Operationalizing the Psychodynamic Diagnostic Manual- 2 with the Psychodiagnostic Chart-2 International Psychoanalytic Assoc. Boston 2015 Robert M. Gordon, Ph.D. ABPP in Clinical Psychology and in Psychoanalysis

Expert diagnosticians (N=61, 80% had doctorates, 44% Psychodynamic, 15% CBT) and “typical” mental health practitioners (N=438, 46% had doctorates, 26% Psychodynamic, 33% CBT) rated each diagnostic dimension as to how helpful (1= not at all helpful, 7= very helpful) it was in understanding a patient that they diagnosed using the Psychodynamic Diagnostic Prototype (PDP) and the Psychodiagnostic Chart (PDC). Scores represent the percent of practitioners who rated the dimensions in the 5-7 range (i.e. “helpful – very helpful”). All differences between the diagnostic dimensions for the current sample were statistically significant.

Psychodiagnostic Chart-2 (PDC-2) The Operationalized PDM-2 –Adult Version Robert M. Gordon and Robert F. Bornstein Cultural-Contextual Issues Symptoms Mental Functioning Personality Patterns Personality Organization

There are PDCs for all the PDM2 age groups Psychodiagnostic Chart-2 Adult (Gordon and Bornstein, ) Psychodiagnostic Chart for Infancy and Early Childhood (PDC-IEC) (Speranza, 2015) Psychodiagnostic Chart-Child (PDC-C ) (Malberg, Rosenberg, & Malone, 2015) Psychodiagnostic Chart-Adolescent (PDC-A) (Malberg, Malone, Midgley & Speranza, 2015) Psychodiagnostic Chart-Elderly (PDC-E) (Del Corno & Plokin, 2015)

PDM-2 Tools Chapter 6 Psychodiagnostic Chart-2 Strengths: The PDC has good reliability and validity (Gordon & Stoffey, 2014). It guides the practitioner through a PDM-2 formulation using all the axises. It is only three pages long and user friendly. It provides a “big picture” summary of the PDM-2 Adult Axis and integrates it with the ICD or DSM. It is FREE! Search “Psychodiagnostic Chart-2” Limitations: The PDC2 is not a “test.” in the sense that it does not produce data independent of the clinician’s insight. Rather it is a practitioner guide to organizing and charting a PDM-2 formulation—a method for describing the patient along multiple domains to aid in diagnostic formulation and treatment planning.

Gordon and Stoffey (2014) took the 7 mental functions from the PDM (Identity, Object Relations, Affect Tolerance, Affect Regulation, Super Ego Integration, Reality Testing, and Ego Resilience) and found with a step wise regression that: Affect Regulation (or level of defensive functioning) (β =.35, t(93) = 6.01, p <.001), Reality testing (β =.32, t(93) = 5.02, p <.001), Object Relations (β =.20, t(93) = 3.76, p <.001) and Identity (β =.19, t(93) = 2.69, p <.001) produced an R2 =.89, indicating that the four components accounted for 89% of the variance in Overall Personality Organization. This finding is very similar to that of Ellison and Levy (2012) factor analysis of the Inventory of Personality Organization (an assessment based on Kernberg’s structural theory).

1.Identity: ability to view self in complex, stable, and accurate ways 2.Object Relations: ability to maintain intimate, stable, and satisfying relationships 3.Level of Defenses: (using the guide below, select a single number) 1-2: Psychotic level (delusional projection, psychotic denial, psychotic distortion) 3-5: Borderline level (splitting, projective identification, idealization/devaluation, denial, acting out) 6-8: Neurotic level (repression, reaction formation, intellectualization, displacement, undoing) 9-10: Healthy level (anticipation, self-assertion, sublimation, suppression, altruism, and humor) 4. Reality Testing: ability to appreciate conventional notions of what is realistic

A. Cognitive and affective processes Capacity for regulation, attention, and learning Capacity for affective range, communication, and understanding Capacity for mentalization and reflective functioning B. Identity and relationships Capacity for differentiation and integration (identity) Capacity for relationships and intimacy Self-esteem regulation and quality of internal experience C. Defense and coping Impulse control and regulation Defensive functioning Adaptation, resiliency and ego-strength D. Self-awareness and self-direction Self-observing capacities (psychological mindedness) Capacity to construct and use internal standards and ideals Meaning and purpose

The Relationship Between Theoretical Orientation and Countertransference Awareness: Implications for Ethical Dilemmas and Risk Management Gordon, R.M., Gazzillo, F., Blake, A., Bornstein, R.F., Etzi, J., Lingiardi, V., McWilliams, N., Rothery, C. and Tasso, A.F. (2015). The Relationship Between Theoretical Orientation and Countertransference Awareness: Implications for Ethical Dilemmas and Risk Management, Clinical Psychology & Psychotherapy

Only the borderline level had significant differences between TO. PDT was significantly more sensitive to CT with Borderline level patients than CBT and Other. PDT v CBT p <.0001, PDT v Other p =.039, CBT v Other p =.128. PDT is significantly greater in the expectation of CT in the differential diagnoses between neurotic and borderline level pathologies than both CBT and Other TO. PDT v CBT p <.0001, PDT v Other p =.009, CBT v Other p =.113. These results support our hypothesis that overall the highest expected countertransference was to patients at the Borderline level of organization and the PDT had a higher expectation of CT than either CBT or Other practitioners

The Relationship Between Theoretical Orientation and Countertransference Awareness: Implications for Ethical Dilemmas and Risk Management “We therefore suggest that regardless of favored treatment biases, the addition of CT expectation as a diagnostic tool may alert the practitioner to difficult patients before many objective symptoms are known. The DSM5 and ICD-10 present with clear descriptive diagnostic criteria, but leave out important transference/countertransference information for differential diagnosis. This exclusion may lead to ignoring or misreading CT feelings to possible high-risk patients. The implications of these findings suggest that clinical training in a taxonomy that considers CT such as the Psychodynamic Diagnostic Manual (PDM Task Force, 2006) may be useful in helping to avoid ethical dilemmas regardless of one’s level of training or theoretical preference.” (Gordon, et al. 2015)

The Relationship between Theoretical Orientation and Accuracy of Countertransference Expectations Valeriya Spektor Lehigh University, Linh Luu Lehigh University, Robert M. Gordon, (2015). Journal of the American Psychoanalytic Association. 16