Psychodynamic Imaginative Trauma Therapy, PITT

1. Introduction

Version followed: Reddemann (with Fürstenau, Gahleitner, Zimmermann), Psychodynamisch Imaginative Traumatherapie – PITT: ein Mitgefühls- und Ressourcen-orientierter Ansatz in der Psychotraumatologie, 11th fully revised and expanded edition (Klett-Cotta, Leben Lernen 320, 2021). The 2021 full text is not drawn on. Chapter logic is checked against the table of contents of the 6th revised edition (PITT – Das Manual, 2011). Exercises follow Imagination als heilsame Kraft (English edition: Who You Were Before Trauma, 2020) and the companion exercise CD (2003). [uncertain: 2011→2021 changes not verified]

PITT was developed by the psychoanalyst Luise Reddemann and her team at the Bielefeld clinic for psychotherapeutic and psychosomatic medicine (1985–2003). It is a psychodynamic, resource- and resilience-oriented treatment for complex trauma sequelae, mainly after severe early attachment and relational trauma. Its core idea of change: the patient first learns to regulate, soothe and distance herself using her own imagination. The adult, present-day parts of the self then learn to look after injured younger ego states, instead of the therapist becoming the main source of comfort. Only on that footing are traumatic memories met, gently and at a distance (observer or screen technique), and then integrated through grief, meaning-making and a new self-compassionate identity. Most of the work is stabilisation. Confrontation is usually the smallest part and is sometimes never needed. [source: 6th ed. TOC and preface; Reddemann/Höfer/Schäfer 2023 introduction; Who You Were Before Trauma publisher descriptions; DocCheck PITT]

2. Framework

PITT follows a Janet-style three-phase model, preceded by an introductory phase. Reddemann treats the phases as process-oriented, not rigid: stabilisation is not a one-time step and returns whenever needed (6th ed. §3.3 Prozess- versus Phasenorientierung; 2023 introduction). [source: 6th ed. TOC; BPtK/Drebes 2013; Reddemann/Höfer/Schäfer 2023]

Phase 0: Introductory phase (Einleitungsphase, 6th ed. ch. 3)

Goals: build a working alliance from the first contact; recognise traumatic stress; take a history that gathers resources alongside problems; clarify goals; offer predictability, structure and patient control; begin distinguishing external from internal threat.
Format: individual sessions, face to face, therapist active and transparent.
Move on when: there is a shared, written-down understanding of goals, current safety has been reviewed, and the patient agrees to try imaginative work.

Phase 1: Ego-strengthening or stabilisation (Ichstärkung, ch. 4)

Goals: psychoeducation; affect differentiation, regulation and tolerance; distancing from intrusions; self-soothing; external safety; boundaries; everyday functioning; caring for injured child parts; reducing the power of perpetrator introjects.
Format: individual sessions, groups, or inpatient programmes (ch. 4.10, ch. 10). Exercises are practised in session and then daily at home.
For many patients this phase is the whole treatment, and it is legitimately so. [source: 6th ed. preface; 2023 introduction]

Phase 2: Trauma confrontation (ch. 5)

Goals: meet a defined traumatic memory with a clear beginning and end, at a distance and from today's safety. Comfort the injured part and restabilise afterwards.
Format: planned single sessions, often double-length [uncertain], within the ongoing therapy. Restabilisation follows (ch. 5.6).

Phase 3: Integration (ch. 6)

Goals: grieve lost integrity and childhood deprivation; address meaning, guilt and reconciliation; orient to the future; transfer gains to daily life and relationships.

Session counts. The manual is written for German guideline therapy (ch. 1.4) [uncertain: exact numbers]. Typical frames:

Psychodynamic outpatient courses of roughly 25–100 sessions. [synthesis, based on German guideline contingents]
Inpatient stays of several weeks with group and individual modules (ch. 10).
A specific 5–10 session resource-oriented crisis-intervention format (ch. 8.1).

Criteria for starting confrontation [source: BPtK/Drebes 2013; Kahn 2007; 6th ed. ch. 5.1.2 title]

External safety: no ongoing perpetrator contact; social and physical stability.
Psychological stability: affect tolerance and control over dissociation.
Reliable access to resources: the safe place, helpers and the Tresor work.
Ability to distance oneself from the event.
The patient wants confrontation and chooses the timing.
Contraindications listed in secondary sources: tranquilliser treatment, ongoing perpetrator contact, acute suicidality, psychotic experience. [source: BPtK/Drebes 2013]

Move to integration when the confronted memories no longer intrude with the same force and the patient can tell them as past events. Integration themes may also begin without any confrontation. [synthesis]

3. Guiding principles

[source for all items: 6th ed. TOC section titles; Reddemann/Höfer/Schäfer 2023 introduction; BPtK/Drebes 2013; Kahn 2007. One-line practical meanings are synthesis.]

Resource and resilience orientation. Look for and strengthen what works, from the first session onward. Suffering is acknowledged but stays in the background. Resource work must never serve denial or trivialisation.
Compassion (Mitgefühl). Compassion is the therapist's basic stance and the target attitude of the patient toward herself. Model it, and ask what kind of compassion this person needs and what gets in its way.
Dignity and self-determination (Würde, Selbstbestimmung). The patient decides about pace, content and exercises. Ask, offer and give choices; never push.
Patient as expert; inner wisdom. Assume the patient knows best what she needs. Explore it with her instead of prescribing it.
Answering stance (beantwortende Haltung, ch. 3.1.4). Respond authentically and transparently as a real person. Do not use abstinent silence that invites regression. [uncertain: concept traced to psychoanalytic-interactional method, not verified in text]
Working alliance from the start (ch. 3.1.5–3.1.6). Explicitly build cooperation between the patient's adult self and the therapist's adult self, working together on the problems of younger parts.
Transference awareness without fostering regressive transference (ch. 3.1.1, 3.5). Note and name transference. Do not deepen it. Gently redirect regression toward the adult self.
Affect control rather than intensification (ch. 3.4). Abreaction for its own sake is not the goal. Help the patient modulate and contain feelings instead.
Ego-state model as conceptual base (ch. 3.2.4). Understand symptoms as states of younger or hurtful parts. Adult parts increasingly care for younger parts, so the patient does not depend on the therapist for re-parenting.
Imagination as an offer (ch. 3.2.1, 4.2). Exercises are proposals that the patient adapts creatively. There is no correct image. Anything unpleasant may be changed.
Symptoms as coping attempts. Validate every symptom as a survival achievement before working to change it.
Cognitive work counts (ch. 3.2.3). Explain, reality-test and correct false causal beliefs such as 'it was my fault'.
Process over phase (ch. 3.3). Use the phases as a map, not a timetable. Return to stabilisation whenever needed.
Psychoeducation as intervention (ch. 4.1). Knowledge about trauma reactions is itself stabilising.
Concepts judged by usefulness (ch. 3.2). Keep or drop a concept or technique depending on whether it helps this patient.
Positive psychology (ch. 2). Deliberately cultivate joy, gratitude, hope and meaning.
Therapist self-care (ch. 7). Protect the therapist against secondary traumatisation. The therapist can use the same exercises on herself.
Gender and context sensitivity (ch. 9). Consider the gender of therapist, helpers and perpetrators, and the social context of the violence.

4. Intervention inventory

Interventions are listed by phase. Names come from the tables of contents of the 6th edition, Who You Were Before Trauma and the 2023 child and adolescent volume, from the exercise-CD track list (Reichert review), and from secondary clinical sources (BPtK/Drebes 2013; Kahn 2007).

The step sequences are my paraphrased reconstructions. They combine those sources with the widely taught form of each exercise. Reddemann's own scripts are not drawn on, so treat details as [uncertain] unless otherwise tagged. All example language is illustrative and is not Reddemann's wording.

Rules for every imaginative exercise [source: Reichert review of CD; praxis-psychologie-berlin; 6th ed. ch. 4.2]

Introduce it as an offer.
Allow eyes open or closed.
Let the patient change anything unpleasant.
Always end with a deliberate return to the room: body, floor, sounds, look around.
Debrief afterwards.
Agree on daily home practice once it works in session.

4.1 Psychoeducation (ch. 4.1)

Purpose / when: From the first sessions on, whenever symptoms frighten or shame the patient. Use it to explain trauma reactions, dissociation, intrusions, triggers, the ego-state model and why PITT stabilises first.
Steps:
1. Ask what the patient already knows or fears about her symptoms.
2. Explain one mechanism at a time (alarm system, freezing, splitting off, memory fragments) in everyday words.
3. Link it to her own example.
4. Reframe the symptom as a survival response.
5. Check her understanding and give written or reading material if she wants it.
Example language (illustrative): 'What you call going blank was your mind's emergency brake back then. It protected you. Today it switches on even when there is no danger, and we can teach it new signals.'
Watch for: Lecturing instead of dialogue; overload; shame. It is working when the patient starts naming her own reactions ('that was a trigger') with less self-blame.

4.2 Resource-oriented history and resource search (ch. 3.1.3, 3.2.5)

Purpose / when: At intake and throughout. Map resources as carefully as problems, and keep a resource 'counterweight' visible.
Steps:
1. Take the trauma history briefly and factually, without details. A 'trauma map' with headings only is enough. [source: BPtK/Drebes 2013]
2. Ask systematically about good moments, skills, people, animals, places, interests, faith, body pleasures and past coping.
3. When she reports a good moment, slow down. Explore how she felt, perceived and thought in it, and how her body felt.
4. Write a resource list together and add to it every session.
Example language (illustrative): 'Before we look at what hurt you, I'd like to know what has helped you get through. Was there anything, even small, that was good back then?'
Watch for: A patient who finds nothing good. Then go smaller (a smell, a song, a moment). It is working when the list grows and the patient brings examples spontaneously.

4.3 Mindfulness practice (Achtsamkeit)

Purpose / when: The basis for all other exercises (first track of the CD). Use it to train non-judging present-moment attention and orientation in the here-and-now.
Steps:
1. Invite her to sit comfortably.
2. Guide her to notice the contact of feet and body with the floor and chair.
3. Guide her to notice breath without changing it, then sounds, then what she sees.
4. Name thoughts and feelings simply as passing.
5. Keep it to 2–5 minutes at first.
6. Return to the room and debrief.
7. Home practice: brief everyday mindfulness, such as one mindful activity a day.
Example language (illustrative): 'Just notice where your feet touch the floor. Nothing to achieve, just noticing. If your mind wanders, that's fine; come back to your feet.'
Watch for: Body focus can trigger trauma memories. Then shift to external senses and keep eyes open. It is working when the patient can name current sensations and feels more present.

4.4 Mindful body awareness and body exercises (CD track 3; Who You Were Before Trauma ch. 2)

Purpose / when: To rebuild a friendly relationship with the body and to notice tension early.
Steps:
1. Move attention briefly through regions of the body, starting with neutral or pleasant areas.
2. Skip any area the patient wants to skip.
3. Notice pleasant or neutral sensations.
4. Optionally add gentle movement practices. The book names Breema bodywork and Qigong; teach them only if trained, or refer.
Example language (illustrative): 'Choose a part of your body that feels okay right now, maybe your hands. Just let your attention rest there.'
Watch for: Body memories or numbing. Respect skipped areas. It is working when she reports more nuanced, less threatening body perception.

4.5 Getting to know the inner observer (CD track 4)

Purpose / when: Early in stabilisation. Strengthens a part that can watch thoughts, feelings and images from a distance without being swept away. It is a prerequisite for the observer technique.
Steps:
1. Explain that everyone can watch themselves from a little distance.
2. Invite her to notice a mild current feeling and then to notice that she is noticing.
3. She may give the observer a position (beside her, a step back) or a form.
4. Practise briefly describing what the observer sees: neutral, factual, present tense.
5. Return and debrief.
Example language (illustrative): 'There is the part of you that feels the worry, and there is a part that can notice: ah, worry is here. Let's get to know that noticing part.'
Watch for: Confusion with depersonalisation. Distinguish chosen observing (controllable, voluntary) from involuntary dissociation. It is working when she can step into the observer on request and step out again.

4.6 Inner safe place (Ort der Geborgenheit, Wohlfühlort)

Purpose / when: The central imaginative resource. A place where she feels completely safe and comfortable, to use for self-soothing, as a refuge during exercises, and as the destination for injured child parts.
Steps: [source for details: praxis-psychologie-berlin, crediting Reddemann; Kahn 2007]
1. Allow about 20 undisturbed minutes; sitting or lying, eyes closed or fixed on a point.
2. Invite a place, real or imagined, on earth or fantastical. Advise against her current home or any place linked to people who hurt her.
3. Build it through every sense: what she sees, hears, smells, feels and tastes, plus temperature and light. Find a comfortable posture there.
4. Change anything that is not right.
5. Set a boundary so that only she decides who may enter. Prefer animals, helper beings or fantasy figures over real people.
6. She may create her own way in, such as a gate, word or gesture.
7. Anchor it with a small body gesture.
8. Return to the room. Practise daily.
Example language (illustrative): 'Let a place come to mind where you could feel really safe. It doesn't have to exist. If anything about it doesn't feel right, you may change it.'
Watch for: No place appears, or the place 'turns bad' because intrusions break in. Then strengthen the boundary, try a smaller place (a bubble, a cocoon) or first build helpers. It is working when she can reach it quickly and her arousal drops measurably.

4.7 Inner helpers (hilfreiche Wesen)

Purpose / when: Early stabilisation, and as support for every later step. Imagined helper beings who are strong, caring, wise and always available. They accompany her and later care for child parts.
Steps:
1. From the safe place, invite one or more helpers to appear without deliberately choosing them.
2. Accept animals, fantasy, religious or fairy-tale figures. Idealise any real-person helpers so they cannot fail.
3. Get to know each helper: appearance, qualities, what it offers.
4. Agree how she can call them.
5. Thank them and return.
6. In later work, assign a dedicated helper to each child part. [source: Kahn 2007]
Example language (illustrative): 'Let's see whether a being wants to come that is completely on your side. You don't have to make it up; just see what shows itself.'
Watch for: Helpers who look like perpetrators or turn critical are not helpers. Send them away and invite others. A male helper may be unwanted after abuse by men, or preferred as protection; let her choose. It is working when she can call on them spontaneously in daily stress.

4.8 Tree exercise (Baumübung, CD track 5)

Purpose / when: Grounding and strengthening. Connects her with an image of rootedness, nourishment and protection.
Steps: [uncertain: Reddemann's sequence]
1. Invite a tree that feels good to appear.
2. Explore its roots, trunk, crown, bark and its place in the landscape.
3. Optionally lean against it or imagine feeling as it does: rooted, drawing nourishment from the earth and light from above.
4. Let her take some of its strength or calm with her.
5. Thank the tree and return.
Example language (illustrative): 'Notice how the roots reach into the ground and draw up what the tree needs. What would it be like to borrow a little of that steadiness?'
Watch for: Damaged or dead trees may reflect self-image. Do not interpret them; invite care or a different tree. It is working when she reports feeling grounded and can recall the tree when stressed.

4.9 Vault or safe exercise (Tresorübung)

Purpose / when: Containment. Lock away distressing images, memories and feelings until a chosen time. Use it at the end of sessions, against intrusions, and between confrontation sessions.
Steps:
1. Invite a container image (safe, vault, chest) that is strong enough. It can be placed anywhere, even far away.
2. She designs the locks and decides who has the key.
3. She puts the distressing material inside in a transformed form: as a film reel, written on paper, shrunk, or as a symbol. Feelings may be poured in as liquid or colour.
4. She closes the container and checks that it is secure.
5. Make clear the material is stored, not destroyed, and will be taken out later when she decides.
6. Return.
Example language (illustrative): 'This memory belongs to you and we will look at it when you choose. For now, let's find a place to keep it safely, so you don't have to carry it around all the time.'
Watch for: Material leaking out. Add more locks or move the container further away. Watch for avoidance that becomes permanent. It is working when intrusions decrease and she can 'close' a topic at session end.

4.10 Putting down baggage (Gepäck ablegen, CD track 2)

Purpose / when: At the start of a session or before an exercise. Lets her symbolically set aside current burdens to become more present.
Steps: [uncertain: content inferred from title]
1. Imagine putting down what she is carrying today (worries, tasks, feelings) somewhere safe, for example a bag, backpack or shelf.
2. Notice the relief.
3. Make clear she can pick it up again later.
Example language (illustrative): 'Notice what you've brought along today. You could set it down beside the door for the next half hour. It will still be there when you leave.'
Watch for: Guilt about putting things down. It is working when the patient feels lighter and more available.

4.11 Light-stream exercise (Lichtstromübung)

Purpose / when: Soothing for physical tension or pain and for diffuse distress. Use it in stabilisation and after confrontation.
Origin: [uncertain] Widely taught in German PITT-oriented settings and adapted from an EMDR resource exercise (Shapiro). It is not confirmed in the tables of contents.
Steps:
1. Locate the distressing sensation.
2. Describe its shape, size, colour, temperature and texture.
3. Invite a healing light in a colour she chooses, coming from above and flowing in through the crown of the head.
4. Let the light flow to and around the sensation, then through the whole body and out through hands and feet.
5. Check how the sensation changes.
6. Return.
Example language (illustrative): 'If that tight feeling had a colour and a shape, what would it be? … And what colour of light might be soothing for it?'
Watch for: The light becomes threatening (for example in religious trauma). Let her choose any other soothing image. It is working when the rated distress drops.

4.12 Counter-images and a counterweight to horror (Who You Were Before Trauma ch. 1)

Purpose / when: When intrusive horror images dominate. Deliberately build pleasant, strengthening images and experiences as an inner counterweight.
Steps:
1. Collect good images: memories, nature, art, imagined scenes, the safe place and helpers.
2. Practise calling one up whenever a horror image appears.
3. Strengthen it with all the senses.
4. Keep a daily record of good moments, such as a joy diary. [uncertain: diary form is synthesis]
5. Review the record in sessions.
Example language (illustrative): 'Your mind has learned to show you the worst pictures very quickly. Let's train it to show you some other pictures too.'
Watch for: Using good images to override acknowledged pain. Reddemann warns resource work must not serve denial. It is working when she can call up a counter-image during real intrusions.

4.13 Distancing from horror images (Who You Were Before Trauma ch. 1: 'Distancing')

Purpose / when: In stabilisation, to control intrusions by changing how an image is presented. This is a precursor of the screen technique.
Steps: [uncertain: specific manipulations are standard imagery techniques]
1. Picture the intrusive image as a photo or on a screen, not as reality.
2. Make it smaller, farther away, black-and-white, blurred, silent or framed.
3. Press pause, rewind or switch off with an imagined remote control.
4. Put it into the Tresor.
5. Return to the safe place.
Example language (illustrative): 'Try putting that picture on an old TV across the room. Now turn the colour down. What changes for you?'
Watch for: Distancing that tips into uncontrolled dissociation. Watch the gaze, response latency and voice. It is working when she can make the image less vivid at will.

4.14 Learning to cope with difficult feelings (ch. 3.4; Who You Were Before Trauma ch. 1)

Purpose / when: Throughout. Differentiate, name, regulate and tolerate feelings rather than intensify them.
Steps: [synthesis of the headings]
1. Name the feeling and rate its intensity.
2. Find where it sits in the body.
3. Ask which part of her is feeling it and how old that part is.
4. Choose a regulation tool: the safe place, a helper, the Tresor, a mindful anchor, the light stream, or giving the feeling a form (4.15).
5. Re-rate the feeling.
6. Validate the feeling's message ('anger tells you a boundary was crossed').
Example language (illustrative): 'On a scale of zero to ten, how strong is the fear? … Where in your body is it? … What would help it get even one point smaller?'
Watch for: Over-control and emotional shutdown. The goal is choice, not suppression. It is working when ratings drop with self-applied tools.

4.15 Giving a form to the unpleasant (Who You Were Before Trauma ch. 1)

Purpose / when: With diffuse, overwhelming feelings or body states. Externalise them into an image that can be looked at, changed and distanced from.
Steps:
1. Ask: if this feeling had a shape, colour, size, material or weight, what would it be?
2. Place the form outside the body, at a chosen distance.
3. Explore what it needs, or how it could be changed, made smaller or contained.
4. Put it in the Tresor if needed.
Example language (illustrative): 'Let's give this heaviness a shape. If you could put it on the table between us, what would it look like?'
Watch for: A form that turns into a perpetrator image. Switch to introject work (4.19) or use the Tresor. It is working when the feeling loses intensity and she gains a sense of control.

4.16 Emergency kit and flashback stop

Purpose / when: For dissociative states or flashbacks, especially outside sessions.
Source: Described in a PITT-oriented inpatient programme. [source: BPtK/Drebes 2013; synthesis for details]
Steps:
1. Build a personal emergency kit together: strong sensory stimuli (scent, sour sweet, cold pack, textured object), orienting objects (photo, date card), and a short card with what to tell herself.
2. Practise stopping a flashback through all five senses: say aloud what she sees, hears, smells, tastes and touches, plus today's date and her current age.
3. Use the kit early, before the state peaks.
Example language (illustrative): 'When the memory pulls you back, your senses can pull you here. Let's make you a small kit you can carry.'
Watch for: Kits that contain self-harm substitutes she experiences as harmful. Review after each use. It is working when episodes shorten.

4.17 Work with injured child parts (verletzte kindliche Anteile; 'Encountering our younger selves'; ch. 4.5–4.7)

Purpose / when: Central to PITT. Use it when present reactions come from younger ego states (helplessness, panic, shame). Reddemann now prefers the terms 'child parts' or 'injured parts' to 'inner child'. The adult self, not the therapist, learns to care for the younger part.
Steps: [synthesis from 2023 introduction, BPtK/Drebes 2013 and Kahn 2007; Reddemann's protocol in ch. 4.6 not drawn on]
1. Identify the younger state: 'How old do you feel right now?'
2. Strengthen the adult: today's age, her abilities and her safety now.
3. Acknowledge with compassion what the child went through. She does not need to relive the child's feelings.
4. The adult self (with helpers if needed) takes the child out of the old situation in imagination and brings it to a child-appropriate safe place. Helpers may stay with the child and look after its needs.
5. The adult checks from a distance that the child is safe. She offers comfort and asks what it needs.
6. Agree on regular short contact, such as daily check-ins.
7. Reality-test and correct the child's beliefs ('it was my fault').
Example language (illustrative): 'That little girl had no one who came. You are grown now. What does she need from you, and can you give it to her, or would you like a helper to do it?'
Watch for: Rejection of or disgust toward the child. That is common; do not force closeness. A helper can care for the child first. Watch also for regression in the session and the patient's wish that the therapist take the child. Redirect gently to the adult and helpers. Kahn reports that the adult watching a rescue can trigger flashbacks, so keep the adult at a distance or at her safe place. It is working when the patient comforts herself between sessions and symptoms tied to that age ease.

4.18 Inner stage (innere Bühne; 'The Inner Stage as a Place for Problematic Characters')

Purpose / when: To work with problematic inner figures (critical voices, perpetrator-like parts, conflicting parts) at a safe distance, as roles on a stage that the patient watches from the auditorium.
Steps: [uncertain: Reddemann's procedure]
1. The patient imagines a theatre and sits safely in the audience, possibly behind a protective barrier with helpers beside her.
2. Invite the problematic figure onto the stage and describe it.
3. Explore what it does, what it wants and what it protects.
4. Change the scene: shrink the figure, dim the light, have helpers intervene, or end the performance.
5. Close the curtain.
6. Return.
7. Variant: art-therapy work on the inner stage, by drawing or modelling the figures (Who You Were Before Trauma ch. 4).
Example language (illustrative): 'Let's give that critical voice a place up on a stage, far enough away that you can watch it. What does it look like?'
Watch for: The figure leaving the stage or overwhelming her. Increase distance, add protective glass or close the curtain. It is working when she can watch and talk about the figure without being flooded.

4.19 Ego-state work with hurtful parts (perpetrator introjects, Täterintrojekte; ch. 4.8)

Purpose / when: When inner parts attack the self with self-hatred, self-harm impulses or devaluing messages copied from perpetrators. They are understood as originally protective.
Steps: [source: BPtK/Drebes 2013 aims; Kahn 2007 summary of Reddemann's exercise; Reddemann's protocol in ch. 4.8.2 not drawn on. Sequence partly synthesis.]
1. Psychoeducation: the voice is an inner part that took on the perpetrator's words to survive. It is not who she is.
2. Identify the part and give it a form, at a distance (stage, behind glass).
3. Explore with respect what it wants to protect or prevent ('if you weren't harsh, what would happen?').
4. Acknowledge its protective intention.
5. Negotiate a new, less harmful way to fulfil that function.
6. Win over perpetrator-loyal parts; aim for respectful coexistence.
7. Reality-test: the danger is past, and the perpetrator has no power here.
Example language (illustrative): 'That voice sounds a lot like him. And yet maybe it learned to talk like that to keep you from something worse. What do you think it is afraid of?'
Watch for: Escalating self-harm after contact with the introject. Slow down, contain it in the Tresor and assess safety (standard risk assessment). Do not demonise the part. It is working when the voice becomes quieter or more cooperative and self-attacks decrease.

4.20 Dragon-slayer model (Drachentötermodell; ch. 4.9)

Purpose / when: An alternative to negotiation, for introjects whose destructive core cannot be won over. Kahn attributes this exercise to Reddemann (2004).
Steps: [source: Kahn 2007 summary; details uncertain]
1. Give the introject a form.
2. Invite strong helpers.
3. The patient watches from a safe distance while the helpers neutralise or destroy the destructive core.
4. Look at what the core had been blocking or covering, such as a valuable quality, and take it back.
5. Unfinished material goes into the Tresor.
6. Kahn's own addition: first extract the useful functions of the introject.
Example language (illustrative): 'You don't have to fight it yourself. Your helpers are strong enough. You can watch from where you are safe.'
Watch for: Guilt or loyalty conflicts if the introject resembles a parent. Clarify that it is the inner copy being addressed, not the real person. It is working when relief follows and the attacks lose their force.

4.21 Group work with stabilising techniques (ch. 4.10; ch. 10)

Purpose / when: In inpatient or outpatient settings, to teach psychoeducation and imaginative exercises to several patients at once, with peer support.
Steps: [synthesis]
1. Use a structured, closed or semi-open group.
2. Open each session with mindfulness or putting down baggage.
3. Give one psychoeducation topic.
4. Practise one guided exercise with options to keep eyes open and to opt out.
5. Debrief briefly.
6. Set home practice.
7. No trauma narratives in the group; individual sessions are for that.
Example language (illustrative): 'In this group we won't talk about details of what happened to anyone. We'll practise ways of feeling steadier.'
Watch for: Contagion of distress when someone discloses. Redirect kindly and offer an individual follow-up.

4.22 Preparing confrontation: readiness check and BASK frame (ch. 5.1)

Purpose / when: Before any confrontation. Check the prerequisites (section 2) and structure the memory along the BASK levels of Braun's dissociation model: Behaviour, Affect, Sensation, Knowledge. The manual uses BASK in ch. 5.1.1; the application below is [synthesis].
Steps:
1. Review external safety, current stability, self-harm and suicidality (standard risk assessment), and medication.
2. Test that the safe place, helpers, Tresor and observer work reliably under mild stress.
3. Choose together one circumscribed episode with a clear start and end. The end should be a point after which she was out of immediate danger.
4. Agree on a stop signal and on whether the session will be longer.
5. Plan aftercare: rest time after the session, a contact person, no demanding tasks.
6. Get explicit consent on the day.
Example language (illustrative): 'We will only look at this when you decide you want to. Let's agree on a signal you can give at any moment to stop, and what we'll do afterwards.'
Watch for: Pressure from outside (courts, partners, the therapist's own urge to 'get to the trauma'). Postpone if the criteria are not met.

4.23 Observer technique (Beobachtertechnik; ch. 5.2)

Purpose / when: PITT's preferred, gentle way of confronting a traumatic memory. The patient's present-day adult self stays safe. An observing part watches the event from a distance and reports. Afterwards the injured child part of the scene is rescued and comforted. Use it when the confrontation criteria are met.
Steps: [uncertain: Reddemann's step list in ch. 5.2.2 not drawn on. Sequence reconstructed from the 6th-edition structure, BPtK/Drebes 2013 (clear start and end, accompanied, followed by inner comfort) and Kahn's modification (adult at safe place, observer goes to the scene).]
1. Begin with grounding and contact with the adult self of today: age, date, room, therapist.
2. The adult self goes to her inner safe place with her helpers. Any child part not needed for the scene can be cared for at its own safe place.
3. Invite the observer part to step forward. The observer watches the agreed episode from a distance (for example through thick glass or from a high place), beginning before the trauma at a neutral moment.
4. The observer reports in the present tense, factually and in the third person, while the therapist asks about all BASK levels. What does the child do? What does she feel? What does her body sense? What does she know or think?
5. The therapist checks distance throughout and adjusts it: slower, further away, pause.
6. The observer follows the episode to its end, the point where it is over.
7. The adult self, or helpers on her behalf, goes to the child at the end of the scene, takes it out, brings it to a safe place, comforts it and asks what it needs now.
8. Remaining material goes into the Tresor.
9. The observer rejoins the adult.
10. Grounding, and a cognitive review of what the patient now understands about then and now.
11. Restabilisation (4.26).
Example language (illustrative): 'You stay where you are safe. Let your observer look over from a long way off. What does the observer see happening to the girl right now? … What might she be feeling? … And what is her body doing?' Later: 'It's over now. Who would like to go to her: you, or one of your helpers?'
Watch for: Collapse of distance. The patient speaks in the first person, cries uncontrollably or shows freezing. Pause, re-anchor the observer, make the image smaller or switch to screen technique; stop if needed. It is working when arousal stays in a workable range, the patient can report all BASK levels, and the memory later feels more like past and less like now.

4.24 Screen technique (Bildschirmtechnik; ch. 5.3)

Purpose / when: An alternative distancing procedure. The memory is watched as a film on an imaginary screen. Some patients find it easier than splitting into observer and child parts. The manual compares the two in ch. 5.4 (not drawn on).
Steps: [source: BPtK/Drebes 2013 (screen, third person, present tense, all four levels); remote-control details are synthesis]
1. Use the same preparation as 4.22–4.23.
2. The adult self is safe, with helpers nearby.
3. She imagines a screen far away and holds a remote control for pause, rewind, fast-forward, smaller, black-and-white and sound off.
4. She starts the film before the trauma and watches it to the point where it is over, narrating in the third person and present tense across BASK.
5. She uses the controls to keep the distance.
6. Afterwards the child in the film is cared for as in 4.17.
7. Tresor, grounding, cognitive review.
Example language (illustrative): 'You have the remote in your hand. You decide how fast, how big and how loud. Tell me what's on the screen now.'
Watch for: The film 'jumping out' of the screen. Make the screen smaller, add glass or stop the film. It is working when she can stay in control of the pictures.

4.25 Combining techniques (ch. 5.2.3)

Purpose / when: When one technique alone doesn't hold distance.
Steps: [synthesis]
1. The observer watches a screen.
2. Helpers stand with the observer.
3. The inner stage is used for a perpetrator figure.
4. The Tresor is used for parts of the film.
5. Add elements one at a time and agree them in advance.
Watch for: Complexity that confuses. Keep it as simple as possible.

4.26 Restabilisation (Restabilisierung; ch. 5.6)

Purpose / when: After each confrontation session and in the following days, when temporary increases in symptoms are common.
Steps: [synthesis]
1. Resume stabilising exercises daily: safe place, child-part check-ins, Tresor.
2. Schedule a short follow-up contact.
3. Review sleep, intrusions and self-harm urges.
4. Pause further confrontation until baseline returns.
5. Normalise transient worsening.
Example language (illustrative): 'It's quite common to feel more shaken for a few days. That doesn't mean it went wrong. Let's plan how you'll look after yourself this week.'
Watch for: Prolonged destabilisation beyond about two weeks [synthesis]. Return fully to phase 1 and reassess.

4.27 Giving sorrow room and form (integration; Who You Were Before Trauma ch. 5)

Purpose / when: In integration, to grieve what was lost: childhood, trust, health, years of life.
Steps:
1. Invite the patient to name losses.
2. Allow grief in doses.
3. Give it form: an image, colour, object, place or time of day for mourning.
4. Close each grief session with a resource.
Example language (illustrative): 'There is a lot you never got. Grief has a right to a place here. Where could it have a place in your life where it doesn't take over everything?'
Watch for: Grief sliding into depression or self-blame. Ensure resource balance. It is working when grief becomes bearable and less ruminative.

4.28 Writing letters (ch. 5)

Purpose / when: To express what was never said, to perpetrators, bystanders, the younger self or lost people. Letters are not usually sent.
Steps:
1. Choose an addressee and write freely at home.
2. Optionally read the letter aloud in session.
3. Decide what happens to it: keep, store, burn or ritual (4.30).
4. Sending is discussed separately with a safety check. [synthesis]
Example language (illustrative): 'This letter is for you, not for him. You can write everything that needs to be written.'
Watch for: Impulsive sending; flooding. Contain with the Tresor.

4.29 Encountering the older person you will someday become (ch. 5)

Purpose / when: Future orientation and wisdom. The patient imagines meeting her wise, older future self, who looks back on today.
Steps: [uncertain: Reddemann's script]
1. From the safe place, let her future older self appear.
2. Observe how she looks and lives.
3. Ask her what mattered and what advice she has.
4. Receive a word, image or gesture.
5. Return.
Example language (illustrative): 'Imagine the woman you'll be in many years, who has come through all of this. What does she know that you'd like to know?'
Watch for: No future can be imagined, which can be a marker of hopelessness. Assess suicidality using standard risk assessment and return to stabilisation.

4.30 Rituals (ch. 5)

Purpose / when: To mark endings, farewells or transitions: closing a chapter, honouring the child part, saying goodbye to a lost person.
Steps:
1. Plan together what is to be marked and what form fits her values and beliefs (burning a letter, planting something, a walk, a symbolic object).
2. Carry it out alone, with chosen people, or partly in session.
3. Reflect on it afterwards.
Watch for: Rituals imposed by the therapist. The patient owns them.

4.31 Guilt and redemption (ch. 5)

Purpose / when: To distinguish inappropriate guilt and shame taken over from perpetrators from real responsibility (for example, for harm she later caused).
Steps: [synthesis]
1. Explore the guilt beliefs.
2. Reality-test what a child could have known or done.
3. Return inappropriate guilt symbolically to the perpetrator.
4. For real guilt, acknowledge it and look for repair or self-forgiveness.
Example language (illustrative): 'Let's look at this from the outside: what could an eight-year-old really have done?'
Watch for: Premature reassurance that dismisses the guilt feelings.

4.32 Existential questions (ch. 5)

Purpose / when: When questions of meaning, justice, faith or 'why me' arise in integration.
Steps:
1. Take the questions seriously without offering answers.
2. Explore her own sources of meaning: values, spirituality, commitment.
3. Link them to the future.
Watch for: Imposing the therapist's worldview.

4.33 Gratitude and reconciliation (ch. 5)

Purpose / when: Late integration, to cultivate gratitude for what helped and, only if she wishes, reconciliation with herself or others. This is never required toward perpetrators. [synthesis on that limit]
Steps:
1. Notice what she is grateful for, daily.
2. Explore what reconciliation would mean for her: with her body, her past and her younger self.
Watch for: Forgiveness pressure from family, religion or the therapist.

4.34 Beginning anew (ch. 5)

Purpose / when: In the final phase, to transfer gains into everyday life, relationships, work and plans, and to prepare for ending therapy.
Steps: [synthesis]
1. Review the resources and skills acquired.
2. Make a written self-help plan for future crises.
3. Taper session frequency.
4. Agree on booster sessions if needed.
Watch for: Ending-related reactivation of abandonment themes. Name it openly.

4.35 Resource-oriented crisis intervention in 5–10 sessions (ch. 8.1)

Purpose / when: A short PITT format for acute crises or limited resources.
Steps: [uncertain: the manual's session plan; synthesis]
1. Session 1: safety and crisis assessment.
2. Sessions 2–3: psychoeducation, resources, mindfulness, safe place.
3. Sessions 4–6: Tresor, helpers, distancing, care for child parts in the current crisis.
4. Final sessions: self-help plan and referral if needed. No trauma confrontation.
Watch for: Pressure to process trauma within the short frame. Defer it.

5. Handling problems

The 6th edition devotes FAQ sections to imagery (3.2.2, 4.3), child-part work (4.7), introject work (4.9.2) and confrontation (5.5), and chapters to dissociative, suicidal, addicted, tortured and perpetrator patients (ch. 8). Those texts are not drawn on. The responses below are therefore [synthesis] consistent with the PITT principles above, unless a source is given.

Patient cannot imagine anything, or 'sees nothing'. Imagery may be felt, heard, thought or told as a story; seeing is not required [source: praxis-psychologie-berlin]. Start with real memories or objects (a photo, a stone, a scent). Allow eyes open. Shorten exercises. Draw or write the image. [synthesis]
Safe place or helpers turn bad, or intruders appear. Stop, ground, and validate this as information, not failure. Strengthen boundaries, choose a new or smaller place, or bring helpers first. Persistent contamination often signals an active perpetrator introject: move to 4.19 or 4.20. [synthesis]
Imagination triggers dissociation or flashbacks. These are known risks of imagery in highly dissociative patients [source: DocCheck Imagination]. Keep eyes open. Use very short, externally anchored exercises. Use the emergency kit (4.16). Monitor gaze and responsiveness. For DID, work with parts more cautiously and keep the whole system informed (6th ed. ch. 8.2.1, not drawn on). [synthesis]
Stuck in stabilisation: the patient keeps practising but symptoms persist. Review whether the exercises are actually used between sessions. Check external safety; ongoing perpetrator contact undermines everything [source: Kahn 2007; BPtK/Drebes 2013]. Look for unaddressed introjects or child parts. Consider whether careful confrontation is now indicated, or whether stabilisation is the realistic endpoint, which is legitimate in PITT. [synthesis]
Pressure to confront too early, from the patient ('I just want to get it out') or the therapist. Explain the rationale: distance and control first, so that remembering helps rather than retraumatises. Offer a readiness checklist the patient can tick herself. Respect self-determination, but do not start without the criteria. [synthesis]
Avoidance disguised as resource work. Reddemann warns resources must not serve denial or trivialisation [source: 6th ed. preface]. Gently name the avoidance, link it to fear, and agree on graded steps. [synthesis]
Non-adherence with home practice. Explore the obstacles: shame, 'it's silly', intrusions while practising, chaotic life. Reduce practice to one minute a day. Attach it to a routine. Use recordings, which can be self-made by the patient, avoiding copyrighted ones unless purchased. Ask which part of her doesn't want to practise, and why. [synthesis]
Regression and dependency: the patient wants the therapist to rescue or parent the child part. Acknowledge the longing. Redirect toward the adult self and the helpers caring for the child. Keep the frame (session times, limited contact). Discuss transference openly (ch. 3.5, 3.1.6). [synthesis]
Rejection of the child part ('I hate her, she was weak'). Common; often reflects the introjected perpetrator view. Do not force closeness. Let a helper care for the child. Explore the hatred as protection. Return to it later. [synthesis]
Ruptures, such as feeling unseen, misattunement, the therapist triggering as a perpetrator figure. Use the answering stance: name what you noticed, take your share, and ask how it was for her. Repair explicitly. Check for transference triggers (voice, gender, posture) and adjust what you can. [synthesis]
Overwhelm during confrontation. Stop the scene. Strengthen distance (smaller, further away, glass, pause). Bring her back to the adult self in the room through orientation and senses. Put the rest in the Tresor. Restabilise and reassess readiness; return to phase 1 if needed. [synthesis]
Escalating self-harm, suicidality or crisis. Pause trauma-focused work. Perform a standard suicide risk assessment and safety planning according to local guidelines, and involve crisis services as indicated. PITT then returns to resource-oriented crisis intervention (ch. 8.1, 8.4). Introject work may follow once she is safe. [synthesis; source for chapter existence: 6th ed. TOC]
Ongoing perpetrator contact or current violence. This is a contraindication for confrontation [source: BPtK/Drebes 2013; Kahn 2007]. Focus on external safety, protective measures, legal or social support, and stabilisation. [synthesis]
Substance use. Stabilisation and addiction treatment run in parallel. Confront only when use is stable. Build helpers and safe-place work as alternatives to the substance (6th ed. ch. 8.5, not drawn on). [synthesis]
Patients who find imagery 'esoteric' or reject it on religious grounds. Frame it as ordinary mental training, like athletes' visualisation. Adapt the imagery content to her worldview. Offer cognitive, body-based or art-based alternatives. [synthesis]
Therapist overload or secondary traumatisation. Reddemann includes therapist self-care in the manual (ch. 7). Use supervision and limit the number of confrontation cases. Apply the exercises to yourself. [synthesis on specifics]
Uncertainty about memories or suggestibility. Imagery can shape memory content. Do not use imagery to 'recover' unknown memories, and do not confirm details beyond what the patient brings. Keep the focus on current functioning. Note that Kahn's observer variant explicitly searches unknown memories; this is her modification and not standard PITT, and caution is advised. [synthesis; source for Kahn variant: Kahn 2007]

Sources

Sources:

Further reading (full text not drawn on unless listed above):

Reddemann, L. et al. (2021). Psychodynamisch Imaginative Traumatherapie – PITT: ein Mitgefühls- und Ressourcen-orientierter Ansatz in der Psychotraumatologie (11th ed.). Klett-Cotta.
Reddemann, L. (2011). Psychodynamisch Imaginative Traumatherapie – PITT – Das Manual (6th rev. ed.). Klett-Cotta.
Reddemann, L. Imagination als heilsame Kraft. Klett-Cotta (multiple editions); exercise CD 2003.
Reddemann, L. (2020). Who You Were Before Trauma: The Healing Power of Imagination for Trauma Survivors. The Experiment.
Reddemann, L., Höfer, S., & Schäfer, F. (2023). PITT mit Kindern und Jugendlichen. Klett-Cotta.
Krüger, A., & Reddemann, L. PITT-KID – Das Manual (2nd ed.). Klett-Cotta.
Braun, B. G. (1988). The BASK model of dissociation. Dissociation, 1(1), 4–23.

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