Operationalized psychodynamic diagnosis in childhood and adolescence (OPD-CA): Changes across psychodynamic child and adolescent therapy

Psychodynamic therapies are effective in reducing mental health symptoms. However, little is known in terms of changes in the core psychodynamic concepts, like the structural level, interpersonal relatedness, and intrapsychic conflicts. The current study focused on these psychodynamic concepts – measured with the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence (OPD-CA) – over the course of therapy and its relation to therapy outcome. Additionally, the OPD-CA axis treatment prerequisites was tested as a predictor of outcome. Therapists assessed the OPD-CA as well as the level of psychosocial impairment of 146 patients (aged M = 12.7 years, 62% female) at the beginning and end of therapy as part of a larger study on the effectiveness of psychodynamic psychotherapy. Structural level, interpersonal relations, and conflicts improved significantly over the course of therapy. Positive outcome was predicted by communicative abilities, positive self-relatedness and a high conflict level at the beginning of therapy as well as the improvement of these variables during therapy. Among the treatment prerequisites, only the subjective level of psychosocial impairment and the intrapsychic resources were predictive of outcome. Psychodynamic psychotherapy for children and adolescents may improve central psychodynamic concepts like structural level, interpersonal relations, and conflicts.