Symptom checklists are helpful but Psychodynamic treatment aims for deeper change: how a person organizes self, how defense mechanisms are used to ward off unconscious content, object relations, and ontological meaning. So how do researchers measure that kind of growth?
There are a lot Psychodynamically orientated assessments and tests out there, but here are three common “beyond symptoms” targets these tools measure and how they are operationalized in studies and research:
1) Personality structure (how the mind holds together under stress) Researchers often use clinician-rated, theory-informed systems that translate rich clinical material into reliable scores. The Operationalized Psychodynamic Diagnosis (OPD-2) includes a structured “structural” axis (e.g., self-perception, affect regulation, object perception) that can be tracked over time.
(A great text that goes into one’s personality structure is the Psychodynamic Diagnostic Manual: PDM-2 edited by Nancy McWilliams and Vittorio Lingiardi)
2) Enduring personality patterns (not just traits on a questionnaire)
Instead of asking patients to endorse items, tools like the Jonathan Shedler–Drew Westen Assessment Procedure (SWAP-200) have trained clinicians sort descriptive statements to generate empirically derived personality profiles—useful for detecting shifts in personality pathology and strengths.
3) Reflective functioning (mentalizing) Psychodynamic change is often reflected in a growing ability to think about feelings, intentions, and motives—one’s own and others’. The Reflective Functioning (RF) Scale codes narratives from interviews (commonly the Adult Attachment Interview) to quantify mentalizing capacity and its development across treatment.
The take home message is psychodynamic outcome research is increasingly multi-dimensional as tracks personality levels, defense organization, unconscious life, interpersonal relationships and mentalizing ability alongside symptoms. That’s how studies get closer to what clinicians and clients mean by “real change.”
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References:
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual, Version 5, for application to adult attachment interviews (Unpublished manuscript). University College London.
Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review, 34(2), 107–117.
OPD Task Force. (2008). Operationalized psychodynamic diagnosis OPD-2: Manual of diagnosis and treatment planning. Hogrefe & Huber.
Shedler, J., & Westen, D. (2007). The Shedler–Westen Assessment Procedure (SWAP): Making personality diagnosis clinically meaningful. Journal of Personality Assessment, 89(1), 41–55.
Dr. Alex Rowell 