From symptom to process: how the PDM alters goals and strategies in psychological assessment

In many respects the Psychodynamic Diagnostic Manual (PDM) P and M Axes represent psychoanalytic versions of Diagnostic and Statistical Manual of Mental Disorders (DSM) Axes II and V: Whereas the DSM axes focus on surface behaviors and their associated mental states (e.g., thought patterns, affective responses), the PDM axes emphasize underlying psychodynamic processes (e.g., implicit motives, conflicts, defenses), with more modest attention to expressed behavior. The paradigmatic shift envisioned by the PDM creates tremendous opportunities for clinicians and researchers, and significant assessment challenges as well. This article discusses those opportunities and challenges. After briefly contrasting the DSM and PDM conceptualizations of personality pathology and global psychological functioning, I discuss the implications of these contrasting perspectives for diagnosis and psychological assessment, outline strategies for documenting the construct validity of DSM and PDM symptom criteria using symptom-focused and process-focused methods, and offer suggestions for how DSM symptom-focused data can be integrated with PDM process-focused data to facilitate case conceptualization and treatment planning.