The psychodynamic diagnosis in a contemporary perspective

The most widespread diagnostic classification manuals such as the International Classification of Diseases (ICD; see World Health Organization, WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders (DSM; see American Psychiatric Association, APA, 2000), in their various editions, are based on a descriptive, atheoretical and substantially symptom-behavior oriented approach to psychopathology. This approach has provoked different reactions in dynamic training clinicians: disinterest, dissatisfaction, distrust, hostility. The recent appearance of evaluation procedures and diagnostic manuals of psychodynamic inspiration, but well anchored to empirical research, such as the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen, Shedler, 1999a,b; Westen, Shedler, Lingiardi, 2003) and the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) has promoted a "cultural revolution" in the community of mental health professionals, enhancing an approach to diagnosis closer to clinical practice and more compatible with psychotherapeutic interventions. Where diagnosis is not only a label, but also an evaluation process capable of bringing the symptom back into the context of personality and patient-friendly treatment.