Psychodynamically Imaginative Trauma Therapy

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The Psychodynamically imaginative trauma therapy ( PITT ) according Luise Reddemann is a deep psychological psychodynamic short-term psychotherapy . It is used in particular when working with trauma patients in an inpatient setting. The PITT increasingly starts with the patient's resources , using controlled dissociation as a therapeutic tool.

Basic theoretical assumptions

Psychodynamic Imaginative Trauma Therapy is an answer to the difficulties observed in psychoanalytic work with trauma patients: on the one hand, the massive flood of emotions and the associated separation of feelings, on the other hand, the resulting transference and countertransference conflicts, as well as the very long therapy required by many psychoanalysts. Duration.

Ego psychology and object relationship theory are fundamental . Traumatic experiences are kept as a memory trail. The type of what is remembered and its level of consciousness are strongly dependent on the level of development at the time of the experience. Overwhelming feelings are split off ( dissociation ). Early relationship patterns are internalized ( introjection ) and relived in current relationships. Defense mechanisms control feelings and change the perception of others as well as self-perception; they suppress inner needs and prevent satisfactory participation in life.

PITT strengthens the resources. Reddemann encourages the patient to consciously use splitting mechanisms in order to protect himself from negative affects and affect overload through self-regulation . She avoids interpretation and confrontation. It recognizes the defense mechanisms as necessary and uses them specifically for stabilization. She regards the ego as an “inner team” of different personality parts that are to be brought into contact with one another.

PITT has developed special techniques for dissociative patients or integrated other forms of therapy that enable shorter treatment times. Helpful images are created on an “inner stage” as an imaginary space for visual presentations. The patient brings the injured inner part - usually an " inner child " - to a good, safe inner place in order to be cared for and comforted by ideal parents and "helpful beings" that are always available. The patient can later use the exercises learned in the therapy independently and thus regulate stress.

The methods are used in psychotraumatology for post-traumatic stress disorder , complex post-traumatic stress disorder and borderline personality disorder .

Therapeutic approach

The “Psychodynamic Imaginative Trauma Therapy” was specially developed for use in hospitals, i.e. for a mostly short treatment period. It was published as a manual. This makes it easier to use and check. The therapy is divided into three phases:

stabilization

First, an inner stabilization of the psyche is stimulated through targeted splitting ( dissociation ) of stressful ideas on the one hand and affect energy on the other. The technology for this are inner images ( imaginations ). The stressful feelings are z. B. initially locked in an "inner safe" in the performance. Techniques for distancing are learned for suddenly appearing overwhelming feelings: "inner safe place" (a place that is imagined in the imagination, to which one is safe from any danger), "inner helper" (a figure that has all strength and Contains wisdom and protects you) and the "inner healer" (not personified). At the same time, the inner “sources of power” are built up through inner images. There are also various exercises such as mindfulness training (e.g. controlled perception of body sensations in the "here and now"), list of your own abilities (resources), "emergency kit" (self-help strategies), "tree exercise" (so strong being like a tree), “the inner team” (aspects of one's own personality), working on the “inner stage”, and other things.

Trauma processing

The distancing observer technology or screen technology enables a careful, step-by-step approach to the traumatic feelings, depending on the current state of internal security. Well-known exercises are: "Screen" (like looking at the action as a spectator in the cinema) and "Helicopter" (looking at the whole thing from a safe distance from above) etc.

integration

The last phase is about giving shape to grief , letting go of feelings such as shame , guilt and atonement, clarifying questions of meaning, achieving forgiveness, gratitude and reconciliation and ultimately starting a new life. Imagination, rituals (writing and burning letters, burying objects), inventing stories (telling and playing), music therapy , art therapy and creative therapy help again .

PITT-KID

The principles of psychodynamic imaginative trauma therapy were “translated” step by step by the child and adolescent therapist Andreas Krüger for the treatment of traumatized children and adolescents. Important principles of the so-called PITT-KID are the consideration of all development phases of the young person, the emphasis on age-specific resources as well as the inclusion of the social environment of the child.

Combination with other forms of therapy

Different psychotherapeutic techniques are often combined with one another:

  • Due to the rather gentle form of trauma confrontation, PITT is also suitable for outpatient treatment phases, which are then combined with inpatient treatment.
  • With EMDR ( Eye Movement Desensitization and Reprocessing ) trauma content prepared with PITT can be treated even more profoundly. Because of the more violent reactions and stress, the stationary setting is preferred.
  • In the screen art of Ulrich Sachsse the patient trauma projects the subject onto a screen. He uses a “remote control” to control the duration of viewing as well as proximity, size, clarity, etc. of what is visible.
  • Due to the trauma in the nervous system, “oscillating” between well-being and discomfort releases bound energy in small steps, without going into a special trauma topic itself. See Somatic Experiencing by Peter Levine.

See also

literature

  • Luise Reddemann (Ed.): Psychotraumata. Primary medical care for the emotionally shaken patient . Cologne: Deutscher Ärzte-Verlag, 2006.
  • Luise Reddemann: Psychodynamic Imaginative Trauma Therapy. PITT the manual . Pfeiffer at Klett-Cotta, 2004, ISBN 3-608-89729-1 .
  • Luise Reddemann: The psychodynamic imaginative trauma therapy (PITT) ( Memento from December 3, 2008 in the Internet Archive ) (PDF; 74 kB). Journal for Psychotraumatology & Psychological Medicine 1st year (2003), issue 2
  • Luise Reddemann: Imagination as a healing force. For the treatment of the consequences of trauma with resource-oriented methods , 2001, ISBN 3-608-89708-9 .

Individual evidence

  1. ↑ L. Reddemann: The psychodynamically imaginative trauma therapy (PITT). Journal for Psychotraumatology & Psychological Medicine 1st year (2003), issue 2
  2. ↑ Luise Reddemann: Psychodynamic Imaginative Traumatherapy. PITT - the manual (series: Learning to live 167) . 3. Edition. Pfeiffer at Klett-Cotta, 2005, ISBN 3-608-89729-1 , p. 154-171 .