Diagnostic Practice in Psychodynamic Therapy with Children and Adolescents: A Scoping Review

Abstract

Within the field of mental health and psychological treatment, diagnostic practice is largely biomedical. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the predominant diagnostic system used in Aotearoa New Zealand. Non-medical practitioners working within government or medically oriented organisations are required to follow DSM-5 terminology and categories to maintain inter-clinician communication and inter-profession consistency. However, this may represent a philosophical conflict for practitioners offering non-medical treatments in mental health, such as psychodynamic therapy. This conflict may be exacerbated by the absence of a ubiquitous approach to diagnosis within the field of psychodynamic therapy.

This dissertation aims to present an overview of diagnostic practice within psychodynamic therapy with children and adolescents, and how this has been influenced by the philosophy and practice of psychiatric diagnosis. A preliminary literature review critiques the conceptual and clinical antecedents to the contemporary practice of both psychiatric and psychodynamic diagnosis. A scoping review of published psychodynamic case studies with children and adolescents then addresses the research question: what diagnostic frameworks are used within psychodynamic therapy with children and adolescents? The scoping review found a mix of diagnostic frameworks were used within the psychodynamic case studies reviewed. These ranged from referencing diagnoses from the DSM, the Psychodynamic Diagnostic Manual (PDM), through to structured formulation tools, and unstructured approaches to formulation. The discussion then pulls together learnings from the past and the results of the scoping review to describe principles of ethical and effective diagnostic practice, for both psychodynamic therapy and mental health diagnosis overall. Independent of diagnostic framework, a distinction is made between diagnostic label and diagnostic process and ultimately the need for a renewed balance between the two is called for.