In Germany psychotherapy is strictly subjected to rules of the national health system. A special commentary (Kommentar der Psychotherapie-Richtlinien) is setting guidelines demanding that psychotherapy has to be handled in a way called conflict-centered treatment ("konflikt-zentriertes Vorgehen"). This special German way of psychotherapeutic treatment needs metapsychological assumptions of what the therapist is thinking about his patient, a focus. The author presents a model of how the therapist can create this metapsychological subtext of such a conflict-centered treatment out of the dialogue and the scene which evolves from the first session both, therapist and patient, are together. He describes two modes of mentalizing work the therapist does while listening to the patient, (1) an emotional mode consisting of empathy for the patient and perception of his own countertransference and (2) a reflective mode which at least aims at creating psychodynamic and metapsychological hypotheses. The outcome of this mental work is what the author calls a central pattern of relationship. It combines different elements such as symptom, psychodynamic hypotheses and reflections on psychic structure and conflict to a complex text which has to serve as a kind of agenda (that is focus) for the therapist while working with the patient.
