Psychotherapy is to be understood here as a treatment using psychic means. Defined in this manner, it includes many of the recommendations made by psychotherapy both in the broad and in the narrow sense. The recommendations nonetheless belong more in the area of psychohygiene intended to impede the worsening of already existent disturbances.

If the question is asked of why so little is known about psychotherapeutic methods of treatment of sleep disturbances, it should be understood that in practical terms the only question concerns psychoreactive disturbances in falling asleep and functional hyposomnia. There is reason to suspect, especially concerning functional hyposomnia, that an analytic treatment as practiced by psychotherapy would not reveal much. The reason for the ineffectiveness of psychotherapy is that these functional sleep disturbances do not involve an abnormal psychic (neurotic) development; they involve tendencies deeply rooted in biological development.

These psychic tendencies are direct consequences of this physical condition. In less frequent instances, they are indirect consequences of the physical condition. They are therefore psychological signs of illness in a narrower sense. They are psychic reactions or manifestations of a psychic inability to cope with a bodily disfunction— namely, of the inability to sleep. If such psychopathological conditions are involved, analytic psychotherapy has hardly any relevance to the condition and little promise of success. The use of psychotherapy among functional hyposomniacs has been so fruitless that it has hardly been worthwhile to publish anything about such treatment.

Psychotherapy exists, however, in forms other than analytic therapy and includes many other kinds of treatment in addition to those methods already described here in some detail. These methods may either be the normative pragmatic technique of a concrete, treatment-oriented form of therapy or may be objective psychotherapy, which is considered supportive. I prefer to call these methods active-autohypnotic procedures, because this term characterizes both the technique and the goal.

The designation, "active," as used here means that the method emphasizes concentration for achieving relaxation. Initially this is done by achieving muscle relaxation as a step toward reaching other psychic changes best described as a self-induced trance that is very similar to a state achieved through hypnosis and autohypnosis.

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