Case conceptualisations used by psychodynamic psychotherapists seeking insurance reimbursement in Germany

Abstract

Aims: This study investigated which working models psychodynamic psychotherapists use to conceptualise their approach to working with individual patients.

Methods: We randomly selected 1000 samples from a larger pool of reimbursement applications clinicians submitted to health insurance providers. From these, we extracted whether one or more of the following theories were used: drive theory, object relations theory, Winnicott's, Bion's and attachment theory. We also tracked whether the concepts of the unconscious, the super-ego and regression appeared.

Results: The most frequently used theory was object relations theory, followed by drive theory. The concepts developed by Bion and Winnicott were rarely used. The following concepts did not appear in any of the reports: reverie, alpha-function, beta-elements and pathological organisation. A fifth of the reports did not mention any of the concepts investigated. Therapists trained in psychoanalysis used drive theory, object relations theory, Bion's theory and regression more often than those trained in low-frequency psychodynamic psychotherapy.

Conclusions: We conclude that case conceptualisations for psychodynamic therapies with adult patients nowadays most frequently cite the use of object relations theory and drive theory, whereas Bion's and Winnicott's concepts are rarely explicitly mentioned. On average, therapists trained in psychoanalysis use more theories than those with psychodynamic training.