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Guide I-050

Neo-psychoanalysis

Harald Schultz-Hencke1940Berlin
A 20 · L 55 · M 2515 interventions in the Trinity explorer1 described for recognition only
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Harald Schultz-Hencke's own neoanalysis ("Neo-Psychoanalyse", "Neoanalyse") as set out in Der gehemmte Mensch (1940), Lehrbuch der Traumanalyse (1949) and Lehrbuch der analytischen Psychotherapie (1951). It is reconstructed from secondary accounts because none of these primary books is drawn on directly. It is not the later Rudolf/Rüger-era adaptation or today's German tiefenpsychologisch fundierte Psychotherapie. [uncertain: the primary texts are not drawn on]

What it is. Neoanalysis is a Berlin revision of psychoanalysis. Schultz-Hencke dropped libido theory and the Es/Ich/Über-Ich structural model as speculative. In their place he put an observation-near theory of drive experience (Antriebserleben) and its inhibition (Hemmung, Gehemmtheit). He saw it as an amalgam: Freud as the base, with roughly a third drawn from Adler and Jung. [source: en/de Wikipedia; Laub-Metzenthin 1982; Spektrum Lexikon]

How change happens. Neurosis rests on a Neurosenstruktur, a disposition formed in the first five years of life. Harshness (Härte), indulgence (Verwöhnung) or an unpredictable switch between the two caused one or more drive areas to be inhibited. The disposition becomes manifest illness only when a current temptation situation or deprivation situation (Versuchungs-/Versagungssituation) stirs the inhibited drive. The inhibited drive is not destroyed. It persists as "das Gehemmte" and leaves a gap in experience. Fragments of it break through as symptoms (Antriebssprengstücke). Secondary consequences follow: passivity and ease-seeking (Bequemlichkeit), exaggerated demands (Riesenansprüche) and a vicious circle. Change comes from making the inhibition, its origin and its consequences conscious, so that the inhibited drive can be lived and steered by the adult person again. Ease-seeking and giant demands are worked through along the way. [source: de Wikipedia "Neurosenstruktur"; Spektrum "Antriebssprengstück"; Laub-Metzenthin 1982 pp. 32–33]

Plain statement. This is mainly a theory of neurosis with a textbook technique. It is not a manualised therapy. No session-by-session protocol exists. Where this guide turns concepts into in-session steps, they are marked [synthesis]. Schultz-Hencke's teaching is still a recognised option for the Strukturdiagnose in German psychotherapy reports under the Psychotherapie-Richtlinie, alongside OPD. [source: de Wikipedia "Neurosenstruktur"]

History, stated briefly. In 1936 Schultz-Hencke became a member of the Deutsches Institut für psychologische Forschung und Psychotherapie (the "Göring Institute"), led by M. H. Göring and charged with building a "Neue Deutsche Seelenheilkunde". He trained analysts there. He was not an NSDAP member. Kemper reported that he told Göring's board he would never be a National Socialist. After 1945 he co-founded the Institut für Psychopathologie und Psychotherapie and the Zentralinstitut für psychogene Erkrankungen with Werner Kemper. At the 1949 IPA congress in Zürich, the question of whether German analysis had been compromised under Nazism got mixed up with the question of whether his neoanalysis still counted as psychoanalysis. Müller-Braunschweig then left the DPG and founded the DPV in 1950, which the IPA admitted in 1951. The DPG, still shaped by Schultz-Hencke, stayed outside the IPA. His political role is still debated. Theilemann (2025) argues from new documents that he was not a National Socialist. [source: de Wikipedia; DPG biography page; Ärzteblatt review of Theilemann 2025; Spektrum Lexikon]

Harm account: clinical practice at the Göring Institute (Schultz-Hencke's institutional setting)

Scope. The sources document what the institute did as an organisation, mostly under Johannes Heinrich Schultz as deputy director (1936–1945) and head of its outpatient clinic. They do not show Schultz-Hencke personally carrying out the practices below. The DPG biography records his teaching of analysts, his release for therapeutic duties after the institute became a Reichsinstitut in 1943, and his 1942/43 post as a senior physician in a military hospital, doing mainly surgical and internal-medicine work. [source: DPG biography; Brunner & Steger 2006] [uncertain: whether Schultz-Hencke treated, assessed or wrote reports on homosexual patients, soldiers or hereditary-health cases is not documented in the sources; Theilemann (2025) argues he was not a National Socialist] Clinicians trained in his tradition should know the setting in which it was taught.

What was actually done.

  • The outpatient clinic as a sorting station. The Poliklinik was the "heart of the institute". It worked as a screening and allocation point, and Schultz called it a "Waffenschmiede" (armoury). Schultz's 1940 diagnostic scheme sorted patients into those treatable by psychotherapy and those classed as hereditarily ill. It has been characterised as "a death sentence in the form of a diagnosis", because hereditary-illness labels fed into compulsory sterilisation. Schultz had publicly backed compulsory sterilisation under the 1933 hereditary-disease law, and in 1935 called psychotherapy and hereditary hygiene "inseparable allies". [source: Brunner & Steger 2006] [uncertain: the claim that Schultz took an active part in Aktion T4 killings appears unsourced in Wikipedia "J. H. Schultz"]
  • Coerced "treatment" of homosexual men. The institute cooperated with the SS. Men convicted of homosexuality were taken from concentration camps for psychotherapy, which made treatment a condition of possible release. Schultz's own case material includes a 21-year-old Waffen-SS man under sentence of death. He had about 30 sessions over three months, and the death sentence was then lifted, but he was probably killed afterwards in a penal unit. Schultz tested whether men were "cured" by forcing them to have sex with prostitutes. In his 1952 case book he conceded "the inhumanity of some of his experiments" while still defending the results. [source: Brunner & Steger 2006; Wikipedia "J. H. Schultz", citing Schultz 1952]
  • Outcome decided fate. Men judged cured were sent to the front, where most were probably killed. Men judged incurable were returned to the camps. [source: Wikipedia "J. H. Schultz"] Reported figures are 510 treated and 341 "cured". Schultz announced 500 cures in 1944. [source: Brunner & Steger 2006, citing Cocks] [uncertain: the dating of the 510/341 figures differs between sources]
  • Wartime purpose. During the war the aim of the field shifted to restoring the fighting capacity of traumatised soldiers. Help was meant for those regarded as racially "worth protecting" and gemeinschaftsfähig (fit for the community). [source: Spektrum interview with Martin Wieser 2024] The institute was classed as "important to the war effort" and its budget rose during the "total" war. [source: Brunner & Steger 2006]

How it caused harm.

  • No real consent. Consent was impossible when the alternative to therapy was the camp or execution. Therapy became an instrument of state persecution.
  • Sexual coercion. Forced sex was used as an outcome measure.
  • Diagnosis as selection. Diagnosis was used to select people for sterilisation and, possibly, for worse.
  • Inflated claims. Success claims (for example "350 cases of complete cure") were made without independent follow-up. Brunner and Steger note that the fate of the remaining two-thirds is "easy to imagine". [source: Brunner & Steger 2006]
  • Exclusion of colleagues. Jewish analysts were excluded from the institute and its society. [source: Wikipedia "Matthias Göring"]
  • Lasting damage to the profession. After 1945 this history split German psychoanalysis and shaped how Schultz-Hencke's neoanalysis was received (see "History, stated briefly"). [source: de Wikipedia; Ärzteblatt review]

Recognising it today. [synthesis unless tagged]

  • Conversion practices. Any attempt to change or "cure" sexual orientation or gender identity continues the institute's homosexuality programme, whatever it is called ("reparative", "reorientation", "healing unwanted attraction", "restoring natural identity"). That includes cases where the client appears to ask for it.
  • Third-party goals with sanctions. Watch for therapy whose goal is set by a state body, military, employer, court or family, where release, benefits, custody or status depend on the therapist's report.
  • Diagnosis as gatekeeping. Watch for diagnostic categories ("untreatable", "incurable", "not fit for the community") used to decide access to rights or resources rather than to plan care.
  • Unchecked success claims. Watch for success claims built on the clinic's own unchecked figures.
  • Legitimate dual-role work looks different. Forensic, occupational or military assessment is legitimate when the evaluator states the role openly, explains who receives the report and what it can lead to, and obtains consent to the assessment. It does not present itself as therapy, and the assessed person can refuse knowing the consequences.

What to do instead / helping those harmed. [synthesis unless tagged]

  • Instead. Use affirmative, non-pathologising work on sexual and gender identity, with goals set by the client. Keep assessment and therapy roles separate. Be transparent about every report and its recipients. Keep outcome evaluation independent.
  • Clients. Some clients have been through conversion practices or coerced, report-dependent "therapy", including in religious, forensic or migration settings.
    • Assess for trauma, shame, depression and suicidality, and run a structured risk assessment.
    • Be explicit early on that their orientation or identity is not a treatment target.
    • Be prepared for mistrust of therapists as agents of an institution.
  • Families. With descendants of victims or of practitioners, the history may surface as family secrecy or shame. Address it directly rather than as background.
  • Duties. Refuse to take part in coercive or conversion work. Report it to the professional body or regulator. [uncertain: Germany has a statutory ban on conversion treatment (2020) covering minors and coerced or deceived adults]

2. Framework

Schultz-Hencke's analytic-procedure chapter covers spontaneous healing, the aim of treatment, anamnesis and first consultation, the basic rule, the analyst's procedure, ending, psychosis therapy and analyst training. The phases below follow that order. [source: Laub-Metzenthin 1982, table of contents pp. 126–138; the chapter text is not drawn on, so phase details are [synthesis] unless tagged otherwise]

Phase 1: First consultation and anamnesis (about 1–5 sessions, face to face).

  • Goal: take a detailed life history; find the triggering situation (auslösende Situation) that turned the structure into symptoms; estimate prognosis and indication.
  • Basis: the Berlin institute worked to a written guideline for the psychotherapeutic history and a guideline for a "Vor- und Überschau" (preliminary overview) for prognosis. [source: stz.digitheo article] Annemarie Dührssen, trained by Schultz-Hencke, later systematised this as the biographische Anamnese. [source: biapsy Dührssen entry]
  • Move on when: you can state the trigger as a temptation or deprivation situation, a provisional structure diagnosis (see Phase 2), and the patient agrees to analytic work.

Phase 2: Structure diagnosis and indication (end of Phase 1; written).

  • Goal: name which drive areas are inhibited, which of the four structures predominates (depressive, obsessive/zwanghaft, schizoid, hysterical), and the Bequemlichkeit/Riesenansprüche profile.
  • Move on when: the formulation explains the current symptoms from the structure plus the trigger. [source: de Wikipedia "Neurosenstruktur"]

Phase 3: Analytic phase (main body).

  • Goal: work on the inhibitions as they show up in material, dreams and the relationship to the therapist. This is relatively active work: Schultz-Hencke's "aktive therapeutische Methode" was a reason for his 1920s teaching ban. [source: de Wikipedia; DPG biography]
  • Format: individual sessions, using the basic rule. [uncertain: setting (couch or chair), frequency and number of hours in the 1951 textbook were not verified. Berlin practice was briefer than classical analysis, and the Zentralinstitut's catamnestic outcome studies of 1962/65 paved the way for statutory-insurance coverage. Current Richtlinie hour limits come from today's regulations, not from Schultz-Hencke.] [source for outcome studies: biapsy Dührssen entry]
  • Move on when [synthesis]: the patient spontaneously notices inhibition and ease-seeking in daily life, symptoms have eased, and previously absent drive qualities appear (wanting, keeping, asserting, tenderness).

Phase 4: Working through and ending.

  • Goal: consolidate lived drive expression, reduce giant demands to realistic expectations, and end. [uncertain: the textbook's ending criteria are not drawn on; the goal is inferred from the theory]

3. Guiding principles

Each principle is followed by its practical meaning. [source unless tagged: Laub-Metzenthin 1982 pp. 12–35; de Wikipedia "Neurosenstruktur"; Spektrum]

  • Understand from drive experience ("vom Antriebserleben her verstehen"). Ask of every piece of material which need (wanting, having, keeping, asserting, loving, attending) is at work or missing.
  • Inhibition, not repression, is the core concept. Look for what is absent, not only for hidden content.
  • A missing drive implies Gehemmtheit. When a drive response anyone would expect does not appear (no anger, no wanting), treat the gap as a lead.
  • The emotional impulse is inhibited, not the idea. Patients may describe a situation fully yet feel nothing. Aim at the impulse and affect, not at more recall.
  • Symptoms are drive fragments breaking through (Antriebssprengstücke). Read a symptom, an obsessive thought or a masochistic dream as a distorted piece of the inhibited drive.
  • Neurosis = inhibition + Bequemlichkeit + Riesenansprüche. Always assess all three; insight into the inhibition alone is not enough.
  • Structure needs a trigger. Always locate the current temptation or deprivation situation.
  • Normal and neurotic differ in degree. Everyone has neurotic parts. Avoid a pathologising stance and frame work as freeing capacities.
  • Six drive areas, three basic strivings. The areas are intentional, captative (oral), retentive (anal), aggressive/status-seeking, urethral, and loving-sexual, plus spiritual needs. They reduce to possession, status and sexuality. Map the patient across all of them, not just sexuality.
  • Aggression is not primarily destructive. Motor activity, mastery and pleasure in work are "positive aggression". Encourage healthy assertion; do not treat it as dangerous.
  • Tenderness and Eros are original phenomena, not aim-inhibited sex. Value tenderness on its own terms.
  • Observation over speculation. Keep interpretations close to what the patient reports and can verify. Avoid metapsychological constructs.
  • Integrative stance (Freud, Adler, Jung). Status-striving (Adler) and spiritual needs (Jung) are legitimate themes, not just defences.
  • Therapist activity. Ask questions, point things out and steer more than a classical abstinent analyst would. [source: de Wikipedia; DPG biography] [uncertain: how far this went in the 1951 textbook]
  • Psychotherapy by physicians. This was Schultz-Hencke's position; today, licensed psychotherapists. Historical only. [source: DPG biography]

4. Intervention inventory

Scope note: the technique chapters of the 1951 Lehrbuch (anamnesis, basic rule, analyst's procedure, ending) and the method of the 1949 Lehrbuch der Traumanalyse are not drawn on. The items below are the procedures that secondary sources attribute to Schultz-Hencke. Step-by-step wording is [synthesis] built on his documented concepts. Nothing here is presented as his verbatim protocol. All example language is (illustrative).

4.1 First consultation and biographical anamnesis

  • Purpose: Gather a detailed life history from early childhood, the family climate (harshness, indulgence, inconsistency) and the onset of symptoms. Use it for diagnosis, prognosis and indication. Do it at the start. [source: stz.digitheo (Berlin guideline for the psychotherapeutic history; "Vor- und Überschau"); Dührssen's later Biographische Anamnese 1981 builds on this school]
  • Steps [synthesis]:
    1. Take the current complaint and its exact onset date.
    2. Ask what changed in the patient's life in the weeks to months before onset: relationships, work, losses, opportunities, temptations.
    3. Take the childhood history: who raised the patient; how strict or indulgent they were; how reliable; major hardships such as poverty, illness in the family or separation. [source for these factors: de Wikipedia "Neurosenstruktur"]
    4. For each drive area, ask how the child dealt with curiosity, wanting and taking, keeping and giving, rage and self-assertion, tenderness and sexuality.
    5. Note the patient's present way of life for each area: what they allow themselves and what they avoid.
    6. Close with a provisional formulation and a prognosis estimate.
  • Example language (illustrative): "Let's pin down exactly when this started, and what was going on in your life in the months before." / "When you wanted something as a child, how did the adults at home usually react?"
  • Watch for: Areas the patient skips or flattens ("nothing special"): these are candidate inhibitions. Gaps in the timeline around onset. It is working when the onset links clearly to a specific life situation.

4.2 Locating the temptation or deprivation situation (Versuchungs-/Versagungssituation)

  • Purpose: Find the current situation that activated the inhibited drive and so tipped the structure into manifest neurosis. It is the key to why the symptoms appeared now. [source: de Wikipedia "Neurosenstruktur" and "Harald Schultz-Hencke" (terms attributed to him)]
  • Steps [synthesis]:
    1. From the onset history (4.1), list candidate events.
    2. For each event, ask whether it offered something the patient might want (temptation: a new love, a promotion, a chance to assert themselves) or took something away (deprivation: a loss, a rejection, a demand that could not be met).
    3. Link the event to the drive area it touches. For example, a promotion touches status-seeking and aggression; an affair offer touches sexuality and love.
    4. Check the link against the symptom's timing and content.
    5. Share the formulation with the patient tentatively.
  • Example language (illustrative): "It sounds as if the trouble began just when you were offered the lead role. Being seen to want more may be exactly what is hardest for you."
  • Watch for: Several overlapping triggers, which call for a combined formulation. Patients who reject the link outright may be showing the inhibition itself. It is working when the patient recognises the conflict as "wanting it and not being allowed to".

4.3 Drive-area mapping (Antriebsbereiche)

  • Purpose: Build a systematic picture of how each drive area is lived: freely, inhibited, or replaced by substitutes. Use it in assessment and to update the picture during treatment. [source for the six areas plus the spiritual area, and the reduction to possession, status and sexuality: Laub-Metzenthin 1982 pp. 17–25; de Wikipedia "Neurosenstruktur"]
  • Steps [synthesis]:
    1. Intentional: curiosity, attention, turning toward the world and people.
    2. Captative: wanting, taking, accepting, being able to ask.
    3. Retentive: keeping, holding on, giving, letting go, order.
    4. Aggressive/status-seeking: motor activity, mastery, pleasure in work, assertion, standing.
    5. Urethral: letting go, impulsivity. Schultz-Hencke only sketched this area and folded it largely into aggression.
    6. Loving-sexual: tenderness, Eros and genital sexuality, assessed separately.
    7. Spiritual needs: permanence, order, peace, contemplation.
    8. For each area, rate free, partly inhibited or strongly inhibited, and note any substitutes (see 4.6).
  • Example language (illustrative): "When did you last simply ask for something you wanted?" / "What happens inside you when someone takes credit for your work?"
  • Watch for: Over-expression in one area can be a substitute for inhibition in another (compensation). It is working when a clear one-to-three-area inhibition profile emerges.

4.4 Structure diagnosis (Neurosenstruktur)

  • Purpose: Classify the predominant structure and write it up. Use it in assessment and in German insurance reports (Strukturdiagnose). [source: de Wikipedia "Neurosenstruktur"]
  • Steps:
    1. Match the inhibition profile to the four structures:
      • Depressive: inhibited captative/oral and aggressive drives; latent giant demands; hatred toward frustrating figures turned inward.
      • Obsessive (zwanghaft): inhibited motor aggression; inability to act at the right place and time; forceful breakthroughs under temptation or deprivation.
      • Schizoid: inhibited intentional drive; contact disturbance, distrust, distance.
      • Hysterical: inhibited development of a realistic view of the world; role-playing; irrationality.
    2. Record mixed forms. [synthesis]
    3. Write the formulation in this form: structure + inhibited areas + Bequemlichkeit/Riesenansprüche + trigger situation + resulting symptoms. [synthesis; uncertain: Schultz-Hencke's exact written "Strukturformel" format was not verified]
    4. Distinguish the structure, which is a disposition and not an illness, from a personality disorder. If the patient has a personality disorder, consider structure-focused rather than uncovering work. [source: de Wikipedia "Neurosenstruktur" (modern commentary, Boessmann/Remmers)]
  • Example language: This is the clinician's written formulation, not spoken. (illustrative): "Anxious-depressive neurosis structure; marked inhibition of captative and aggressive striving; latent giant demands for care; decompensated after the deprivation situation of the partner leaving."
  • Watch for: Assigning a label without explaining the symptom dynamically. It is working when the formulation predicts which situations will be hard.

4.5 The basic rule (Grundregel) and the analyst's active procedure

  • Purpose: Get material, meaning thoughts, feelings, memories and dreams, in which inhibitions can be seen. Use it throughout Phase 3. [source: Laub-Metzenthin 1982, table of contents ("Grundregel", "Vorgehen des Analytikers"); "aktive therapeutische Methode": de Wikipedia, DPG biography]
  • Steps [synthesis; uncertain: Schultz-Hencke's own wording and degree of activity were not verified]:
    1. Explain the basic rule: say what comes to mind, including what seems trivial, embarrassing or unpleasant.
    2. Let material unfold. Then ask concrete, drive-focused clarifying questions: what was wanted, what was felt, what was done.
    3. Point out omissions and flat passages.
    4. Bring the material back to the formulated inhibition and the trigger situation.
  • Example language (illustrative): "Please say whatever comes up, even if it seems beside the point." / "You described the whole argument, but not what you felt like doing in that moment."
  • Watch for: Sparse associations, which may themselves signal intentional inhibition. Over-questioning, which turns the session into an interrogation. It is working when the patient brings drive-relevant material unprompted.

4.6 Identifying the gap: making Gehemmtheit visible

  • Purpose: Show the patient where a drive response is missing. This is the core uncovering move of the theory. Use it whenever material shows an expected impulse that does not appear. [source: Laub-Metzenthin 1982 (inhibition is assumed when an expected drive does not appear; the emotional impulse is inhibited, not the idea; a gap in experience remains; "Übersteuerung": the counter-pole is reinforced)]
  • Steps [synthesis]:
    1. Notice the absence: no anger at an injustice, no wish where there was an offer, no grief after a loss.
    2. Mark it neutrally, without supplying the missing feeling yourself.
    3. Explore what shows up instead, such as excessive politeness, tiredness or a sudden change of topic. This is the reinforced counter-pole.
    4. Over many sessions, collect instances until a pattern is plain.
    5. Link the pattern to the drive area and to the structure formulation.
  • Example language (illustrative): "I notice that when he cancelled again, what you describe is understanding for him. Where did your own disappointment go?" / "Each time we come near wanting something for yourself, you get very tired."
  • Watch for: Intellectual agreement without affect, meaning the idea has been accepted but the impulse is still inhibited. Shame. It is working when a faint impulse appears in the session, such as irritation or a wish voiced tentatively.

4.7 Reading symptoms as Antriebssprengstücke

  • Purpose: Reframe a symptom as a distorted fragment of the inhibited drive breaking through. This reduces fear of the symptom and points to the drive. Use it for obsessive thoughts, masochistic or sadistic fantasies, impulsive outbursts and somatic equivalents. [source: Spektrum "Antriebssprengstück" (drives such as status and love can never be fully inhibited; a person who cannot assert himself may develop sadistic obsessive thoughts; one who can never surrender may dream of being overpowered)]
  • Steps [synthesis]:
    1. Get a precise description of the symptom.
    2. Ask which drive quality it contains: force, possession, surrender, tenderness.
    3. Contrast it with how little of that quality the patient allows in ordinary life.
    4. Offer the link and keep watching whether the symptom eases as direct expression grows.
  • Example language (illustrative): "These violent images that frighten you have a great deal of force in them, and force is exactly what you never permit yourself with people. Perhaps it is pushing its way out here instead."
  • Watch for: Patients who hear this as "so I am really violent". Normalise it: everyone has these drives (degree, not kind). It is working when symptom distress falls and assertion grows.

4.8 Confronting Bequemlichkeit

  • Purpose: Address the passivity and ease-seeking that follow inhibition and keep the neurosis going (the vicious circle). Use it once the inhibition is understood but the patient does not move. [source: concept and position in the theory: Laub-Metzenthin 1982 intro (consequences of inhibition: passivity, Bequemlichkeit, Riesenerwartungen, vicious circle); de Wikipedia "Neurosenstruktur" (neurotics are often "bequem"). Technique: [synthesis]]
  • Steps [synthesis]:
    1. Point out specific moments when the patient avoids effort, risk or decision, and the short-term relief this brings.
    2. Frame it as an understandable result of the inhibition, not as a moral failing.
    3. Explore what the patient gains by not acting, such as protection from failure or being looked after.
    4. Encourage small concrete steps in the inhibited area and examine them in the next session.
  • Example language (illustrative): "Not applying spared you the risk of a no. It also leaves you exactly where you were. What would the smallest version of trying look like?"
  • Watch for: Shame and feeling blamed. Treat it as a rupture (section 5). It is working when the patient starts to act, even clumsily.

4.9 Working through Riesenansprüche

  • Purpose: Make conscious the unrealistic, often unconscious demands on others, on oneself and on life that grow from long frustration. Turn them into proportionate wishes. Use it especially with depressive structures. [source: de Wikipedia "Neurosenstruktur" (latent giant demands in the depressive structure; exaggerated demands on self, others and life); Laub-Metzenthin 1982 intro. Technique: [synthesis]]
  • Steps [synthesis]:
    1. Notice disproportionate disappointment, hurt or resentment, including toward the therapist.
    2. Name the implicit demand behind it, for example "should know without my asking" or "should always be available".
    3. Link the demand to early deprivation or indulgence.
    4. Separate the legitimate need from its absolute form.
    5. Help the patient state the need directly and in proportion.
  • Example language (illustrative): "Part of you seems to expect that I should have known how bad the week was without your telling me. The wish to be looked after is understandable; the 'without telling' part makes it nearly impossible to satisfy."
  • Watch for: Rage turned inward when demands are named. Assess risk with depressive structures (section 5). It is working when the patient asks for things directly and tolerates partial fulfilment.

4.10 Reconstructing the original inhibiting situation

  • Purpose: Recover the childhood context in which the inhibition first formed. Schultz-Hencke defined repression as the forgetting of the situation in which the inhibition first occurred. Use it in Phase 3, once the pattern is clear. [source: Laub-Metzenthin 1982 pp. 32–33; factors (harshness, indulgence, inconsistency): de Wikipedia "Neurosenstruktur"]
  • Steps [synthesis]:
    1. Starting from a current instance of the inhibition, ask for the earliest similar feeling or memory.
    2. Explore what happened to the child's impulse: punishment, ridicule, overwhelming indulgence, unpredictability.
    3. Reconstruct what the child had to do with the impulse at that time.
    4. Contrast that with the adult's present options.
  • Example language (illustrative): "When you were small and furious, what happened next at home?" / "Back then, swallowing it was the only safe option. Is it still the only one?"
  • Watch for: Blaming the parents as a replacement for change. Memories that are too vague to use, in which case work in the present. It is working when affect connects to memory and present behaviour loosens.

4.11 Analysing substitute satisfactions and coping forms

  • Purpose: Identify how the patient handles frustrated drives through compensation (another drive takes over summatively), sublimation, renunciation (looking away, playing down, humour) or inhibition. Decide which forms are adaptive and which keep the neurosis going. [source: mechanisms: Laub-Metzenthin 1982 pp. 25–33; clinical use: [synthesis]]
  • Steps [synthesis]:
    1. Note repetitive over-activity in one area, for example overeating or overwork.
    2. Ask what is missing that it might replace.
    3. Differentiate healthy sublimation from compulsive substitution.
    4. Return to the primary inhibited area.
  • Example language (illustrative): "The late-night eating seems to start on the evenings when nobody has asked how you are."
  • Watch for: Removing a substitute before the primary need has another outlet. It is working when the substitute diminishes without being replaced by another symptom.

4.12 Dream analysis (Traumanalyse)

  • Purpose: Use dreams to see the inhibited drives and the Antriebssprengstücke. Schultz-Hencke gave dreams great weight: he wrote a separate textbook (1949), reportedly drew on about 50,000 dreams read within the dreamer's life context, and kept a theory of dream work with a "Modelltafel" (a table of typical models). Use it whenever the patient brings a dream. [source: Laub-Metzenthin 1982, table of contents (Traumlehre: meaning of the dream, dream work, Modelltafel, dream analysis) and biography p. 8; DPG biography (postwar focus on dream analysis)]
  • Steps [synthesis; uncertain: the 1949 method is not drawn on]:
    1. Have the dream told in full and note the manifest scenes.
    2. Ask for associations to the key elements and for the day's events.
    3. For each scene, ask which drive area is in play and whether it is lived, blocked or distorted. For example, being overpowered may stand for surrender the patient never allows in waking life.
    4. Relate the dream to the current trigger situation and to the transference.
    5. Offer a drive-centred reading close to the manifest content.
  • Uncertain points: Secondary accounts suggest Schultz-Hencke stayed closer to the manifest dream than Freud did. How he treated the dream censor (Traumzensur) and its variants, and what exactly the Modelltafel contains, could not be verified. Do not attribute specific censorship categories to him without the 1949 text. [uncertain]
  • Example language (illustrative): "In the dream you finally shouted at him, the thing you never do awake. What was it like to be the one shouting?"
  • Watch for: Over-interpretation far from the manifest content, which goes against his observation-near principle. It is working when dreams change over the course of treatment, for example the dream-self becoming more active.

4.13 Working with inhibition in the therapeutic relationship (transference and resistance)

  • Purpose: The same inhibitions, ease-seeking and giant demands show up toward the therapist. Address them in the here and now. Use it whenever they appear. [uncertain: Schultz-Hencke's handling of transference and resistance in the 1951 textbook is not drawn on. Sources confirm only that the textbook covers the analyst's procedure, and that his activity and his rejection of libido theory set him apart from classical technique. The approach below is [synthesis] consistent with his concepts.]
  • Steps [synthesis]:
    1. Notice patterns in the relationship: never disagreeing, never asking for anything, missing sessions after a good one, sulking over small frustrations.
    2. Name the pattern as the inhibition or the giant demand appearing here.
    3. Invite the missing impulse toward you, safely.
    4. Link it to life outside and to history.
  • Example language (illustrative): "You have never once told me I got something wrong. I doubt I always get it right. What makes disagreeing with me so hard?"
  • Watch for: Compliance that only performs the new behaviour. It is working when the patient genuinely disagrees, asks or protests, and the relationship holds.

4.14 Ending

  • Purpose: Conclude treatment once the drive areas are livable and symptoms have eased. [source: Laub-Metzenthin 1982, table of contents ("Ende einer Therapie"); criteria [synthesis], [uncertain]]
  • Steps [synthesis]:
    1. Review the structure formulation against present functioning in each drive area.
    2. Anticipate future temptation and deprivation situations.
    3. Work through the giant demands that ending itself stirs up, such as "you should always be there".
    4. Set the end date jointly.
  • Example language (illustrative): "Let's look at which kinds of situations are still likely to catch you, and what you would notice first."
  • Watch for: Symptoms returning as the end approaches, which may be a deprivation situation in miniature. Work it through rather than extending reflexively.

Historical note: leucotomy and psychosis treatment (no clinical use)

Schultz-Hencke accepted leucotomy (prefrontal lobotomy) as a legitimate treatment, and he wrote on schizophrenia (Das Problem der Schizophrenie, 1952). [source: DPG biography] Leucotomy was a mid-century psychosurgery with documented severe and irreversible harm, including personality blunting, disability and death. It is now regarded as unethical except under tightly regulated neurosurgical conditions unrelated to psychotherapy. It has no place in psychotherapeutic practice. No steps are given.

Harm account: leucotomy (prefrontal lobotomy)

What was actually done.

  • Origins (Portugal, 1935). António Egas Moniz and the neurosurgeon Pedro Almeida Lima first injected ethanol into the frontal white matter. They then switched to a "leucotome", a cannula with a retractable wire loop, which was pushed into each frontal lobe and turned to cut cores of tissue. Store norske leksikon describes Moniz's first operations as forced treatment (tvangsbehandling). [source: Wikipedia "Lobotomy"; SNL "lobotomi"]
  • Freeman–Watts "precision method" (USA, 1937). The neurologist Walter Freeman and the neurosurgeon James Watts drilled holes in the side of the skull in an operating room and cut the fibres linking the prefrontal lobes to deeper brain structures. [source: Wikipedia "Lobotomy"; Wikipedia "Psychosurgery"]
  • Transorbital "ice-pick" lobotomy (from January 1946). Witnesses described the sequence like this. The patient was made unconscious with electroshock instead of anaesthesia. An ice-pick-like instrument was pushed above the eyeball, through the bone of the eye socket and into the frontal lobe. It was swept back and forth, and then the same was done on the other side. It could take under ten minutes. It did not need a surgeon or an operating theatre, so it was done in mental hospitals without surgical facilities, and Freeman toured hospitals to do and demonstrate it. Freeman performed or supervised several thousand operations (Wikipedia gives over 3,500 and NPR about 2,500). His last ice-pick patient, Helen Mortenson (1967), died of a brain haemorrhage. [source: NPR 2005; Wikipedia "Lobotomy"; Wikipedia "Psychosurgery"]
  • How it was introduced and "consented to". Consent usually came from families, guardians or the hospital, not from the patient. Howard Dully's case is a documented example. Freeman's notes record that his stepmother described the 12-year-old as defiant and "savage looking". In November 1960 Freeman proposed a transorbital lobotomy to change his personality. In December the notes record that the parents agreed and that Freeman advised them not to tell the boy. Dully's father later said he had been "sold a bill of goods". [source: NPR 2005]
  • Who received it. It went largely to people on "restless" (unruhige) wards of asylums, to people with chronic psychosis, and also to people with depression, postpartum depression, chronic headache and childhood behaviour problems. Freeman operated on 19 children, the youngest aged 4. In a 1951 US study nearly 60% of patients were women, and most Swedish patients were women. Use spread through Europe after 1945 and lasted into the 1970s, including in Switzerland. In Germany it was done only a few times. [source: Meier, Spannungsherde (contents and review); Wikipedia "Psychosurgery"; Wikipedia "Lobotomy"; Perlentaucher] [uncertain: no source here shows whether Schultz-Hencke referred or assessed any patient for leucotomy; the DPG biography says only that he accepted it as legitimate]
  • Aftercare. In the days afterwards patients were often stuporous and incontinent. Seizures were common, and some gained a great deal of weight. Families were then left with the person who emerged. [source: Wikipedia "Lobotomy"]

How it caused harm.

  • Destruction of the person. Spontaneity, responsiveness and self-control fell. Patients became inert, emotionally blunted and intellectually restricted. Freeman himself described the result as an "infantile personality". Contemporary authors called it "reducing the complexity of psychic life". [source: Wikipedia "Lobotomy"]
  • Medical injury and death. Reported complications included intracranial haemorrhage, epilepsy, brain abscess, dementia and death. Average mortality in the 1940s was about 5%. A British follow-up of 1942–1954 found 4% dead and 25% unchanged. In Norway mortality reached up to about 30% in some periods, and poor statistics make the true total hard to establish. [source: Wikipedia "Lobotomy"; SNL "lobotomi"]
  • Success meant being calmer. "Success" was judged largely by whether patients were quieter and easier to manage. A review of Meier's Swiss study sums up the outcome: patients were not cured but calmed, or damaged so badly they became "menschliches Gemüse" (human vegetables). [source: Perlentaucher review of Meier 2015] Norway's 1991 review committee found insufficient documentation that the operation worked. [source: SNL "lobotomi"]
  • Named cases.
    • Rosemary Kennedy (1941) was left incapacitated and institutionalised for life.
    • Anita McGee was operated on in 1953 for postpartum depression and spent most of her life in institutions.
    • After Anna Ruth Channels' 1950 operation, her daughter said she had "the mind of a child".
    • Howard Dully was put into state care after the operation and lived for decades feeling like a "freak, ashamed", not knowing "what I lost in those 10 minutes".
    [source: Wikipedia "Lobotomy"; NPR 2005]
  • Redress. The Soviet Union banned the procedure in 1950. In 1996 the Norwegian Storting offered ex gratia compensation (billighetserstatning), and several hundred former patients were compensated. [source: Wikipedia "Lobotomy"; SNL "lobotomi"]

Recognising it today.

  • Rhetoric to watch for. Leucotomy was sold as relief of "affective tension" that worked even in "hopeless cases" and that would also relieve the asylums and society. [source: Perlentaucher on Meier] The same arguments can return around any irreversible or high-risk intervention: "nothing else has worked", "it will make him calmer", "the family can't cope".
  • Red flags in a colleague's or service's practice. [synthesis]
    • The goal of treatment is set by a family, institution or ward because the patient is troublesome, not because the patient wants it.
    • Success is measured by how manageable the patient is, not by how they experience their own life.
    • Advice not to tell the patient what is planned.
    • Children, or people whose capacity is in doubt, are put forward for irreversible procedures.
    • Outcome claims rest on the practitioner's own impressions with no independent follow-up.
  • How modern psychosurgery differs. It still exists, but in a different form:
    • It uses stereotactic lesions (anterior capsulotomy, cingulotomy, subcaudate tractotomy, limbic leucotomy) or deep brain stimulation.
    • It is done in a few centres for small numbers of people with severe, treatment-refractory OCD or depression.
    • Some jurisdictions require a review board. Victoria, Australia is an example, and all of its 2007–2012 applications were for DBS.
    Even so, outcome data are poor, no placebo-controlled studies exist, seizures and personality change remain possible, and the adequacy of consent is still questioned. [source: Wikipedia "Psychosurgery"] A psychotherapist's role is limited to supporting the client's own informed decision. It is never to recommend such surgery as an answer to "unmanageable" behaviour. [synthesis]

What to do instead / helping those harmed.

  • Instead. For psychosis and severe affective illness, use current evidence-based care in collaboration with psychiatry. In neoanalytic terms, that means pacing uncovering work, keeping the frame stable and running structured risk assessment (section 5). [synthesis] Where a client or family raises surgery or another irreversible option, refer them to a specialist centre with independent review, and make sure the client hears the risks and the poor evidence base directly. [synthesis]
  • Clients who went through it. Surviving patients are now very old, and most of them live in care settings. The clients you are more likely to meet are their adult children and other relatives, like Rebecca Welch, Anita McGee's daughter. They may carry grief for a parent who was "lost" while still alive, shame or secrecy in the family, and anger at the doctors or at the relative who signed. [source: NPR 2005 for the family accounts; synthesis for clinical implications]
    • For a former patient, arrange neuropsychological assessment of executive function, emotional regulation and seizure history before you attribute difficulties to personality. [synthesis]
    • Help with getting records if the client wants them. Dully reconstructed his case from Freeman's archived files and from conversations with his father. [source: NPR 2005]
    • Validate a sense of injustice without pushing for a verdict on the relatives involved. [synthesis]
    • Where a compensation scheme existed, as in Norway, support the client's access to information about it. [source: SNL "lobotomi"; synthesis]
  • Ethical duties. Informed consent, capacity assessment and independent second opinions are the safeguards whose absence made leucotomy possible. If you learn of an irreversible intervention planned without valid consent, especially for a child, raise it through safeguarding and professional channels. [synthesis] [uncertain: specific statutory provisions (e.g. England's Mental Health Act s57)]

5. Handling problems

The accessible sources say almost nothing about handling clinical problems. Everything in this section is [synthesis] built from the theory unless tagged otherwise.

  • Stuck client (insight without change). Typical sign: the patient understands the inhibition intellectually but nothing moves. Response: shift from the inhibition to Bequemlichkeit and Riesenansprüche (4.8, 4.9). Ask what not changing protects, and agree on one concrete step in the inhibited area per week. Re-check whether the trigger situation is still active and unaddressed. [synthesis, consistent with the inhibition + Bequemlichkeit + Riesenansprüche triad]
  • Resistance as inhibition at work. Treat silence, empty associations and changes of topic as the inhibition appearing in the session, not as opposition. Name the moment just before it. Example (illustrative): "You went quiet right after mentioning your brother's success." With schizoid structures (inhibited intentional drive), sparse contact is the material itself. Give more time and less pressure. [synthesis]
  • Overwhelm when inhibited drives break through. Released aggression or need can be intense: rage attacks, frightening fantasies, sudden dependency. Slow down. Reaffirm that drives are normal and that steering them is the aim, not discharge. Help the patient find proportionate everyday outlets. With obsessive structures, expect forceful breakthroughs under temptation or deprivation and prepare the patient for them. [source for breakthrough under temptation/deprivation in obsessive structure: de Wikipedia "Neurosenstruktur"; response: synthesis]
  • Depressive structures and suicide risk. The theory describes latent giant demands and murderous hatred toward frustrating figures turned inward as suicidal impulses. [source: de Wikipedia "Neurosenstruktur"] When you confront giant demands or aggression, run a standard structured suicide risk assessment and follow local crisis protocols. Pace uncovering accordingly. Uncovering never replaces a risk assessment. [synthesis]
  • Non-adherence (missed sessions, no homework-like steps). Read it first as Bequemlichkeit or as a protest the patient cannot voice openly (aggressive inhibition). Address it in the relationship (4.13) before setting rules. Keep the frame clear and predictable: inconsistency is itself a pathogenic factor in this theory. [synthesis; inconsistency factor: de Wikipedia "Neurosenstruktur"]
  • Ruptures (feeling blamed, hurt, disappointed in the therapist). Confronting ease-seeking can feel like moral criticism. Acknowledge your part and restate that Bequemlichkeit follows from inhibition and is not a character flaw. Disappointment that is out of proportion may show giant demands. Repair first, interpret later. [synthesis]
  • Hysterical structure: role-playing and "being in someone else's clothes". Material may feel performed. Keep returning to concrete reality: what actually happened, and what was actually wanted. Avoid being drawn into the role. [structure description: de Wikipedia "Neurosenstruktur"; response: synthesis]
  • Personality disorder rather than neurosis structure. If there is no clear trigger and long-standing pervasive dysfunction, purely uncovering work may fail. Shift to structure-focused work, such as OPD-informed approaches. [source: de Wikipedia "Neurosenstruktur" (modern commentary); synthesis for application]
  • Over-reliance on activity. Too many questions and too much steering can make the patient passive and give them another reason to be bequem. Balance active pointing-out with space for association. [synthesis]
  • Rigid labelling. Pinning a patient to one of the four types can obscure mixed pictures and make the patient feel boxed in. Keep the formulation provisional and revise it as material appears. [synthesis]
  • Historical baggage. Patients or colleagues may raise the Göring Institute history. Acknowledge the documented history plainly (section 1). Note that the clinical concepts are separable from it and that the historical judgement is still debated. [source: de Wikipedia; Ärzteblatt review; synthesis for response]
  • Primary-source gap. Before using the dream method or ending criteria as "Schultz-Hencke's", check them against the 1949 and 1951 textbooks or Rudolf & Rüger (1988). [uncertain]

Sources

Sources:

Further reading (not drawn on unless noted):

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