Depth-psychologically based and analytic psychotherapy (German statutory forms)

1. Introduction

Version followed: the G-BA Psychotherapie-Richtlinie (PT-RL) as amended 19 March 2026, in force 17 June 2026. All contingent figures below are 2026 figures from that text. TP technique follows Wöller & Kruse (eds.), Tiefenpsychologisch fundierte Psychotherapie. Basisbuch und Praxisleitfaden, 5th ed. 2018, plus Rudolf 2019 (Psychodynamisch denken – tiefenpsychologisch handeln). AP technique follows Freud's technique papers (1912–1915) and the standard German AP textbook tradition (Ermann; Rudolf). The Ermann text is not drawn on, so AP-specific detail is marked [uncertain] where it rests on it.

What it is. TP and AP are two separate statutory treatment forms (Richtlinienverfahren) under the umbrella of "psychoanalytically based procedures" (§ 16 PT-RL). Each has its own definition, contingent, application route and technique. Neither is a single manual. Each is defined at procedure level in social-law terms and operationalised in textbooks, so this guide combines the RL framework with textbook technique. [source: PT-RL 2026 §§ 16, 16a, 16b; Wöller & Kruse 2018 ch. 2]

• TP treats the unconscious dynamics of current neurotic conflicts and structural disorders, attending to transference, countertransference and resistance. It concentrates the process through limited goals, a mainly conflict-centred approach and limitation of regressive processes (§ 16a). Special forms are short-term therapy, focal therapy, dynamic psychotherapy and low-frequency, holding long-term therapy (§ 16a(3)).
• AP treats the neurotic conflict material and the underlying neurotic structure. Through transference, countertransference and resistance analysis it sets therapeutic processes in motion using and promoting regressive processes (§ 16b).

How change happens.

• TP: a focal, currently active conflict (or a structural limitation) is made experienceable, understood and reworked in a face-to-face, time-limited relationship. Regression is kept in check. Change comes from insight into the conflict pattern, a new relationship experience with the therapist, and strengthened ego functions, so that symptoms drop and current relationships change. [source: Wöller & Kruse 2018 ch. 2 (excerpt); Rudolf 2019 ch. 1]
• AP: the setting (couch, high frequency, free association, abstinence) lets the infantile conflict re-emerge in a regressive transference neurosis. Interpreting it and working it through over a long period aims at change in personality structure as well as symptoms. [source: PT-RL § 16b; Freud 1912/1913/1914; Wöller & Kruse 2018 ch. 2]

2. Framework

2.1 Statutory pathway common to both forms (2026 figures)

[source: PT-RL 2026 §§ 11–14, 22–23, 28–30, 34–35; KVBW FAQ 2025; TK FAQ 2026]

• Session length: 50 min (double session 100 min); group units are 50 min, usually held as 100-min double units (§ 28). § 28(5) allows 25-min units for some TP forms; check the exact scope in the RL text [uncertain].
• Individual + group: these may be combined within one procedure under a Gesamtbehandlungsplan set before treatment begins (§ 22). TP and AP may not be combined with VT or ST (§ 19).
• Exceeding a step: only if the goal has not been reached and continued treatment has a justified prospect of success (§ 30).
• Gutachterverfahren: still in force in 2026 for LZT (individual or mainly individual). For continuation applications the insurer decides whether to involve a Gutachter. A data-based QS procedure has been on trial in North Rhine-Westphalia since 2025 and is planned to replace the Gutachterverfahren after a multi-year evaluation; no national date has been set. [source: PT-RL § 35; Ärzteblatt 19.01.2024]
• Übende/suggestive techniques: the RL text restricts combining these with TP/AP (§§ 16(1), 26(1) as summarised to me). Wöller & Kruse describe TP as able to integrate cognitive, educational and suggestive elements. Check the current RL wording before adding hypnosis or autogenic training [uncertain].

2.2 Version A: tiefenpsychologisch fundierte Psychotherapie (TP)

Format: sitting face to face, 50 min, usually once a week. The frequency is reduced towards the end, or kept low throughout in holding long-term TP. Contingent: KZT 12+12, then LZT 60 → 100. [source: Rudolf 2019 ch. 1 ("meist mit einer Wochenstunde"); PT-RL § 30]

The phase structure follows Wöller & Kruse 2018 parts II–IV and IX, and Rudolf 2019 ch. 3.9 (opening, working-through, ending phase). Session ranges are [synthesis].

Variants inside TP (§ 16a(3)):

• Short / focal therapy: 12–24 h with strict focus discipline.
• Dynamic psychotherapy: a conflict-centred LZT of up to 100 h.
• Low-frequency long-term therapy in a holding relationship, for example every 2–4 weeks.
• Structure-related TP (Rudolf) for low structural integration, with a supportive and ego-building emphasis (Wöller & Kruse part V).

2.3 Version B: analytische Psychotherapie (AP)

Format: the classical arrangement is the couch, with the patient lying and the therapist sitting out of view behind. Typically 2–3 sessions/week of 50 min; the RL caps frequency at 3/week (§ 23). Contingent: 160 → 300 h, which at 2–3/week is roughly 1.5–3 years for the first step. [source: Rudolf 2019 ch. 1 ("2–3 Wochenstunden"); Wöller & Kruse 2018 ch. 2 (classical setting: lying, high frequency); PT-RL §§ 23, 30] The RL does not itself prescribe the couch; it prescribes the use of regression (§ 16b). [uncertain: a sitting AP at 2/week is practised; the requirements are those of § 16b, not the furniture]

3. Guiding principles

3.1 Shared by TP and AP

[source: PT-RL §§ 16–16b; Wöller & Kruse 2018 ch. 2, 5; Freud 1912–1915]

• Unconscious determination: symptoms are compromise formations or attempts at regulation. Practice: ask "what does this symptom solve or protect?", not only "how do we remove it?".
• Attention to transference, countertransference and resistance: these are required by the RL in both forms. Practice: track in every session how the patient treats you and how you feel.
• Neutrality: you do not side with any part of the conflict. Practice: don't advise for or against a wish; explore both sides.
• Abstinence: you do not gratify the patient's transference wishes and keep your own needs out of the relationship. Practice: no private contact, no self-serving disclosure, no gifts or favours beyond the frame.
• Working alliance: analysis works only on the basis of a cooperative bond with the observing part of the patient. Practice: repair the alliance before deepening the conflict work.
• From surface to depth: work from what is near consciousness, and take defence before content. Practice: interpret what the patient avoids before what is avoided.
• Affect as guide: the most affect-laden material is the most relevant. Practice: follow emotional intensity, not narrative completeness.
• Frame constancy: time, place, fee, frequency and holidays are therapeutic instruments. Practice: keep the frame consistently and treat deviations as material.
• Psychodynamic diagnosis as ongoing hypothesis (adaptive diagnosis): Practice: revise your focus or formulation when new material contradicts it (Wöller & Kruse ch. 6).

3.2 TP-specific

[source: PT-RL § 16a; Wöller & Kruse 2018 ch. 2, 9, 22, part V; Rudolf 2019; Lachauer 2004 via Hintenberger 2009]

• Focus and limited goals: Practice: hold a written focus sentence and steer back to it; don't open every topic.
• Conflict-centred, current conflict: the actualised conflict in present relationships and the triggering situation is the material, not a full reconstruction of childhood. Practice: ask "what happened right before the symptom got worse?", then link it to the pattern.
• Here-and-now orientation: current relationships, and where useful the therapeutic relationship, are worked on in the present tense. Practice: use childhood links sparingly, to explain the present.
• Regression limitation: face to face, low frequency, an active and structuring therapist, a focus on adult functioning. Practice: when the patient slides into helpless, childlike states, re-engage their observing adult self.
• Active, dialogic therapist: more active than in AP, including clarifying questions, structuring and summaries. Practice: you may speak first, summarise, and name the focus.
• Transference: analyse or limit: transference is recognised and used selectively; the regressive transference neurosis is not cultivated (Wöller & Kruse ch. 22). Practice: address transference when it blocks the work or illustrates the focus; otherwise work extra-transferentially.
• Adapt to structure level: low structure calls for structure-related, supportive and ego-building work rather than conflict interpretation (part V; Rudolf). Practice: assess integration first and choose the mode accordingly.
• Positive relationship experience is itself an agent of change (Wöller & Kruse ch. 18). Practice: be reliably interested, respectful and attuned, without gratifying the transference.
• Resource orientation: Practice: actively ask about competencies and use them (ch. 16).
• Perspective plurality and adaptivity: drive, ego, object-relations, self and attachment perspectives are used flexibly (ch. 5). Practice: pick the lens that makes this patient's material workable.
• TP as its own procedure: Rudolf stresses that the TP therapist is not a "Kurzzeit-Psychoanalytiker". Practice: don't run a diluted analysis; run a focused, active treatment.
• Triadic positioning (structure-related work): treat the disorder as "etwas Drittes" that you and the patient look at together, from behind, opposite or beside the patient (Rudolf 2019, foreword by Hauten). Practice: frame difficulties as a shared object of study.

3.3 AP-specific

[source: PT-RL § 16b; Freud 1912, 1913, 1914, 1915; Wöller & Kruse 2018 ch. 2; Ermann, uncertain]

• Using regression: setting and technique are designed to let earlier modes of experience emerge. Practice: couch, high frequency, few structuring interventions, and silence that you tolerate.
• Basic rule (free association): the patient says whatever comes to mind without selecting. Practice: introduce it once, then interpret departures from it as resistance rather than rule-breaking.
• Evenly suspended attention: you listen without selecting or focusing (Freud 1912). Practice: no focus formulation steers your listening; you let patterns emerge.
• Strict abstinence and technical neutrality: stricter than in TP. Practice: you answer questions about yourself rarely; you explore the question.
• Development and resolution of the transference neurosis: the central conflict is relived in the analytic relationship. Practice: transference interpretation is the main vehicle.
• Resistance analysis before content: Practice: interpret how and why the patient avoids before what they avoid.
• Reconstruction: linking present transference to childhood experience is part of the work, not optional. Practice: genetic interpretations once the transference is lived and affect is present.
• Working through takes time: a single insight changes little; repetition in new contexts does (Freud 1914). Practice: expect to interpret the same conflict many times.
• Countertransference as instrument: Practice: use your own reactions as data, and seek supervision or self-analysis when they become driving.
• Setting holds regression: frequency and constancy carry the patient between sessions. Practice: announce breaks early and interpret reactions to them.

4. Intervention inventory

Each intervention is marked [TP], [AP] or [TP+AP], with the difference stated where the technique is shared. Chapter numbers refer to Wöller & Kruse 2018. Only the table of contents and ch. 1–2 of that book are drawn on, so the step-by-step operationalisations below are standard psychodynamic technique as taught in German training, aligned to those chapter headings. They are marked [synthesis] where they go beyond what is verified. All example language is my illustrative wording, not quoted from the sources.

A. Assessment, indication and framing

4.1 Psychodynamic first interview with scenic understanding [TP+AP]

• Purpose / when: Sprechstunde and probatory sessions. Gathers three kinds of information: objective (facts, history), subjective (the patient's own meaning) and scenic (how the patient stages the relationship with you in the room). [source: Argelander 1970, from knowledge, uncertain]
• Steps:
  1. Open minimally ("What brings you?") and let the patient structure the opening.
  2. Note how they arrive, sit, begin, and what they make you feel or do.
  3. Explore the current symptom, its onset and the triggering situation (Auslösesituation).
  4. Ask for concrete relational episodes.
  5. Take a biographical history focused on key relationships.
  6. Offer one or two tentative links (trial interpretation) and observe the response: affect, new associations, defensiveness.
  7. Feed back your understanding in plain language. Rudolf treats feedback as part of diagnosis.
• Example language (illustrative): "You began by telling me what others think is wrong with you. I wonder what you think." / "The panic started the week after your promotion. Does that connection mean anything to you?"
• Watch for: the scene often anticipates the transference. A response to a trial interpretation that deepens affect or brings new memories supports insight-oriented work (TP or AP). Concretism or flight supports a structure-related or supportive mode. [source: Rudolf 2019 ch. 2 (diagnosis as interpersonal process, feedback); synthesis]

4.2 OPD-based formulation: conflict, structure, relationship [TP+AP]

• Purpose / when: probatorik, the application, and later refocusing. OPD-3 axes: I illness experience and treatment prerequisites; II relationship; III conflict; IV structure; V ICD. [source: Rudolf 2019 ch. 2 (OPD conflicts, structural level); Arbeitskreis OPD 2023]
• Steps:
  1. Identify the leading conflict, choosing among the OPD conflict themes such as dependence vs autonomy, submission vs control, need for care vs autarky, self-worth, guilt, oedipal and identity conflicts. Name its mode (active or passive).
  2. Rate structural integration: good, moderate, low or disintegrated.
  3. Describe the dysfunctional relationship pattern from both sides: how the patient experiences others and themselves, and how others (including you) experience the patient.
  4. Derive the indication: good or moderate structure with a clear conflict points to conflict-centred TP or AP; low structure points to structure-related TP.
• Watch for: don't force a conflict diagnosis when the problem is structural. Use the countertransference to check the relationship axis.

4.3 Indication decision: TP vs AP (and KZT vs LZT) [TP+AP]

• Purpose / when: end of probatorik. [source: PT-RL §§ 16a, 16b; Wöller & Kruse 2018 ch. 2; synthesis]
• Steps / criteria [synthesis from the RL definitions]:
  • TP: a circumscribed, current conflict or a definable focus; limited goal (symptom or behaviour change); regression risky (low structure, crisis); life circumstances or motivation fit weekly sessions.
  • AP: a pervasive neurotic character structure behind the symptoms; repeated relapses after focal treatment; capacity to use regression and to tolerate frustration; motivation and practical capacity for 2–3 sessions/week over years.
  • KZT first: acute, focal problems, or when you are unsure whether LZT is needed. KZT can later be converted with a Gutachten.
• Example language (illustrative): "I'd suggest weekly sessions sitting face to face, centred on the question of why you lose yourself in close relationships. An alternative is a longer, more intensive analysis on the couch. Let me explain the difference."
• Watch for: match the indication to the patient's need, not to your own training; mixing the two forms is not permitted within one application.

4.4 Focus formulation [TP; not used in AP]

• Purpose / when: end of probatorik in KZT, focal and dynamic TP; it orients the whole course. [source: Lachauer 2004 via Hintenberger 2009; Götze et al. 2003; PT-RL § 16a(2)]
• Steps:
  1. Name the patient's main current problem in their own experiential language.
  2. Add a hypothesis about its unconscious background: the wish, fear or conflict it protects against.
  3. Join the two halves with "weil" in the first person: "Ich ..., weil ...". Lachauer describes the focus as a link between a current main problem and a statement about its unconscious background.
  4. Check it against the countertransference and the scene.
  5. Decide whether to share it with the patient or hold it internally (both are described).
  6. Use it to select material and steer back.
  7. Revise it when new material contradicts it; Lachauer frames it as orientation for the next steps, not the whole path.
• Example language: focus (illustrative): "I keep taking on more work until I collapse, because saying no would make me feel I'd lose others' approval, which I count on to feel worth anything." In session (illustrative): "We've come back to it: you said yes again when you wanted to say no. That's our theme."
• Watch for: a focus that explains everything is too broad. A study of focal therapy found that therapists who referred to the focus more often and formulated it in more complex, interpersonal terms had better outcomes (Götze et al. 2003).

4.5 Treatment contract and frame setting [TP+AP]

• Purpose / when: before the first therapy session (Wöller & Kruse ch. 8: preparing therapy). Sets the frequency, session length, setting (sitting or couch), contingent and its limits, missed-session rule, holidays, contact between sessions and confidentiality. [source: Wöller & Kruse 2018 ch. 8 (heading); Freud 1913; synthesis]
• Steps:
  1. State the procedure and the expected duration ("up to 60 sessions, which we may extend to 100" / "160 sessions at 2–3 per week, extendable to 300").
  2. Explain how sessions work: in TP, "bring what concerns you, and we'll relate it to our focus"; in AP, the basic rule.
  3. Agree on missed-session and holiday rules in writing.
  4. Explain the Gutachten or application process and that reports are pseudonymised.
• Example language (illustrative, AP): "We'll meet three times a week at fixed times. You'll lie on the couch and I'll sit behind you. The one request is that you try to say everything that comes to mind, even if it seems irrelevant, embarrassing or unpleasant."
• Watch for: early attacks on the frame (lateness, renegotiation) are the first transference material. Note them rather than rebuke.

4.6 Application report (Bericht an den Gutachter) [TP+AP]

• Purpose / when: first LZT step, KZT conversion, and continuation if the insurer requests it. It forces a coherent psychodynamic formulation. [source: Rudolf 2019 ch. 5; Wöller & Kruse ch. 7; PT-RL §§ 34–35]
• Steps: use the current form sheet (PTV 3 guidance) for structure [uncertain].
  1. Symptoms and triggering situation.
  2. Relevant biography.
  3. Psychodynamics: conflict and/or structure, and why the symptoms appear now.
  4. Diagnosis.
  5. Treatment plan with goals, focus (TP) or regressive process (AP), setting and frequency.
  6. Prognosis.
• Watch for: the TP report must argue for focus and regression limitation, and the AP report for the need for, and the capacity to use, regression. A report that reads as interchangeable between TP and AP is a warning sign. [synthesis]

B. Core conflict work (TP throughout; also AP)

4.7 Building a working alliance [TP+AP]

• Purpose / when: from the first contact; repair whenever needed (ch. 10). [source: Wöller & Kruse ch. 10 (heading); synthesis]
• Steps:
  1. Agree on the goals and the way of working.
  2. Address the observing adult part of the patient explicitly.
  3. Acknowledge suffering before exploring its meaning.
  4. Check in on how the work feels.
  5. Name misunderstandings promptly.
• Example language (illustrative): "Let's look at this together, as two people trying to understand something puzzling." / "How was it for you when I pointed that out last time?"
• Working sign: the patient brings material spontaneously and refers back to previous sessions.

4.8 Letting the relevant problem unfold (problem exposition) [TP]

• Purpose / when: initial phase (ch. 11). Gets the focal conflict into concrete, affect-laden episodes rather than general complaints.
• Steps:
  1. Ask for specific recent episodes: who, what, when, what you felt, what you did, what the other did.
  2. Slow down at moments of affect.
  3. Collect several episodes and look for the common pattern.
  4. Link them to the trigger situation of the symptom.
• Example language (illustrative): "Can you take me through Tuesday evening, step by step?" / "Right there, when he didn't answer, what happened inside you?"
• Watch for: generalising ("it's always like that") is a defence; gently return to the concrete.

4.9 Accepting and clarifying affects [TP+AP]

• Purpose / when: throughout, central in the initial phase (ch. 12). Turns diffuse states into nameable feelings and is a precondition of interpretation.
• Steps:
  1. Notice non-verbal affect.
  2. Name it tentatively.
  3. Validate that it makes sense.
  4. Differentiate it (anger vs hurt vs shame).
  5. Explore what the feeling wants or fears.
• Example language (illustrative): "You're smiling, but your voice sounds sad." / "Is it more anger, or more that it hurt?"
• Watch for: in low-structure patients, naming affect can overwhelm. Dose it and switch to stabilisation (4.26). Working sign: the patient starts naming feelings without prompting.

4.10 Clarification [TP+AP]

• Purpose / when: the first step on the clarification–confrontation–interpretation continuum (ch. 17: from clarification to interpretation). Makes vague or contradictory material precise without adding your own hypotheses. [source: Wöller & Kruse ch. 17 (heading); Kernberg's triad, from knowledge, uncertain]
• Steps: ask about unclear words, gaps and missing affect; reflect back what you understood and invite correction.
• Example language (illustrative): "When you say 'it was fine', what do you mean exactly?" / "Let me check I understand: you were relieved and furious?"
• Watch for: clarifying can become endless questioning. Move on once the picture is clear.

4.11 Confrontation [TP+AP; more frequent and active in TP]

• Purpose / when: draws attention to contradictions, avoided topics, or discrepancies between words and behaviour that are near consciousness but not reflected on. Wöller & Kruse note that short and focal approaches use an active, confronting-interpretive style.
• Steps:
  1. Set the two observations side by side.
  2. Name them neutrally and without accusation.
  3. Invite curiosity about the gap.
  4. Wait.
• Example language (illustrative): "You say it doesn't matter that she left, and you've spoken of nothing else for twenty minutes."
• Watch for: confrontation without an alliance is experienced as attack. If the patient feels criticised, switch to repair (5.5).

4.12 Interpretation (Deutung) [TP+AP; in TP mostly conflict and focus interpretations in the here-and-now]

• Purpose / when: makes an unconscious connection conscious: the link between a feeling, a defence and a feared or wished-for consequence, and between current, past and therapeutic relationships. Use it after clarification and confrontation have prepared the ground and affect is present (ch. 17). [source: Wöller & Kruse ch. 17 (heading), ch. 2; Malan 1979, uncertain]
• Steps:
  1. Formulate the hypothesis internally in three parts: what the patient does or avoids (defence), what they would otherwise feel or wish (impulse), and what they fear would happen (anxiety).
  2. Offer it tentatively, starting with the defence and its function.
  3. Link it to the focus.
  4. Where useful, link current others, you, and early figures (in TP mostly current-life links; in AP the genetic link too).
  5. Watch the response, not the agreement.
• Example language (illustrative, TP): "I think when your boss praises a colleague, you get busy and helpful, perhaps so you don't feel how hurt and angry you are, because showing that might make you the difficult one nobody wants."
• Watch for: working signs are new associations, affect, memories, or later spontaneous use of the idea by the patient. Polite agreement, intellectualising, or a sudden topic change mean the interpretation was premature, too deep or wrong. Go back to clarification.

4.13 Working on conflictual object relations and repetitive patterns [TP+AP]

• Purpose / when: initial and middle phases (ch. 13). Identifies the recurring relational script: what the patient wishes from the other, how they expect the other to respond, and how they then react. [source: Wöller & Kruse ch. 13 (heading); OPD axis II; synthesis]
• Steps:
  1. Collect 3–5 episodes (4.8).
  2. Extract the common wish, the expected response and the self-response.
  3. Show the pattern to the patient.
  4. Find it in the therapeutic relationship.
  5. Explore what keeps it going (self-fulfilling expectations).
• Example language (illustrative): "With your partner, your sister and your manager it's the same: you hope to be seen, you expect to be overlooked, and so you withdraw first, which makes being overlooked more likely."
• Working sign: the patient catches the pattern in real time between sessions.

4.14 Reframing maladaptive patterns as once adaptive [TP]

• Purpose / when: ch. 14, "maladaptive patterns were once adaptive". Reduces shame and resistance by honouring the original protective function before change is asked.
• Steps:
  1. Explore when and where the pattern began.
  2. Name what it protected the patient from then.
  3. Acknowledge its value.
  4. Contrast the then-context with the now-context.
  5. Ask what it costs today.
• Example language (illustrative): "Becoming invisible was a clever solution in a house where any need made your father explode. The question is whether you still live in that house."
• Watch for: stay out of blame of parents; the aim is understanding, not indictment. [synthesis]

4.15 Working with negative beliefs and internalised object relations [TP+AP]

• Purpose / when: ch. 15. Addresses harsh internal voices or convictions ("I am too much") as internalised relationships between a self part and an object part.
• Steps:
  1. Notice self-condemning statements.
  2. Ask whose voice or attitude it resembles.
  3. Explore the internal dialogue, including both roles.
  4. Examine whether the patient now treats others or themselves the same way.
  5. Question its present validity.
• Example language (illustrative): "When you call yourself pathetic, whose tone is that?"
• Watch for: in TP keep this linked to the focus. The belief easily becomes enacted in the transference, for example when the patient expects you to judge them. [synthesis]

4.16 Using and strengthening resources [TP; AP only implicitly]

• Purpose / when: ch. 16. Throughout; especially for depressed, traumatised or low-structure patients, and in crises.
• Steps:
  1. Ask about competencies, good relationships, past coping and pleasurable activities.
  2. Mirror the strengths you observe.
  3. Link resources to the current problem.
  4. Encourage their use between sessions.
• Example language (illustrative): "You held your family together through your mother's illness. What did you draw on then?"
• Watch for: a patient who devalues every resource may be defending against hope or against disappointing you. Interpret that rather than insisting. [synthesis]

C. Relationship, defence, resistance, transference

4.17 Providing a positive relationship experience [TP; implicit in AP]

• Purpose / when: ch. 18. The therapist responds differently from the patient's expected (feared) object. This gives a new experience that disconfirms the pattern, without gratifying the transference. [source: Wöller & Kruse ch. 18 (heading); synthesis]
• Steps:
  1. Identify what the patient expects from you (criticism, exploitation, indifference).
  2. Reliably not confirm it: keep time, remember details, stay calm under provocation, take their perspective seriously.
  3. When the difference becomes noticeable, make it explicit and explore it.
• Example language (illustrative): "You expected me to be annoyed that you cancelled. I'm not, and I'm curious what it's like to see that."
• Watch for: confusing it with gratification (extra sessions, reassurance on demand, friendship). That inflames regression and dependency.

4.18 Defence work: loosening defences [TP+AP]

• Purpose / when: middle phase (ch. 19). Makes the patient aware that and how they defend before addressing what is defended against. [source: Wöller & Kruse ch. 19 (heading); Freud 1914 resistance-first logic; synthesis]
• Steps:
  1. Observe a recurring defence: intellectualising, minimising, changing topic, joking, turning passive into active, projection.
  2. Name the observable behaviour.
  3. Explore its function ("what might happen if you didn't...?").
  4. Acknowledge its protective value.
  5. Only then approach the warded-off affect or wish.
• Example language (illustrative): "Each time you get close to how lonely that was, you make a joke, and we both laugh. Perhaps the joke protects us from something."
• Watch for: with mature defences go step by step. With primitive defences (splitting, projective identification) in low-structure patients, prioritise structure-related work over loosening.

4.19 Resistance work: resistance as relationship regulation [TP+AP]

• Purpose / when: whenever the work stalls through lateness, silence, forgetting, compliance or arguing (ch. 20). Wöller & Kruse frame resistance as regulating the therapeutic relationship: it protects against feared closeness, dependence, shame or loss of autonomy. [source: Wöller & Kruse ch. 20 (heading); Freud 1912–1914]
• Steps:
  1. Treat the resistance as information, not opposition.
  2. Name it neutrally.
  3. Ask what it protects in the relationship with you.
  4. Link it to the focal conflict.
  5. In AP, interpret it systematically as a transference resistance.
• Example language (illustrative): "We've had three sessions where you said there was nothing to talk about, right after you told me about your father. Perhaps getting closer to that, here with me, feels risky."
• Watch for: pushing harder escalates it. A working sign is that the patient can talk about the resistance itself.

4.20 Recognising transference and addressing it in the here-and-now [TP+AP]

• Purpose / when: ch. 21. Recognise when the patient experiences you through the template of earlier relationships. Address it when it blocks the work, when it vividly illustrates the focus, or when negative transference threatens the alliance. [source: Wöller & Kruse ch. 21 (heading), ch. 2; PT-RL §§ 16a, 16b]
• Steps:
  1. Collect cues: allusions to you in stories about others, reactions to breaks or fees, idealisation or devaluation, your own countertransference.
  2. Choose the moment, usually when affect is present and the alliance holds.
  3. Make the allusion explicit ("I wonder if this also applies to us").
  4. Explore the patient's experience of you before interpreting.
  5. In TP, link it back to current outside relationships and the focus. In AP, also link it to the past.
• Example language (illustrative): "You've been telling me about teachers who never noticed your effort. I wonder whether you feel I don't notice how hard you're working here."
• Watch for: forced transference interpretations feel artificial. If the patient cannot relate to them, return to extra-transferential work.

4.21 Limiting transference regression [TP]

• Purpose / when: ch. 22 (analyse or limit transference?). This is the technical expression of the RL requirement to limit regression (§ 16a(2)). Use it when intense idealising, erotic, dependent or hostile transferences start to replace the work on the focus. [source: PT-RL § 16a; Wöller & Kruse ch. 2, 22]
• Steps:
  1. Keep the setting face to face and weekly or less; avoid extra contacts.
  2. Address the real, adult working relationship and the shared task.
  3. Name the transference but turn it towards current outside relationships.
  4. Become more structuring: summarise, set the agenda against the focus, refer to goals and the remaining contingent.
  5. Make your own reality visible where useful (a limited, task-relevant answer).
• Example language (illustrative): "It sounds as if part of you would like me to take over decisions for you. That's understandable. Let's look at where else in your life that wish shows up, and at what you'd decide yourself here."
• Watch for: limiting is not ignoring. Unaddressed negative transference ends therapies. Working sign: affect stays workable and the focus remains central.

4.22 Using countertransference [TP+AP]

• Purpose / when: ch. 23 ("I feel paralysed in the session"). Your feelings, impulses and fantasies are data about the patient's inner world and relational pattern (concordant or complementary). [source: Wöller & Kruse ch. 23 (heading); PT-RL §§ 16a, 16b]
• Steps:
  1. Notice unusual states: boredom, sleepiness, irritation, rescue impulses, paralysis, sexual feelings.
  2. Separate your own issues from those induced by the patient (supervision, self-reflection).
  3. Ask what role the patient might be putting you in.
  4. Use it to formulate an interpretation or a clarifying question. Disclose the feeling only selectively and in processed form.
• Example language (illustrative): "As you tell me this, I notice it's hard for me to stay with you. I wonder if that's how others have reacted, and how you've learned to tell things so as not to be really heard."
• Watch for: acting countertransference out (rescuing, punishing, extending sessions). Strong, repetitive countertransference calls for supervision.

4.23 Development, attunement and regulation work [TP]

• Purpose / when: ch. 24 (development, attunement, regulation). For patients whose problems lie more in early regulation and attunement deficits than in conflict.
• Steps:
  1. Attune to the patient's affective state (tone, tempo).
  2. Help them regulate affect in session by slowing down, naming body signals and taking breaks.
  3. Explicitly support self-soothing and reflecting capacities.
• Example language (illustrative): "Let's slow down a bit. What do you notice in your body right now?"
• [uncertain: only the chapter heading is drawn on. The operationalisation is synthesis consistent with Wöller & Kruse's structure-related approach.]

4.24 Working through (Durcharbeiten) [TP+AP; central in AP]

• Purpose / when: middle and late phases (ch. 25, "laborious relearning"). Insight becomes change only through repeated recognition of the same conflict in new situations and in the transference (Freud 1914). [source: Freud 1914; Wöller & Kruse ch. 25 (heading)]
• Steps:
  1. Each time the pattern reappears (new episodes, the transference, dreams), name it again, adding a new facet.
  2. Explore the resistances against giving it up, including the secondary gains and the grief for the old solution.
  3. Support experiments with new behaviour.
  4. Review what has changed.
• Example language (illustrative): "It's the old fear again, now with your new partner. What's different from how you handled it in spring?"
• Watch for: frustration on both sides ("we've been here before"). Repetition is the process, not a failure. Stagnation without new facets is different and calls for 5.1.

4.25 Dream work [TP: focus-related; AP: full associative work]

• Purpose / when: whenever the patient brings a dream. [source: Freud 1900 (dream interpretation), from knowledge; Wöller & Kruse 2018 ch. 26 ("what else happens"), uncertain]
• Steps (TP):
  1. Ask the patient to tell the dream and to say how it felt.
  2. Focus on the affect and the relational scene in the dream and its link to the current conflict and the focus.
  3. Use day residues.
  4. Avoid extensive symbolic decoding.
• Steps (AP):
  1. Listen to the whole dream and the way it is told.
  2. Invite associations to individual elements.
  3. Note day residues and transference references (does the dream relate to you or the setting?).
  4. Interpret the latent wish or conflict and the defence (distortion), often together with the current transference.
• Example language (illustrative): TP: "In the dream you were locked out while everyone celebrated. How does that feeling connect to what we've been working on?" AP: "What comes to mind about the locked door?"
• Watch for: in TP, deep symbol work can foster regression; keep it near the focus.

D. Structure-related, stabilising and supportive work (TP; adapted for AP)

4.26 Stabilising [TP]

• Purpose / when: ch. 28. Patients with structural disorders, trauma sequelae or acute destabilisation; before or instead of conflict work. [source: Wöller & Kruse part V headings; Reddemann is a contributor (imaginative stabilisation), uncertain]
• Steps:
  1. Prioritise safety and daily functioning.
  2. Agree on a skills and crisis plan.
  3. Use stabilising techniques that fit TP (affect labelling, grounding attention in the present, distancing from intrusive material, imaginative safe-place exercises in Reddemann's tradition).
  4. Postpone trauma or conflict exposure.
• Example language (illustrative): "Before we go into what happened, let's make sure you have ways to bring yourself back to the here and now when it gets too much."
• Watch for: RL limits on combining TP with übende/suggestive techniques (2.1) [uncertain]. A working sign is that the patient can leave sessions regulated.

4.27 Building ego functions (auxiliary-ego work) [TP]

• Purpose / when: ch. 29; Rudolf's structure-related psychotherapy. Strengthens self-perception, self-regulation, perception of others, communication and attachment capacities where they are deficient. [source: Wöller & Kruse ch. 29 (heading); Rudolf 2019 ch. 4 (headings: promoting structural capacities, interventions); Rudolf 2013]
• Steps:
  1. Identify the deficient function from the OPD structure axis.
  2. Take over a missing function temporarily and visibly: you name affects, anticipate consequences, take the other's perspective, or set limits.
  3. Invite the patient to do it with you, then alone.
  4. Position yourself next to the patient, looking at the problem as "etwas Drittes" (Rudolf).
• Example language (illustrative): "Let's look at it together: what might your colleague have been feeling when she said that?" / "If you sent that message now, what might happen tomorrow?"
• Watch for: classic interpretation of unconscious conflict in these patients is often experienced as attack or confusion. Use an answering stance: make your own reaction available (in the tradition of Heigl-Evers' "Prinzip Antwort"). [uncertain: the psychoanalytic-interactional method is related but not identical]

4.28 Supportive interventions [TP]

• Purpose / when: ch. 30. Ego weakness, crisis, low motivation for insight, chronic illness; also as phases within insight-oriented therapy. [source: Wöller & Kruse ch. 2 (indication for supportive work), ch. 30 (heading)]
• Steps:
  1. Offer a holding relationship.
  2. Reassure, advise, encourage, educate (psychoeducation on symptoms) and actively problem-solve where needed.
  3. Lower the frequency for long-term holding TP.
  4. Set limited goals.
• Example language (illustrative): "It makes sense to contact the GP about your sleep this week. Let's think together about what you'll say."
• Watch for: supportive is not non-dynamic. Keep tracking transference and countertransference and the focus. Document why insight-oriented work is not indicated (Gutachter perspective). [synthesis]

4.29 Patient-group-specific stances [TP]

[source: Wöller & Kruse ch. 31–34 (headings only); operationalisation is synthesis]

• Helpless-dependent ("You're the expert"): acknowledge the wish to be guided. Return responsibility in small, achievable steps and interpret the fear of autonomy. (Illustrative) "You'd like me to tell you what to do. What would it mean if you trusted your own judgement here?"
• Reproachful-aggressive ("How could you do this to me!"): stay non-defensive and acknowledge any real lapse. Explore the hurt beneath the reproach, then the pattern.
• Devaluing / idealising: don't accept either position. Explore what idealisation protects against (disappointment) and what devaluation protects against (dependence and envy).
• Denying-projecting ("The others have the problem"): start from the patient's view of others. Explore their own part through their suffering, and confront later and gently.

E. AP-specific technique

[source: PT-RL § 16b; Freud 1912 (recommendations to physicians), 1913 (beginning the treatment), 1914 (remembering, repeating, working through), 1915 (transference love), cited from PEP-Web records, content from knowledge; Wöller & Kruse ch. 2. Ermann's AP chapters are not drawn on (uncertain).]

4.30 Moving to the couch and introducing the basic rule [AP]

• Purpose / when: start of AP proper, usually after sitting probatory sessions. It reduces visual cues and social control, so that free association and regression become possible. Freud recommended the lying position and the basic rule in his 1913 paper.
• Steps:
  1. Explain the rationale briefly.
  2. Give the basic rule once, simply.
  3. Explain that you will sit behind and speak less.
  4. Invite questions and reactions (fear, relief, shame) and treat them as the first material.
  5. Let the patient choose when to lie down if they hesitate; their hesitation is analysable.
• Example language (illustrative): "From now on I'd suggest you lie on the couch. Not seeing me can make it easier to follow your thoughts. Try to say whatever comes to mind, without sorting out what seems unimportant or embarrassing."
• Watch for: strong anxiety on the couch, dissociation or disorganisation are contraindication signs; return to sitting and reconsider TP (5.3).

4.31 Evenly suspended attention and analytic listening [AP; partly TP]

• Purpose / when: throughout AP. Freud (1912) recommended that the analyst give equal attention to everything without selecting, and use their own unconscious as a receiving instrument.
• Steps:
  1. Don't take notes in the session.
  2. Don't steer towards topics.
  3. Register sequences (what follows what), slips, images, silences and your own associations.
  4. Let patterns emerge over sessions before interpreting.
• Example language: mostly silence and minimal prompts. (Illustrative) "Mm." / "What comes to mind about that?"
• Watch for: passivity that leaves the patient alone with unbearable affect is not neutrality. Intervene when anxiety disorganises. In TP, listening is "focused" rather than evenly suspended.

4.32 Abstinence and neutrality as active technique [AP; modified in TP]

• Purpose / when: throughout. Frustrating transference wishes, rather than fulfilling them, lets them become visible and analysable. Freud (1915) argued that transference love should be neither gratified nor suppressed, but analysed.
• Steps:
  1. When the patient seeks reassurance, personal information, advice or love, don't comply and don't reject coldly.
  2. Acknowledge the wish.
  3. Explore its meaning and history.
  4. Interpret its function in the transference.
• Example language (illustrative): "You'd very much like to know whether I have children. Let's see what knowing would give you, and what not knowing stirs up."
• Watch for: abstinence is a stance towards wishes, not withholding of warmth or basic courtesy. Excessive frustration produces malignant regression or dropout (5.3).

4.33 Fostering regression and the transference neurosis [AP only]

• Purpose / when: opening and middle phases. Required by RL § 16b ("regressive Prozesse in Gang setzen und fördern").
• Steps:
  1. Keep a high frequency (2–3/week) and a constant frame.
  2. Make few structuring or supportive interventions.
  3. Tolerate silence.
  4. Interpret resistances against the transference ("I'm just here for treatment") rather than the content.
  5. Monitor the observing ego, so that regression stays in the service of the ego.
• Example language (illustrative): "You've said several times that what you feel here doesn't matter because I'm just your analyst. Perhaps it would be dangerous if it did matter."
• Watch for: malignant regression (acting out, demands, collapse of self-observation; Wöller & Kruse warn of this in high-frequency settings). Respond with 5.3.

4.34 Transference interpretation [AP; selectively in TP]

• Purpose / when: the main instrument in the middle phase of AP. It interprets the patient's here-and-now experience of the analyst as a revival of earlier relationships, at the point of maximal affect. Strachey (1934) argued that such interpretations were the main mutative ones. [source: Strachey 1934 from knowledge, uncertain]
• Steps:
  1. Identify the current transference feeling (anger at a cancelled session, fear of judgement).
  2. Interpret the defence against it.
  3. Interpret the feeling and wish towards you, and the anxiety.
  4. Once accepted, link it to its historical prototype.
  5. Repeat in new forms (working through, 4.24).
• Example language (illustrative): "Since I told you about my holiday, you've been polite and distant. Maybe you're angry that I'm leaving, and it feels safer to show nothing, as you did when your mother was in hospital."
• Watch for: working signs are relief, affect, new memories, or a change in the transference itself. Denial followed by confirming associations also counts as response. A purely intellectual "yes" does not.

4.35 Reconstruction and genetic interpretation [AP; sparingly in TP]

• Purpose / when: once the transference pattern is lived and understood. It links present experience to childhood relationships and fantasies, giving the conflict a history. Freud (1914) describes repeating in action as a substitute for remembering.
• Steps:
  1. Collect transference, dreams and memories that point to a common early scene.
  2. Offer a tentative reconstruction ("it may have been like this for you then").
  3. Revise it with the patient's associations.
  4. Separate then from now.
• Example language (illustrative): "Perhaps as a small boy you learned that your needs exhausted your mother, and so you began to need nothing, as you try to need nothing from me."
• Watch for: reconstruction used to avoid the here-and-now. In TP use it only to explain the focus.

F. Ending and relapse prevention

4.36 Ending phase and Rezidivprophylaxe [TP and AP versions]

• Purpose / when: Wöller & Kruse ch. 44 (the therapy comes to an end); PT-RL § 14 (Rezidivprophylaxe as an integral part of the ending phase: up to 8 h after LZT ≥40 h, 16 h after ≥60 h, within 2 years). [source: as cited; procedural details are synthesis]
• Steps (TP):
  1. Announce the remaining sessions against the contingent at least 10–15 sessions ahead.
  2. Review goals and the focus.
  3. Address termination feelings: loss, disappointment, relief, and repetition of earlier separations.
  4. Name relapse signals and the patient's own coping.
  5. Reduce frequency (fortnightly, then monthly) using the RP hours.
  6. Report the end with or without RP to the insurer, using the relevant billing code (KVBW).
• Steps (AP):
  1. Set the termination date months in advance, ideally jointly.
  2. Expect a re-emergence of old symptoms and transference patterns, and interpret them as part of separating.
  3. Work through mourning of the analyst as transference object and as real person.
  4. Possibly reduce frequency.
  5. Use the RP hours for spaced follow-up.
• Example language (illustrative): "We have twelve sessions left. I notice that since we fixed the date, the old tiredness has come back. Maybe ending stirs up the feeling of being left that we know so well."
• Watch for: abrupt endings, missed final sessions, or sudden new crises are often enactments of the separation conflict. Interpret them rather than simply extending. If extension is clinically justified, apply for it in time (§ 30).

G. Other settings and adjunct methods (pointers only)

4.37 Group TP / group AP [TP+AP]

• Purpose / when: 3–9 patients; double hours of 100 min; may be combined with individual sessions under a Gesamtbehandlungsplan (§§ 21–22). Wöller & Kruse ch. 40 (Mattke) covers TP group technique; that chapter is not drawn on [uncertain].
• Core moves [synthesis from general psychodynamic group technique]: TP groups: the leader is active, works on interpersonal patterns in the group's here-and-now with a focus on current conflicts, and limits regression. AP groups: the leader is more reserved and works with group-as-a-whole processes and transferences.
• Example language (illustrative): "I notice that whenever Ms A talks about anger, the group goes quiet. What's happening between us right now?"

4.38 Adjunct methods described in the TP literature [TP]

• Imaginative methods (Katathym-imaginative Psychotherapie / Katathymes Bilderleben) and trauma-focused methods including EMDR are named in Wöller & Kruse ch. 2. The book also includes chapters on integrating body, art and music therapy (ch. 41–43, Trautmann-Voigt, Voigt and others).
• Under the PT-RL, EMDR is recognised as a method for adult PTSD within a Richtlinienverfahren including TP and AP [from knowledge; RL paragraph not verified in this research, uncertain].
• No steps are given here because these are separate trainings. Apply them only within your qualification, and check the RL's restrictions on übende/suggestive techniques (2.1).

4.39 Boundary violations: historical note, not a technique [TP+AP]

• Historical note: sexual and other boundary violations by analysts are documented in the history of psychoanalysis. One instance is the analyst–patient relationships of early analysts, which Freud's 1915 paper on transference love responded to by insisting the analyst must not respond to the patient's love. [source: Freud 1915, from knowledge]
• Current ethical limits: in Germany, sexual contact with patients is a criminal offence (§ 174c StGB) and a breach of the professional code. Abstinence also covers financial, social and narcissistic exploitation [from knowledge; consult your Berufsordnung]. If you notice erotic countertransference becoming action-guiding, seek supervision immediately.

5. Handling problems

Wöller & Kruse devote part VI (difficult patient groups) and part VII (disorder-specific aspects) to these issues; only the headings are drawn on. Concrete responses below are therefore marked [synthesis] unless a source is named.

5.1 Stuck therapy (stagnation, no movement on the focus)

• TP:
  1. Re-read your focus. Is it still true, or too broad, too deep, or the wrong conflict?
  2. Check whether you are colluding, for example both avoiding the aggressive side.
  3. Check the countertransference (boredom or paralysis: Wöller & Kruse ch. 23).
  4. Name the stagnation openly as shared material: (illustrative) "We seem to be circling. What do you make of that?"
  5. Reformulate the focus with the patient.
  6. Consider whether structure-related work is needed instead of conflict work. [synthesis]
• AP: treat stagnation as a resistance phenomenon, often a stable, unspoken transference (comfortable dependency, secret triumph over the analyst). Interpret the function of not moving; consult or seek supervision. [synthesis; Freud's 1914 working-through framing]
• Contingent pressure: use the approaching end of a Bewilligungsschritt as reality. Discuss openly whether continuation is justified (§ 30) rather than extending automatically. [synthesis]

5.2 Resistance

• Understand it as relationship regulation, not opposition (Wöller & Kruse ch. 20). Name it, explore what it protects, link it to the focus or transference (4.19).
• Intellectualising: return to concrete episodes and affect.
• Compliance: interpret the wish to be a "good patient".
• Silence: in TP, help actively with a question or by naming the silence. In AP, wait longer, then explore what the silence is about. [synthesis]

5.3 Overwhelm and malignant regression

• Signs: flooding affect, dissociation, self-harm increase, collapse of self-observation, escalating demands for contact, acting out between sessions. Wöller & Kruse note the risk of malignant regression in high-frequency settings. [source: Wöller & Kruse ch. 2]
• Response [synthesis]:
  1. Become more structuring and present.
  2. Sit up (from the couch in AP), and focus on today and on adult functioning.
  3. Use stabilisation (4.26) and auxiliary-ego work (4.27).
  4. Reduce rather than increase frequency in TP.
  5. Clarify the frame for contact between sessions.
  6. Reconsider the indication. Switching from AP to TP, or to structure-related TP, needs a new application [uncertain on the exact procedure; check §§ 29–35 and your KV].

5.4 Non-adherence: missed sessions, lateness, payment, between-session contact

• Address it in the frame agreement (4.5) at the start.
• When it happens, respond in two steps:
  1. Reality: restate the agreement. Missed-session fees are a private agreement, not a GKV service; check legal permissibility and the Berufsordnung [uncertain].
  2. Meaning: (illustrative) "You missed the session after we talked about your father. Could the two be connected?"
• Repeated breaches in low-structure patients call for explicit contracting rather than interpretation alone. [synthesis]

5.5 Alliance ruptures

• Withdrawal ruptures: the patient becomes compliant and distant. Confrontation ruptures: the patient attacks.
• Response [synthesis; the rupture-repair concept is from Safran & Muran, secondary]:
  1. Notice the rupture.
  2. Invite the patient to say what happened.
  3. Acknowledge your own contribution non-defensively.
  4. Explore the patient's experience.
  5. Only later, link it to the pattern.
• (Illustrative) "I think what I said last time hurt, and I may have pushed too fast. Can we look at what happened?"
• In TP, repair takes precedence over interpretation. In AP, the rupture is also transference material, but the alliance must be restored first.

5.6 Erotic or idealising transference

• Follow Freud's 1915 position: neither gratify nor suppress; analyse the wish's meaning and its function, often as resistance against the analytic work. [source: Freud 1915, from knowledge]
• In TP, name it calmly and redirect it towards the patient's real relationships and the focus (4.21).
• Seek supervision early if your countertransference is action-guiding (4.39). [synthesis]

5.7 Negative therapeutic reaction (worsening after progress)

• Concept: Freud (1923) describes paradoxical worsening after progress, linked to unconscious guilt or need for punishment [from knowledge, uncertain].
• Response [synthesis]:
  1. Spot the timing (worse right after a good session or a success).
  2. Interpret the guilt or fear of surpassing others, of loyalty conflicts, or of losing therapy if the patient gets well.
  3. Avoid praise-heavy responses.

5.8 Suicidality and acute crisis

• Conduct a standard suicide risk assessment as in the German S3 guidelines and your clinical routine: ideation, plans, preparations, prior attempts, protective factors. Document it and involve psychiatric or emergency services as indicated.
• Temporarily suspend regression-promoting work and use a structuring, supportive mode. Wöller & Kruse ch. 35 addresses depressive and suicidal patients (heading only).
• In AP, a crisis may require sitting up and more active intervention for a period. [synthesis; no medication guidance given here]

5.9 Contingent and Gutachter problems

• Negative or partial Gutachten: a Zweitgutachten (second review) is possible [from knowledge, uncertain on current procedure]. Revise the report so that it clearly argues the psychodynamics and the TP vs AP indication (4.6).
• Contingent ending before goals are reached:
  • Apply for continuation in time (§ 30), or use the RP hours (§ 14).
  • Over-limit applications are possible in exceptional cases (KVBW), but don't promise them.
  • Plan the ending from session one in TP.
• Akutbehandlung counts toward KZT 1 (§ 29). Count it in your session plan. [source: PT-RL 2026]

5.10 Modality drift: TP turning into "mini-analysis", or AP becoming supportive chat

• TP drift signs: no focus, increasing regression, long silences, the patient asking for more sessions. Remedy: re-establish the focus and an active, here-and-now stance (Rudolf: TP is not short-term analysis), or apply to convert to AP if the indication has truly changed. [synthesis]
• AP drift signs: the analyst gives advice, discussion stays at surface reality, transference is never interpreted. Remedy: return to resistance and transference interpretation, and seek supervision. [synthesis]
• Patient asks to lie down in TP or to sit up in AP: explore the wish first. In TP, normally keep face to face (regression limitation). In AP, sitting up for phases is legitimate when regression becomes unmanageable (5.3). [synthesis]

5.11 Disorder-specific difficulties

[source: Wöller & Kruse ch. 35–39 (headings only); responses are synthesis]

• Somatoform patients ("Without the complaints everything would be fine"):
  • Accept the bodily complaint as real and keep medical care involved (ch. 38).
  • Build a bridge from body to affect slowly, via the life situation at symptom onset.
  • Don't press psychogenic interpretations early.
• Anxiety and panic: link attacks to the triggering situation and the underlying conflict (often autonomy vs dependence), and support confrontation with avoided situations within the dynamic frame. Check the RL limits on übende elements [uncertain].
• Trauma sequelae: stabilise first (4.26). Avoid regressive settings early and avoid premature detailed recounting. Use trauma-specific methods only within your qualification (4.38).
• Depression: watch for guilt, self-reproach and aggression turned inward. Assess suicidality (5.8). A more active, holding stance is appropriate in the acute phase.

5.12 Problems the sources do not address [synthesis]

• Video sessions: online sessions within the RL rules on video consultation alter the scene and the couch setting. Name the change and treat interruptions and private surroundings as material. Check the current KBV video rules [uncertain].
• Language or cultural distance: clarify meanings more actively, beware of interpreting culturally normative behaviour as defence, and use the countertransference to detect your own assumptions.
• Third-party pressure (employer, pension insurer, court): clarify the confidentiality and reporting frame early; the external interest itself becomes material.

Sources

Sources:

• G-BA: Psychotherapie-Richtlinie, Fassung 19.03.2026, in Kraft 17.06.2026 (PDF)
• KV Baden-Württemberg: FAQ Psychotherapie-Reform (updated 06.03.2025)
• Techniker Krankenkasse: Welche psychotherapeutischen Behandlungsarten zahlt die TK? (dated 19.01.2026)
• Deutsches Ärzteblatt: Qualitätssicherung in der Psychotherapie wird in Nordrhein-Westfalen erprobt (19.01.2024)
• Klett-Cotta reading sample: Wöller & Kruse, Tiefenpsychologisch fundierte Psychotherapie, 5th ed. (TOC, ch. 1–2)
• Reading sample: Rudolf, Psychodynamisch denken – tiefenpsychologisch handeln (TOC, ch. 1)
• Hintenberger (2009): Der Fokus in der Online-Beratung, e-beratungsjournal.net (summarises Lachauer's focus formulation)
• Götze et al. (2003): Fokaltherapie, Psychotherapeut 48 (abstract)
• PEP-Web record: Freud (1912) Ratschläge für den Arzt bei der psychoanalytischen Behandlung (citation only)
• PEP-Web record: Freud (1913) Weitere Ratschläge zur Technik der Psychoanalyse I (citation only)
• PEP-Web record: Freud (1914) Weitere Ratschläge zur Technik der Psychoanalyse II (citation only)

Further reading (not drawn on in full; content from knowledge where marked):

• Wöller, W. & Kruse, J. (eds.) (2018). Tiefenpsychologisch fundierte Psychotherapie. Basisbuch und Praxisleitfaden, 5th ed. Stuttgart: Schattauer. A later edition may exist [uncertain].
• Rudolf, G. (2019). Psychodynamisch denken – tiefenpsychologisch handeln. Praxis der tiefenpsychologisch fundierten Psychotherapie. Stuttgart: Schattauer.
• Rudolf, G. (2013). Strukturbezogene Psychotherapie. Leitfaden zur psychodynamischen Therapie struktureller Störungen, 3rd ed. Stuttgart: Schattauer.
• Ermann, M. (2020). Psychotherapie und Psychosomatik. Ein Lehrbuch auf psychoanalytischer Grundlage, 7th ed. Stuttgart: Kohlhammer. [uncertain].
• Lachauer, R. (2004). Der Fokus in der Psychotherapie. Stuttgart: Pfeiffer bei Klett-Cotta (cited via Hintenberger 2009).
• Arbeitskreis OPD (ed.) (2023). OPD-3 – Operationalisierte Psychodynamische Diagnostik. Bern: Hogrefe.
• Argelander, H. (1970). Das Erstinterview in der Psychotherapie. Darmstadt: Wissenschaftliche Buchgesellschaft.
• Freud, S. (1912). Ratschläge für den Arzt bei der psychoanalytischen Behandlung. Zentralblatt für Psychoanalyse 2, 483–489.
• Freud, S. (1913). Zur Einleitung der Behandlung (Weitere Ratschläge I). Int. Z. Psychoanal. 1, 1–10.
• Freud, S. (1914). Erinnern, Wiederholen und Durcharbeiten (Weitere Ratschläge II). Int. Z. Psychoanal. 2, 485–491.
• Freud, S. (1915). Bemerkungen über die Übertragungsliebe (Weitere Ratschläge III). Int. Z. Psychoanal. 3, 1–11.
• Freud, S. (1923). Das Ich und das Es (negative therapeutic reaction).
• Strachey, J. (1934). The nature of the therapeutic action of psycho-analysis. Int. J. Psycho-Anal. 15, 127–159.
• Malan, D. H. (1979). Individual Psychotherapy and the Science of Psychodynamics. London: Butterworths.
• Safran, J. D. & Muran, J. C. (2000). Negotiating the Therapeutic Alliance. New York: Guilford.
• Dieckmann, M., Becker, M. & Neher, M. (eds.). Faber/Haarstrick. Kommentar Psychotherapie-Richtlinien (current ed.). München: Elsevier. The official commentary on the RL.