Integrative Therapy (Petzold)

1. Introduction

Version followed: Hilarion G. Petzold's Integrative Therapie (3 Teilbände, Junfermann, revised edition 2003) as the main reference text, with the current Austrian presentation in Höfner, Mantl & Stefan, Integrative Therapie (Facultas, Wien 2024), and the expanded list of 17 healing factors (Orth & Petzold 2015; Petzold et al. 2016, as reported by Eichert 2024). Sources are limited to the tables of contents and publisher previews of both books, abstracts of Polyloge papers, and secondary reports. The full chapter texts (Polyloge PDFs on PsychArchives) are not drawn on here. Section headings and named methods are verified. The detailed content of many procedures comes from general knowledge of the IT literature and is tagged [uncertain] or [synthesis].

Integrative Therapy (IT; German Integrative Therapie) is a broad framework for psychotherapy that works across schools (schulenübergreifend), not one single technique. Hilarion Petzold developed it from the mid-1960s with Johanna Sieper and Ilse Orth. It is taught at the Fritz Perls Institut (FPI) and the Europäische Akademie für biopsychosoziale Gesundheit (EAG) in Germany. In Austria it is taught as the Fachspezifikum Integrative Therapie through the ÖAGG, and was taught at Danube University Krems. [source: Junfermann 2003 book page; Orth 2018 abstract; ÖAGG webinar 2024; Sieper, Orth & Petzold 2020 title "seit 1965" cited there] It is described as drawing on Gestalt therapy, psychodrama and Ferenczi's active analysis. A bibliographic record for Petzold (1988) Therapie und Integration lists psychoanalysis, psychodrama, Gestalt therapy, transactional analysis and NLP as integrated sources. The Ferenczi lineage (mutuality, active technique) is consistent with "Mutualität" as a named relational mode, but the primary text is not drawn on here. [source: gestaltresearch.org record; Eichert 2024] [uncertain: exact founding year of FPI (commonly given as 1972) and the year of Austrian state recognition were not verified]

The theory is organised as a "Tree of Science": metatheory (philosophy, anthropology), realexplicative theories (personality, development, health and illness), and praxeology (process, intervention and method theory). [source: Petzold 2003 TOC, Teilband II] The core idea of change runs as follows. The person is an embodied subject (Leibsubjekt) living in context and over time. Health and illness sit on a continuum shaped by risk and protective factors across the whole lifespan. [source: Höfner et al. 2024 Leseprobe, ch. 3–4; Petzold 2003 book page] Change happens through intersubjective Ko-respondenz between therapist and patient. In this process, bodily and relational experience is perceived, grasped, understood and explained (the hermeneutic spiral). This works along four "ways of healing and fostering": insight, corrective re-socialisation, activation of new experience, and solidarity or engagement. It is carried by a set of evidence-informed healing factors, delivered multimodally through talk, body work and creative media. [source: Petzold 2003 TOC; Eichert 2024; Winkler 2022 abstract; Petzold 2011 abstract]

2. Framework

Structure of the approach. IT has no fixed session-by-session protocol. Instead the therapist works with a set of nested frameworks: a process model (the tetradic system), a diagnostic model (IPD plus ongoing process diagnosis), a choice of modalities, styles and settings, the four ways of healing, the healing factors, and levels of depth. [source: Höfner et al. 2024 TOC ch. 5–6; Petzold 2003 TOC]

Process phases: the tetradic system. These are the phases of the Ko-respondenz model. [source: Petzold 2003 TOC, Teilband I, pp. 127–133, phase labels verified] The goals below are [uncertain] where they go beyond the labels.

Initial phase (Differenzierung, differentiation): warming up, contact, collecting material. A diffuse problem becomes differentiated into themes. In a whole therapy this phase includes the IPD diagnostic modules. [source: Höfner et al. 2024 ch. 5]
Action phase (Strukturierung, structuring): active, experiential work on the chosen theme (scene, body, medium, conflict). Here the material gains structure and emotional intensity.
Integration phase (Stabilität, stability): reflecting on and making sense of what was experienced, linking it to life history and current life. This consolidates the work.
Reorientation phase (Kreation/Transgression): carrying the work into everyday life, trying out new behaviour, planning, and going beyond old limits.
Scope: the four phases are commonly applied to a single session, to a sequence of sessions, and to the whole course of therapy. [uncertain]

Diagnostics: Integrative Psychotherapeutic Diagnostics (IPD). IPD begins in the initial phase and has five modules: (1) psychosocial history, (2) classification (ICD), (3) aetiological diagnostics, (4) personality diagnostics, (5) treatment planning. It runs alongside process diagnostics. Under the principle of Theragnostik, assessment and therapy are interwoven throughout. [source: Höfner et al. 2024 Leseprobe] Older IT texts add identity diagnostics, the life-span panorama technique and focal diagnostics. [source: Petzold 2003 TOC, Teilband III]

Modalities (choose one or combine per patient and phase). [source: Eichert 2024, Table 1; Höfner et al. 2024 TOC 6.2.1] Indications are [synthesis].

Übungszentriert-funktional (exercise-centred, functional): training skills, relaxation, movement. Use for deficits and symptom management.
Konservativ-stützend (conservative, supportive) and supportiv: stabilising. Use in crisis, low structural capacity, or chronic illness.
Erlebniszentriert-stimulierend (experience-centred, stimulating): new, positive and creative experiences. Use for deprivation and anhedonia.
Konfliktzentriert-aufdeckend (conflict-centred, uncovering): working through conflicts and trauma scenes. Use only with sufficient stability.
Netzwerk- und lebenslageorientiert (network and life-situation oriented): working on social network and material situation.
Medikamentengestützt-supportiv (medication-supported, supportive): combined with psychiatric treatment.

Styles and settings. The 2024 book lists Stile (therapeutic styles) and Formen/Setting. [source: Höfner et al. 2024 TOC 6.2.2–6.2.3] Settings in the IT literature include individual, couple, family, group and network therapy, plus specific fields such as older adults. [source: Petzold 2003 TOC, Teilband III] [uncertain: the 2024 list of styles]

Levels of depth (Ebenen der Tiefung). These are a named component. [source: Höfner et al. 2024 TOC 6.5] The usual four-level form is [uncertain]: (1) reflection; (2) images, memories and affects; (3) involvement, meaning partial regression and intense emotional re-experiencing; (4) autonomous bodily reactions, meaning deep regression with vegetative responses. The therapist chooses and regulates depth on purpose.

Session count and format.

There is a brief variant, Integrative Fokal- und Kurzzeittherapie (IFK), with focal diagnostics and focus finding. [source: Petzold 2003 TOC, Teilband III, p. 985 ff.]
Otherwise length is set individually, from short focal work to long-term therapy for structural disorders. [uncertain: no specific session numbers]
Sessions in Höfner et al. are presented as dyadic, with case examples. [source: Höfner et al. 2024]

Criteria for moving between phases. No explicit criteria are documented in the sources used. [uncertain] Working criteria [synthesis]:

Move from initial to action when there is a shared, agreed focus, enough safety, and consent to experiential work.
Move from action to integration when affect peaks and starts to settle, or a new perspective emerges.
Move from integration to reorientation when the patient can put the meaning into their own words.
Close a session or therapy only after a transfer step is formulated and arousal is back in the tolerable range.

3. Guiding principles

[source: Petzold 2003 TOC; Höfner et al. 2024 TOC and intro; Eichert 2024; Petzold 2011 abstract; ÖAGG webinar; Orth 2018 abstract. One-line meanings are [synthesis] unless cited.]

Ko-respondenz (the basis of IT): therapy is a dialogue between two subjects who both bring perspectives. Goals, focus and meanings are negotiated, not imposed.
Intersubjectivity and alterity (Alterität, otherness): respect the patient's otherness. Do not reduce them to your theory. [source: Höfner TOC 3.4; Petzold 2011]
Grundregel (basic rule): a binding rule for both partners in therapy. [source: Petzold 2003 TOC p. 1050] Its practical content is commonly described as mutual commitment to transparency, fairness, informed consent and protecting the patient's dignity. [uncertain] Practically: explain methods before using them, and get explicit agreement, especially for body and regression work.
Embodiment (Leibsubjekt, "der informierte Leib"): the body stores life experience. Perceive posture, breath and movement as clinical information, alongside words. [source: Petzold 2003 TOC pp. 141, 1051]
Lifespan development: look at the whole life course, not just early childhood. Damage and resilience accumulate at every age. [source: Petzold 2003 book page]
Health–illness continuum, salutogenic plus pathogenic: assess resources and protective factors as carefully as deficits and conflicts. [source: Höfner et al. 2024 ch. 4]
Hermeneutic spiral (perceive → grasp → understand → explain): start from what is perceptible here and now, then deepen into meaning and explanation. Do not interpret before perceiving. [source: Petzold 2003 TOC p. 162]
Theragnostik / process diagnosis: every intervention is also a diagnostic probe. Revise the formulation and plan continuously. [source: Höfner et al. 2024]
Multiperspectivity and eccentricity (Exzentrizität): help both patient and therapist step back and view the situation from several angles. Petzold describes clinical philosophy as giving "einen selbstkritischen Blick, der Dogmatismen entgegenwirkt" (a self-critical view that counters dogmatism). [source: Petzold 2005r, p. 135, quoted in ÖAGG webinar]
Theory-guided integration, not eclecticism: choose techniques from different schools only when they fit the IT theory frame and the current case formulation. [source: Petzold 2003 book page; Petzold 2011 abstract; gestaltresearch record]
Healing factors as orientation: name which factor(s) you are targeting with each intervention, e.g. empathy, emotional support, a lively relation to nature. [source: Eichert 2024; Petzold 2011]
Four ways of healing and fostering: decide which way a phase of therapy mainly serves: insight, re-socialisation, new experience, or solidarity. [source: Petzold 2003 TOC pp. 590–592; Winkler 2022]
Relationship modalities: track which mode is active: contact, encounter, relationship, attachment (Bindung), mutuality, or transference/countertransference. Respond to that mode. [source: Eichert 2024]
Selective openness and partial engagement: the therapist shows themselves as a real person, in measured and purposeful ways. [uncertain: the terms selektive Offenheit and partielles Engagement are associated with Petzold]
Multimodality and synergy: combine verbal, bodily, creative and network interventions so that their effects add up ("synergetische Multimodalität"). [source: Eichert 2024]
Creative media: every patient can be reached nonverbally. Offer media, but never require artistic skill. [source: Höfner et al. 2024 intro; Eichert 2024]
Context and social network: the problem and its solution also lie in the patient's network and material situation. Work on these directly when indicated. [source: Eichert 2024]
The person of the therapist: tailoring treatment to the patient depends on the therapist's own trained self-awareness. Training includes extensive self-experience. [source: Höfner et al. 2024 intro; Winkler 2022 abstract]
Gender and diversity sensitivity: treat gender, class and age as part of the formulation. [source: Höfner TOC 6.6; Eichert 2024 structural levels]
Disorder-specific work: IT includes disorder-specific procedures referenced to ICD-11. It does not apply one method to all patients. [source: Höfner TOC 6.9]
Ecology, nature and co-creativity ("third wave", since about 2000): include nature, time and the shared shaping of one's life (Lebenskunst) as resources. [source: Orth 2018 abstract; ÖAGG webinar]

4. Intervention inventory

Scope note: all procedures below are named in the sources used: Petzold 2003 TOC, Höfner et al. 2024 TOC and intro, Eichert 2024, Belchior 2020, and the Winkler 2022 and Orth 2018 abstracts. Step-by-step instructions are my reconstruction from the IT literature and general clinical practice. They are tagged [synthesis], or [uncertain] where the IT-specific content is unverified. All example language is my own (illustrative).

A. Assessment and case formulation

4.1 Integrative Psychotherapeutic Diagnostics (IPD), 5 modules

Purpose / when: structured assessment in the initial phase of every therapy, leading to a treatment plan. [source: Höfner et al. 2024]
Steps: (1) Psychosocial history: biography, current life situation, network, work, material situation, body and health. (2) Classification: ICD diagnosis. (3) Aetiological diagnostics: risk and protective factors across the lifespan, and the sequence of strains (deficits, traumas, disturbances, conflicts). (4) Personality diagnostics: self, ego and identity functions, and structural level. (5) Treatment planning: goals, modality, setting, media, planned depth, which ways of healing and healing factors. Share the result with the patient and agree on it (Ko-respondenz). [steps 1, 2, 4, 5 named in source; content of 3–5 is synthesis]
Example language (illustrative): "Before we decide how to work, I'd like to understand your whole life so far: what weighed on you, and what has kept you going."
Watch for: history-taking that only collects pathology. Make sure there is an equally detailed inventory of resources. The plan should be a written or spoken agreement the patient can repeat back.

4.2 Process diagnostics and Theragnostik

Purpose / when: continuous assessment in every session. Diagnosis and therapy are interwoven. [source: Höfner et al. 2024; Petzold 2003 TOC p. 1048]
Steps [synthesis]: At the start of each session, note bodily state, mood, relational mode and network events. After each intervention, observe the response (breath, posture, affect, content). Ask what the patient noticed. At the end of the session, briefly update your working formulation and the next focus. Review goals with the patient at regular intervals.
Example language (illustrative): "When we did that just now, what did you notice in yourself?"
Watch for: sticking with a plan the process contradicts. Revise the focus when the patient's response repeatedly points elsewhere.

4.3 Life-span panorama technique (Panoramatechnik / Lebenspanorama)

Purpose / when: a creative, projective overview of the whole life course, used in the initial phase, focal diagnosis, or when the patient is stuck on one period. [source: Petzold 2003 TOC p. 993, technique named]
Steps [uncertain: detailed format not verified]: (1) Provide a large sheet of paper and colours or crayons. (2) Invite the patient to draw their life from birth to now, and on into the future, as a path, landscape or line in whatever form they choose. Include high and low points, important people, places and turning points. (3) Allow about 15–30 minutes; the therapist watches quietly. (4) The patient presents the panorama. The therapist asks phenomenologically first (what you see), then about atmospheres, people and resources. (5) Jointly mark protective and risk periods and chains of strain. (6) Agree which part becomes the focus. A commonly described variant uses several panoramas, e.g. health and illness, work and career, relationships. [uncertain]
Example language (illustrative): "Take a few minutes to paint your life as a path from your birth until today, and if you like, a bit beyond. Use any colours or symbols; it doesn't need to be art."
Watch for: flooding when traumatic periods appear. Stay at the reflection or image level (see 4.11), and name resources found on the same sheet. A good sign is the patient seeing patterns over time ("it always happens after a loss").

4.4 Five pillars of identity (Fünf Säulen der Identität) and identity diagnostics

Purpose / when: to map identity stability and resources across five areas: (1) body and embodiment (Leiblichkeit), (2) social network and relationships, (3) work, achievement and leisure, (4) material security, (5) values. Use it in assessment, in crises of identity (job loss, illness, migration, retirement), and for treatment planning. [source: Petzold 2003 TOC p. 994; Eichert 2024; Belchior 2020]
Steps: (1) Draw five columns (or let the patient draw them). (2) Patient shades or rates how strong or full each pillar is currently. A coaching adaptation uses a 0–100% fill. [source: Belchior 2020] (3) Explore each pillar: what supports it, what threatens it, recent changes. (4) Look at interactions between pillars, e.g. a strong network carrying an unsatisfying job. [source: Belchior 2020] (5) If several pillars are weak, choose one to work on first. [source: Belchior 2020] (6) Repeat later to track change. A self-report questionnaire, FESI (Kames, Polyloge 18/2011), exists for this model. Use the published instrument; items are not reproduced here.
Example language (illustrative): "If your identity rested on five pillars – body, people, work, money and home, values – how solid is each one right now?"
Watch for: shame around material insecurity or unemployment. Also watch for collapse of several pillars at once, which indicates supportive and network modalities rather than uncovering work. [synthesis]

4.5 Body charts

Purpose / when: projective diagnosis and a creative therapy medium for bodily experience: pain, tension, feelings, body image, illness experience. [source: Petzold 2003 TOC p. 885]
Steps [uncertain: the IT-specific instructions]: (1) Provide a body outline, or the patient draws one. (2) Patient colours or marks where in the body they feel tension, pain, emotions or comfort, and can add symbols or words. (3) Explore phenomenologically: colour, size, location, and the atmosphere of each area. (4) Link areas to life events and scenes (the informed body). (5) Optionally repeat later to show change.
Example language (illustrative): "Show me with colours where in your body you carry this – and also where it feels okay."
Watch for: dissociation or shame in patients with body trauma. Let them choose the level of detail. Always ask for resource zones as well.

4.6 Social network diagnostics and network map

Purpose / when: assess the quality and size of the social network (a structural level and identity pillar) and plan network-oriented work. [source: Eichert 2024, network modality; Petzold 2003 TOC p. 914 network therapy]
Steps [synthesis; the IT-specific format]: (1) Patient places themself in the centre of a sheet. (2) Patient draws people (and pets and institutions) at distances that show emotional closeness, with symbols for supportive, burdensome or ambivalent relationships. (3) Add a time dimension: who accompanied the patient through which life phases. (4) Identify gaps, losses and possible resources to reactivate.
Example language (illustrative): "Who is around you in your life now? Put them on the paper as close or as far as they feel."
Watch for: isolation, which is an indication for network and supportive modalities. Also watch for abusive relationships that are hidden as close ones.

4.7 Focal deep interview and focus finding (IFK)

Purpose / when: in brief or focal therapy (Integrative Fokal- und Kurzzeittherapie), to find and agree one central focus. [source: Petzold 2003 TOC pp. 985, 998, 1020]
Steps [uncertain: the interview structure]: (1) Explore the presenting problem in depth: current situation, onset, life-span context (often combined with the panorama), body, network. (2) The therapist proposes candidate foci. (3) Negotiate the focus and the number of sessions with the patient. (4) Keep sessions oriented to the focus. Note side themes, and either defer them or renegotiate. (5) Review the focus at the midpoint and at the end.
Example language (illustrative): "Of everything we've looked at, what would make the biggest difference if it changed in the next few months?"
Watch for: foci too broad to fit a brief therapy. Also watch for a focus the therapist favours but the patient doesn't own.

B. Relational core interventions

4.8 Contracting under the Grundregel (informed consent)

Purpose / when: at the start of therapy and before each new type of intervention (body, regression, group, media). [source: Petzold 2003 TOC p. 1050] [uncertain: content of the rule]
Steps [synthesis]: (1) Explain IT's way of working, including that it may include body, creative media and scene work. (2) Explain the rights and duties of both partners: transparency, confidentiality and its limits, fees, cancellations, and the patient's right to refuse any exercise. (3) Agree goals. (4) Before any experiential or body intervention, describe it briefly and ask for consent. Re-check consent if the intervention deepens.
Example language (illustrative): "I'd like to suggest an exercise with breathing. I'll explain it first, and you can stop or say no at any point."
Watch for: compliance that looks like consent, especially in patients with abuse histories. Watch for a quick "yes" with a frozen body.

4.9 Ko-respondenz dialogue and work with relationship modalities

Purpose / when: throughout therapy. The relationship is a healing factor in its own right, carrying empathy and emotional acceptance. [source: Eichert 2024; Petzold 2011 abstract]
Steps [synthesis]: (1) Notice which relational mode is active: contact, encounter, relationship, attachment, mutuality, or transference/countertransference. [source: Eichert 2024 mode list] (2) For contact and encounter, stay present and responsive. (3) In attachment phases, provide reliability and continuity. (4) When transference is active, take it up gently, link it to life-span scenes, and distinguish it from the real relationship. (5) Use measured self-disclosure where it serves the patient. (6) Negotiate divergent views openly; reach consensus or agree on dissent.
Example language (illustrative): "I think I see this a little differently – may I tell you how it looks from my side, and then you tell me what fits?"
Watch for: mutuality sliding into the therapist's own needs (role reversal). Watch for idealising or hostile transference left unaddressed. A working sign is the patient openly disagreeing and the dialogue continuing.

4.10 Hermeneutic spiral as session method

Purpose / when: to structure exploration of any theme from experience to meaning. [source: Petzold 2003 TOC p. 162]
Steps [synthesis]: (1) Perceive: direct attention to what is perceptible now, in the body, voice, image or scene. (2) Grasp: help the patient register and name it (feelings, atmosphere). (3) Understand: connect it to biography and context, in dialogue. (4) Explain: offer or co-create an explanatory frame, e.g. a learned pattern, the impact of a strain, or a protective function. Then cycle back to perceiving at a deeper level.
Example language (illustrative): "Let's first just notice what's happening in you right now… What is that feeling like?… Where do you know it from?… How would you make sense of it today?"
Watch for: jumping to explanation, which leads to intellectualising. Also watch for looping in perception without making sense of it.

4.11 Regulating levels of depth (Tiefung)

Purpose / when: whenever experiential work is used. Match intensity to stability and to the agreed goal. [source: Höfner et al. 2024 TOC 6.5] [uncertain: level definitions]
Steps [synthesis]: (1) Decide in advance the maximum depth that fits the current IPD and agreement. Uncovering work at involvement level needs good structural capacity and an established relationship. (2) Deepen gradually: from reflection, to images and affect, to involvement. Use the present tense, sensory detail and slowing down. (3) Watch for signs of moving to deeper levels: autonomic reactions, child-like states, loss of the observing self. (4) To make the experience shallower again, use eyes open, orientation to the room, an adult perspective, past tense, and reflection. (5) Always come back to reflection before ending.
Example language (illustrative, de-intensifying): "Let's step back for a moment. Feel your feet on the floor, look around the room – you're here with me, today."
Watch for: unplanned deep regression, dissociation, and post-session decompensation. Risk flag: levels 3–4 (deep regression, autonomic discharge) carry risks of retraumatisation and dependency. Avoid them in acute crisis, psychosis, severe dissociation, or without consent. [synthesis]

C. The four ways of healing and fostering

The four ways are named as a component of IT (Petzold 2003 TOC, pp. 590–592; Höfner TOC 6.3). Only the second (Nachsozialisation, post-socialisation or re-socialisation) is verified by name (Winkler 2022). The labels of the other three below are the ones commonly used in IT teaching. [uncertain]

4.12 First way: consciousness work, insight and finding meaning (Bewusstseinsarbeit)

Purpose / when: for patients who benefit from understanding connections between life history, patterns and symptoms, and from finding meaning. It corresponds to the healing factor "promoting insight, sense of meaning and evidence experiences". [source for factor: Eichert 2024]
Steps [synthesis]: Use the hermeneutic spiral (4.10). Link the scenes that emerge to the panorama and life-span patterns. Formulate an explanation together, ideally one that is felt in the body as well as understood (an "evidence experience": insight plus affect plus bodily resonance). Check how the insight fits the patient's values.
Example language (illustrative): "So when your boss raises his voice, your body reacts like the eight-year-old in your father's kitchen. Does that fit?"
Watch for: purely intellectual insight without change in feeling or behaviour. If that happens, combine with experiential ways.

4.13 Second way: re-socialisation, basic trust and reparenting (Nachsozialisation)

Purpose / when: for early deficits and missing basic trust (deprivation, neglect, insecure attachment). Corrective relational experience in the therapy relationship and through media, which can include an animal such as a horse in animal-assisted IT. [source: Winkler 2022 abstract; Petzold 2003 TOC pp. 588–597, 865 "reparenting"]
Steps [synthesis]: (1) Provide a reliable, warm, predictable frame; reliability itself is the intervention. (2) Respond attuned to needs at the developmental level being expressed. (3) Use the active techniques below (4.14) with consent. (4) Help the patient take in and keep the experience ("What is it like to be met like this?"). (5) Move gradually towards self-care and the patient's own network, to avoid lasting dependency.
Example language (illustrative): "It makes sense that you never learned to trust that someone stays. I'll be here next week, same time."
Watch for: dependency, idealisation, and boundary blurring. Risk flag: reparenting that slides into physical caretaking or exclusive closeness can become harmful. Keep it transparent, consented and supervised.

4.14 Active techniques: creativity activation, gaze dialogues, mirroring

Purpose / when: active treatment techniques for re-socialisation and new experience, informed by infant research. [source: Petzold 2003 TOC pp. 588–597, technique names verified; Höfner 2024 mentions empirical infant research]
Steps [uncertain: IT-specific procedures]:
- Gaze dialogue (Blickdialog): with consent, therapist and patient make brief, gentle, regulated eye contact. The patient chooses distance and duration. Then talk about what was felt (being seen, shame, warmth).
- Mirroring (Spiegelung): reflect the patient's expression, posture, movement or rhythm back, verbally or bodily. This conveys being perceived and resonated with.
- Creativity-based activation: playful use of media or movement to wake up curiosity and vitality.
Example language (illustrative): "Would you be willing to look at me for a moment – as long as feels okay – and notice what happens?"
Watch for: shame floods and dissociation in eye contact (common after trauma or in autism). Offer alternatives, such as looking at an object together or side-by-side contact.

4.15 Third way: experience activation and personality development (Erlebnisaktivierung)

Purpose / when: for impoverished, rigid or depressed experience. Offer alternative, positive, creative experiences that enlarge the patient's repertoire. Corresponds to the factors of creative experience, emotional expression, learning, aesthetic experience and lively relation to nature. [source for factors: Eichert 2024]
Steps [synthesis]: Choose a medium (4.16) or nature activity (4.23) that fits the patient's interests. Set up a low-pressure experiment and explore the experience. Plan transfer into everyday life, e.g. a hobby, a group, or regular walks.
Example language (illustrative): "What did you enjoy as a child before life got so heavy? Shall we try a little of that here?"
Watch for: performance pressure. A working sign is spontaneous enjoyment and the patient initiating activities.

4.16 Creative media (kreative Medien)

Purpose / when: nonverbal or partly verbal access to experience, expression and new experience; usable in all phases. The media are: language, visual and art media (painting, clay, collage), poetic media (writing, poetry and bibliotherapy), movement and dance, music, and puppets, masks and dramatherapy media. [source: Eichert 2024; Höfner et al. 2024 intro; Petzold 2003 book page]
Steps [synthesis]: (1) Offer a choice of materials. (2) Give an open, theme-related instruction, e.g. "paint the atmosphere of your home", "form your anger in clay", "write a letter you won't send". (3) Give time to create while the therapist observes the process. (4) Look at the result together, first in a phenomenological way (what is there), then let the patient say what it means. Avoid therapist interpretation. (5) Possibly dialogue with the work, or change it ("How would you like it to look?"). (6) Integrate it and keep the work, with the patient's agreement.
Example language (illustrative): "Let's look at it together. What do you see first? … If this figure could speak, what would it say?"
Watch for: media triggering regression faster than talk (clay and finger paint in particular). Adjust depth. Watch for embarrassment about skill, and reassure that the result is not judged.

4.17 Fourth way: solidarity, empowerment and engagement

Purpose / when: for patients who are isolated, marginalised, or harmed by social conditions. Experiences of solidarity, empowerment and network support, and a broader perspective on one's own situation. Corresponds to the factors of empowerment and solidarity, viable social networks, and positive values. [source: Eichert 2024]
Steps [synthesis]: Validate the social dimension of suffering (job loss, discrimination, poverty). Work with the network map (4.6) to reactivate or build supports. Link to self-help, peer or advocacy groups. Support the patient in standing up for their rights and in meaningful engagement. Where appropriate, use group therapy.
Example language (illustrative): "Part of what you're carrying isn't a personal failing – it's what happens to many people in your situation. Who else is dealing with this?"
Watch for: the therapist imposing their own political views. The patient's values lead.

4.18 Healing-factor-guided intervention planning

Purpose / when: a way to select and check interventions, using 14 factors (Petzold 2003 TOC p. 1036) or the expanded list of 17. [source: Eichert 2024; Petzold 2011 abstract]
Steps: For each phase, name 2–4 target factors from the list: (1) empathic understanding; (2) emotional acceptance and support; (3) help with realistic coping; (4) fostering emotional expression and volitional decision-making; (5) insight, meaning and evidence experiences; (6) communicative competence and relationship capacity; (7) bodily awareness and self-regulation; (8) learning possibilities and interests; (9) creative experience and shaping power; (10) positive future perspectives; (11) positive values and the existential dimension; (12) a clear, coherent sense of self and identity; (13) viable social networks; (14) empowerment and solidarity experiences; (15) a lively relation to nature; (16) healing aesthetic experiences; (17) synergetic multimodality. [list as given by Eichert 2024, my translation] Choose interventions that serve those factors. Review at intervals which factors have improved. [synthesis]
Watch for: spreading thin across all factors. Prioritise by the IPD.

D. Body, movement and emotion work

4.19 Integrative body and movement therapy (Integrative Leib- und Bewegungstherapie, IBT)

Purpose / when: body-centred work on bodily awareness, self-regulation, and the body memories and expressive patterns stored in the "informed body". Covers the therapeutic climate, reparenting, technical perspectives and relational body images. The movement branch is listed separately, in Domain IV. [source: Petzold 2003 TOC pp. 851–876; Höfner TOC 6.7]
Steps [synthesis]: (1) Build a safe climate and get consent; clarify touch rules (whether and how). (2) Start with awareness: standing, walking, breath, contact with the ground. (3) Explore movement qualities (space, tempo, strength) and how the patient habitually moves. (4) Amplify or vary a pattern and notice the feelings and scenes that arise. (5) Practise new movement possibilities, e.g. taking up space, pushing away, reaching out. (6) Return to rest and reflection, and link the experience to everyday life.
Example language (illustrative): "Walk through the room at your own pace… now try walking as if you had every right to be here."
Watch for: touch-related boundary issues. Use touch only with explicit consent and clear purpose; offer non-touch alternatives. Watch also for medical limits, so adapt to physical health.

4.20 Thymopraktik (emotion-focused body work, breath, regression)

Purpose / when: an IT approach to emotional expression and processing via the body, including breath work and regression. [source: Petzold 2003 TOC pp. 607, 655] [uncertain: procedural detail]
Steps [synthesis, conservative]: Use only with stable patients, after agreement. (1) Breath awareness without forcing. (2) Allow expressive movement or sound connected to the theme. (3) Stay within the agreed depth (4.11). (4) Give careful integration time and grounding before the session ends.
Example language (illustrative): "Just let the breath go where it wants. If a sound wants to come, that's fine; we can stop any time."
Watch for / Risk flag: deliberately intensified breathing and induced regression can trigger panic, dissociation, flashbacks or physical symptoms, as well as dependency on cathartic states. Contraindications include acute trauma, dissociative disorders, psychosis, cardiovascular or respiratory conditions, and pregnancy. Prefer regulation-oriented body work for these patients. [synthesis]

4.21 Integrative and Differential Relaxation Therapy (IDR)

Purpose / when: a functional, exercise-centred method for self-regulation, stress and anxiety. It is presented as an example of IT body work. [source: Höfner et al. 2024 intro]
Steps [uncertain: IDR protocol]: Choose a relaxation method that fits the patient, e.g. breath-based, progressive tension and release, imagery, or movement-based. Teach it, practise it in session, and agree on home practice. Adjust ("differential") if the method causes discomfort.
Example language (illustrative): "Let's find out which way of relaxing actually suits your body."
Watch for: relaxation-induced anxiety. Offer eyes-open and movement-based options.

E. Scene and drama work

4.22 Dramatherapy and scene work

Purpose / when: enacting, re-staging and transforming life scenes and their atmospheres. Roots in psychodrama and therapeutic theatre. [source: Petzold 2003 TOC pp. 681, 699, "scene theory" and dramatherapy; gestaltresearch keywords] [uncertain: IT-specific techniques]
Steps [synthesis]: (1) Identify a significant scene from the panorama or the current session. (2) Set the scene with chairs, cushions, puppets or masks, describing place, time and atmosphere. (3) Patient enters the scene in the present tense, at a controlled depth. (4) Use dialogue with empty chairs or objects, role change, or puppet play to express what was not possible then. (5) Try an alternative scene ending, with new behaviour or protective figures. (6) Step out of the scene, de-role and reflect.
Example language (illustrative): "Put a cushion where your father stood. From here, what would you have wanted to say to him?"
Watch for: overwhelming re-enactment. Use puppets or a distanced observer position for fragile patients.

F. Other procedures named in the sources

4.23 Nature-based therapies ("green" methods, third wave)

Purpose / when: using nature, gardens, landscapes and animals as therapeutic media. Supports the factors of a lively relation to nature and healing aesthetic experience; includes animal-assisted work, e.g. with horses. [source: Orth 2018 abstract; Winkler 2022 abstract; Eichert 2024]
Steps [synthesis]: Agree on goals and safety for outdoor or animal work. Do mindful perception in nature, walking sessions, gardening, or contact with animals under trained supervision. Reflect on the experience and plan everyday nature contact.
Watch for: confidentiality outdoors, physical limits, allergies, animal-safety training.

4.24 Work with resistance

Purpose / when: IT describes forms of resistance within its lifespan and illness theory. [source: Petzold 2003 TOC pp. 582–587] [uncertain: the typology]
Steps [synthesis]: Treat resistance as a protective, meaningful achievement. Explore what it protects. Respect its timing. Adjust modality or depth instead of pushing (see section 5).

4.25 Crisis intervention

Purpose / when: acute crises within or outside therapy. [source: Höfner TOC 6.8] [uncertain: content]
Steps [synthesis]: Switch to the supportive or conservative modality. Assess risk, including suicide risk, using standard practice. Activate the network, reduce depth to reflection, give structure, and increase contact frequency if needed.

4.26 Disorder-specific adaptation

Purpose / when: tailoring IT to ICD-11 diagnoses. [source: Höfner TOC 6.9] [uncertain: specific protocols]
Steps [synthesis]: Use evidence-based disorder knowledge within the IT frame, e.g. exposure elements for anxiety, stabilisation before trauma confrontation, and activation for depression. Document the rationale for each choice in IT terms (modality, ways, factors).

4.27 Work with older adults: movement, memory and network therapy

Purpose / when: a gerontological field developed by Petzold, with recreational, functional and conflict-centred movement work, plus network therapy and memory work. [source: Petzold 2003 TOC pp. 905–914]
Steps [synthesis]: Choose the modality by capacity. Use gentle movement and dance in groups. Use biographical and memory work (panorama, objects, music of their youth). Strengthen or rebuild networks after losses.

5. Handling problems

The sources used name resistance (Petzold 2003 TOC pp. 582–587) and crises (Höfner TOC 6.8) as topics, but their content is not drawn on here. All concrete responses below are [synthesis], built from IT principles (modalities, depth regulation, Ko-respondenz, four ways) and general clinical practice.

Stuck client (no movement over several sessions) [synthesis]
- Re-run process diagnosis: is the focus still the patient's own? Revisit the panorama or the five pillars. The block may lie in an unaddressed pillar, such as money or work.
- Change the channel: from talk to a creative medium, or from medium to body, or vice versa.
- Change the way of healing: insight work that is stuck often needs re-socialisation (relationship) or new experiences.
- Name the impasse openly in Ko-respondenz: "We seem to be circling. What's your sense of it?" (illustrative).
Resistance [synthesis]
- Treat it as protective and meaningful. Explore what it guards: shame, loyalty, fear of collapse.
- Reduce depth or switch to a supportive modality.
- Respect the right to refuse an exercise under the Grundregel. Offer alternatives, e.g. drawing instead of enactment, or an observer position.
- Never override a "no" to body or media work.
Overwhelm, dissociation, flooding [synthesis]
- Stop deepening. Ground the patient: eyes open, orientation, feet, naming objects in the room, present tense.
- Return to the reflection level and the adult perspective.
- Close the session with stabilisation and a resource image.
- Re-plan: use stabilising, exercise-centred modalities and resource work before any further uncovering work.
- Document it, and discuss it in supervision.
Non-adherence (between-session tasks, attendance) [synthesis]
- Revisit the agreement. Check whether goals are still shared and whether the task fits everyday life and the patient's resources.
- Make tasks smaller and more bodily or creative, e.g. a five-minute walk or one drawing.
- Explore network or material obstacles (shifts, childcare, money) and work on them in the network modality.
Ruptures in the relationship [synthesis]
- Address them directly and early.
- Acknowledge your own contribution; measured openness and mutuality are part of IT's stance.
- Separate transference from current real-relationship issues.
- Re-negotiate in Ko-respondenz, aiming for consensus or agreed dissent.
- Example (illustrative): "Last time I pushed that exercise too quickly. I'm sorry – how was it for you?"
Modality-specific difficulties
- Reluctance towards creative media ("I can't draw"): say clearly that quality doesn't matter. Offer simple forms (colours only, collage, choosing objects), or stay verbal. [synthesis]
- Body work and touch: get explicit consent each time and give non-touch alternatives. Watch for trauma reactions. Be cautious with gender and power dynamics, and get supervision. Risk flag for reparenting, deep regression and breath-intensifying work (4.13, 4.20): risks are dependency, retraumatisation, boundary violations and decompensation. Use them only with stable patients, explicit consent, set limits on depth, and supervision. [synthesis]
- Dependency after re-socialisation work: plan endings from the start. Build up the outside network (fourth way). Taper the frequency of sessions. [synthesis]
- Integration overload: an approach this broad can tempt the therapist into a different technique every session. Anchor the work in the IPD plan, and check each intervention against the target factors and ways. [synthesis]
- Self-disclosure going too far: check each disclosure against the question "whom does it serve?". [synthesis]
Not addressed in the sources used (own synthesis):
- Suicidality: use standard structured risk assessment and a safety plan, including lethal-means counselling (safe storage and removal). Use the supportive modality and network activation, and avoid uncovering work until the patient is stabilised.
- Psychosis or severe dissociation: use reflection-level work and functional or supportive modalities only. No regression, breath-intensifying or deep scene work. Coordinate with psychiatric care (medication-supported modality).
- Online sessions: adapt the media (patient's own materials, shown on camera). Limit depth because grounding is harder at a distance. Agree on a crisis plan.

Sources

Sources: