How does psychodynamic therapy differ from cognitive behavioural therapy?

Cognitive behavioural therapy works more in the here and now with concrete exercises, while psychodynamic therapy looks for the unconscious roots of symptoms. Both are recognised and effective — which suits you better depends on your needs and preferences.

Do I have to lie on a couch for this?

No. Psychodynamic therapy usually takes place sitting up and in direct conversation. Lying down belongs to classical psychoanalysis with a higher session frequency — a related but more intensive form.

How long does such therapy last overall?

That is very individual. Often it is several months to a few years with weekly sessions. Progress and goals are regularly reviewed together, and you help decide when it is enough.

Does the therapy also help with physical symptoms?

When physical symptoms such as exhaustion, tension, or stomach problems are connected to emotional distress, therapy can make an important contribution. Physical causes should be medically investigated beforehand.

What happens if I find it difficult to talk?

That is not an obstacle, but often part of the issue. Your therapist is experienced in working with silence and hesitation as well — you determine the pace.

Psychodynamic Therapy — Procedure, Preparation & Cost

Psychodynamic therapy is based on the idea that current symptoms are often connected to unconscious conflicts and earlier relationship experiences. In a safe therapeutic conversation, these inner patterns become understandable — and thereby lose their power over everyday life. It is particularly suitable when difficulties in relationships, moods, or self-esteem keep repeating themselves in similar ways.

Typical Areas of Use

Depressive moods
Recurring relationship patterns and conflicts
Anxiety and inner restlessness
Self-esteem problems
Persistent exhaustion without clear physical cause

How It Works

1In the first sessions, you describe your symptoms and your life history; your therapist pays attention to recurring patterns and connections.
2Together you establish a focus — usually a central inner conflict or relationship pattern that feeds the current symptoms.
3In regular sessions, you talk about what is on your mind; the therapist helps you recognise connections between the present, the past, and what is happening in the therapy itself.
4As understanding grows, experience and behaviour often change gradually — the therapy accompanies this process until what has been achieved becomes sustainable.

How to Prepare

No special preparation is needed — openness and willingness to reflect on yourself are the most important things.
Bring your insurance card to the first session and, if available, the medical referral.
It is helpful if you think in advance about which situations or patterns repeat themselves in your life.

Side Effects & Risks

Engaging with old wounds can be painful at times and may temporarily intensify symptoms.
Because the method goes into depth, it takes time — if you are looking for a quick, purely symptom-focused solution, another approach might serve you better.
Feelings towards your therapist — closeness, anger, disappointment — are part of the process but can be unsettling; talking about them is explicitly encouraged.
A lack of fit between you and your therapist can slow progress; changing therapists is then legitimate.

Afterwards — and When to Seek Help

After the sessions, the conversations often stay with you — pensiveness, vivid dreams, or turbulent feelings are normal and part of the process. Allow yourself some space after intense hours before everyday life takes over again. Get in touch with your therapist between appointments if the burden increases significantly, if you can't steady yourself over several days, or if thoughts of harming yourself arise — in acute crises, the emergency number 144 or Dargebotene Hand (phone 143) are available around the clock.

Cost & Insurance

Like other recognised psychotherapy methods, psychodynamic therapy with psychological psychotherapists is covered by basic health insurance if a medical referral is provided — usually initially for 15 sessions, with the possibility of extension. With psychiatrists, it is directly covered by basic insurance. The deductible and co-payment apply as usual; longer therapies are reviewed periodically. This is for guidance only, without guarantee — if in doubt, ask your insurer.

Frequently Asked Questions

How does psychodynamic therapy differ from cognitive behavioural therapy?: Cognitive behavioural therapy works more in the here and now with concrete exercises, while psychodynamic therapy looks for the unconscious roots of symptoms. Both are recognised and effective — which suits you better depends on your needs and preferences.
Do I have to lie on a couch for this?: No. Psychodynamic therapy usually takes place sitting up and in direct conversation. Lying down belongs to classical psychoanalysis with a higher session frequency — a related but more intensive form.
How long does such therapy last overall?: That is very individual. Often it is several months to a few years with weekly sessions. Progress and goals are regularly reviewed together, and you help decide when it is enough.
Does the therapy also help with physical symptoms?: When physical symptoms such as exhaustion, tension, or stomach problems are connected to emotional distress, therapy can make an important contribution. Physical causes should be medically investigated beforehand.
What happens if I find it difficult to talk?: That is not an obstacle, but often part of the issue. Your therapist is experienced in working with silence and hesitation as well — you determine the pace.