Forms of Therapy
Forms of Therapy
Section titled “Forms of Therapy”Fundamentally, no therapy works overnight. No disorder, no depression, no addiction developed overnight, and likewise no therapy can resolve a problem in the shortest possible time.
Many enter therapy believing their condition will improve immediately. This assumption is completely wrong. When old structures are broken open and the causes are addressed, it hurts at first. Or as Goethe put it: “One must first tear down in order to rebuild.”
Classical Psychoanalysis
Section titled “Classical Psychoanalysis”Classical psychoanalysis goes back to Sigmund Freud (1856-1939). He assumed that every person has developed a “basic pattern” containing important characteristics and behaviors, such as how they behave in relationships and during conflicts. This basic pattern is anchored in the unconscious and influences the individual’s thinking, feeling and acting. This means that the individual always deals with conflicts in the same way, without necessarily being aware of it.
In psychoanalytic therapy sessions, the patient talks about everything they are currently feeling, thinking or fearing. This form is also called “free association.” In doing so, they will eventually repeat a “pattern” that contributes to the current conflict. This gives the therapist the opportunity to pick up on and address this pattern.
In classical psychoanalysis, the patient lies on a couch. The analyst sits behind the patient so that the patient cannot see them. Only in this way is it ensured that client and analyst do not distract or influence each other.
Setting:
- Sessions last 45 minutes
- Approximately twice a week
- Between 160 and 240 sessions
- Covered by health insurance upon application
The classical form of psychoanalysis is rarely practiced today. It serves more for self-knowledge and is used in the training of therapists.
Analytical Psychotherapy
Section titled “Analytical Psychotherapy”Analytical psychotherapy has the same origins as psychoanalysis. However, classical psychoanalysis is too lengthy a procedure for many conditions. Therefore, the modified and more streamlined procedure of analytical psychotherapy has developed in practice.
An important difference from psychoanalysis is the assumption that children must master different conflicts during their development and thereby mature. Some of these conflicts remain unresolved and can persist in the unconscious until adulthood. However, these unresolved childhood conflicts can still be processed and mastered at a later time.
Setting:
- Mostly individual sessions
- 45 minutes per session
- Approximately two sessions per week
- Duration approximately two to three years
- Up to 240 sessions covered by health insurance upon application
Analytical psychotherapy is applied for neuroses and personality disorders. Psychoses and psychosomatic disorders can only be treated to a limited extent with this method.
Depth Psychology-Based Psychotherapy
Section titled “Depth Psychology-Based Psychotherapy”Depth psychology-based psychotherapy is a modification of classical psychoanalysis. The depth psychology approach focuses on current psychological conflicts. The “here and now” is important. From there, memories of childhood and adolescent experiences are then taken up, with the goal of changing current attitudes toward life.
The therapy always takes place in a seated position. The client can see and interpret the therapist’s facial expressions and gestures (countertransference). This creates a more everyday-like conversational situation between therapist and patient.
Setting:
- Individual or group sessions
- Usually once a week
- 45 minutes per session
- Duration depends on complaints and needs
In practice, depth psychology-based psychotherapy is the most frequently conducted form of psychotherapy. It is applied for:
- Neuroses
- Psychoses
- Psychosomatic disorders
- Personality disorders
- Addictive disorders
Dynamic Psychotherapy
Section titled “Dynamic Psychotherapy”Dynamic psychotherapy is a procedure developed by psychologist Annemarie Dührssen in the 1950s. It has its roots in psychoanalysis but is actually a depth psychology-based procedure.
Dynamic psychotherapy starts from the everyday experiences of patients. The focus is on patients’ experiences, their life design, their self-esteem and their relationships with their environment.
Significant formulas based on disturbed processing of childhood experiences can include, for example:
- “Nobody loves me.”
- “I can manage on my own.”
- “I’ll never be able to do that.”
These basic attitudes can be so firmly anchored that events always develop in this pattern - a “self-fulfilling prophecy.”
Dynamic psychotherapy attempts to support the patient and strengthen their self-esteem.
Setting:
- Mostly individual sessions
- Intervals depend on need
- 20 to 60 sessions in total
Dynamic psychotherapy is used for neuroses, psychosomatic disorders, personality disorders and in addiction therapy.
Client-Centered Psychotherapy
Section titled “Client-Centered Psychotherapy”Client-centered psychotherapy was founded by Carl Ransom Rogers (1902-1987). Through his research, he was able to demonstrate that the success of therapy does not depend exclusively on which method is applied. What is also important is the nature of the connection between patient and therapist.
This should be characterized by:
- Congruence (authenticity)
- Openness or acceptance
- Empathy
At the center stands the patient and their self-concept. A person has certain ideas of themselves, how they are and how they would like to be. But the individual’s actual experiences and ways of acting do not always align with their self-concept.
In client-centered psychotherapy, the aim is to find and expose such contradictions in the patient’s self-concept. The focus is not on the past but on the current problem.
Action-Oriented Approaches
Section titled “Action-Oriented Approaches”In action-oriented approaches, the unconscious or childhood conflicts play a subordinate role. The goal is the specific current problem and its resolution. Special exercises are carried out to train the affected person to change their behavior so that the disorder no longer occurs.
The foundation is the learning-theoretical concept of behaviorism, which assumes that all behavior of an individual can be explained through stimulus-response connections.
Important action-oriented approaches:
- Dialectical Behavior Therapy (DBT)
- Behavioral therapy
Behavioral Therapy
Section titled “Behavioral Therapy”In behavioral therapy, insight is at the forefront. The theory assumes that feelings and behavior arise through the cognitive processing of events and perceptions.
In the case of “disturbed” behavior, the aim is to identify the conditions and circumstances that lead to this behavior. The mechanisms that cause a person to continue disturbed behavior are also examined.
The foundation is learning self-control. On average, 25 to 40 sessions are estimated.
Treatment Techniques
Section titled “Treatment Techniques”- Anxiety management training: Affected persons learn to control emerging anxieties through relaxation
- Exposure and stimulus confrontation: Affected persons are directly exposed to their fears
- Systematic desensitization: In a relaxed state, affected persons are gradually confronted with their fears
- Role-playing: Particularly suitable for social anxieties
- Problem-solving training: Basic skills for resolving conflict situations
Guided Affective Imagery
Section titled “Guided Affective Imagery”Guided affective imagery (katathymes Bilderleben) assumes that images and ideas that flow through our thoughts during the day reflect unconscious conflicts and feelings.
In collaboration with a therapist, an attempt is made to consciously evoke daydreams centered on a specific theme. The resulting images are then interpreted together with the therapist.
Standard Motifs - Basic Level
Section titled “Standard Motifs - Basic Level”| Motif | Meaning |
|---|---|
| Meadow | Life, calm, fertility, encounter |
| Stream | Origin, change, free flow |
| Mountain | Authority, rivalry, outlook, vision |
| House | Symbol of one’s own person |
| Forest edge | Boundary to the unconscious |
Standard Motifs - Intermediate Level
Section titled “Standard Motifs - Intermediate Level”- Partner: Dealing with closeness, contact, touch
- Sexuality: Attitude toward sexuality
- Aggressiveness: Dealing with aggression
- Ego ideal: Clarification of identity problems
Standard Motifs - Advanced Level
Section titled “Standard Motifs - Advanced Level”- Cave: Repressed and unconscious material
- Swamp hole: Relationship to “dark forces”
Guided affective imagery is used in short-term therapy with children, adolescents and adults for the treatment of crises, depression, psychosomatic complaints, obsessive-compulsive neuroses and psychologically caused sexual disorders.
Further Information
Section titled “Further Information”- Dialectical Behavior Therapy (DBT) - specifically developed for borderline disorder
- Clinics - facilities for inpatient treatment
- Self-Help - support in everyday life