Depth psychology is an umbrella term. It encompasses all approaches that assign a central role to the unconscious, and psychoanalysis belongs to it just as much as analytical psychotherapy (AP) does.
Alongside this is a separate approach with its own significance: depth psychology-based psychotherapy, TP for short, so named in the Psychotherapy Guidelines. Patients faced with this choice usually hear first about the number of sessions and the couch. Both are the result, not the cause.
Two of them are approaches; the third is a theory.
Depth psychology is the theory: the assumption that unconscious processing shapes our experience. The Dorsch encyclopedia lists it as an umbrella term for the branch of psychology that does not remain at the surface of conscious mental life, and counts Freud, Adler, and Jung alike as part of it. Narrower in scope is the approach that the Psychotherapy Guidelines define in Section 16a and call depth psychology-based: the treatment of currently active neurotic conflicts and structural disorders, taking into account transference, countertransference, and resistance. The second approach is AP, with its own definition in Section 16b. Colloquially, it is called psychoanalysis. The two are not entirely identical: AP is the name of the approach in the statutory health insurance system, while the term psychoanalysis also stands for the theory and for the theory of treatment as a whole.
And then there’s the counting trap. Section 15 of the Psychotherapy Guidelines lists three forms of treatment: psychoanalytically based approaches, behavioral therapy, and systemic therapy. It is not until Section 16, paragraph 2, that the first of these three is divided into two distinct approaches. Anyone who speaks of four psychotherapy approaches is correct. Anyone who speaks of three forms of treatment is also correct. The North Rhine-Westphalia Chamber of Psychotherapists lists four approaches of equal rank side by side on its patient page.
The difference between the two approaches lies in a single word: regression.
The Psychotherapy Guidelines word this in almost mirror-image fashion in two places. For depth psychology-based psychotherapy, Section 16a, paragraph 2, aims to focus the process, among other things, through “limitation of regressive processes.” For AP, Section 16b stipulates the opposite: the therapeutic process is to be initiated and promoted with the help of transference, countertransference, and resistance analysis, precisely “through the use of regressive processes.”
The same paragraph identifies two additional characteristics of TP: a limited treatment goal and a predominantly conflict-centered approach. Both are tied to the same concept. Anyone who limits regression must also limit the scope of the work.
An example makes this easier to understand. A patient brings with him a feeling toward his own boss that actually stems from his relationship with his father. That is transference, and this applies to both approaches: the Psychotherapy Guidelines expressly require that it be taken into account in TP as well. The decisive factor is where the work takes place. In depth psychology-based psychotherapy, the feeling remains where it arises, at the workplace and in the current relationship. In psychoanalysis, it shifts into the relationship with the therapist and is worked through there. Ermann refers to these as external transference and internal transference.
In his textbook, Ermann states that TP is a “form of treatment that differs qualitatively from analytical psychotherapy and is not merely a shortened variant.” It has a relational quality of its own.
Freud’s psychoanalysis is the standard approach in the narrow sense: high-frequency treatment while lying down, originally five to six sessions per week, with a very broad aim. Psychoanalysis emerged as a theory of treatment from this way of working. In health care today, the standard approach has been replaced almost completely and is used mainly in training analysis.
AP has taken this place and is listed in the Psychotherapy Guidelines as an approach: two or three sessions per week, lying down on the couch, 160 to 300 sessions. In Section 23, the Psychotherapy Guidelines cap treatment at three sessions per week and expressly exclude continuous high-frequency treatment. If there is a justified need, the frequency may be higher for limited periods of time.
The modified form of analytical treatment is the same psychotherapy, conducted sitting face to face. What changes is the technique. Regression is limited rather than deepened, the corrective relational experience takes priority over insight, and the therapist is more active.
The couch is therefore a feature of the variant and not of the approach. A patient who asks about it is asking about the technique, not the quota. It does not appear even once in the Psychotherapy Guidelines, and the application forms do not ask about the position. The professional association DGPT calls Freud’s couch setting an essential tool of treatment and insight in analytical treatment.
The real difference lies in the scope. Section 16a describes TP as work on currently active neurotic conflicts and structural disorders, while Section 16b describes psychoanalysis as work on neurotic conflict material and the underlying neurotic structure. This sounds like two different conflicts, but it is actually one.
Anyone who is torn between independence and the fear of losing the other person brings this conflict into both approaches, and in both the therapist is interested in where it comes from. The approaches are separated by where the work is done. TP clarifies the pattern where it occurs today, in a relationship or at work. Psychoanalysis lets it arise once more between patient and therapist and works through it there as it happens. That is the greater depth.
This leads to the stated goal. In depth psychology-based psychotherapy, the goal is to reduce or eliminate the current disorder; in analysis, it is the restructuring and further maturation of the personality. Structure here refers to the enduring patterns through which a person relates to themselves and to others. TP must understand these patterns in order to put the disorder in context, but it treats them only to the extent that they play a part in the disorder.
How analysis changes them depends on what is missing. If a conflict has been repressed, analysis works with interpretations. Understanding it once changes nothing; the pattern must keep reappearing and be recognized again and again, and this repetition is called working through. Because the pattern shapes all relationships, what shifts in the end is not a single symptom but how one deals with people. If, on the other hand, a capacity has been missing from early on, such as regulating feelings or sustaining a relationship, interpretation helps little. Then it is the relationship itself that carries the work. The therapist takes over the missing function for a time, a corrective experience that fills in developmental deficits.
This is reflected in the quotas that health insurance providers cover as standard care. For adults in individual therapy, the limit for TP is 60 sessions in the first approval step and 100 in total. Analysis comes to 160, and 300 in total. Separate figures apply for children, adolescents, and group therapy. The “up to” holds under one condition: sessions 61 to 100 require that the treatment goal has not yet been reached but is within reach. Short-term therapy is the same for both approaches, twelve plus twelve sessions each.
TP can also be the long variant. Section 16a, paragraph 2, sentence 2 expressly states that it also applies in cases where a long-term therapeutic relationship is necessary.
The path to the application is the same for all four approaches. Form PTV 1 from the sample collection of the National Association of Statutory Health Insurance Physicians lists four boxes of equal rank: behavioral therapy, systemic therapy, depth psychology-based psychotherapy, and AP. All four have the same status. The preliminary steps are also the same for all four: a psychotherapy consultation, the trial sessions, and, if the treatment is not provided by a physician, a medical consultation report.
The expert review procedure is tied to long-term therapy as individual therapy, regardless of the chosen approach. Psychoanalysis is almost always applied for as long-term therapy, its maximum is 300 sessions, and that is why it almost always ends up with an expert reviewer. In the case of short-term therapy, the health insurance provider can still require an expert opinion in an individual case.
The trial sessions, two to four of them before the actual therapy begins, are used to discuss which approach is an option. They do not count toward the session quota.
I base my recommendation mainly on personality structure. More marked abnormalities or deficits there tend to point toward psychoanalysis. This is a tendency and not a rule: the Psychotherapy Guidelines expressly assign structural disorders to depth psychology-based psychotherapy as well. Structure tends to decide how treatment is carried out rather than which approach is on the label. For more conflict-oriented neurotic disorders and a moderately to well-integrated structure, TP is often sufficient.
Motivation plays a role. Those who are already reflective and ready to accept themselves often get further with analysis. For those who have little motivation, are afraid of the treatment, or above all want to resolve current conflicts, TP is usually the better first step. Analysis can follow if needed.
In the end, the patient decides this together with the practitioner, after the initial consultation and not before it.
In a broad sense, yes. Depth psychology is the umbrella term for all approaches that assign a central role to the unconscious, and psychoanalysis is one of them. In a narrow sense, however, as the name of an approach in the Psychotherapy Guidelines, TP is an approach of its own, separate from analysis.
No, that is not a requirement. The Psychotherapy Guidelines do not mention the couch at all. It is a technical aid to promote regression and is not part of the application or the approval.
For adults in individual therapy, up to 100 sessions in depth psychology-based psychotherapy and up to 300 in analysis, in each case as the maximum limit across several approval steps. Short-term therapy is the same for both approaches, at twelve plus twelve sessions.
The name of the approach in the statutory health insurance system for what is colloquially called psychoanalysis. It addresses the symptoms that bring a person to the therapist’s office, as well as the unconscious conflicts underlying them and the personality structure from which these conflicts repeatedly arise. To do this, it uses regression: old, often very early patterns of experience resurface in the relationship with the therapist and are worked through there. Two to three sessions per week are typical.
As a theory, it includes every approach that gives the unconscious a central role. The Dorsch encyclopedia counts Freud, Adler, and Jung alike as part of depth psychology. As treatment, two approaches on this basis are listed in the Psychotherapy Guidelines: depth psychology-based psychotherapy under Section 16a and AP under Section 16b.
Psychotherapy is the umbrella term; psychoanalysis is one of the approaches it encompasses. The difference lies in the level: four approaches have the status of psychotherapy in the statutory health insurance system, and AP is one of them.
This is agreed individually. One session per week is typical for depth psychology-based psychotherapy, and two to three sessions for psychoanalysis. The Psychotherapy Guidelines do not allow more than three sessions per week on a continuous basis, at least not at the health insurance provider’s expense.
