Psychodynamic Psychotherapy and Psychoanalysis Difference: Psychotherapy and Analysis Based on Depth Psychology

Depth psychology is an umbrella term. It encompasses all approaches that assign a central role to the unconscious, and psychoanalysis is just as much a part of this as the Analytical Psychotherapy (AP).

Alongside this is a separate process with its own significance: the Psychodynamic psychotherapy explained simply, or TP for short, named in the Psychotherapy Guidelines. Patients faced with this choice usually hear first about the number of hours and the couch. Both are the result, not the cause.

Two of them are methods; the third is a theory.

Depth psychology is the theory: the assumption that unconscious processing shapes our experience. The Encyclopedia Cod He uses it as an umbrella term for the branch of psychology that does not remain confined to the surface of conscious mental life, and includes Freud, Adler, and Jung alike within this category. In a narrower sense, the method defined in § 16a of the guidelines and described as “depth psychology-based” refers to the treatment of currently active neurotic conflicts and structural disorders, taking into account transference, countertransference, and resistance. The second approach is AP, defined separately in § 16b. Colloquially, it is called Psychoanalysis. The two terms aren't exactly the same: "AP" is the procedure code in the point-of-sale system, while the term also refers to the theory and treatment methodology as a whole.

And then there’s the counting trap. Section 15 of the directive 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 procedures side by side on its patient page, giving them equal prominence.

The difference between the two methods lies in a single word: regression.

The directive formulates this in almost mirror-image fashion in two places. With regard to depth psychology-based psychotherapy, Section 16a, paragraph 2, aims to focus the process, among other things, by „limiting regressive processes.“ For AP, § 16b stipulates the opposite: the therapeutic process is to be initiated and promoted—precisely „through the use of regressive processes“—with the help of transference, countertransference, and resistance analysis.

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 guideline explicitly requires that it be followed in transpersonal psychotherapy as well. The decisive factor is where the work takes place. In depth psychology-based psychotherapy, the emotion remains where it arises—at the workplace or 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 version of it.“ It has its own unique quality of relationship.

Freud's Psychoanalysis is the standard procedure in the narrow sense: high-frequency treatment while lying down, originally five to six hours per week, with a very broad scope. Psychoanalysis emerged as a therapeutic discipline from this approach. In clinical practice today, the standard procedure has been almost completely replaced and is primarily found in the Classroom Analysis Usage.

AP has taken this place and is specified in the guidelines as a treatment: two or three hours per week, lying down on the couch, 160 to 300 sessions. The Psychotherapy Guidelines Section 23 sets a limit of three treatment hours per week and expressly excludes continuous high-frequency treatment. If there is a justified need, the frequency may be higher for limited periods of time.

The modified form of the analytical approach is the same face-to-face psychotherapy. What changes is the technique. Regression is limited rather than deepened; the corrective relational experience precedes insight; and the therapist plays a more active role.

The couch is therefore a characteristic of the specific version of the procedure, not of the procedure itself. When a patient asks about it, they are asking about the technique, not the quota. It is not mentioned even once in the guidelines, and the application forms do not ask about this item. The professional association DGPT describes Freud's couch setting as an essential tool for treatment and insight in psychoanalytic therapy.

The real difference lies in the scope. Section 16a describes TP as work on currently active neurotic conflicts and structural disturbances, 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 types of therapy, and in both cases, the therapist is interested in where it comes from. The procedures are distinguished by where the work is performed. TP addresses the pattern wherever it manifests itself today—whether in a relationship or at work. Psychoanalysis allows it to emerge between Patient and it arises once again between the client and the therapist, and they work 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 disturbance; in psychoanalysis, 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. Psychotherapy must understand these patterns in order to contextualize the disorder, but it addresses them only to the extent that they contribute to the disorder.

How the analysis changes her depends on what’s missing. If a conflict has been repressed, she works with interpretations. Understanding it once doesn’t change anything; the pattern must keep reappearing and be recognized again and again, and this repetition is what we call “working through it.” Because the pattern shapes all relationships, what ultimately shifts isn’t a single symptom, but rather how one interacts with others. If, on the other hand, a skill—such as regulating emotions or maintaining a relationship—is missing from the outset, interpretation is of little help. In that case, the relationship itself takes on that role. The therapist temporarily takes on the missing function, providing a corrective experience that helps fill in developmental gaps.

This is reflected in the Quotas ...which health insurance companies cover as standard care. For adults in individual therapy, the limit for TP in the first approval stage is 60 hours, with a total of 100. The analysis comes to 160, for a total of 300. Separate figures apply for children, adolescents, and group therapy. The „up to“ provision applies under one condition: Hours 61 through 100 are contingent on the treatment goal not yet having been achieved, but being within reach. Short-term therapy is the same for both approaches: twelve plus twelve hours each.

The TP may also take the form of a long-term relationship. Section 16a, paragraph 2, sentence 2 expressly states that it also applies in cases where a long-term therapeutic relationship is necessary.

The application process is the same for all four methods. Form PTV 1 from the Federal Association of Statutory Health Insurance Physicians’ sample collection lists four boxes of equal importance: 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 psychotherapeutic consultation, which preliminary hearings and, if the treatment is not being provided by a doctor, a medical Consultation Report.

The expert evaluation process applies to long-term therapy as individual therapy, regardless of the chosen approach. Psychoanalysis is almost always requested as long-term therapy; its maximum limit is 300 hours, which is why it almost always ends up being reviewed by an expert. In the case of short-term therapy, the health insurance provider may still require an expert review on a case-by-case basis.

The appropriate treatment approach is discussed during the assessment phase, which takes place two to four sessions before the actual therapy begins. These sessions are not counted toward the total number of hours.

I base my recommendation primarily on the patient’s personality structure. Significant abnormalities or deficits in this area tend to point toward psychoanalysis. This is a general trend rather than a rule: The guidelines explicitly assign structural disorders to depth psychology-based psychotherapy as well. The structure tends to determine how treatment is conducted rather than which specific method is used. For more conflict-oriented neurotic disorders and a moderately to well-integrated structure, psychotherapy is often sufficient.

Motivation plays a role. Those who have already reflected on their situation and are ready to accept themselves often get further with the analysis. Those who have little motivation, are afraid of the treatment, or—above all— Current Conflicts For those looking to solve a problem, TP is usually the best first step. The analysis can follow if necessary.

Ultimately, the patient decides this together with the practitioner, following the initial consultation—not before it.