Psychodynamic Psychotherapy for Trauma: What It Contributes

Thinking of trauma therapy in terms of depth psychology sounds like a distinct method for processing trauma. It is not. Trauma-related disorders are primarily treated using trauma-focused approaches.

The distinctive contribution of depth psychology-oriented therapies lies at a different point in the same treatment. It begins with the assessment of how resilient a person currently is. This assessment is part of every trauma treatment that meets professional standards. What is distinctive is the framework used for the assessment: a concept of structure, that is, how well someone can regulate their emotions, maintain their self-esteem, and allow themselves to get close to others.

But that’s not where the contribution ends. The emotional wounds left behind by trauma (shame and guilt, damaged self-esteem, and relationships that fail over and over again in the same way) have long been this tradition’s field of work: addressing the inner psychological and psychosocial consequences of trauma.

A severe experience can overwhelm a person’s ability to process it at the moment it occurs. Most people do not go on to develop post-traumatic stress disorder (PTSD). PTSD is only diagnosed when re-experiencing, avoidance, and constant vigilance persist and significantly interfere with daily life.

If it persists, depth psychology views it as an experience that remained disconnected rather than becoming integrated into one’s life story. In severe cases, dissociative symptoms also appear: memory lapses, a feeling of being detached from oneself, and a sense that one’s own perceptions are unreal. The psychodynamic reading describes this as separation of individual self-states, so that the unbearable does not have to be felt as a whole. This is an interpretation, not an established explanation of every consequence of trauma. This tradition’s own perspective lies precisely in this: how it has continued to have an effect since then matters more than what happened.

Attachment trauma and developmental trauma are terms from the clinical literature, not diagnoses. To date, neither of these words appears in the 195 pages of the current S3 guideline.

This refers to two related concepts. In 2018, Jochen Peichl described attachment trauma as the result of early separations from parents (for example a prolonged hospital stay with the visiting ban that was usual at the time), of caregivers who were experienced as unpredictable, or of neglect and emotional coldness.

In my experience, attachment trauma often manifests as mistrust, insecurity, and problems with self-esteem. People who have been severely emotionally neglected or humiliated may express this through insecure, submissive behavior, and sometimes through how little self-care remains over the years. Ermann cites nearly the same signs as indicators of a hidden post-traumatic disorder: a distrustful, withdrawn personality, unhappy relationships, and disruptions in the course of life.

In the version of February 27, 2026, the S3 guideline on post-traumatic stress disorder recommends trauma-focused therapy in an individual setting (grade of recommendation A). Five approaches with robust evidence are named: EMDR, cognitive therapy, cognitive processing therapy, narrative exposure therapy, and prolonged exposure. The article Processing trauma with EMDR describes how such processing with EMDR works. Guidelines normally recommend well-studied approaches, and because of the one-sidedness of the current research system, that then inevitably comes down to cognitive and behavioral therapy approaches.

Depth psychology is not included on this list. It is not recommended anywhere in the guideline. Where it is mentioned at all in relation to adults, it appears under the research recommendations: There, the guideline calls for the “systematic evaluation of the effectiveness of various psychodynamic treatment approaches for PTSD, given the great importance of the approaches of psychoanalytic psychotherapy and depth psychology-based psychotherapy in the German healthcare system.” The guideline thus explicitly acknowledges how widespread the approach is in Germany, yet still lists its evaluation as something that remains to be done.

Nevertheless, the two are not mutually exclusive. The Psychotherapy Guidelines of the Federal Joint Committee explicitly permit EMDR for adults with PTSD, specifically “as part of a comprehensive treatment concept of behavioral therapy, depth psychology-based psychotherapy, analytical psychotherapy, or systemic therapy.” An appropriate qualification is required.

The phase model goes back to Judith Herman, whose book appeared in German in 1993 as “Die Narben der Gewalt” (literally “The Scars of Violence”). She herself describes the three stages differently than the German shorthand: establishing safety, recounting the story of the traumatic event, and reestablishing connections with others. In an essay from 1998 she puts it cautiously, “The recovery process may be conceptualized in three stages,” that is, as a model and not as a rule. In German-speaking countries, this became stabilization, processing, and integration. In his 2018 standard work, Jochen Peichl turns this into a clear principle: “It is imperative to turn to the traumatic material only when the patient knows enough methods to distance themselves from the emerging memories (intrusions) again afterward, in order to avoid retraumatization.”

The current guideline contradicts this, saying: “There is currently no evidence to support the need for a general preliminary stabilization phase prior to trauma-focused psychotherapy for adult patients with PTSD.” It also points out the cost: A stabilization phase could delay symptom reduction and unnecessarily prolong treatment. A preparatory phase is warranted only when there are specific indications: as examples, the guideline names acute suicidality and severe dissociation that hinders therapeutic progress. Whether trauma therapy requires stabilization is thus no longer a matter of principle, but rather a question of the individual case.

In my experience, the structural level, that is, how well organized and resilient someone was before the event, mediates between the guideline and the tradition. Time is of secondary importance. The guideline itself acknowledges this idea in one passage. In its chapter on adults with intellectual developmental disorders, it states that where self-regulation does not succeed, improving it is the necessary prerequisite for trauma-focused work.

In cases of complex trauma, the guideline becomes more specific. Grade of recommendation B, also new in 2026: “For complex PTSD according to ICD-11, psychotherapeutic treatment should be carried out with a combination of trauma-focused techniques that emphasize processing the memory of the traumatic experiences and/or their meaning, as well as techniques for emotion regulation, and for improving self-esteem and relationship disturbances, in the sense of working on dysfunctional interpersonal patterns.”

What is recommended is not a school of therapy but a combination. The work on the memory itself is named first, and it remains the core. Alongside it are emotion regulation, self-esteem, and recurring patterns in relationships, and this is the foundation of depth psychology-based psychotherapy. Those who come with these issues are less often looking for quick relief from symptoms than for an answer to why certain patterns repeat themselves in every new relationship.

The consequences of trauma rarely occur in isolation. The guideline provides statistics: About 80 percent of people with PTSD meet the criteria for at least one additional mental disorder at some point in their lives, and two-thirds even meet the criteria for two or more. The most common are mood disorders, anxiety disorders, physical symptoms without sufficient organic findings, and substance-use disorders. This is no reason to wait. In cases of additional mental illnesses, the guideline recommends trauma-focused therapy with its strongest grade of recommendation. Trauma-focused treatment should also be used in cases of suicidality, self-harm, or substance use, as long as there are no severe disorders of behavioral control. This point is based on expert consensus rather than on studies. Another condition is given priority only if it prevents a person from benefiting from trauma treatment at all, for example in cases of severe depression.

This is exactly where the work discussed on this page begins. The guideline calls for a comprehensive treatment plan at this very point. Four diagnoses listed side by side do not yet constitute one. From a psychodynamic perspective, what matters is what connects the diagnoses. How many labels a person has is less important. What matters is not so much the syndrome as the etiology, that is, the cause. Too many diagnoses listed side by side can obscure the cause and narrow the treatment down to just one aspect.

Two situations arise in practice. If a patient presents after a traumatic event with PTSD as the clear primary issue, and if the person was reasonably stable beforehand, a trauma-focused approach can be taken immediately. This is trauma therapy, and it does not require depth psychology.

The other scenario is more common, and it’s the one rooted in depth psychology: A trauma isn’t brought up until later, once someone has gained access to their feelings and has engaged with their own past over the course of several sessions. Michael Ermann calls this a hidden post-traumatic disorder and interprets the recollection as a sign that the therapeutic relationship has become stable. In the past, I would then assess whether it was appropriate: whether the person was stable, and whether other issues were currently taking center stage.

In the end, what decides is the person before the event, more than the event itself. If someone has a well-integrated personality, they’re naturally more resilient. But if someone can’t regulate their emotions or has severe deficits of some kind, you have to proceed with greater caution.

Today I work as an online psychologist in counseling. With me, depth psychology online is also counseling, not trauma treatment. In the case of PTSD, in-person treatment is the right path, and I will help you look for it.