Psychotherapy: an overview

Psychotherapy is the targeted treatment of mental health conditions or psychosomatic disorders using psychological methods. It is about guiding patients’ thinking, experiences, feelings and behavior in a healthier direction.

In principle, there is no diagnosis that rules out psychotherapy from the outset. Psychotherapy can help alleviate symptoms, positively influence the course of health conditions, manage health conditions, improve social adjustment or even promote understanding of a condition.

Common mental health conditions in Germany include anxiety disorders, depression, addictive disorders, personality disorders, psychoorganic disorders and psychoses. Psychotherapy can help with almost all mental health conditions, as well as psychological issues that arise in conjunction with physical conditions. Despite this though, psychotherapy is not truly beneficial for all patients. As psychotherapy is also a comparatively expensive form of treatment and can also have side effects, its use should be well justified.

Psychotherapy is beneficial if professionals believe that it can positively and sustainably change a health condition. A medical professional such as a family doctor will recommend psychotherapy as a form of treatment.

Depending on the health condition, psychotherapy can potentially be used as the sole form of treatment. However, it can also be used to complement medication and other treatments or as an alternative to these.

Psychotherapy can be delivered on an inpatient (in a medical facility), day patient or outpatient basis. For statutory health insurance providers to cover the costs of outpatient psychotherapy, certain conditions must be met. Over the course of two to four sessions, the therapist and patient get to know each other and a treatment plan is created. This summarizes which psychotherapeutic approaches could help with the problems at hand. These sessions are also used to make a diagnosis and determine which problems or health conditions are present and how pronounced they are. In the case of a mental health condition, the patient applies to his/her health insurance provider for psychotherapy with the assistance of the therapist. In a review process, this request is then either granted or in rare cases, where there is a sound reason to do so, it may also be denied.

Psychotherapy is also provided on an outpatient basis by qualified medical specialists, such as specialists in psychiatry and psychotherapy. If necessary, these can incorporate psychotherapy into their medical treatments. Depending on their qualifications, they may interweave elements of behavioral therapy, psychoanalysis, depth psychotherapy, systemic therapy, supportive psychotherapy or other effective methods into their treatment. With professional psychotherapy, there is no limit on the duration of the individual treatments or the number of therapy sessions.

People with statutory health insurance do not have to pay for recognized psychotherapeutic treatment. In the outpatient sector, psychological and medical psychotherapists must be approved by the health insurance providers. People with private health insurance must check with their health insurance provider as to which costs are covered. The cost of inpatient psychotherapy is covered regardless of the type of health insurance cover the patient has.

Scientifically recognized psychotherapeutic treatments covered by statutory health insurance include:

• (cognitive) behavioral therapy
• depth psychotherapy (psychodynamic psychotherapy)
• (psycho)analytical psychotherapy (psychoanalysis)
• systemic psychotherapy

Client-centered talk therapy is also scientifically recognized but is not covered by statutory health insurance.

Although the effectiveness of the various psychotherapy methods does not differ significantly, certain methods are the first choice when treating specific health conditions. For example, behavioral therapy or treatment with suitable medication is initially recommended for panic disorders. Furthermore, individual patients respond differently to different approaches.

Cognitive behavioral therapy

With cognitive behavioral therapy, it is presumed that behavior, thoughts and feelings can be changed through learning processes, regardless of whether they are innate or learned. Attitudes, feelings, abilities or reflexes are changed using a variety of methods.

Behavioral therapy includes aspects such as describing the behavior, analyzing behavioral triggers and consequences, training in helpful skills, conducting “behavior experiments” and keeping records of moods, feelings and behavior. Cognitive behavioral therapy usually takes place once a week and can involve up to 80 sessions depending on requirements.

Psychodynamic psychotherapy

Today, psychoanalysis and depth psychotherapy are both referred to using the umbrella term “psychodynamic psychotherapy”. This approach assumes that unconscious conflicts exist between inner drives, rules and needs that can cause and maintain psychological problems. Conflicts can also exist between internal needs and external requirements. The therapist helps the patient to compensate for any impairments associated with these unconscious conflicts. During this process, the conflicts and their consequences should be brought to light in the here and now.

During psychoanalysis, patients are typically in a relaxed position and shielded from external stimuli, for example lying on a sofa. This should enable them to focus on their thoughts, feelings and mental images. Psychoanalysis usually occurs as long-term therapy involving two to three sessions per week and up to 300 sessions in total.

Depth psychotherapy tends to focus on the present and coping with everyday life. It helps patients resolve current conflicts by activating existing unconscious abilities. The relationship between the therapist and the patient is used to identify and resolve everyday relationship problems. Depth psychotherapy usually takes place once or twice a week and can involve up to 100 sessions depending on requirements.

Systemic therapy

Systemic therapy is based on the belief that patients’ mental health problems can only be understood and changed by also addressing their social environment, for example their family circumstances. After all, people and their behavior must be understood in a social context. As a result, systemic therapy takes a particular interest in interpersonal relationships and the communication within these relationships that causes and sustains the problems. Consequently, relationships are also important for changing and resolving the problems.

In systemic therapy, relationships, problems or feelings are often symbolized by figures or objects. Attempts are then made to make the problems tangible and resolve them within such systemic constellations. Systemic therapy is usually quite short and comprises up to 48 sessions.

Decades of proof of efficacy exist in relation to the therapy methods recognized by the health insurance companies. The level of efficacy depends on the type of disorder. On the whole, it can be assumed that psychotherapy leads to significant improvements in 50 percent of patients.

However, psychotherapy can also have side effects. If, for example, the therapy teaches someone to be more self-determined, this can result in conflicts in their relationship. According to scientific studies, about a third of patients are likely to experience significant side effects. These can also include an increase in symptoms and helplessness.

Many people do not understand the differences between psychologists, psychiatrists and medical psychotherapists.

Psychologists

Psychologists have a degree in psychology. However, this does not authorize them to provide psychotherapy. This can only be done by “psychological psychotherapists”, who have obtained a special qualification. In future, the job title to be used in Germany will be “Psychotherapeut*in mit einer fünfjährigen Fachpsychotherapeutenweiterbildung” (“psychotherapist with five years of specialist training in psychotherapy”).

Doctors of psychotherapy

Doctors of “psychiatry and psychotherapy” or “psychosomatic medicine and psychotherapy” have a medical degree plus five years of further training as a medical specialist. This includes training in one of the methods approved in the guidelines on psychotherapy. Medical psychotherapists are also referred to as “psychiatrists”. As doctors, they can not only provide psychotherapy within the limits of their specialized field but also perform physical examinations and prescribe medication.

Doctors from other disciplines can complete an additional qualification in psychotherapy in their specialist medical field. This takes three years and is equivalent to the further training in psychotherapy completed by other therapists.

In the event of health problems, people should start by contacting a professional, such as a family doctor or psychiatrist. Such professionals can then determine whether psychotherapy is advisable and provide information about how to proceed.

Psychotherapists in your area can be found through the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), for example. Simply call 116 117 or use the online directory for physicians.

For more information about finding a psychotherapist and understanding emotional stress, visit the website Wege zur Psychotherapie (Paths to Psychotherapy) from the Chamber of Psychotherapists (Bundespsychotherapeutenkammer).

More detailed information on how to find psychotherapy services can be found at gesundheitsinformation.de.