Background/Aims: To determine whether the Operationalized Psychodynamic Diagnosis (OPD) system can be useful in predicting patient outcome in the long term. Methods: OPD was assessed by the therapists prior to and after inpatient treatment. Patients completed psychometric scales at the start and completion of psychosomatic-psychotherapeutic inpatient treatment and at the follow-up. Outcome was defined by the general factor emerging from a principal component analysis of the Brief Symptom Inventory, Hospital Anxiety and Depression Scale and Inventory of Interpersonal Problems at katamnesis, representing individual differences in general distress. Results: Several dimensions of the OPD system proved to be predictors of general distress at the follow-up in 253 former inpatients. Negative predictors of long-term outcome were the high internal impediments to change, namely high secondary gains from illness and also less integrated structural abilities. Positive OPD predictors of long-term outcome were the treatment success achieved at the end of inpatient psychotherapy in changing the illness concept towards a psychological understanding of symptoms, lower levels of complaints and a higher functional level. Also the achieved level of awareness for the individual maladaptive behavioral pattern is predictive of a favorable long-term outcome. Conclusions: The results provide evidence for the clinical relevance and the predictive value of OPD.

1.
Beutel ME, Höflich A, Kurth R, Brosig B, Gieler U, Leweke F, Milch WE, Reimer C: Short-term and long-term inpatient psychotherapy - indications, results, predictors. Z Psychosom Med Psychother 2005;51:145-162.
2.
Beutel ME, Höflich A, Kurth R, Reimer C: Who benefits from inpatient short-term psychotherapy in the long run? Patients' evaluations, outpatient after-care and determinants of outcome. Psychol Psychother 2005;78:219-234.
3.
Fliege H, Rogalinski A, Schmid G, Kocaleven R-D, Lohmann R, Danzer G, Klapp BF: Evaluation of the effectiveness of psychosomatic in-patient treatment on the basis of subjective and objective criteria. Z Psychosom Med Psychother 2006;52:63-80.
4.
Franke GH, Hoffmann T, Frommer J: Does improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy correspond to long-term outcome? Z Psychosom Med Psychother 2005;51:360-372.
5.
Geiser F, Imbierowicz CR, Wermter F, Liedtke R: Impact of an additional behavioral anxiety intervention on therapy outcome in a psychodynamic inpatient setting. Z Psychosom Med Psychother 2004;50:53-69.
6.
Haase M, Frommer J, Franke GH, Hoffmann T, Schulze-Muetzel J, Jäger S, Schmitz N: From symptom relief to interpersonal change: treatment outcome and effectiveness in inpatient psychotherapy. Psychother Res 2008;18:615-624.
7.
Huber D, Albrecht C, Hautum A, Heinrich G, Klug G: Effectiveness of inpatient psychodynamic psychotherapy: a follow-up study. Z Psychosom Med Psychother 2009;55:189-199.
8.
Konzag A, Bandemer-Greulich U, Bahrke U, Fikentscher E: Psychotherapeutic relationship and outcome in psychotherapy of personality disorders. Z Psychosom Med Psychother 2004;50:395-405.
9.
Sack M, Lempa W, Lamprecht F, Schmid-Ott G: Individualized therapy goals and treatment efficacy - a follow-up study one year after inpatient psychotherapy. Z Psychosom Med Psychother 2003;49:62-73.
10.
Sammet I, Staats H, Schauenburg H: Relationship experiences and therapeutic outcome in inpatient psychotherapy. Z Psychosom Med Psychother 2004;50:376-393.
11.
Schaefer A, Gieler U, Kurth R, Brosig B, Leweke F, Milch WE, Beutel ME: Long-term outcomes of short-term and long-term psychosomatic inpatient treatment and their predictors. J Psychosom Res 2008;65:329-336.
12.
Barber JP: Issues and findings in investigating predictors of psychotherapy outcome: introduction to the special section. Psychother Res 2007;17:131-136.
13.
OPD Task Force (eds): Operationalized Psychodynamic Diagnosis (OPD). Foundations and Manual. Seattle, Hogrefe & Huber, 2001.
14.
OPD Task Force (eds): Operationalized Psychodynamic Diagnosis OPD-2. Cambridge, Hogrefe & Huber, 2008.
15.
Cierpka M, Grande T, Oberbracht C, Schneider W, Schüssler G, Heuft G: Validity of Operationalized Psychodynamic Diagnosis (OPD). Psychotherapeut 2001;46:122-133.
16.
Cierpka M, Grande T, Rudolf G, von der Tann M, Stasch M; OPD Task Force: The operationalized psychodynamic diagnostics system: clinical relevance, reliability and validity. Psychopathology 2007;40:209-220.
17.
Schneider W, Klauer T, Freyberger H: Operationalized psychodynamic diagnosis in planning and evaluating the psychotherapeutic process. Eur Arch Psychiatry Clin Neurosci 2008;258:86-91.
18.
Grande T, Rudolf G, Oberbracht C, Jakobsen T: Therapeutic changes beyond the symptoms - effects of inpatient treatment according to the Heidelberg Structural Change Scale. Z Psychosom Med Psychother 2001;47:213-233.
19.
Faber R, Micka R, Seidler GH: Zum Zusammenhang von Veränderungen in der Symptomatik und struktureller Schuldfähigkeit während stationärer Psychotherapie. Psychodyn Psychother 2005;4:18-28.
20.
Spitzer C, Michels-Lucht F, Siebel U, Freyberger HJ: The relationship between OPD features of personality structure and symptom-related and interpersonal outcome of inpatient psychotherapy. Z Psychosom Med Psychother 2004;50:70-85.
21.
Strauss B, Hüttmann B, Schulz N: Category distribution and prognostic significance of operationalized psychodynamic diagnosis. Initial experiences with ‘OPD-1' in inpatient psychotherapy. Psychother Psychosom Med Psychol 1997;47:58-63.
22.
Godemann F, Schuller J, Uhlemann H, Budde A, Heinz A, Ströhle A, Hauth I: Psychodynamic vulnerability factors in the development of panic disorders - a prospective trial in patients after vestibular neuritis. Psychopathology 2009;42:99-107.
23.
Thomasius R, Weiler D, Sack P-M, Schindler A, Gemeinhardt B, Schuhbert C, Küstner U: Validity of operationalized psychodynamic diagnostics (OPD) in the field of family therapy with adolescent and young adult drug addicts. Psychother Psychosom Med Psychol 2001;51:365-372.
24.
Rudolf G, Grande T, Oberbracht C, Jakobsen T: First empirical investigations on a new diagnostic system: the operationalized psychodynamic diagnosis (OPD). Z Psychosom Med Psychother 1996;42:343-357.
25.
Müller C, Kaufhold J, Overbeck G, Grabhorn R: The importance of reflective functioning to the diagnosis of psychic structure. Psychol Psychother 2006;79:485-494.
26.
Schneider G, Schmitz-Moormann S, Bär O, Driesch G, Heuft G: Psychodynamic therapy foci in inpatient psychotherapy - relations to self-assessment scales and individual therapeutic goals. Z Psychosom Med Psychother 2006;52:259-273.
27.
Tiemann M, Heuft G, Schneider G: Long-term outcome of inpatient psychotherapy in older patients. Z Psychosom Med Psychother 2012;58:180-191.
28.
Heuft G, Schneider G, Lange C: Dokumentation ambulanter Diagnostik in psychosomatischer Medizin und Psychotherapie. Psychotherapeut 2005;50:57-67.
29.
Mendler TM, Schneider G, Heuft G: Dokumentation auf einer Station für psychosomatische Medizin und Psychotherapie. Psychotherapeut 2005;50:133-143.
30.
Rudolf G, Grande T, Oberbracht C: Die Heidelberger Umstrukturierungsskala. Ein Modell der Veränderung in psychoanalytischen Therapien und seine Operationalisierung in einer Schätzskala. Psychotherapeut 2000;45:237-246.
31.
Rudolf G, Jakobsen T, Micka R, Schumann E: Results of psychodynamic inpatient psychotherapy in relation to diagnosis. Z Psychosom Med Psychother 2004;50:37-52.
32.
Stiles WB, Elliott R, Lewelyn SP, Firth-Cozens JA, Margison FR, Shapiro DN, Hardy G: Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy 1990;27:411-420.
33.
Stiles WB, Shapiro DA, Harper H, Morrison LA: Therapist contributions to psychotherapeutic assimilation: an alternative to the drug metaphor. Br J Med Psychol 1995;68:1-13.
34.
Herrmann C, Buss U, Snaith RP: HADS-D. Hospital Anxiety and Depression Scale - deutsche Version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Göttingen, Beltz Test, 1995.
35.
Derogatis LR: Brief Symptom Inventory (BSI), Administration, Scoring and Procedures Manual, ed 3. Minneapolis, National Computer Services, 1993.
36.
Franke GH: BSI - Brief Symptom Inventory von Derogatis. Kurzform der SCL-90-R (deutsche Version). Göttingen, Beltz Test, 2010.
37.
Horowitz LM, Strauss B, Kordy H: Inventar zur Erfassung interpersonaler Probleme - deutsche Version - Manual (IIP-D). Göttingen, Beltz Test, 1994.
38.
Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods 2002;7:147-177.
39.
Cohen J: Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, Erlbaum Associates, 1988.
40.
Dunlop WP, Cortina JM, Vaslow JB, Burke MJ: Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods 1996;1:170-177.
41.
Zastrow A, Faude V, Seyboth F, Niehoff D, Herzog W, Löwe B: Outcome of simultaneous psychosomatic/internal medicine inpatient care - a naturalistic follow-up study. Z Psychosom Med Psychother 2009;55:229-247.
42.
Riehl A: Prognosis and treatment success in psychosomatic disorders. Praxis Psychother Psychosom 1985;30:318-330.
43.
Grosse Holtforth M, Krieger T, Bochsler K, Mauler B: The prediction of psychotherapy success by outcome expectations in inpatient psychotherapy. Psychother Psychosom 2011;80:321-322.
44.
Hölzel L, von Wolff A, Kriston L, Härter M: Risk factors for non-response in inpatient depression treatment. Psychiatr Prax 2009;37:27-33.
45.
Möller HJ, Krokenberger M, von Zerssen D: Prediction of short-term outcome of neurotic-depressive inpatients. Results of an empirical study of 134 inpatients. Eur Arch Psychiatry Clin Neurosci 1993;242:301-309.
46.
Riedel M, Möller H-J, Obermeier M, Adli M, Bauer M, Kronmüller K, Seemüller F: Clinical predictors of response and remission in inpatients with depressive syndromes. J Affect Disord 2011;133:137-149.
47.
Grande T, Dilg R, Jakobsen T, Keller W, Krawietz B, Langer M, Rudolf G: Structural change as a predictor of long-term follow-up outcome. Psychother Res 2009;19:344-357.
48.
Rudolf G, Jakobsen T, Keller W, Krawietz B, Langer M, Oberbracht C, Grande T: Structural change as an outcome paradigm in psychodynamic psychotherapy - results of the PAL Study (long-term psychoanalytic psychotherapy). Z Psychosom Med Psychother 2012;58:55-65.
49.
Fehlinger T, Stumpenhorst M, Stenzel N, Rief W: Emotion regulation is the essential skill for improving depressive symptoms. J Affect Disord 2013;144:116-122.
50.
Stek ML, van Exel E, van Tilburg W, Westendorp RG, Beekmann AT: The prognosis of depression in old age: outcome six to eight years after clinical treatment. Aging Ment Health 2002;6:282-285.
51.
Strauss B, Kirchmann H, Eckert J, Lobo-Drost A, Marquet A, Papenhausen R, Höger D: Attachment characteristics and treatment outcome following inpatient psychotherapy. Results of a multi-site study. Psychother Res 2006;16:579-594.
52.
Koelen JA, Luyten P, Eurelings-Bontekoe LHM, Diguer L, Vermote R, Lowyck B, Bühring MEF: The impact of level of personality organization on treatment response: a systematic review. Psychiatry 2012;75:355-374.
53.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Arlington, American Psychiatric Association, 2013.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.