Psychotherapy Based on Depth Psychology

Psychotherapy based on depth psychology, often abbreviated as TP, is a recognized treatment method for mental disorders. In Germany, there are four such guideline-based approaches—that is, approaches whose effectiveness has been proven and whose costs are covered by statutory health insurance: TP, analytical psychotherapy, behavioral therapy, and systemic therapy.

TP evolved from classical psychoanalysis. Its basic premise is that symptoms such as anxiety, withdrawal, stomachaches with no physical cause, or school refusal often stem from an emotional conflict of which the child is unaware. The therapy aims to make this conflict visible and discussable so that the child can find new ways to cope with distressing feelings. With children and adolescents, this often involves play, drawing, and collaborative creative activities for younger children, as they often find it easier to express themselves through these means. A preschooler may sometimes show more clearly through puppet play what is troubling them than they could put into words.

TP assumes that early relationship experiences shape how a person copes with stress later in life. Experiences from the early years of life can crystallize into an internal pattern that resurfaces in difficult situations. The therapy focuses on the current conflict—that is, what is troubling the child right now, in the here and now.

The therapist listens closely to how the child speaks, plays, and reacts, and carefully interprets connections between the current distress and earlier experiences. Unlike in classical psychoanalysis, it is not necessary to establish a conscious link to early childhood conflicts. It is sufficient to understand and work through the distressing focal conflict. Related to this is psychodynamic therapy as an umbrella term and the even more narrowly defined focal psychodynamic therapy, which concentrates on a single central theme.

What makes these terms confusing is that “depth psychology,” “psychodynamic,” and “analytical” are closely related. A few differences can help clarify their distinctions:

• Classical psychoanalysis: very open-ended and without a fixed program, involving a large number of sessions over a long period of time. It delves deeply into a person’s life story.
• Analytical psychotherapy: the health insurance-covered approach within this tradition, also extensive and focused on fundamental personality development.
• Depth psychology-based psychotherapy: more focused and oriented toward current conflicts, with significantly fewer sessions than psychoanalysis.

The difference is greater when compared to cognitive behavioral therapy. Behavioral therapy focuses primarily on how a behavior was learned and what maintains it, and specifically trains new responses. Depth-psychologically based psychotherapy addresses unconscious inner conflict. Both approaches are scientifically recognized and effective; they simply approach the problem from different angles.

Psychotherapy based on depth psychology typically lasts between six months and two years. It usually begins with a few exploratory sessions in which the child, parents, and therapist get to know one another and determine whether there is a good rapport and whether the approach is a good fit. This is followed by the actual treatment, often in the form of individual therapy, sometimes supplemented by group sessions.

For children and adolescents, depth psychology-based treatment plays a particularly important role: it accounts for a significant portion of the psychotherapy covered by health insurance in this age group, and its effectiveness for children with mental health conditions has been demonstrated on multiple occasions. Important for parents: The treatment is conducted by a licensed medical or psychological professional; for minors, this is usually a child and adolescent psychotherapist or a specialist in that field. Parents are generally closely involved through parent-therapist meetings and discussions about daily life at home. How often these parent-teacher conferences take place depends on the child’s age and the specific issue; they are usually more frequent for younger children.

Whether TP, behavioral therapy, or another approach is right for your child depends on the nature of the symptoms and how well the child and therapist get along. Sometimes it takes a second try to find the right fit. An important consideration in everyday life is the wait time for a therapy spot, which can be long depending on the region. During this time, it’s worth contacting several practices at once and getting added to their waiting lists.

As parents, you don’t have to figure this out on your own. Rückenwind is designed to provide support and coaching for parents and is not a substitute for psychotherapy or diagnostic evaluation. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she is not licensed and does not make diagnoses. Whether your child has a condition and what treatment is appropriate can only be determined by a child and adolescent psychiatrist (KJP) or a medical or psychotherapeutic specialist. The first point of contact is often the pediatrician, who will refer you to a child and adolescent psychiatrist or a psychotherapy practice if necessary.