Mental Health: Psychotherapy, But How?

Anyone in need of psychotherapeutic help faces an almost unmanageable jungle: There are psychiatrists and psychotherapists, psychologists and alternative practitioners, and an equally complex list of possible forms of therapy. These include:

  • Psychoanalysis / Analytical psychotherapy
  • Behavioral therapy
  • Conversational psychotherapy
  • Depth psychology based psychotherapy
  • Gestalt therapy
  • Psychodrama
  • Systemic therapy

In addition, there are still a number of mixed forms, which each therapist applies individually. So if you want to find the right therapy and the right therapist from this variety, you should be able to orient yourself at least to some key points.

A law as an anchor

Since January 1, 1999, the Psychotherapists Act has been in force, legally protecting the title “psychotherapist.” Psychological psychotherapists can thus obtain a health insurance license if they have received state recognition as a medical or psychological psychotherapist. Basically, three types of psychotherapists can be distinguished:

  • Medical psychotherapists
  • Psychological psychotherapists
  • Other psychotherapists

Medical and psychological psychotherapists have studied medicine and psychology, respectively, and then completed several years of in-service training, which then leads to the specialization “psychotherapy“. Among medical doctors, a distinction is also made between psychotherapists and psychiatrists. A psychiatrist does not necessarily have psychotherapeutic training, but is most familiar with the treatment of severe personality disorders and psychoses, which are often treated with medication. However, some psychiatrists also have psychotherapeutic training and offer outpatient psychotherapy themselves or form joint practices with psychotherapists. Training as a psychotherapist is offered and conducted by private therapy institutes and societies. In order for the therapist to obtain a license to practice and health insurance approval, the corresponding training institute must be state-approved.

The qualification is crucial

The third group of psychotherapy providers consists of psychologists with further psychotherapeutic training other than that to become psychological psychotherapists. There are also alternative practitioners who have undergone psychotherapeutic training. But also other professional groups such as pedagogues or social workers can work psychotherapeutically with a corresponding additional training. For this reason, it is particularly important to find out about the professional and specifically psychotherapeutic training of the respective therapist before starting treatment.

Ethical principles

Psychotherapists are subject to certain professional and ethical rules. They are subject to strict confidentiality and must have their therapeutic work reviewed by supervision, a kind of internal quality control within the profession. The views and dignity of each person who confides in them must be respected and their limits and values respected. There is also a so-called “abstinence requirement”: therapists should not and must not enter into private relationships with their patients for their own benefit. This approach hinders the progress and success of the therapy. In case of doubt, the therapist must stop the treatment and refer his client to another therapist.

Cost absorption

Psychotherapy, like any curative treatment in Germany, is a health insurance benefit. The patient can visit any psychotherapist of his or her choice who has been approved by the Association of Statutory Health Insurance Physicians. The health insurance companies cover the costs of the three methods approved by the health insurance companies: psychoanalytic psychotherapy, depth psychology-based psychotherapy and behavioral therapy. Other forms of therapy are not usually covered by health insurance. Self-awareness, personal development, couples therapy and marriage counseling are excluded from the catalog of services provided by health insurance companies. The state aid also reimburses the costs of psychotherapeutic treatment by psychological psychotherapists and child and youth psychotherapists. The applicable regulations correspond to those of the statutory health insurance; some details, such as hourly quotas, should be inquired about individually.

Big differences in private health insurance

In general, most private health insurance companies also cover the costs of psychotherapeutic services. Within the individual tariffs of the respective insurance companies, however, there are large differences, so that a detailed discussion with the insurance company is recommended before taking up a therapy. Under certain conditions, cost coverage is also possible through the Federal Social Assistance Act.

Trial sessions are possible and useful

Those who want to take advantage of therapy choose a therapist and use the first hours to get to know each other. During this period, the therapist establishes the diagnosis and makes a preliminary decision about the indication and prognosis for possible treatment. Psychotherapy is granted as an application benefit from the sixth session onwards, in the case of psychoanalytic psychotherapy from the tenth session onwards. This means that the health insurance fund thus assumes the costs after reviewing the need for treatment.

How am I doing?

Whether the respective therapist is the right one and with which procedure he wants to treat his client, one should test out in a preliminary talk and the trial sessions. Whoever goes to therapy expects help and support. At the same time, however, one should not hand over one’s own perception upon entering the practice, but should make a note of it for oneself:

  • Is the therapist sympathetic to me?
  • Do I feel comfortable around him, in the office?
  • Is the practice easily accessible to me?
  • Are distance, time, parking right?
  • What contact arrangements are in place?
  • Can I call outside office hours?

During the conversation can be determined:

  • Does he take time to listen to my concerns? Does he answer my questions in detail?
  • What training does he have? Where is the focus of his work?
  • Does he have experience with my problem?
  • What form of work awaits me, and what does he expect from me? Does he give himself and me enough time to get to know?
  • How long is the therapy expected to last?

In the first few hours, you should check:

  • How does the therapist treat me?
  • Do I feel accepted or pressured by him?
  • How does he react to any discomfort?
  • Do I feel better after the sessions?

Apart from long-term psychoanalytic therapy, which is designed to last for years, psychotherapeutic treatment – depending on the severity of the disorder and the methodological approach – usually lasts between 20 and 100 hours.So if you do not feel better after 10 – 20 sessions and no positive change is foreseeable, you should consider whether the therapist and therapy are right.

Application process

From the sixth or tenth session on, a cost approval from the health insurance company must be obtained for billing purposes. The client must submit an application for treatment. The application is then anonymized and supplemented with a professional justification by the therapist. An expert from the respective health insurance company reviews the application. A report from the family doctor is also required, which rules out physical causes for the illness. The number of sessions approved depends on the therapy procedure proposed in each case. The duration of a single session is usually 50 minutes. Continuation of therapy must be justified at each stage of treatment. Anyone with questions about therapists and psychotherapy will find contacts not only in the psychotherapeutic professional associations but also in the state chambers of psychotherapists, which are responsible for developing and maintaining professional and ethical standards.