Psychotherapy Based on Depth Psychology Explained Simply: How It Works and What It Changes

The experiences of our childhood shape us in ways we often don’t notice for a long time. In particular, our relationships with our primary caregivers leave their mark on the way we feel, think, and act.

As children, we lack the freedom to consciously choose certain behaviors. We adopt the behaviors we see modeled. We develop strategies to cope with whatever comes our way. A child who repeatedly experiences that their feelings aren’t taken seriously learns to hide them. Another child, who is praised for achievements and criticized for mistakes, may come to believe that: I'm only valuable if I'm perfect. In transactional analysis, this type of pattern has its own name: the „Be Perfect“ Drive.

What exactly does “based on depth psychology” mean in this context? It means looking at where these patterns originated, rather than focusing solely on current behavior.

Therapy Based on Depth Psychology makes us aware of what unconsciously guides us: old feelings, relationship patterns, and experiences that have become ingrained in our lives.

For change to happen, something must first come to life. Change occurs through interaction: when an old experience elicits a different reaction from the other person than expected. When feelings are expressed and taken seriously, or when appreciation is shown even without any specific achievement. That’s when space is created for something new.

Consciousness lies above the surface of the water. It encompasses everything we clearly perceive: our actions, thoughts, speech, and the feelings we are aware of. It is the part of ourselves that we believe we know.

Just below that lies the preconscious mind. What lies there is not constantly accessible to us, but we can tap into it when we direct our attention there: a mood that resonates in the background, a memory that can be recalled, a pattern of reaction that has become so familiar that it happens on its own.

But we don't see most of the iceberg. The unconscious.

The Id, the Ego, and the Superego

The image shows just how much—or how little—we are aware of ourselves. Yet at this depth, several forces are at work simultaneously, and they are distributed across all levels.

There is the Id: the seat of our instincts and basic needs. The desire for closeness, for recognition, for pleasure, for protection. The Id does not ask whether something is allowed. It simply wants. And it remains the most deeply hidden part of us, almost entirely submerged.

Opposite it stands the superego: the internalized norms and prohibitions, the rules and ideals that we have adopted from our significant others. It tells us what we are allowed to do and what we are not, often in exactly the same tone in which it was once said to us. Sometimes we hear its voice very clearly. Sometimes it seems to come from the shadows.

The ego mediates between the two. It defines who we are and regulates how we deal with what drives us from within and what is forbidden to us. We are aware of part of this. Much of it—including our defenses—takes place unnoticed.

Relationship Representations

The classic instances describe how our psyche works: what drives us, what guides us, and what restrains us. Relationship representations describe what our inner life consists of: specific scenes in which an image of ourselves, an image of the other, and the connecting emotion come together.

And these scenes come first. These instances do not emerge as finished structures that one then fills; they first take shape out of patterns of interaction that are repeated early on. Representations of relationships are the stuff of which the inner world is made. The material comes before the function. The Id, the Ego, and the Superego spend a lifetime working on something that took shape before they did.

These images are not just another layer on top of the others. They are the very fabric of our inner world. The Id, the Ego, and the Superego work on them and with them.

The unconscious does not remain hidden. Largely unnoticed by us, it becomes visible in our current relationships. At work, in romantic relationships, and in therapy, what is at work beneath the surface comes to the surface.

In the image, there is a dividing line between consciousness and everything that lies beneath it. It represents the defense mechanism.

The psyche does not allow everything that goes on within it to enter consciousness unchecked. It keeps some things at bay, rearranges others, keeps some things separate—and does most of this without us even noticing.

Why?

Because some feelings, desires, and memories are linked to fear—the fear of losing the love of people who are important to us. The fear of being punished or shamed. And an even more fundamental one: the fear of being overwhelmed by a feeling that is unbearable.

A child who senses that their anger is threatening their relationship with their parents faces a problem. The anger is there. But showing it seems dangerous. So the mind does what makes the most sense in that moment: it pushes the anger out of consciousness. The child no longer feels it. And along with the anger, the fear also disappears.

Defense mechanisms are not a flaw. They are an achievement of the soul—often a wise one—that has carried us through a time when we had no other choice.

Defenses as Filters
There are many such mechanisms, and they do not all work the same way. Some respond to a conflict—that is, to a desire that clashes with an internalized prohibition. They do this by pushing something below the threshold of consciousness. Here are four examples:

Repression: An unbearable feeling or a threatening memory is pushed so far away that, in the end, we no longer even know it ever existed.
Displacement: Frustration with one's boss spills over into the family in the evening. The feeling is directed at a less threatening substitute target, because the actual target would be too risky.
Reaction Formation: Those who fear intimacy come across as deliberately independent. Those who are not allowed to acknowledge their own anger are conspicuously friendly. The forbidden impulse manifests as its opposite.
Rationalization: The real reason remains unconscious, and another, more acceptable one takes its place. Someone does not apply for the job they’ve been hoping for and convincingly explains that the conditions would have been poor anyway.
As different as these four may seem, they all require the same thing: a reasonably stable inner image of ourselves and of the people who are important to us. Only then can a feeling continue to work behind the scenes without shattering the entire image.

Defense as a Division
Splitting is older than these mechanisms and works differently. It doesn't hide any feelings. It changes the image we form of a person.

To understand this, it helps to look back to the beginning. A very young child experiences his mother in separate moments: Sometimes she is there, warm and kind. Sometimes she is out of reach, and in that moment, she is completely bad to the child. These two aspects of the mother do not yet belong together. The child is not yet able to think: That's the same person who loves me and is still making me wait right now.

This ability develops over the course of a child’s first few years of life. It becomes more firmly established sometime between the ages of three and five. The child can now hold a single, complete image of a person within themselves—an image that encompasses both the good and the bad. This image remains intact, even when the person is currently angry, disappointing, or unavailable. The mother hasn’t disappeared just because she’s upset. She’s still the same person.

As long as we lack this ability, there is only one solution: to keep the incompatible things separate:

Polarization: People and situations are divided into either purely good or purely evil. Not out of malice, but because the ambivalence of loving the same person and being angry with them at the same time would create more inner tension than one can bear. The feeling does not disappear into the unconscious. The image of the other person breaks down into two separate halves—one good and one evil—that alternate with one another.
Projection: We perceive in others a feeling of our own that we cannot bear in ourselves. It's not me who's angry—it's the other person. The feeling isn't buried—it's simply shifted: from within oneself to another person.
Denial: A reality that would be too painful to face is simply ignored.
To name just a few mechanisms of splitting. This early form of defense responds to the most fundamental of the fears mentioned: the fear of being overwhelmed. For those who do not yet have a reliable inner image capable of holding a contradictory feeling, that feeling threatens to overwhelm them. Keeping things separate is then not a form of concealment, but a protection against being overwhelmed.

The Price of Defense
As useful as these mechanisms once were, over time they take their toll.

What we push away doesn’t disappear. What we keep submerged demands to be expressed. It takes energy to keep it submerged permanently—energy that’s then lacking for other things. And it distorts our perception: Those who had to lock away their anger as children often fail to feel it as adults, even when it would be justified and necessary. Those who have come to view closeness as dangerous keep people at a distance who would actually be good for them.

What is kept separate remains divided. The world then repeatedly breaks down into good and evil: people are idealized and soon afterward devalued; relationships swing from closeness to disappointment. And when that separation fails, the very thing it was meant to protect against descends upon us: a feeling that overwhelms us.

The protection that used to help is now holding us back.

This is often where a symptom originates. It usually requires a trigger: a current situation that closely mirrors the old, unconscious conflict, revives the repressed conflict, and undermines the defense mechanism. The symptom then emerges as a kind of stopgap solution.

For a large portion of complaints—the classic neurotic symptoms—it is a compromise: it keeps the conflict and the associated anxiety out of consciousness while at the same time allowing some aspect of the forbidden to emerge, in a coded form. The conflict remains unconscious, but at the cost of the symptom.

Here’s an example. A person is deeply hurt and at the same time angry at a parent whom they still love and need. Feeling this anger seems dangerous: it could threaten the bond and trigger feelings of guilt. So it is kept out of consciousness. But that doesn’t mean it has disappeared. It returns in a transformed form—for example, as a constant, agonizing worry that something might happen to that parent. This is precisely where the compromise lies: the hostile impulse takes on a disguised form, from „I could wish you harm“ will be „I'm afraid something bad will happen to you.“, and is turned on its head in the very same moment. Concern is a sign of love rather than hate, yet at the same time robs the person affected of their peace of mind. The real conflict remains hidden, yet is at work the entire time.

Or: Someone learned early on that needing help is shameful, that one must be strong and independent. The longing for closeness and care remains, but openly showing it is impossible. Instead, recurring physical ailments arise, forcing him to slow down and prompting others to take care of him. This, too, is a compromise: the longed-for care is provided, but in a coded way—through the symptom rather than through a request. He is spared the shame of openly appearing needy, but he pays the price with his ailments.

Not every symptom arises in this way. Some symptoms do not stem from a repressed conflict, but rather from a lack of inner resources: for example, the ability to regulate emotions, maintain relationships, or sustain one’s self-esteem. In these cases, the symptom does not hide anything; rather, it reveals a deficiency. This often becomes apparent precisely when life demands something that one was never able to learn: in a new relationship, when starting a course of study, or when entering the workforce.

Post-traumatic stress disorders arise from an experience that was so overwhelming that it could not be processed or made sense of. In situations that remind the person of what happened, the original experience comes back to life, often as if it were happening right now, rather than as a distant memory.

These three factors—conflict, developmental deficits, and trauma—lead to various symptoms and require different forms of therapy.

If symptoms are primarily related to stressful or traumatic experiences, a specific Trauma therapy such as EMDR be a good idea.

Depth psychology psychotherapy focuses on identifying the internal and external triggers that have led to the current symptoms. It does not aim to completely transform the entire personality or to work through one’s entire life story.

The goal is to work with the patient to understand and change only those aspects that are contributing to the current problem. In this way, treatment can help correct distorted perspectives, address skill deficits, and enable the patient to better cope with current life situations. This focus distinguishes the depth psychology approach from classical psychoanalysis, which is more comprehensive and long-term in nature.

Whether a therapy is grounded in depth psychology or structured as psychoanalysis depends primarily on its scope and focus. Both approaches share the same understanding of the unconscious. Psychoanalysis takes a broader approach and extends over a longer period of time, while the depth psychological approach focuses on the underlying causes of current symptoms.

Depth psychology-based psychotherapy takes two different approaches, depending on the nature of the problem.

Conflict-Oriented Work

Repressed conflicts continue to affect us as long as they remain hidden. In therapy, they are brought to light: As a patient, you come to recognize what truly drives you—which old desires, fears, or hurts continue to have an impact to this day.

But recognition alone is not enough. What was not allowed back then now needs space: the grief that was never mourned. The anger that was never allowed to be shown. The longing that was seen as a weakness. In therapy, these feelings can finally be expressed and met by someone who responds with understanding and acceptance.

This brings about a fundamental change. You come to realize, in a tangible way, that your feelings are valid and that you can be understood despite them. What had been exerting power in secret for years loses its terror.

In my practice, I have often witnessed just how powerful this moment can be: when someone voices for the first time what they have hidden from themselves for years and realizes that they are not being judged for it.

Similar ideas can also be found in Gestalt therapy, which focuses more on awareness, direct experience, and what is currently being felt in the moment.

Developing Missing Skills

Inner abilities originally develop within relationships. A child learns to calm down because it has been calmed down often enough. It can comfort itself because it has been comforted. It can view itself positively because it has been viewed positively.

What was missing back then can be made up for later. The therapist offers comfort where no one else did. He sees something valuable where you may see only a lack.

This isn't a lesson—it's an experience. You learn that someone will stay by your side when you're upset, and over time, you become able to calm yourself down. You experience comfort and learn to comfort yourself. Little by little, this external experience becomes an internal ability.

When old patterns emerge in the room

At the beginning, there was talk of an image: The unconscious does not remain submerged; it seeks out a place where it can become visible. This place is also the therapeutic relationship.

What a person has learned early on about themselves and others, they unconsciously bring into every new relationship—including the one with me. Someone who has learned that closeness is followed by disappointment will expect that disappointment here as well. Someone who has learned that feelings are not welcome will hold them back even in the therapy room. This reemergence of old relationship patterns in the here and now is called transference. It can often be recognized by the fact that a reaction doesn’t quite fit the actual situation, is accompanied by a strong emotion, and can hardly be resolved through rational explanations.

Transference is not a problem, but an opportunity. What would otherwise merely be talked about becomes immediately palpable in the relationship—and it is precisely this that makes it possible to work through it.

Even as a therapist, these patterns trigger something in me. I might feel the pressure to step in and reassure them, or a subtle irritation, or the desire to withdraw. These internal reactions are called countertransference. Instead of simply following them, I ask myself: Why am I reacting this way right now? What does this say about what’s happening between us at this moment? In this way, my own experience becomes a tool that helps me understand a person’s inner world—a world that often cannot be fully grasped through words alone.

This brings us full circle to what this form of therapy is fundamentally about. The old pattern is not only understood; it resurfaces in the relationship, where it elicits a different response than the one expected. It is precisely in this difference that the corrective experience—which we have already discussed—lies.

In depth psychology therapy, the relationship between you and me is not merely the framework within which healing takes place. It is itself a key factor in the therapeutic process.

Trust, empathy, and reliability create the conditions under which change becomes possible for patients in the first place. For many people, the restorative experience of this relationship is already an essential part of healing: experiencing stability, feeling accepted, and sensing emotional presence. What was missing in childhood can be experienced differently here for the first time.

But a positive atmosphere alone is not enough for effective treatment. Only when difficult, conflict-ridden dynamics are actively addressed and worked through does the relationship reach its full therapeutic depth. The quality of the relationship is thus both a prerequisite for good therapeutic work and its result.

I describe in more detail what factors generally make psychotherapy effective in the article „What Works in Psychotherapy?“

Depth psychology therapy does not promise quick solutions. The patterns that are weighing on us today have developed over years or decades. Understanding and changing them takes time. It also requires a willingness to engage in a process that is not always pleasant.

It is not clear from the outset how long depth psychology-based psychotherapy will take. Short-term therapy involves up to 24 sessions, while long-term therapy involves up to 100.

If you are interested in this type of treatment, please feel free to contact me.

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