Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM-5

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.     

Die Verleugnung der Realit?t

Denial is of great importance for the ego functions and for the constitution of the entire ego but little of this is reflected in case reports and theoretical treatises. The reason for this probably lies in the circumstance that two further problems play a role in the issue of denial: that of reality and that of truth. According to the theory of correspondence, truth is the equivalent of reality. According to this theory, subject and object are opposed. The repudiation of the theory of correspondence has led to blindness and deafness for many things. The modern concept of truth, according to which truth is constructed intersubjectively, destroys the opposition of subject and object. The destruction is an act of denial. Although the theory of correspondence may be outmoded, it could nevertheless retain its former appreciation. ??If we stopped reading canonical philosophy books??, wrote Richard Rorty, ??we would be less aware of the forces that make us think and talk as we do?? (citation from Habermas 2008, S.?34).     

Behandlungs- und Kunstfehler in der Psychoanalyse

Failures and transgressions in psychoanalyses are nowadays more often published and also ascribed to mistakes made by the therapists. In German professional literature, however, no difference is made between treatment errors due to the special method and serious malpractice. The authors show in case studies transgressions in the psychoanalytic setting und discuss their causes and consequences.     

?Du sollst dir kein Bildnis machen��

??The Progress in Spirituality??, a short section of Freud??s last major work ??Moses and Monotheism?? (1939) received special attention when his daughter read it on his behalf in 1938 at the last International Psychoanalytical Congress before the Second World War in Paris: it was almost like reading the will of the founder of psychoanalysis. ??The Progress in Spirituality?? is an implicit reflection on the core of psychoanalysis and its technique of eliminating vision. The image of God reflected there??the establishment of Jewish monotheism, of a nameless, aniconic, abstract God and the ethical demands imposed by him??exhibits all the characteristics of a cultural revolution in which all the existing traditions were thrown away. In it seems hidden what was for Freud the mysterious feature in the Jewish tradition. Through the prohibition of images Mosaic monotheism enforced a higher level of intellectuality and encouraged introspection. In the psychoanalytical setting the prohibition of images seems to reappear in the form of the ??cultural memory??. The denial demanded of the patient and the renunciation of instincts demanded from both corresponds to ??The Progress in Spirituality?? in which Freud??s Moses finds his culmination point.     

Zeitlosigkeit und Verg?nglichkeit (in) der Psychoanalyse

The author shows that the accessible psychoanalytic unconscious is not timeless. Freud??s ??timeless unconscious??, which was ontologized by himself and his successors, proves to be fiction with negative consequences. Assuming ??timeless?? primary processes psychoanalysis as a therapy would bite the hand which feeds it. Instead of contrasting linear time to the cyclic personal experience of time, the author suggests to speak about the ??emergence of lived time?? and the ??new moments?? of encounter in the therapeutic situation, to emphasize the importance of the opportune moment for change in contrast to the cyclic repetition of transference. In order to understand and approach disorders of time perception knowledge of unconscious conflicts and defense processes remains crucial. Even dreams are not timeless. While our conscious mind works according to chronological patterns, the pictorial representation in the particular form of thinking asleep, dreaming, makes it possible to map different memory traces simultaneously. Freud??s speculations about the ??timeless unconscious?? and Nirvana may originate from a longing for redemption. In contrast the author??s final chapter deals with the potential life span and transience of some central psychoanalytic concepts. Not even those who prove to be very close to observation can be attributed with ??eternal life??.     

Das Unheimliche der Ambivalenz

This essay??s main concern consists of a critical survey of the coherences, alliances and associative entanglement between psychic ambivalences, encounters of the uncanny and the connections to the issues of death. References for the considerations presented here are Freuds??s seminal papers ??The antithetical meanings of primal words?? (1910), ??The uncanny?? (1919) and ??Beyond the pleasure principle?? (1920). The axis formed by these essays is being crisscrossed by the phenomen of the uncanny valley, an issue widely discussed within the cyber scene which may introduce a new perspective in order to extend the analysis of the concept and structure of ambivalences with new questions. This approach adverts to an inherent paradox which seems to be constitutive for ambivalence itself.     

Ambivalenz und gleichschwebende Aufmerksamkeit

Starting from some aspects of a case study the clinical significance of the concept of ambivalence will be exposed. It will be shown that beyond all the different symptoms ambivalence plays an important role in evenly-suspended attention, a concept which was developed by Freud at nearly the same time as ambivalence itself. As far as this attention is not freely suspended, ambivalence means that the suspension is always threatened by the danger of a crash. When it is right, that from a psychoanalytical viewpoint the achievement of the subject lies particularly in a misachievement, in the Freudian slip, the promise of efficiency and cure in an analysis will prove itself in its failure. The young man in the case study tells the psychoanalysis about the ambivalences it is involved in and in this he is very efficient. Ambivalence as an essential part of the evenly-suspended attention will reveal itself as a strong means of deconstructing efficiency.