Psychotherapy Based on Depth Psychology - Medical Experts

Psychotherapy grounded in depth psychology is derived from psychoanalysis, which traces its origins to Sigmund Freud (1856–1939). Through this approach, therapists treat patients who have difficulty relating to significant others. These patients

• have current conflicts,
• suffer from structural disorders, or
• neurotic disorders.

The therapy has been proven effective. It is therefore covered by health insurance in Germany as a so-called “guideline-based treatment.”

Sigmund Freud, circa 1905 © Ludwig Grillich | Public Domain on Wikimedia

The goal of depth psychology-based psychotherapy is to

• to resolve underlying conflicts,
• improve the patient’s psychological structure, and
• thereby help the patient overcome their disorder.

Before the actual therapy begins, preliminary discussions take place between the patient and the therapist. During these discussions, the therapist attempts to determine the nature of the mental illness and how it arose. Psychotherapy grounded in depth psychology is possible if the therapist identifies treatable conflicts.

Depth psychology-based psychotherapy always focuses on the present. Biographical aspects are only important if they can help to better understand current problems. Sessions are typically held once a week and take place while seated.

The patient’s task during depth psychology-based psychotherapy is free association. The patient describes, as unfiltered as possible, whatever comes to mind at the moment. The patient should not worry about whether what is said is important or unimportant.

The therapist’s role is to filter what is said. In doing so, the therapist attempts to identify what is helpful for understanding and treating the current problem. The therapist must put themselves in the patient’s shoes. Accordingly, they must fully understand the patient’s problems and the realities of their life.

Conflict-Centered Approach: Clarification, Confrontation, and Interpretation

In a conflict-centered approach, the therapist primarily uses the techniques of clarification, confrontation, and interpretation.

Clarification:

The therapist must empathize with the patient’s experience. To do this, they may ask follow-up questions for clarification. These can include questions such as

• “Can you explain that to me in more detail?”,
• “How did that make you feel?”, or
• “Did I understand correctly that…?”

Only when the therapist fully understands what is troubling the patient and why can the therapy be successful.

Confrontation:

The therapist draws the patient’s attention to significant inconsistencies. These are often contradictions, such as when the patient

• tells sad stories with a smile, or
• talks about what a good person his partner is while at the same time mentioning how badly she treats him.

The patient is usually not aware of these contradictions. They are important because they can point to significant internal conflicts.

Interpretation:

If the therapist believes he has understood the cause of the conflict, he communicates this to the patient. This communication is called an interpretation. An example: “I get the impression that you are unable to see how badly your partner treats you, because that might raise the question of separation, and that thought frightens you.”

Often, unconscious desires, feelings, and conflicts are the source of the patient’s problems.

Transference and Countertransference

Working with transference and countertransference also plays a special role in this process. Transference means that the patient applies the same beliefs they have about interacting with others to their relationship with the therapist. For example, if they often feel in life that

• that others don’t listen to them or give them enough attention, or
• only to be worthy of value if others make a special effort, or
• that they are always to blame for everything, etc.,

they will generally experience the therapist in similar ways to some extent.

This is not surprising, since transference is a process that occurs everywhere in life. We often perceive people in our immediate circle in certain ways that resemble how we once perceived our father, mother, grandmother, etc.

The therapist recognizes this transference through his or her observations of the patient. In cases of transference, the patient’s feelings or behavior cannot be explained by the current situation.

At the same time, countertransference helps the therapist. These are the therapist’s own feelings and perceptions. Even a therapist is not objective. The stories and conflicts of their patients can trigger emotions in the therapist. They recognize countertransference when their emotions have nothing to do with their own current life. It is therefore likely that the patient is triggering them.

Such a problematic relational constellation within the therapeutic relationship is very valuable. The therapist and patient are thus particularly well-positioned to understand and work through this constellation.

The therapist then shares his experience and understanding with the patient bit by bit. In this way, the patient can gain insight into aspects of himself that he was previously unaware of. Recognizing and understanding one’s own unconscious aspects or conflicts is the first step toward change.

Structure-Centered Approach in Depth-Psychologically Grounded Psychotherapy

In a structure-centered approach, the focus is on the therapist helping the patient

• better tolerate intense emotions,
• better manage potentially harmful behavioral impulses,
• and to improve the perception and differentiation of their own feelings and needs as well as those of others.

To achieve this, the therapist employs interventions that have a stabilizing effect. To this end, the therapist seeks to build up what are known as “ego functions.” The therapist also attempts to limit the transference process described above.

Stabilizing Interventions

Stabilizing interventions include, for example, learning techniques and relaxation exercises to improve emotional control. In this way, the patient can learn to better tolerate unpleasant emotions.

Bringing structure to inner chaos and providing support in creating, for example, a daily schedule also has a stabilizing effect.

Building “I” Functions

The therapist builds “I” functions by helping the patient better understand themselves. For example, the therapist points out to the patient

• why they are so angry right now,
• what situation triggered it, and
• how they can cope with that anger.

It is also important for the patient to learn how to avoid or change such situations in the future. Patients often do not understand how others react to them. The therapist must help the patient become aware of

• how they behave and the effect this has on others, and
• what this triggers in others.

Often, patients do not differentiate between their feelings but perceive them, for example, merely as tension. The therapist helps them identify the associated feelings. This allows the patient to better understand themselves and learn to assess their own behavior.

Limiting Transference Processes

Under certain circumstances, the patient may develop unrealistic fantasies about the therapist and the therapist’s relationship with them. The therapist must prevent such projection or transference. This is important because, in cases of structural disorders, such fantasies often trigger anxiety and can jeopardize therapy.

If the therapist has the impression that the patient is perceiving him in a distorted way or misinterpreting something, he addresses the issue.

People with current conflicts

Psychodynamic psychotherapy treats people with mental health conditions that have developed as a result of current conflicts.

Such conflicts can be triggered by various factors. For example,

• a major life event, such as a breakup,
• the death of a close relative, or
• an unwanted job transfer

can cause inner conflicts—which one had previously managed well—to resurface. Such conflicts may involve feeling excessively

• abandoned,
• inadequate,
• worthless, or
• alone

. These feelings can lead to severe anxiety, depression, or other psychological symptoms. Other common triggers include serious physical illnesses or recent traumatic events.

People with structural disorders

Psychodynamic psychotherapy can also help people with structural disorders. These refer to specific problems that arise primarily in relationships with others. They include, for example, difficulties in

• regulating emotions,
• self-perception,
• perceiving significant others,
• attachment, and
• communication.

These abilities develop primarily during the first years of life through interaction with significant caregivers. Individuals continue to refine and adapt these abilities throughout their lives.

If disruptions occur during this early phase of development, these skills may not develop adequately. The problems then manifest primarily in relationships with other people.

Such interpersonal problems, in turn, can be so distressing that they lead to mental illness.

People with Neurotic Disorders

Current conflicts or structural disturbances can cause mental illnesses at the neurotic level. If this is the case, they can be treated with depth psychology-based therapy. Particularly positive results have been observed in

• acute crises,
• depressive disorders, 
• anxiety disorders,
• eating disorders,
• somatoform disorders, and
• personality disorders 

.

People with trauma-related disorders or psychotic illnesses

In cases of trauma-related disorders, therapists who use depth psychology must also be trained in trauma therapy techniques. They adapt the treatment accordingly.

The same applies to psychotic disorders. These must be treated with psychiatric medication during the acute phase. Once the acute phase has subsided, a modified form of depth psychology-based psychotherapy can be helpful.

Psychodynamic psychotherapy has been proven effective. The costs are therefore covered by health insurance. To this end, the therapist must submit a therapy request to the health insurance provider.

A medical reviewer from the health insurance provider then assesses whether the therapy is medically necessary. The reviewer also evaluates whether the therapy is likely to be successful. If the reviewer concludes that it is, they will recommend that the health insurance provider cover the costs of therapy. The insurance providers follow this recommendation.

Before the therapist writes such a request, they must get to know the patient. A maximum of five “trial sessions” are available for this purpose. During these sessions, the therapist assesses whether their therapeutic method is highly likely to help the patient. The patient should also consider whether they can envision a trusting working relationship with this therapist.

Psychotherapy is a very personal form of therapy. Therefore, it is important for both the patient and the therapist that “the chemistry” is right.

Patients can meet with different therapists. Health insurance covers up to five trial sessions without requiring an application.

Health insurance covers a maximum of 80 hours. The trial sessions are excluded from this limit. As a rule, an application is initially submitted for either short-term therapy (25 hours) or therapy lasting 50 hours. An extension to 80 hours is possible.