Depth psychology-based psychotherapy is derived from psychoanalysis, which goes back to Siegmund Freud (1856-1939). Therapists use it to treat patients with limited abilities in dealing with important other people. These patients
- have current conflicts,
- suffer from structural disorders or
- neurotic illnesses.
The therapy has been proven to be effective. It is therefore covered by health insurance in Germany as a so-called guideline procedure.
Siegmund Freud around 1905 © Ludwig Grillich | Public Domain on Wikimedia
Theaim of depth psychology-based psychotherapy is to
- to resolve the underlying conflicts,
- to improve the structure and
- thereby helping the patient to overcome their disorder.
Before the actual therapy begins, preliminary discussions take place between the patient and therapist. The therapist tries to find out which mental illness is present and how it came about. Depth psychology-based psychotherapy 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 the problems of the present. As a rule, we work with one session per week. It takes place in a sitting position.
The patient's task during depth psychology-based psychotherapy is free association. They tell what comes to mind as unfiltered as possible. They should not worry about whether it is important or unimportant.
The therapist's task is to filter the narrative. He tries to find out what is helpful for understanding and treating the current problem. The therapist must put themselves in the patient's shoes. Accordingly, he must fully understand the patient's problems and reality of life.
Conflict-centered approach: Clarification, confrontation and interpretation
In a conflict-centered approach, the therapist prefers to work with the techniques of clarification, confrontation and interpretation.
Clarification:
The therapist must empathize with the patient's experience. To do this, he may ask follow-up questions for clarification. These can be questions such as
- "Can you explain that to me in more detail?"
- "How did that make you feel?", or
- "Did I understand correctly that...?".
Therapy can only be successful if the therapist understands exactly what is bothering the patient and why.
Confrontation:
The therapist draws the patient's attention to significant abnormalities. These are often inconsistencies, such as the patient
- tells sad things with a smile, or
- tells what a good person his partner is and at the same time mentions how badly she treats him.
The patient is usually not aware of these contradictions. They are important because they can point to significant inner conflict issues.
Interpretation:
When the therapist believes that he has understood the cause of the conflict, he tells the patient this. This communication is called interpretation. An example: "I have the impression that it is not possible for you to see how badly your partner is treating you, because then the question of separation might arise and this thought would frighten you."
The patient's problems are often caused by unconscious wishes, feelings and conflicts.
Transference and counter-transference
Working with transference and countertransference also plays a special role here. Transference means that the patient also applies their beliefs to the therapist when dealing with others. For example, if he often has the feeling in life that
- not being listened to or given enough attention by others, or
- that they are only worth something if they make a special effort, or
- always being to blame for everything, etc.,
usually experiences the therapist in part in the same way.
This is not surprising, as transference is a process that occurs everywhere in life. We often perceive people from our immediate environment in certain aspects in the same way as we did our father, mother, grandmother, etc. in the past.
The therapist recognizes this transference from his observations of the patient. In the case of transference, the patient's feelings or behavior cannot be explained by the current situation.
At the same time, the counter-transference helps the therapist. These are the feelings and perceptions of the therapist. Even a therapist is not objective. The patient's stories and conflicts can trigger emotions in the therapist. He recognizes the countertransference by the fact that his emotions have nothing to do with his own current life. It is therefore likely that the patient triggers them in him.
Such a problematic relationship constellation in the therapeutic relationship is very valuable. Therapist and patient can understand and work on this constellation particularly well.
The therapist then makes his experience and understanding available to the patient step by step. This enables the patient to understand something about themselves that they did not know before. Seeing and understanding one's own unconscious parts or conflicts is the first step towards change.
Structure-centered approach in depth psychology-based psychotherapy
In a structure-centered approach, the focus is on the therapist helping the patient
- better tolerate intense feelings,
- better control potentially damaging behavioral impulses,
- improve the perception and differentiation of their own feelings and needs and those of others.
To achieve this, the therapist uses interventions that have a stabilizing effect. To this end, he tries to build up the so-called "ego functions". He also tries to limit the above-mentioned transference process.
Stabilizing interventions
Stabilizing interventions include, for example, learning techniques and relaxation exercises to improve emotional control. In this way, the patient can learn to cope better with unpleasant feelings.
Structuring inner chaos and support in creating a daily schedule, for example, is also stabilizing.
Building up the ICH functions
The therapist achieves the development of ego functions by helping the patient to understand themselves better. For example, the therapist points out to the patient
- why they are so angry at the moment,
- what situation triggered it and
- how they can deal with the anger.
It is also important for the patient to know how they can avoid or change such situations in the future. Patients often do not understand the reactions of their environment to them. The therapist must make the patient aware of
- how they behave and how this affects others, and
- what this triggers in others.
Patients often do not differentiate their feelings, but only perceive them as tension, for example. The therapist helps them to identify the associated feelings. This enables the patient to understand themselves better and learn to assess themselves.
Limiting the transference processes
Under certain circumstances, the patient may develop unrealistic fantasies about the therapist and their relationship with them. The therapist must prevent such projection or transference. This is important because in the case of structural disorders, such fantasies often trigger anxiety and can jeopardize the therapy.
If the therapist has the impression that the patient has a distorted perception of him or is misinterpreting something, he addresses this.
People with current conflicts
Depth psychology-based psychotherapy treats people with mental illnesses that have developed as a result of current conflicts .
Such conflicts can be triggered by various things. For example
- a drastic life event, such as a partnership break-up,
- the death of a close relative or
- an unwanted transfer at work
can lead to inner conflict issues that you were previously coping with being revived. Such conflict issues can be that you feel
- let down,
- inadequate,
- worthless or
- alone
alone. These feelings can lead to severe anxiety, depression or other psychological symptoms. Other common triggers are serious physical illnesses or recent traumatic events.
People with structural disorders
Depth psychology-based psychotherapy can also help people with structural disorders. This refers to specific problems that occur primarily in relationships with others. These include difficulties in
- the regulation of feelings,
- self-perception,
- the perception of important others,
- attachment and
- communication.
These skills develop primarily in the first few years of life in contact with important caregivers. People continue to differentiate and adapt them over the course of their lives.
If there are disruptions in this early phase of development, these skills cannot develop sufficiently. The problems then manifest themselves primarily in relationships with other people.
Such interpersonal problems can in turn be so stressful that mental illnesses develop.
People with neurotic disorders
Current conflicts or structural disorders can cause mental illness at a neurotic level. If this is the case, they can be treated with depth psychology-based therapy. Particularly good experiences have been made with
before.
People with trauma-related disorders or psychotic illnesses
In the case of trauma-related disorders, the depth psychology therapist 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 in the acute phase. Once the acute phase has subsided, modified depth psychology-based psychotherapy can be helpful.
Depth psychology-based psychotherapy has been proven to be effective. The costs are therefore covered by health insurance. For this purpose, the therapist must submit a therapy application to the health insurance company.
A medical expert from the health insurance company then assesses whether the therapy is necessary from a medical point of view. He also assesses whether it is likely to be successful. If this is the case, he will recommend to the health insurance company that the therapy costs be covered. The insurance companies follow this recommendation.
Before the therapist writes such an application, he must get to know the patient. A maximum of five "trial sessions" are available for this purpose. In these sessions, the therapist checks whether their therapy method is likely to help the patient. The patient should also check whether they can imagine working with this therapist on a basis of trust.
Psychotherapy is a very personal form of therapy, so it is important for both the patient and the therapist that the "chemistry" is right.
Patients can get to know different therapists. The health insurance company pays for up to five trial sessions without an application.
The health insurance company covers a maximum of 80 hours. The trial sessions are excluded from this. As a rule, either a short-term therapy of 25 hours or a therapy of 50 hours is initially applied for. An extension to 80 hours is possible.
