)
Miscellaneous OPD literature
Kessler, H., Taubner, S., Buchheim, A., Münte, T. F., Stasch, M., Kächele, H., et al. (2011). Individualized
and clinically derived stimuli activate limbic structures in depression: an fMRI study. PloS ONE,
6(1), e15712. doi:15710.11371/journal.pone.0015712. (available online
http://dx.plos.org/10.1371/journal.pone.0015712.)
(Study using the OPD in the context of a neuroimaging investigation)
Schauenburg, H., & Grande, T. (2011). Interview measures of interpersonal functioning and quality of
object relations. In L. M. Horowitz & S. Strack (Eds.), Handbook of interpersonal psychology. Theory,
research, assessment, therapeutic interventions (pp. 343‐358). New Jersey: John Wiley & Sons.
Boeker, H., Himmighoffen, H., Straub, M., Schopper, C., Endrass, J., Kuechenhoff, B., Weber, S., Hell,
D. (2008). Deliberate self‐harm in female patients with affective disorders: investigation of personality
structure and affect regulation by means of operationalized psychodynamic diagnostics. J Nerv
Ment Dis, 2196(10), 743‐751.
(Study showing a clinical relevant differentiation of depressive women concerning their level of
structural integration)
Gross, S., Stasch, M., Schmal, H., Hillenbrand, E. & Cierpka, M. (2007). Changes in the mental representations
of relational behavior in depressive patients. Psychotherapy Research,17(5), 522‐534.
Leising, D., Rudolf, G., Stadler, K., Jakobsen, T., Oberbracht, C. & Grande, T. (2003). Do interpersonal
behavior and emotional experience change in the course of successful long‐term psychoanalytic
therapies? Psychotherapy Research, 13(4), 461‐474.
Grande, T., Rudolf, G., Oberbracht, C. & Pauli‐Magnus, C. (2003). Progressive changes in patients'
lives after psychotherapy: which treatment effects support them? Psychotherapy Research, 13(1),
43‐58.
Schneider, W., Buchheim, P., Cierpka, M., Dahlbender, R., Freyberger, H. J., Grande, T., Hoffmann, S.
O., Heuft, G., Janssen, P. L., Küchenhoff, J., Muhs, A., Rudolf, G., Rüger, U. & Schüßler, G. (2002).
Operationalized Psychodynamic Diagnostics (OPD): a new diagnostic approach in psychodynamic
psychotherapy. In L. E. Beutler & M. Malik (Eds.), Rethinking the DSM: a psychological perspective
(pp. 177‐200). Washington D.C.: American Psychological Association.
Rudolf, G., Grande, T., Dilg, R., Jakobsen, T., Keller, W., Oberbracht, C., Pauli‐Magnus, C., Stehle, S. &
Wilke, S. (2002). Structural changes in psychoanalytic therapies ‐ the Heidelberg‐Berlin Study on longterm
psychoanalytic therapies (PAL). In M. Leuzinger‐Bohleber & M. Target (Eds.), Outcomes of
psychoanalytic treatment. Perspectives for therapists and researchers (pp. 201‐222). London: Whurr
Publishers.