Diagnosis and case formulation in psychodynamic therapy: a review of current tools / Diagnóstico y formulación de casos en terapia psicodinámica: una revisión sobre herramientas actuales.

In the last two decades, several working groups in the international psychoanalytic community have been interested in the development of systematic tools for psychodynamic diagnosis, case formulation and treatment planning. Such psychodynamic diagnostic manuals are efforts to systematically integrate an enormous and rich amount of historically partialized and dispersed information, but which constitute the substantial contribution of psychoanalysis to the field of mental health. The aim of the present article is to provide an updated review on this kind of systematic tools for diagnosis, case formulation and therapeutic planning, designed for the field of psychodynamic approaches. To this end, we describe the aims and structure of: 1) the Psychodynamic Diagnostic Manual 2 (PDM-2), 2) the Operationalized Psychodynamic Diagnosis (OPD-2/OPD-3) and 3) the Operationalized Psychodynamic Diagnosis for Children and adolescents 2 (OPD-CA-2). The contributions of these current tools to clinical practice and empirical research are discussed, as well as the need to disseminate these types of instruments in our regional context.

En las últimas dos décadas, diversos grupos de trabajo de la comunidad psicoanalítica internacional se han interesado por el desarrollo de herramientas sistemáticas para el diagnóstico, la formulación de los casos y la planificación del tratamiento psicodinámico. Este tipo de manuales diagnósticos psicodinámicos son esfuerzos de integración sistemática de una enorme y rica cantidad de información históricamente parcializada y dispersa, pero que constituye el aporte sustancial del psicoanálisis al campo de la salud mental. El objetivo del presente artículo es ofrecer una revisión actualizada sobre esta clase de herramientas sistemáticas de diagnóstico, formulación del caso y planificación terapéutica, diseñadas para el campo de los abordajes psicodinámicos. A estos fines, se describe la estructura y los objetivos de: 1) el Manual Diagnóstico Psicodinámico 2 (PDM-2), 2) el Diagnóstico Psicodinámico Operacionalizado (OPD-2/OPD-3) y 3) el Diagnóstico Psicodinámico Operacionalizado Infanto-Juvenil 2 (OPD-IJ-2).Se discuten las contribuciones de estas herramientas actuales para la práctica clínica y la investigación empírica, así como la necesidad de difundir este tipo de instrumentos en nuestro contexto regional.

The assessment of pathways towards suicide in adolescent patients: A PDM-2-oriented approach.

OBJECTIVES: Increasing evidence has supported the mutual relationship between suicidal motivations and personality pathology, especially in adolescence. Distinctive aspects of personality functioning can explain the tendency to resort to suicidal ideation and behaviours, which, in turn, may play a specific role in exacerbating severe impairments in self-regulation mechanisms that underlie personality pathology. DESIGN: This study illustrates, through two clinical cases, the clinical utility of using the Psychodynamic Diagnostic Manual - Second Edition (PDM-2) to better understand distinct pathways of suicidal processes. METHODS: Two adolescents, named Luis and Gael, who attempted suicide multiple times were assessed using the Psychodiagnostic Chart Adolescent (PDC-A) of the PDM-2 to evaluate their mental functioning, emerging personality styles or syndromes, and symptom patterns. They were interviewed using the Motivational Interview for Suicidality in Adolescence (MIS-A) to identify the motivations underpinning their suicidal behaviour. RESULTS: The results showed that Luis presented a narcissistic personality characterized by the need to deny his vulnerabilities through suicidal fantasies as a form of escape, while Gael presented a borderline personality characterized by the use of suicide attempts to express her inner and unspeakable pain. CONCLUSION: The study seems to support the reciprocal interconnections between personality functioning and suicidal motivations that should be better identified to plan tailored and more effective interventions.

Personality Organization, Personality Styles, and the Emotional Reactions of Treating Clinicians.

This study explores the relationship between clinicians' emotional reactions and patients' level of personality organization and personality style assessed according to the Psychodynamic Diagnostic Manual-2 (Lingiardi & McWilliams, 2017). Level of personality pathology was positively associated with helpless and overwhelmed responses and negatively with positive responses. Parental and disengaged responses were associated with schizoid, anxious and dependent personalities. Parental and criticized responses were associated with narcissistic personalities; their depressed versions were positively associated with parental reactions, but negatively with positive reactions. Parental and overwhelmed responses were associated with counter-dependent and passive-aggressive dependent personalities; the latter also with criticized reactions. Disengaged responses were associated with depressive personalities, particularly with their introjective subtypes, obsessive-compulsive and somatizing personalities. Overwhelmed reactions were associated with relational self-defeating and hysterical/histrionic personalities, the latter also with sexualized reactions. Sexualized and helpless reactions were connected to hypomanic personalities. Findings show that emotional reactions can be useful for understanding personality features.