[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]

[The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability]

The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability Abstract: Objective: The OPD-CA2 manual for assessing psychodynamic aspects in children and adolescents is well established in clinical practice. However, publications regarding its reliability and validity are limited to (1) adolescents, (2) the structure of the first version of the manual and not to the comprehensive revision of the OPD-CA2, (3) the axes "structure" and (partly) "conflict" but not the axis "relationship," and (4) missing applicability in everyday clinical practice. Methodology: The present study comprised 42 children aged 6-12 years (age level 2 of the OPD-CA2), with and without mental illness, and assessed them using two randomly assigned raters. We assessed them using a low-structured diagnostic symbol game with miniature figurines and objects based on videotapes. We also tested the interrater reliability of the OPD-CA2 axes. Results: The overall assessment of structure and the assessment of the four subdimensions succeeded with good to very good agreement. We could also determine the presence of relevant conflict dynamics with very high agreement, while not recognizing specific conflicts in the clinical sample. Our assessment of the items of the relationship axis shows a low level of agreement. Conclusions: Overall, we can confirm the reliability of the OPD-CA2 for everyday clinical assessment in the younger age groups. Finally, we discuss which factors contribute to the heterogeneous picture.

Level of Structural Integration and Its Association with Intersession Experiences and Outcomes: A Pilot Study

The level of structural integration (LSI), a psychodynamic/psychoanalytic concept originally developed by the Operationalized Psychodynamic Diagnosis (OPD), provides a promising empirical approach that is recognized beyond the boundaries of psychoanalysis and is highly relevant for therapy and research. The aim of our study was to investigate the intersession experiences of patients in psychotherapy with different levels of structural integration. The sample consisted of 69 inpatients who were undergoing psychotherapeutic treatment. The patients were asked to complete the German version of the Intersession Experience Questionnaire (IEQ), the short version of the OPD Structure Questionnaire (OPD-SQS) and the Brief-Symptom Inventory (BSI). LSI is associated with the situations, contents and negative emotions in the intersession experiences of patients, as well as their symptom distress over the course of therapy. Furthermore, the level of structural integration is a significant predictor of outcomes. Patients with different LSI had different intersession experiences.

[Changes in the Level of Conflict through Psychodynamic Psychotherapy: The Perspective of Adolescent Patients and their Therapists]

Changes in the level of structure and conflict are, in addition to alleviating of symptoms, central goals of psychodynamic therapies. This study examines this question with a focus on intrapsychic development-impairing conflicts in the sense of the OPD-CA on a sample of 121 adolescents and their 46 therapists. At the beginning, in the middle and at the end of the M = 73.27 hours (SD = 17.40) therapy, they assessed the level of conflict and structure from the patients' and the therapists' perspectives. The results show large effect sizes with regard to the reduction of the overall conflict level from the point of view of the therapists (η2 = .33). While the therapists reported higher initial values in almost all intrapsychic conflicts and significant linear decreases over time, the therapy tended to sensitize the patients to the existence of an intrapsychic development-impairing conflict. With regard to the structural level, which was already quite good at the start of treatment, there were no significant changes over time. However, the overall structural level and the conflict scales contributed to the explanation of the variance in the severity of symptoms at the end of therapy.

[Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change]

Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change Abstract. This study uses a naturalistic design to assess the course and effectiveness of long-term psychodynamic therapies from the perspective of adolescent patients and their mothers. It looks at the context of different moderators of change, including the characteristics of the patient, the therapist, and the therapy. Assessments of the internalizing, externalizing, and overall symptom burden using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL) were collected on 161 patients and their mothers at three timepoints - the beginning, middle, and end of therapy. The assessments of both informants showed a decrease in symptoms over the course of therapy with similar effect sizes (η² = .25 for the patients, η² = .31 for their mothers). The adolescents differentiated more between the diagnosis groups, reported higher symptom intensities at the beginning, and saw fewer changes in the second half of the therapy than their mothers. Psychodynamic long-term therapy was particularly effective for internalizing disorders according to both parents and patients. Both informants differed, however, in their evaluation of short-term therapy. An examination of the moderators of change in the mothers' evaluation (difference value of the total symptom burden between the beginning and end) showed that the therapist and therapy characteristics predicted change, whereas for adolescents, the patient characteristics have the greatest influence.

[Gender identities in transition]

Gender identities in transition Abstract. In recent years, the healthcare system has been confronted with an increasing number of children and adolescents with gender nonconformity, gender incongruence, and gender dysphoria. Medical professionals are still debating how to interpret this phenomenon and how best to meet the healthcare needs of this diverse group of young people. Meanwhile, the transgender and gender nonconforming youths themselves face enormous challenges in finding appropriate support and treatment in the mental healthcare system. This article reviews the available epidemiological data, the paradigm shift in the social, legal, and medical systems, the developments in diagnostic classifications (DSM-5, ICD-11) as well as important aspects of the AWMF S3 guideline for adults with gender incongruence and gender dysphoria. In addition, it describes the complexity of working with transgender, gender nonconforming, and gender-questioning youth in the context of the current discourse and the underlying ethical dilemmas. In conclusion, this article outlines the challenges facing child and adolescent psychiatry and psychotherapy in this complex environment.