Psychodynamic Imaginative Trauma Therapy (PITT), according to the German psychoanalyst Luise Reddemann, is designed primarily for the treatment of people with complex trauma disorders.

The basis is psychoanalytic concepts. Since 1985, PITT has emerged as a procedure in which therapists play a concomitant role in developing and promoting, in particular, the patient's capacity for self-acceptance, self-pacification and self-comfort.

What is Psychodynamic Imaginative Trauma Therapy?

Psychodynamic Imaginative Trauma Therapy (PITT) is a psychodynamic-psychodynamic short-term psychotherapy.

It is a procedure that is frequently used today in German-speaking countries in patients with complex post-traumatic disorders in inpatient treatment. PITT has evolved from practical needs and is influenced by other processes. Psychotherapeutic procedures could thus be given trauma-adapted applications. Above all, PITT's main concern is to improve patient self-regulation.

Function, effect & goals

Psychodynamic Imaginative Trauma Therapy (PITT) is a rather gentle therapy that is especially designed for people who have been deeply injured and traumatized by physical or psychological violence. Traumas are retained in memory, causing patients to suffer from chronic traumatic stress.

Since these are associated with very strong feelings, they are often split off (dissociation). In this way, one's own ego should be protected from being overwhelmed by too many negative feelings. The trauma is not resolved, however. PITT can improve your own sense of security and mental stability. Patients should be empowered to better control and integrate emerging affects rather than causing further divisions. Thus, further retraumatizations can be avoided. Most of the personality disordered patients are concerned with a relationship trauma.

This is more than a traumatic event. Rather, it is mostly a disturbed relationship with key, significant individuals around the patient over a long period of time. Relationship patterns from earlier times are relived in current relationships. Particularly traumatizing attachment experiences often develop disturbed self-regulatory mechanisms. It creates defense mechanisms against certain emotions, which in turn influences the perception of the environment and self-perception. Own desires and longings are suppressed. Today it is believed that even insecure or disorganized attachment styles can later be developed into a secure bond.

This requires a trusting and strengthening therapeutic relationship as well as the promotion of the patient's self-regulatory powers. The therapist accompanies this process and assumes the role of assistant director. Patients should be actively involved in rediscovering their hidden powers. In the case of PITT, the ego-strengthening approaches are to be preceded by the actual dream work. The separation of certain feelings of the traumatized patient is used as a stabilizing factor. The patient should be taught by imagination, that is, the imagination, that the split-off feeling is helpful and useful and he should come back in contact with this.

The split-off parts are called in therapy inner child, which is also referred to as the child or injured parts of the patient. These proportions require security, protection, attention and support, as is the case with a real child. Only then can they develop into healthy proportions and it is possible to consciously distance themselves from them in imaginative exercises. Imagination is suitable for connecting mind and emotions and also for taking into account the body in the therapeutic work, without it having to be touched. Attention is paid to the careful perception and recognition of physical needs.

This helps the patient to engage in more healing feelings and ideas. This phase of therapy is also called stabilization phase or ego strengthening. This is followed by the phase of the actual confrontation with the trauma in which it is processed. The patient should act from a safe distance. For this he poses z. For example, to watch the happenings from the air or as a movie viewer on a screen. In this way, it is possible to counter the trauma without rekindling the stressful feelings.

Finally, the third phase of integration is about facing the stressful feelings of shame or guilt, forgiving oneself and making peace with them. Again, we work with imagination, images and rituals. Later, the patient should independently apply the learned exercises and, ideally, this would lead to a full participation in life again.

The methods of psychodynamic imaginative trauma therapy are used in psychotraumatology in post-traumatic stress disorder, complex post-traumatic stress disorder and in borderline personality disorder and can be combined with various other forms of therapy. The PITT was developed especially for short treatment periods, eg. B. for outpatient care in hospitals. Child and adolescent therapist Andreas Kr├╝ger adapted PITT for the treatment of traumatized children and adolescents (PITT-KID).

Risks, side effects & dangers

So far, the effectiveness of Psychodynamic Imaginative Trauma Therapy has been poorly understood. One study found evidence of the effectiveness of PITT. The treated patient group showed a significantly higher resilience capacity than a group of patients with psychotherapeutic and psychiatric treatment.

A higher efficacy was found especially in chronically traumatized patients. In the absence of studies, the efficacy of PITT and its specific medical indication in the treatment of critically ill patients has not been supported by empirical evidence. Nevertheless, this therapy method has proven itself in practice. The special features of PITT are the strengthening of resources, the high value of the therapeutic relationship, as well as the individual treatment planning and treatment. There are no indications of risks, side effects or dangers.

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