On 14 February 1920, the world’s first psychoanalytic outpatient clinic opened on Potsdamer Straße in Berlin (Brecht et al., 1985). Karl Abraham, Max Eitingon and Ernst Simmel had founded it, financed in large part from Eitingon’s private fortune. The idea was not charitable; it was political. In 1918 Freud had formulated the demand that the conscience of society would one day have to awaken and tell it that the poor had a right to help for their minds (Freud, 1919a). Eitingon took him at his word. Anyone who approached the Berlin Poliklinik and could not pay was treated.

The same institute produced the training model that today runs worldwide under Eitingon’s name: training analysis, theoretical seminars, clinical supervision. For a little over a decade, Berlin was the laboratory of a young science that did not yet know which science it wanted to be — but knew that it touched something that mattered. The spirit of the institute was that of an emancipatory project: knowledge of the unconscious was not to be a class privilege.

On 10 May 1933, Freud’s books burned on Berlin’s Opernplatz. One could call that a barbaric reflex. Another description is more accurate. The National Socialist regime had read psychoanalysis with a certain precision. A science that shows people to be moved by forces that remain hidden from them is uncomfortable for a regime that depends on strong-willed, racially defined subjects. The expulsion was not an imprecision. It was a reading.

Eitingon emigrated to Palestine. The German Psychoanalytic Society expelled its Jewish members and was absorbed in 1936 into the German Institute for Psychological Research and Psychotherapy. What continued there was called Tiefenpsychologie — the method without its core: the unconscious without drive, without sexuality, without political explosiveness (Cocks, 1997). In 1938 the DPG was dissolved (Lockot, 2002). Freud died in 1939 in his London exile.

What left Germany was not merely a professional group. It was an intellectual temperament: the interest in self-deception, in the costs of the repressed. The international developments of the following decades — Klein’s object relations theory in London, Winnicott’s holding, Bion’s model of containment, Lacan’s structuralist turn in Paris — all took place elsewhere. The German-speaking world was cut off, and it took a generation before it reconnected (Ermann, 2012).

After 1945, psychoanalysis in Germany rebuilt itself along two lines. In Frankfurt, the intellectual line emerged. Alexander Mitscherlich founded the Federal Republic’s first psychosomatic clinic in Heidelberg in 1949, and in 1960 the Sigmund Freud Institute in Frankfurt — within walking distance of the Institute for Social Research, from which Critical Theory had emerged. In Frankfurt a clinical tradition met a philosophical one, and both profited.

1967 saw the publication of Die Unfähigkeit zu trauern: the claim that a society which cannot mourn its narcissistic loss shifts it into the economic miracle. Concepts such as repression, defence and narcissistic injury proved to be instruments of social diagnosis. This bond between clinical practice and cultural critique is a German peculiarity, nowhere else developed with such acuity.

While Frankfurt treated the German consciousness, in West Berlin another woman was building psychoanalysis into the statutory health insurance system. Annemarie Dührssen was a practitioner and a health services researcher. In 1965, together with Eduard Jorswieck, she published in the Nervenarzt a controlled study: patients in analytic treatment needed significantly fewer sick days over the following five years, had fewer hospital stays, generated lower follow-on costs (Dührssen & Jorswieck, 1965). The social insurance system could do the arithmetic.

On 3 May 1967, the Federal Committee adopted the Richtlinien über tiefenpsychologisch fundierte und analytische Psychotherapie in der kassenärztlichen Versorgung. They came into force on 1 October. The word tiefenpsychologisch had made its career at the Göring Institute as a camouflage term for a sanitised psychoanalysis without its Jewish founder. In the West German guidelines it resurfaced, this time as the name of a free-standing focal treatment method. The combination tiefenpsychologisch fundiert appears nowhere in the literature before 1967 — it is an invention of the guidelines commission (Hauten, 2012). Dührssen played a decisive part in shaping the guidelines over three decades.

In 1987, behavioural therapy was added. This gave rise to today’s official umbrella term psychoanalytisch begründete Verfahren, which encompasses AP and TP. In 2018, client-centred psychotherapy (Gesprächspsychotherapie) was removed for lack of proof of efficacy. In 2020, systemic therapy was added. The analytic methods hold their place — structurally untouched. Internationally, there is no equivalent.