What is KIP? – ISKIP

Katathym (Catathym) Imaginative Psychotherapy (KIP) is a psychodynamic therapy method introduced by Hanscarl Leuner in the 1950s under the name “Catathymic imagery”, which has been continuously developed and is used as part of depth psychologically based therapy. In the English-speaking world, psychotherapy with daydreams was introduced in its early days under the term Guided Affective Imagery (GAI). In Italy it is known as Vissuto Imaginativo Catatimico (VIC), and in French-speaking countries as psychothérapie d’imagination catathymique (PIC).

The emotional element of the imagination is expressed in the adjective ‘katathym’ (Greek κατά θυμόν kata thymon ‘moved by the mind’, ‘following the affect’). In contrast, the term symbol drama, which is used synonymously in some countries, emphasises the symbolic element. It indicates that the image representations are staged as if on a virtual theatre stage. At the centre of the method are therapeutically initiated daydreams (imaginations) guided by dialogue. These are developed close to the sensual, physical and affective experience, scenically and symbolically. During the daydream, there is a verbal exchange with the therapist, who guides the imaginers with various possibilities of intervention. Accordingly, catathymic imagination is also referred to as a guided daydream. The therapeutically guided daydream in the context of KIP provides a mental development space. The inner images enable emotional and creative access to unconscious processes, wishes and behavioural patterns, to oneself and one’s relationships with other people.

History of KIP

In the late 1940s, while working at the Psychiatric University Hospital in Marburg, the psychiatrist and psychotherapist Hanscarl Leuner began to develop a research interest in the therapeutic use of imagination. During this time, he also gained experience with the induction of psychotic states by hallucinogenic drugs in test subjects. Imaginations, which contained meaningful symbolic ‘complexes’, could be induced both by psychoactive substances and by relaxation suggestions in conjunction with focussing on certain imaginative motifs of a symbolic nature. The latter proved to be more favourable for therapeutic purposes because it was possible to focus more on the availability of ego functions and self-control.

The first research results on ‘experimental’ catathymic imagery or symbol drama were presented in the mid-1950s[4][5][6][7][8]. With its further development into a psychotherapeutic method, the term ‘Catathymic imagery’ (CI) initially became established until the more comprehensive term Katathym (Catathym) Imaginative Psychotherapy (KIP) was introduced in 1994. This is intended to make it clear that the individual daydream as a CI is integrally embedded into a more comprehensive form of psychotherapy.

Leuner was a versatile psychotherapist, researcher and teacher. He was well versed in medical hypnosis, had experienced Carl Gustav Jung’s analytical psychology on himself and also remained open to other trends in psychotherapy, in particular Sigmund Freud’s psychoanalysis. This method provided him with the appropriate metatheoretical framework for locating CI and KIP in depth psychology-based (psychodynamic) psychotherapy as a psychoanalytically orientated method.

Leuner borrowed the adjective ‘catathymic’ (katathym or catathym) from clinical psychopathology, where it was used to describe the affective aspect of a certain delusional phenomenon. In his own writings, Leuner mentioned a whole series of approaches by other authors to which his ‘catathymic imagery’ could be related: Kretschmer’s ‘image strip thinking’[9], Happich’s ‘image consciousness’[10], Frederking’s deeply relaxed ‘imagery’[11], Silberer’s early work on the ‘symbolism of awakening and threshold symbolism in general’[12][13], autogenic training (AT) according to J. H. Schultz[14], active imagination according to C.G. Jung[15], the guided waking dream (‘rêve éveillé dirigé’) by Desoille[16].

For the imagination researchers Singer and Pope[17], Leuner’s method is ‘probably the most systematic of the European approaches to mental imagination and daydreaming’. This is not least due to the fact that the inventor and founder of the CI endeavoured to make his method easy to teach from the very beginning. Until the last edition of the ‘classic’ large textbook, KIP was consistently divided into basic, intermediate and advanced levels, as with AT[18], although a practice-orientated division into basic and advanced levels is now gaining ground in didactics and therapy[19].

After the initial experimental phase, Leuner consistently developed CI into a clinically applicable method (see Procedure and application of psychodynamic concepts in KIP). He succeeded in getting colleagues from different backgrounds interested in CI very soon, not without giving them impulses for the development of their own activities. Over time, a large number of new application possibilities emerged from the ‘first hour’ lecturers – partly in co-operation – including Edda Klessmann[20] for family therapy, Günter Horn for the treatment of children and adolescents[21][22], Leonore Kottje-Birnbacher for couples therapy[23][24] and group therapy[25][26], Eberhard Wilke for the treatment of psychosomatic disorders[27][28] and Ulrich Sachsse, Beate Steiner and Klaus Krippner for the treatment of trauma-related disorders[29][30][31][32].

Subsequent generations of lecturers took up the concepts mentioned in order to continue, supplement and expand them, or they also developed their own concepts for new applications. The KIP handbook[33] provides an overview of the current status.

In 1974, on Leuner’s initiative, the «Working group for Catathymic Imagery and Imaginative Methods in Psychotherapy» (‘Arbeitsgemeinschaft für Katathymes Bilderleben und imaginative Verfahren in der Psychotherapie’ (AGKB)[34] was founded and established in Göttingen. The method was further developed and taught by Heinz Hennig’s working group in eastern Germany, most recently as part of the “Middle-German Society for Katathym Imaginary and Imaginative Methods in Psychotherapy and Psychology” (‘Mitteldeutsche Gesellschaft für Katathymes Bildereben und imaginative Verfahren in der Psychotherapie und Psychologie’ (MGKB)[35] based in Halle. The ‘German Society for Katathym Imaginative Psychotherapy’ (DGKIP -„Deutsche Gesellschaft für Katathym Imaginative Psychotherapie“ )[36] acts as an umbrella organization.

The eye of Horus, the logo of Katathym Imaginative Psychotherapy, was called ‘Uzat’ by the ancient Egyptians: the healing. By choosing such an emblem, Hanscarl Leuner wanted to indicate that the catathymic imagery he developed contains dimensions that go beyond purely verbal-cognitive methods. In the context of KIP, this image symbolises the healing gaze inwards. This intermediate area of waking conscious reflections and unconscious pictorial fantasies, which can be made accessible in daydreams, is used therapeutically in KIP.

International anchoring of KIP

KIP is now implemented and taught in many European countries. The method has spread from its Central European centres in Germany, Austria and Switzerland to other countries. Up-to-date information on the specialist societies and the courses they offer can be found on the DGKIP website[36].

The legal basis for practising psychotherapy in general and KIP in particular varies from country to country. The best way to find out about the current status is to consult the aforementioned homepage or the websites of individual professional associations. Differences relate, among other things, to the status of KIP as an independent method and to the access criteria for training or further training.

In Germany, for example, KIP can be considered and implemented as a special method of depth psychology-based (psychodynamic) psychotherapy within the framework of the psychotherapy guidelines[37], but so far only by licensed, specifically trained doctors and psychologists. (As of October 2020)

Other professional groups are taught skills for the professional application of imagination for their own purposes at the ‘Institute for the Promotion of Imagination in Counselling and Supervision’ (IFI-BS)[38].

In Austria, the situation in terms of professional policy and treatment practice is currently very different to that in Germany. Here, KIP is considered one of several independent forms of psychotherapy, which can also be learned by other professional groups (after a corresponding propaedeutic course) and finally practised with the national licence. (Status: October 2020)

KIP and other treatment approaches

KIP is implemented as a method of psychodynamic psychotherapy (PDT) or what is known in Germany as depth psychology-based psychotherapy or depth psychology (DP), which in turn emerged from analytical psychotherapy as an independent further development[39]. The psychodynamically orientated forms of treatment derived from psychoanalysis are characterised by various modifications of psychoanalytical psychotherapy, which allow flexible adaptation to the circumstances of the respective patient[40].

The modifications (see Approach and application of psychodynamic concepts in KIP) concern, among other things, the limitation of treatment foci and goals, the reduced duration and frequency of treatment, therapeutic co-operation in sitting opposite one another and a lower regressive moment, which is usually accompanied by a reduced tendency to develop problematic transference. There are also differences in the importance of strategic considerations and more active approaches, with the basic principles of abstinence and neutrality being less strict in certain circumstances. KIP introduces additional modifications to the PDT treatment framework, above all the instrument of the dialogue-guided daydream[41]. This creates limited periods of time within individual therapy sessions for regressive processes and for symbolic action on an imaginative level.

Against the background of a psychoanalytically based attitude, in which processes of defence, resistance, transference and countertransference are always reflected upon, the psychodynamic psychotherapy of KIP provides the need for adaptations and extensions by adapting to a broad spectrum of disorders and using a flexible therapeutic repertoire for this purpose[42]. Here, the well-considered integration of interventions from other schools of therapy is always appropriate[43]. In addition to behavioural and systemic elements, the PDT therapists cited explicitly refer to imaginative techniques.

The integration of techniques and methods from other schools of therapy has long been part of KIP treatment practice. Even in Leuner’s textbook[44], alongside psychoanalysis, analytical psychology and autogenic training, a whole range of other approaches can be found, including those from behaviour therapy and client-centred psychotherapy. In addition, even in its early days, KIP incorporated elements from hypnotherapy, with whose techniques Leuner was well versed.[45] In later years, he also opened up to systemic perspectives.[46] Publications by subsequent daydream therapists deal with areas of overlap and differences with various treatment approaches, e.g. behaviour therapy[47], hypnotherapy[48][49] and systemic therapy[50][51].

Within the framework of KIP, it is possible to borrow and adapt techniques from different forms of therapy, but KIP as such can also be combined well with individual methods, such as psychodrama. While changes in KIP initially take place in the virtual intrapsychic and intersubjective space of the imagination, psychodrama, which is also an imagination-based method, primarily utilises the concrete action of the protagonist on a psychodramatic stage that can be experienced in the concrete space of the therapy. This is where the new construction of reality specific to psychodrama comes into play (surplus reality)[52][53][54][55].

Scientific basics, key points of diagnostics and therapy

Neurobiological and cognitive aspects of memory

The brain is in constant contact with the external environment and the internal environment of the body through sensory organs and nerves. It is integrated into ‘memory-bearing’ systems via the hormone and immune systems. The inherent neuroplasticity of the nervous system enables adequate adaptation of neuronal structures and functions to the demands of the environment. Even before birth, structures are created that are suitable for simple learning processes such as sensory perception, physical sensations, emotions and movements. In early ‘implicit’ (i.e. non-conscious) learning, the memorisation of relational procedures takes place without conscious control[56]. Nevertheless, the memory contents are constantly available in long-term memory. As the limbic system matures in the 9th month of life, the brain structures become more interconnected. The limbic system is regarded as the neuronal control centre for the emotional evaluation of situations. It is connected to the prefrontal cortex (PFC), an area of the brain that is significantly involved in action planning and control, among other things. In the ‘nine-month revolution’, enormous progress is made in memory formation, in which early bonding experiences with important attachment figures are consolidated and become the basis for an advanced sense of self[57].

Together with the episodic memory, the autobiographical memory stores all experiences that make up the material of the biography. Episodic memory is categorised as ‘explicit’ (to be made conscious) and ‘declarative’ (to be expressed in language) memory[58]. Memories stored there continue to develop with increasing language competence and progress in self-awareness. This includes recognising significant others as counterparts and the ability to perceive time. Memories activated in episodic memory always come into contact with implicit content that is not expressed in language. These are remodelled each time they are recalled in the present and are therefore not congruent with the originally experienced reality.

Remembering activates the memory systems and the neuronal networks. Neuroplasticity is a neuronal-based approach that KIP utilises[59] in order to achieve sustainably effective developments through repetition and redundancy.

Affects, emotions, feelings

Affects are intense biological-psychological phenomena. They are triggered by external events or internal psychological processes. They are used to convey or satisfy needs. Emotions have an important mediating function between perception and action. They are used to weigh up the positive or negative effects of what is perceived and felt before an action is initiated by motor activity. Feelings, on the other hand, require the linguistic and conscious memory networks. Through these, affects and emotions in the form of feelings can be recognised, which are processed internally as thoughts and expressed in words or gestures. Verbal forms of therapy get to the underlying emotions and affects by communicating about feelings. Body and movement-based forms of therapy have further-reaching possibilities of access, which can also be utilised in KIP. This is based on the element of imagination in terms of affect-based (‘catathymic’) imagery and the associated mediating element of the symbol.

Imagination

An integral part of KIP is catathymic imagination in the form of a dialogically guided daydream. Imagination as such (from Latin imago, meaning “image”) differs in many ways from nighttime dreams, conscious fantasizing, and visualization—for example, in terms of the element of volition and level of awareness. Information from all five sensory channels and bodily perceptions is brought together in an amodal form[60]. This enables integration with already stored emotional and cognitive information and forms the basis for the creation of symbols. Imagination and its symbolism are connected with the corresponding affect. Catathymic imagination is both guided and influenced by emotional experience, and in turn, also affects it. Psychic content such as sensations and aspects of relationships are transformed through imagination into scenical representations with a sensual, seemingly realistic quality. Imaginations arise from the current situation, draw on episodes from the past, or point out prospectively to the future. They involve multiple sensory qualities and are vivid, colorful, and multidimensional in both spatial and temporal terms. They are experienced as significant inner realities, which, however, can always be distinguished from external reality. During imagination, there is continuous awareness that these are fantasy images—yet unlike purely mental constructs, they possess an involuntary, spontaneous element.

Symbol

In the symbol (Greek σύμβολον – symbolon, meaning “composite,” “feature,” or “emblem”), the philosopher Cassirer sees “a sign to which the mind attributes meaning.” [61]. The symbol stands for something behind it. The object seen internally in a daydream stands for something else in the external or internal world and simultaneously becomes a carrier of meaning. Symbols in imagination are conveyed through the senses and are vividly perceptible—either present in reality or existing in the mind. They are deeply anchored in the perception of both physical and emotional processes and carry multilayered meanings. These meanings extend beyond the observed phenomenon and can produce effects that cannot be fully articulated in words.

Symbolization in daydreams

To symbolize means to translate complex contexts into the language of symbols. The ability to symbolize is part of humanity’s phylogenetically inherited capacities, but the specific ability of symbolizing must be acquired by the individuals during their ontogenetic development. In imagination, a symbol may condense and encode the past or point toward the future. In the therapeutic context, it is important to examine what aspects the imagined content may symbolically represent—whether it refers more to the imagining subject, its “objects” or reference persons, to transference, or to transitional phenomena arising from the therapeutic process [62]. When initiating imagination, the therapist’s suggestion of a motif acts like a predetermined symbol. Resources are activated and problems come into focus, making therapeutic processing of relevant episodes in the daydream possible (“episode activation”). Patients with impaired symbolic capacity due to early disturbances in interaction between infant and caregiver can be supported in their symbolic development and understanding of psychosomatic responses through imagination in KIP, akin to a process of maturation. Here, the therapist’s provision of attachment representations plays a key role.

The ability to understand oneself and others as feeling, thinking, intentional beings—and to empathize with others—is referred to as mentalization. KIP, grounded in sufficient attachment security within the therapeutic relationship, offers various technical possibilities for promoting the ability to symbolize and to mentalize (see areas of indication).

Procedure and application of psychodynamic concepts in KIP

Procedure and process structure of a KIP

Typical process of a Katathym Imaginative Psychotherapy (KIP) (adapted from Ullmann, 2017, p. 33):

Procedure, process[63]: Imagination in KIP is embedded within the basic psychodynamic method2. This means that psychodynamic principles must be taken into account in the motive-finding process, the relaxation phase, therapeutic support and post-processing (see KIP and other treatment approaches).

Motif finding: The therapist initially considers an appropriate and goal-oriented motif—essentially a symbolic theme under which the daydream should initially stand (e.g., “a flower”). The initial motif may be one of the so-called “standard motifs,” which were originally developed based on drive-dynamic and object-relations-theoretical considerations. Additional motifs include resource-oriented themes that promote aspects such as self-efficacy, relaxation, strengthening, and safety. These are particularly used for stabilization purposes, especially in Katathym Imaginative Psychotrauma Therapy (KIPT) [64]. Conflict-oriented motifs are also possible—for instance, with the aim of symbolic confrontation with imagined figures (in what is known as “symbol confrontation”). Motifs may also emerge from prior therapeutic dialogue (e.g., “a landscape that matches your feeling”). The motif is to be seen as a suggestion; the direction in which the imagination develops is primarily determined by the patient. A resource-focused motif can evolve into a conflict-oriented imagination and vice versa.

The guided daydream is usually initiated through such a motif, which symbolically introduces thematic impulses. A variety of proven standard motifs are available for the basic and advanced levels of the method. Motifs can also be created individually and adapted to the current therapeutic context. For example, the basic motif “mountain” can be used to symbolically focus on a person’s level of aspiration, while a tailored motif like “blockade” could vividly depict a neurotic work inhibition.

Setting and relaxation phase: KIP is performed lying down or sitting, usually with eyes closed. The relaxation phase can be short or extended, depending on individual needs. Experience shows that both relaxation and regressive tendencies typically intensify during the course of imagination.

Therapeutic guidance^[65] : After relaxation and motif specification, the patient and therapist usually remain in verbal exchange during the imagination. The therapeutic guidance style is characterized by a fundamentally permissive attitude that focuses on the necessary protection. Therapeutic interventions may include clarifying and differentiating questions (W-questions: Who? Where? What? How?), sensory-oriented one (hearing, feeling, seeing, etc.), emotion-oriented and deepening ones (especially related to bodily sensations), speed-oriented interventions (decelerating or accelerating depending on the situation), solution-focused ones (What might help?) and confrontational or encouraging interventions.

End of imagination: The length of an imagination can vary significantly—usually between 10 to 25 minutes, and in special cases (e.g., during intense symbol confrontation) up to around 40 minutes; for children, it may last only a few minutes. The session is brought to a close with the invitation to find a suitable ending, let the final scene gradually fade, reorient the senses outward, and activate the body through muscle tension to stimulate circulation. The immediate post-imagination discussion is kept relatively brief to allow the emotional impact of the imagery to linger.

Example of KIP follow-up: drawing for the motif “Tree”

Design of the imagination, follow-up, frequency: Standard procedure includes encouraging the patient to create a drawing based on the daydream. Children usually draw immediately after the session. Occasionally, patients are also invited to write a narrative report. Other forms of artistic expression (e.g., collages, sculptures) are also possible. In subsequent sessions, the imagination is revisited, often through the chosen form of design. Depending on the clinical situation and therapeutic process, the frequency of guided daydreams can vary: the standard is approximately one imagination every 3–4 sessions, although imaginations may also be conducted in every session—for example, in crisis situations or in some child therapies[66].

Phases of the therapeutic process: The catathymic imaginative process typically unfolds in several phases, each focusing on specific aspects. Initially, diagnostic aspects and the consolidation of the therapeutic relationship are emphasized. This is followed by resource-oriented and structure-building phases, then conflict-focused and confrontational phases. Toward the end, the focus shifts to review and future outlook, and finally, the farewell.

Psychodynamic (depth psychological) concepts in KIP

Therapeutically guided daydreams share some similarities with spontaneous nocturnal dreams with regard to the understanding of phenomena and psychodynamic relationships. In the diagnosis and follow-up of therapeutically induced daydreams in KIP, corresponding concepts from Sigmund Freud’s interpretation of dreams (e.g., symbolization, primary and secondary processes[67]) are taken into account. In contrast to night dreams, imagination in KIP is developed co-creatively[68] and is controllable. The unconscious is symbolized in active exchange and made accessible to consciousness through narrative[69] in follow-up discussions. This enables symbolic and creative externalization. Furthermore, through episodic activation[70] (see KIP and other treatment approaches) of important relationship experiences, previously inexpressible feelings become accessible and nameable. They can be used in a kind of implicit, symbolic catharsis to regulate affect, be perceived as emotions in a differentiated way and be processed within the therapeutic relationship.

Imagination offers approaches to practicing self-efficacy by developing one’s own resources (e.g., as a “safe place”) or by overcoming hindering situations in daydreams (e.g., through motifs such as “a stone in the way” or ” a threatening-looking animal”). In its processual character, KIP can be understood as the development of a “transition space” or “potential space” according to Winnicott[71]. In the sense of the mentalization concept[72], KIP is suitable for having a structure-building effect because, among other things, it practices symbolization (see KIP and other treatment approaches) and integrates the as-if mode as well as the mode of mental equivalence. The daydream and the subsequent follow-up work enable a very personal and thus meaningful anchoring of therapeutic insights through an “interpretation with metaphor.”[73] In the immediate impressiveness of the imaginations and the insight into their meaning – especially in connection with the symbolization of inner conflicts – there are points of contact with the flash technique described by Balint[74][75].

Areas of indication

Katathym Imaginative Psychotherapy (KIP) can be conducted within the framework of a depth-psychology based (psychodynamic) psychotherapy concept in accordance with the psychotherapy guidelines of the Joint Federal Committee (2009)[76].[77]

The treatment of various clinical pictures is based on a diagnostic triad. This serves to differentiate between neurotic disorders with a mature ego structure, ego-structural disorders with relationship-forming disorders, and/or trauma-related disorders.[78] Initially, KIP was used to treat patients with sufficient symbolization capacity and mature psychological defense mechanisms in the area of repression. In the treatment of these neurotic disorders and the underlying intrapsychic conflicts, the symbols unfold their effect on the image level without further therapeutic interpretation. Later, the range of indications was expanded to include the treatment of patients with ego-structural disorders and disorders in the areas of attachment, symbolization capacity, and mentalization capacity. Depending on their structural or functional level, these patients require therapeutically induced and supported developmental support for the further maturation of their personality. In the treatment of these clinical pictures, a disorder-specific, so-called implicit technique of KIP is used. This implicit technique, which operates below the threshold of consciousness, provides patients with early impairments with a certain degree of subsequent fulfillment of deep-seated needs and promotes their creativity as well as their ability to symbolize.[79]

The treatment of patients with acute or complex traumatization using Katathym Imaginative Psychotrauma Therapy (KIPT) represents a specialization and extension of KIP (see Applications). As with all modern trauma therapies, KIPT consists of a sequence of stabilization, trauma processing, and integration into the personality.[32] Conflict, structural, and trauma pathology are not mutually exclusive. Therefore, each clinical picture requires precise diagnosis and a treatment approach tailored to the structural conditions.

Indications for KIP for adults:

Acute and chronic stress reactions, e.g. exhaustion depression or burnout syndrome
Neurotic symptoms and neurotic structures, e.g. phobias, anxiety neuroses, depressive structure
Ego-structural disorders, personality disorders in which social adaptability is preserved
Post-traumatic stress disorder
Psychosomatic disorders, e.g. anorexia nervosa, bronchial asthma, ulcerative colitis or certain forms of arterial hypertension. e.g. anorexia nervosa, bronchial asthma, ulcerative colitis or certain forms of arterial hypertension
Somatopsychic disorders, e.g. after cancer, processing the consequences of accidents

Indications for KIP for children and adolescents:

Acute stress reaction, e.g. recent trauma, divorce of parents
Post-traumatic stress reaction
Depressive syndromes, anxiety and obsessive-compulsive disorders, e.g. separation anxiety, test anxiety
Psychosomatic disorders, e.g. neurodermatitis, bronchial asthma, non-organic enuresis, anorexia nervosa
Adolecent crises of a non-acute psychotic nature, e.g. detachment crises, identity crises[80]
Family therapy interventions, parent work

Contraindications for KIP:

Acute organic brain disorders, e.g. encephalitis
Severe cognitive impairment, e.g. progressive dementia or speech-restricting, severe impairment of intellectual learning and performance
Severe social adjustment disorders, e.g. dissociality
Acute affective and psychotic disorders, e.g. severe depressive phase
Addiction disorders with continued addictive behaviour, e.g. polytoxicomania

Forms of application

KIP is most frequently used as individual therapy in psychodynamically based short-term therapy and long-term therapy, often in crisis interventions and repeatedly in combination with analytical psychotherapies as long-term treatments[3][19][44][81][82][83].

Group therapy with KIP (G-KIP) represents a further development of psychoanalytically-orientated or depth psychology-based group therapy. The group sessions here are characterised by a special setting that provides for the alternation of pure conversation phases, shared imaginations in the group and specific subsequent talks in which the experience material is considered from a group-dynamic and psychodynamic point of view[25][84][85].

The psychotherapeutic treatment of children and adolescents with KIP requires an individually tailored therapeutic approach due to their different developmental maturity. In special therapeutic situations, parents and children can imagine together[22][86][87].

In couples therapy with KIP, the interactions of the two partners as well as their wishes, needs and conflicts are visualised in joint imaginations. This content can be addressed and further processed using both depth psychology and systemic solution-orientation[24].

Family therapy with KIP is also possible in a combination of systemic and psychodynamic thinking. A special form of imagination in the individual setting is the ‘inner family constellation’ of the respective patient[88][89].

Katathym-Imaginative Psychotrauma Therapy (KIPT) is a specialised variant of KIP for the treatment of patients with psychological traumas. By specifically incorporating imaginative techniques, the therapeutic relationship between patient and therapist can remain protected. Both the verbal treatment technique and the motifs are adapted to the needs of complex psychological traumatisation. Sustainable stabilising techniques, aspects of trauma confrontation, working through intense affects (such as grief, shame or anger) and the goal of integrating the trauma into the personality are among the essential elements of this form of therapy[30][90][91].

In practical work with trauma-related and structural disorders, there are a number of therapists who successfully combine KIP with other approaches, e.g. with Dialectical Behavioural Therapy according to Marsha M. Linehan[92][93].

Overall, KIP with all its treatment techniques and modifications is used in outpatient areas such as psychotherapeutic practices, counselling centres, psychiatric and psychotherapeutic outpatient clinics as well as in inpatient areas such as psychotherapeutic, psychosomatic and psychiatric clinics or day clinics[3][83][94].

KIP can be combined with other forms of psychotherapy and treatment approaches such as psychodrama or therapeutic work with so-called ‘concrete’ (specific) symbols[95][96][97] In addition, there are catathymic imaginative approaches in supervision and coaching[98].