As a descendant and further development of psychoanalysis and as apart of the psychodynamic therapy methods, depth psychology initially assumes that we humans have an unconscious. These are desires, emotions, impulses and memories that are beyond our direct, conscious perception and control, but which can nevertheless influence our perceptions and emotions. The image of an iceberg is often used to illustrate this, as it is just as difficult to see from above what masses are still hidden beneath the surface of the water.

We all have a kind of basic psychological scaffolding: the so-called “structural abilities”, e.g. the ability to bond, to regulate emotions, a sense of identity and self-worth, etc… These basic abilities/structures are formed from early childhood and their development depends very much on what we receive from our closest caregivers. If there is a deficiency in the structural abilities, it may result in a basic instability in our psyche well into adulthood. For example, there may be a lifelong difficulty in forming close relationships or regulating one’s own emotions.

In addition to this basic structure, there are the (mostly unconscious) inner psychological conflicts that are typical of development. In every phase of life, there are typical challenges and difficulties that people go through – even if the basic psychological framework is stable. For example, two to three-year-old children are often testing their own autonomy, while teenagers are more concerned with their identity. We oscillate back and forth between inner desires and needs and are on a lifelong quest for inner balance. For example, conflicts can arise between the desire for autonomy on the one hand and the need for attachment and closeness on the other. The German-American psychoanalyst Erik Erikson, for example, has developed a very vivid stage model here, which spans the entire human lifespan and which I personally find very useful. Sometimes these inner conflicts cannot be resolved properly and we get stuck in one extreme – for example, in an increased need for attachment. In this case, our autonomy suffers and we may become too dependent on other people.

A mental disorder/symptom cannot be assigned to a specific cause across the board. For example, an anxiety disorder can be an expression of a lack of structural abilities (e.g. emotion regulation, i.e. the ability to calm oneself down), as well as an unconscious solution to a conflict of autonomy (along the lines of: “I am dependent on the help of my caregivers when I am anxious. Although this is quite restrictive in everyday life, it perhaps averts the even greater fear of being abandoned”).

How does depth psychology-based psychotherapy work?


The 50-minute sessions usually take place on a weekly basis and face-to-face; in individual cases, it can be decided whether longer intervals make sense. Firstly, the sessions work on making wishes, needs and emotions conscious and understanding where they come from. Then, according to the theory, the psyche no longer needs to search for its own (sometimes dysfunctional and automatic) solutions. The more aware we are of the motives behind our own actions and feelings, the more consciously we can counteract them and opt for other forms of behavior.
 In the example with the anxiety disorder, one hypothesis could therefore be that the symptoms decrease when the unconscious fears of abandonment (or possibly also the unconscious feelings of anger towards the attachment figure) are brought into consciousness.

On the other hand, therapy often consists of much more implicit content. Structural abilities develop from relationships with other people – primarily close caregivers. They are damaged if the relationships were inadequate or even traumatic. They can therefore only heal again in relationships. And this is exactly what a therapeutic relationship is: the chance to strengthen your own psychological foundation through a feeling of trust, security and being recognized and, if necessary, to heal a little afterwards. This may take some time, but it can also alleviate symptoms over time.

Depending on the diagnosis and the person, other elements from other areas can be incorporated into the therapy. It usually makes sense to take a closer look at the individual’s resources and build on them if necessary. In addition, it can sometimes be helpful to learn certain relaxation techniques or self-soothing methods, to keep eating protocols or to question cognitive thinking errors.

Basically, you alone decide what you want to talk about. You lead the way, put one foot in front of the other and decide where you want to look and, if necessary, turn off. The therapist accompanies you on this path, asks clarifying questions, supports you and comments on what he/she sees, but never leads the way. There may be pauses in the conversation during which you are invited to listen more deeply to yourself and express where your thoughts are taking you.