Psychodynamic Imaginative Trauma Therapy (PITT), according to German psychoanalyst Luise Reddemann, is primarily designed to treat people with complex trauma sequelae. It is based on psychoanalytic concepts. Since 1985, PITT has emerged as a procedure in which therapists take an accompanying role, primarily to develop and promote the patient’s abilities for self-acceptance, self-soothing, and self-consolation.
What is psychodynamic imaginative trauma therapy?
Psychodynamic Imaginative Trauma Therapy (PITT) is a short-term depth psychological psychodynamic psychotherapy. It is a method that is frequently used today in German-speaking countries for patients with complex post-traumatic disturbance patterns in inpatient treatment. PITT has developed out of practice-related needs and has been influenced by other procedures. Psychotherapeutic procedures could thus be given trauma-adapted application possibilities. The central concern of PITT is primarily to improve patient self-regulation.
Function, effect, and goals
Psychodynamic Imaginative Trauma Therapy (PITT) is a rather gentle therapy method that has been especially designed for people who have been deeply injured and thus traumatized by physical or psychological violence. Traumas remain in the 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 ego is supposed to be protected from being overwhelmed by too many negative feelings. However, the trauma is not resolved in the process. PITT can improve one’s own sense of security and psychological stability. Patients should be enabled to better control and integrate occurring affects instead of causing further splits. Thus, further retraumatization can be avoided. A large proportion of personality disordered patients are concerned with relational trauma. This means more than a traumatic event. Rather, it is usually a disturbed relationship with central significant persons in the patient’s environment over a long period of time. Relationship patterns from earlier times are relived in current relationships. Especially traumatizing attachment experiences often develop disturbed self-regulatory mechanisms. Defense mechanisms against certain feelings develop, which in turn influences the perception of the environment and self-perception. Own desires and longings are suppressed. Nowadays, it is assumed that even insecure or disorganized attachment styles can later be developed into a secure attachment. 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 takes on the role of assistant director. Patients should actively cooperate in rediscovering their hidden powers. In PITT, the ego-strengthening approaches should precede the actual dream work. The splitting off of certain feelings of the traumatized patient is used as a stabilizing factor. The patient is to be taught by means of imagination, i.e. the power of imagination, that the split-off feeling is helpful and useful and that he should get in touch with it again. The split-off parts are called inner child in the therapy, which is also called the childish or wounded parts of the patient. These parts require, as is the case with a real child, security, protection, attention and support. Only in this way can they develop into healthy parts and it is possible to consciously distance oneself from them in imaginative exercises. Imagination is suitable to connect mind and feelings and also to consider the body in the therapeutic work without touching it. Emphasis is placed on mindful awareness and recognition of bodily needs. This helps the patient to engage in more healing feelings and ideas. This phase of therapy is also called the stabilization phase or ego-strengthening phase. Only after this does the phase of actual confrontation with the trauma follow, in which it is processed.The patient should act from a safe distance. For this purpose, he imagines, for example, that he is watching the events from the air or as a moviegoer on a screen. In this way, it is possible to confront the trauma without reawakening the stressful feelings. Finally, the third phase of integration is about facing the stress-provoking feelings such as shame or guilt, forgiving oneself in the process, and making peace with them. Again, imaginations, images and rituals are used. Later, the patient is expected to apply the learned exercises on his own and ideally this will lead to a fulfilled participation in life again. The methods of Psychodynamic Imaginative Trauma Therapy are used in psychotraumatology for post-traumatic stress disorder, complex post-traumatic stress disorder and borderline personality disorder and can be combined with various other forms of therapy. PITT was developed specifically for short treatment durations, such as hospital outpatient care. Child and adolescent therapist Andreas Krüger adapted PITT for the treatment of traumatized children and adolescents (PITT-KID).
Risks, side effects, and dangers
To date, little research has been conducted on the effectiveness of Psychodynamic Imaginative Trauma Therapy. Evidence of PITT’s effectiveness was found in one study. The treated group of patients showed significantly higher resilience than a group of patients receiving psychotherapeutic and psychiatric treatment. Higher efficacy was shown especially in chronically traumatized patients. Due to a lack of studies, the effectiveness of PITT and its specific healing indication in the treatment of severely traumatized patients has not been based on empirical evidence so far. Nevertheless, this therapeutic method has proven itself in practice. The special features of PITT are the strengthening of resources, the high value of the therapeutic relationship, and the individual treatment planning and implementation. There is no evidence of risks, side effects, or hazards.
