The use of prerequisite for treatment and structure axis of the OPD-CA in psychodynamic treatment: The difficult search for the coherent self

Abstract The comprehensive diagnostic assessment using OPD-CA-2 in the case of a 16-year-old adolescent girl with a debilitating anxiety disorder provides clear psychodynamically relevant information for an individual therapy plan. After a thorough psychiatric evaluation, the Prerequisites for Treatment Axis was used to clarify and discuss the indication for a psychodynamically oriented psychotherapy and to evaluate the patients' motivation and capacity for treatment as well as her resources. The Structure Axis captured the severity of her ego-structural limitations. The Attachment Dimension revealed a very insecure inner base, adversely affecting the development of her emotional self-regulation. Her lack of comforting reliable internal objects led to overwhelming fears of abandonment underlying her anxiety disorder. Preserving a therapeutic alliance was a difficult and important task. The further therapeutic objectives focused on reflective functioning, identity development, and enhancing her self-regulatory abilities.