Psychodynamic Therapy

Psychodynamic therapy is an umbrella term for forms of psychotherapy that have evolved from psychoanalysis. In Germany, this term usually refers to depth psychology-based psychotherapy, often abbreviated as TP. Along with behavioral therapy, analytical psychotherapy, and systemic therapy, it is one of the four guideline-based approaches (scientifically recognized methods covered by statutory health insurance).

The basic premise can be described simply: Psychological distress does not arise by chance. It is often caused by inner conflicts of which the person is not even aware. In therapy, these hidden issues are given a space to emerge. Unlike in classical psychoanalysis with its famous couch, in TP the therapist and patient sit across from each other, and the therapist plays a more active role.

Psychodynamic therapy posits that the cause of psychological problems lies in unconscious internal conflicts. Such conflicts often arise from traumatic or unresolved experiences in a person’s personal history, frequently from past relationships and childhood. Symptoms such as anxiety, low mood, or physical complaints can then be understood as an attempt to cope with this internal pressure.

A second key element is the therapeutic relationship. How a person experiences closeness, trust, or disappointment is shaped early in life. These patterns also emerge in the therapy itself. The therapist and patient consciously build a strong, stable relationship. Within this safe space, it becomes possible to access painful, biographically rooted feelings without having to face them alone.

The focus is strongly on the here and now: current conflicts in everyday life are understood and connected to their deeper roots. The goal is a better understanding of one’s own feelings and greater freedom to act.

Both approaches are recognized and effective, but they have different focuses. Behavioral therapy—and cognitive behavioral therapy in particular—are primarily present-oriented and solution-focused. They examine which thoughts and behaviors perpetuate a problem and help patients practice new ones in a targeted manner.

Psychodynamic therapy goes a step deeper to explore the origins. It examines which unconscious conflicts and relationship experiences underlie a pattern and seeks to make them understandable. Additional differences:

• Time frame: Behavioral therapy is often more clearly structured and involves exercises between sessions; psychodynamic therapy devotes more time to understanding the patient’s history.
• Duration: Psychodynamic therapy typically lasts about six months to two years.
• Approach: The focus is on jointly understanding the inner world, not primarily on training specific skills.

Which approach is best depends on the child, the issue at hand, and what feels right for the family.

For children and adolescents, psychodynamic therapy is tailored to their age. Young children are not yet able to put their inner experiences into words. That is why play therapy plays a major role: Through play—using figures, pictures, or role-playing—what is on a child’s mind becomes apparent and can be addressed. More in-depth conversations usually become possible only around the ages of ten to twelve.

A second important point: Parents and close caregivers are involved. Child and adolescent psychotherapy is always a process that considers the child in the context of their family environment. There are often accompanying parent consultations. This is not about assigning blame. It acknowledges that children grow up within relationships and that change is more easily achieved within the entire system.

For psychodynamic work with children, there are specially trained child and adolescent psychotherapists. A related approach is focal psychodynamic therapy, which concentrates on a central theme.

Because psychodynamic or depth psychology-based psychotherapy is a treatment method covered by guidelines, statutory health insurance providers cover the costs when there is an appropriate medical indication. Analytical psychotherapy and behavioral therapy are also recognized for children and adolescents and are covered. As a rule, there are initial trial sessions (introductory and assessment sessions) before the actual therapy is requested.

The first step for parents is to contact a psychotherapy practice approved by health insurance or a pediatrician’s office that can provide a referral. Unfortunately, waiting times for a therapy slot are common; the appointment service centers of the Association of Statutory Health Insurance Physicians can assist with the search.

Rückenwind supports and empowers parents, but does not replace a diagnosis or psychotherapy. Only a medical or psychotherapeutic specialist—particularly a child and adolescent psychiatrist (KJP)—can determine whether your child has a mental health condition and what treatment is appropriate.