Analytical psychotherapy

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The analytic psychotherapy ( AP ) is the collective term for a certain approved in Germany by the legal health insurance companies supply form of psychotherapy . It is the name for a long-term therapy based on psychoanalysis . The term distinguishes analytical psychotherapy from the other approved methods of psychotherapy based on depth psychology , behavioral therapy and systemic therapy and is also used to distinguish it from “classic” psychoanalysis.

General meaning

The statutory health insurance companies in Germany currently take on four psychotherapy procedures. These are behavior therapy , psychotherapy based on depth psychology , systemic therapy and analytical psychotherapy. The psychotherapy based on depth psychology and the analytical psychotherapy belong to the psychoanalytically based procedures, that is, they are theoretically based on psychoanalysis and its further development, including the developments within psychoanalysis as the most important of the individual psychology according to Alfred Adler and the analytical psychology according to Carl Gustav Belong young .

Analytical psychotherapy encompasses those forms of therapy that, together with neurotic symptoms, treat the neurotic conflict material and, above all, the underlying structure (personality) of the patient and thereby set the therapeutic process in motion with the help of transference , countertransference and resistance analysis using regressive processes set and promote. In contrast to this, in psychotherapy based on depth psychology, the aim is to concentrate the therapeutic process by limiting the treatment goal, by adopting a predominantly conflict-centered approach and by restricting regressive processes; it focuses on dealing with a current conflict for which a clear trigger can be identified. Analytical psychotherapy focuses on personality components, lifelong patterns in experience and behavior, on thinking and evaluation processes such as v. a. also patterns in relationships.

Analytical psychotherapy is a long-term therapy. It can be carried out in individual sessions or in groups. Adults can be treated by psychological psychotherapists who are specially trained in analytical psychotherapy and medical psychotherapists with the additional designation psychoanalysis, and children and adolescents can be treated by 'analytical child and adolescent psychotherapists' . While in child analyzes the therapist usually interacts with the child in a playful way, the treatment with adolescents usually takes place as a conversation, as a responsive dialogue sitting opposite. This also applies to treatment in adults, although here - depending on the indication - the recumbent treatment is also common, in which the patient lies on a couch and the therapist sits next to or behind the patient, out of his field of vision.

Analytical psychotherapy is covered by statutory health insurances for 80–240 hours (maximum 300 hours) with usually a maximum of three treatment hours per week as individual psychotherapy (in exceptional cases, four hours can also be used for a single, shorter period of treatment as part of long-term analytical treatment approved per week). As group therapy , it can be taken on for 80–120 hours (max. 150) twice a week. These values ​​are somewhat lower for children and adolescents.

indication

Analytical psychotherapy is particularly indicated if the patient “suffers from himself” or, for example, if the patient does not experience real life satisfaction in the course of their life or if there is persistent, deep, diffuse life dissatisfaction or, for example, the patient has restricted experiences and behaviors suffers. It is also indicated in the case of recurring, identical, neurotic and solidified patterns, for example if important developmental tasks (such as satisfying relationships, partnerships, family planning, etc.) cannot be mastered. The same applies to a consistently solidified chronic neurotic development that is embedded in a deep basic disorder, i.e. when neurotic structures (basic personality) that have grown and solidified from the biography and their internal patterns have already developed their own disease value due to their severe neurotic character. Analytical psychotherapy is also particularly indicated when a focus on current goals and overcoming an actual conflict would not achieve the necessary major structural changes, i.e. H. if, therefore, coping with the current conflict would not be sufficient to rule out a repetition of such a situation with a renewed illness in the future, because processing the basic patterns and personality components is necessary. Another indication for analytical psychotherapy is the chronification of a mental illness, which has been going on for years. Furthermore, the spectrum of indications for analytical psychotherapy includes various personality disorders (especially narcissistic , histrionic , anankastic , anxious-avoidant , dependent and schizoid personality disorders).

Modifications to analytical psychotherapy may be necessary if, for example, in the case of structural disorders and the consequences of trauma, excessive therapeutic regression has to be avoided and the current interpersonal disorder patterns characteristic of these clinical pictures and the difficulty of self-regulation should be worked on. Here, the intervention and the setting (e.g. sitting opposite, lower hourly frequency) must be tailored more closely to the possibilities and limits of the patient, which means, for example, that supportive, structuring and coping-oriented interventions can take precedence over interventions that, for example, have relationship conflicts in the Interpret transmission. With these clinical problems, the frequency of psychotherapy based on depth psychology may be too low to be able to deal with the negative transference constellations that inevitably also occur in the therapeutic situation in a sufficiently dense process (cf. Rüger et al. 2011). This applies in particular to more severe personality disorders, such as severe narcissistic disorders or borderline personality disorders, possibly with a trauma background and strong tendencies to split, i.e. v. a. when violent transference and countertransference reactions are to be expected, and in which one should therefore work more closely on the interpersonal disturbance patterns and the difficulty of self-regulation (cf. Reimer & Krüger 2006)

Scientific definition

The term analytical psychotherapy is also used to distinguish it from “classical” psychoanalysis, which is mainly based on the psychotherapeutic techniques of Sigmund Freud . The main distinguishing features are:

  • Duration: A classic psychoanalysis is in principle unlimited in time and can last for many years. There is no restriction in the process of psychotherapy here. In analytical psychotherapy, clearer goals are set.
  • Setting : The setting describes the general conditions in which psychotherapy is carried out. The setting of classical psychoanalysis is usually several hours of treatment per week, with three to five sessions usually being aimed for. Another specialty of classical psychoanalysis is the prone treatment, whereby the patient lies on a couch and the analyst sits behind him outside the patient's field of vision. Analytical psychotherapy is open with regard to the setting. It is performed two to three times a week both in a prone position and sitting opposite.
  • The German psychotherapy guideline defines psychoanalysis (in the sense of the "classical" psychoanalysis according to Freud and his successors, as well as Jung and Adler) as a method of personality development for which a high level of mental stability and health (absence of ICD-10 chapter F diagnoses ) is necessary, not as a method of patient treatment. On the other hand, analytical psychotherapy is specifically designed and defined as a method of treating the sick (an attempt at strict differentiation can be found in Mertens). In fact, however, the transitions are fluid and, from a neurotic psychological point of view, also questionable. It is therefore quite common among psychoanalysts who are active in psychotherapy to speak of psychoanalysis in the context of the psychotherapy guidelines when it comes to analytical psychotherapy. Often it is also about mastering the balancing act between the requirements of the guidelines (and their advantages for the practitioner and patient) and keeping the high analytical standards “clean”.

Psychodynamic psychotherapy

The term psychodynamic psychotherapy is suggested by some authors (e.g. Rudolf 2010): “Psychodynamic psychotherapy as a therapeutic procedure encompasses all analytically justified procedures which, like e.g. B. the analytical or depth psychologically founded psychotherapy, methodical variants of the procedure. ”(P. 16). In the opinion of the Scientific Advisory Board for Psychotherapy (2004), psychodynamic psychotherapy should be used as the designation for all psychoanalytically based psychotherapy procedures, in the sense that it should be considered a uniform therapy procedure; with the abolition of the distinction between analytical and psychotherapy based on depth psychology. “The Scientific Advisory Board for Psychotherapy does not see any scientific basis for a distinction between depth psychologically founded and analytical psychotherapies as two separate procedures. This distinction is only due to social law and is a peculiarity of the Federal Republic of Germany (...) Psychodynamic psychotherapy is a procedure in which different methods and techniques with a common disorder and treatment theoretical background are used in different settings. (...) Psychodynamic psychotherapy (PP) is based on psychoanalysis and its further developments. The treatment principles of the PP consist in dealing with life-historically based unconscious conflicts and illness-related psychological disorders in a therapeutic relationship with special consideration of transference, countertransference and resistance. Depending on the procedure, the work is done more in the here and now or in the there and then, the lesson content is more structured (technique: focusing) or unstructured (technique: free association) and the therapist uses a more active or more cautious intervention technique back. “(Scientific Advisory Board for Psychotherapy, 2004) The Scientific Advisory Board (therefore) proposes a uniform training, which then also includes treatments with a duration of more than 100 hours in a supplement from 2008 , so a training similar to the current one integrated training in analytical and deep psychological psychotherapy corresponds: “For in-depth training as a psychological psychotherapist as well as for further medical training, the recommendation of the Scientific Advisory Board continues to apply that, given the variety of methods and techniques of psychodynamic psychotics herapie may not limit the training or further education in this process to individual methods or techniques. ”(Scientific Advisory Board for Psychotherapy, 2008). Training in psychotherapy based on depth psychology alone would no longer be possible.

Proof of effectiveness

In contrast to cognitive-behavioral psychotherapy methods and psychotherapy based on depth psychology, there has been no empirical evidence of the effectiveness of analytical psychotherapy and, in particular, long-term analytical psychotherapy from randomized controlled studies for many years. Analytical psychotherapy is therefore not included in the current guidelines for the treatment of depression (last update 2017). In the meantime, the Munich psychotherapy study and the results of the LAC depression study provide evidence that specific changes have been made through analytical psychotherapy. Both studies show that analytical psychotherapy has a different long-term effect than cognitive-behavioral and depth psychology-based psychotherapy: In the Munich psychotherapy study, all three methods were very effective in reducing symptoms in recurrent depressive disorders, and stable effects (measured three years after the end of treatment) became but only brought about by analytical psychotherapy.

Further evidence of effectiveness and study results on analytical psychotherapy, including health economic aspects, are compiled in the Open Door Review of the International Psychoanalytic Association .

See also

literature

  • Jürgen Kriz : Basic concepts of psychotherapy. 7th, revised and expanded edition. Beltz Verlag, Weinheim, Basel 2014, Section I Psychodynamic Psychotherapy , pp. 35–121. ISBN 978-3-621-28097-6 .
  • R. Langs: The best therapist for me. A guide to psychoanalytic therapy. Rowohlt, Reinbek near Hamburg 1991.
  • T. Moser : Compass of the soul. A guide for psychotherapy patients. Suhrkamp, ​​Frankfurt am Main 1984.
  • O. Saint-Drome: This is how I find the right psychoanalyst. Heyne, Munich 1989.
  • D. Voss: Psychoanalysis is good for you - a guide for those seeking help. Psychosozial-Verlag, Giessen 2011.

Web links

Individual evidence

  1. ↑ Systemic therapy: Recognition of the benefit and medical necessity as a psychotherapy method - Federal Joint Committee. Retrieved October 27, 2019 .
  2. ↑ U. Rüger, A. Dahm, D. Kallinke: Faber / Haarstrick - Commentary on psychotherapy guidelines. 9th edition. Urban & Fischer, Munich 2011.
  3. ↑ C. Reimer, U. Krüger: Psychodynamische Psychotherapien. Textbook of psychotherapy methods based on depth psychology. Springer, Berlin 2006.
  4. ↑ W. Mertens: Introduction to psychoanalytic therapy. 3. Edition. Kohlhammer, Stuttgart 2000, chap. 4. therapie.de
  5. ↑ H. Thomä, H. Kächele: Psychoanalytic Therapy. Volume 1: Basics. 3. Edition. Springer, Heidelberg 2006, p. 38.
  6. ↑ R. Hohage: Analytically oriented psychotherapy in practice. 5th edition. Schattauer, Stuttgart 2011, p. 5.
  7. ↑ G. Rudolf: Psychodynamische Psychotherapie. Working on conflict, structure and trauma. Schattauer, Stuttgart 2010, ISBN 978-3-7945-2784-7 .
  8. ^ Opinion on psychodynamic psychotherapy in adults. ( Memento from October 13, 2011 in the Internet Archive )
  9. ^ Supplement to the statement on psychodynamic psychotherapy dated June 30, 2008 ( Memento dated December 13, 2013 in the Internet Archive )
  10. ↑ Unipolar Depression - ÄZQ. Retrieved March 3, 2019 .
  11. ↑ Dorothea Huber, Günther Klug: Munich Psychotherapy Study . In: Psychotherapist . tape 61 , no. 6 , October 20, 2016, ISSN  0935-6185 , p. 462-467 , doi : 10.1007 / s00278-016-0139-7 .
  12. ^ Marianne Leuzinger-Bohleber, Martin Hautzinger, Georg Fiedler, Wolfram Keller, Ulrich Bahrke: Outcome of Psychoanalytic and Cognitive-Behavioral Long-Term Therapy with Chronically Depressed Patients: A Controlled Trial with Preferential and Randomized Allocation . In: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie . tape 64 , no. 1 , January 2019, ISSN  1497-0015 , p. 47-58 , doi : 10.1177 / 0706743718780340 , PMID 30384775 , PMC 6364135 (free full text).
  13. ↑ Open Door Review of Outcome and Process Studies in Psychoanalysis (ODR-III) ( English ) International Psychoanalytical Association. Retrieved April 17, 2019.