- Psychotherapy - general and specific information
- What is psychotherapy and when should you go to psychotherapy?
- Who does psychotherapy?
- What types of psychotherapy are there?
- Who pays the costs for psychotherapy?
- Alternatives to long waiting lists
- How do I know which therapist is the right one for me?
Psychotherapy - general and specific information
In the Psychological Counseling Service, we can discuss whether psychotherapy would make sense for you and what form of therapy would be best suited to you. We can also help you find a therapy spot.
What is psychotherapy and when should you go to psychotherapy?
Literally translated, psychotherapy means “treating the soul.” With psychological methods, problems in thinking, acting, and experiencing the world are identified and treated.
If you can no longer handle the psychological stress in your life by yourself and this imposes constraints on your everyday life, your relationships, and your ability to study, then it might make sense to go to psychotherapy. You should not hesitate to seek professional help.
Who does psychotherapy?
Psychotherapy is done by medical and psychological psychotherapists. They usually have a Diplom/ Master’s degree in Psychology or Medicine and then get their license (state permission to treat) in Psychotherapy after a further education program they do after their studies.
A psychological psychotherapist does not prescribe medication. Their approach to therapy is different. They support the patients with psychological methods in overcoming the psychological illness by deliberately confronting its causes and/or by purposefully practicing new behaviors. If an organic illness must also be treated, or if a combination of psychological and medicated therapy is necessary for a psychological illness, then the psychological psychotherapist works together with physicians.
What types of psychotherapy are there?
There are different types of psychotherapy. These vary in their understanding of how psychological illnesses arise and in their therapeutic approach. Currently, only so-called “guideline procedures” are covered by the statutory and typically also the private health insurance companies: These are behavioral therapy, depth-psychology based psychotherapy, and analytical psychotherapy.
Analytical psychotherapy comes from the tradition of classical psychoanalysis, which can be traced back to Sigmund Freud and is the oldest form of psychotherapy. Over the course of time variations have developed, but they have in common their understanding of how psychological illnesses arise.
The goal of analytical psychotherapy is to make the patient aware of repressed feelings and memories that block the development to becoming a healthy, independent individual. Analytical therapy assumes that personal life experiences and especially their conflictual, unconscious processing can contribute to or maintain psychological illnesses. If life experiences lead to unconscious conflicts, then psychological and physical symptoms can arise. In analytical psychotherapy, the focus of therapy is on these life experiences and processing them in the present. Analytical psychotherapists support you in becoming aware of these unconscious processes and thus making what is confusing accessible to your conscious experience. They have you describe what you are thinking of and how you feel without evaluating or judging what you say. They not only pay attention to what you say but also how you deal with yourself and your psychotherapist. In the course of therapy, a pattern arises that shows how you unconsciously treat yourself and other people. Besides this, it is determined whether this way of treatment, which made sense in previous situations, is appropriate to your life currently or leads to inappropriate experiences and behavior or to symptoms of illness.
During analytical psychotherapy, you usually lie on a couch and do not look at the psychotherapist. The advantage of this is that you are more free in your thoughts and feelings and can focus more on your inner world, thoughts, and feelings.
Analytical therapy is a long-term therapy and lasts at least two years. With your psychotherapist, you usually agree to have two or three therapy sessions per week.
Depth Psychology-Based Psychotherapy
This form of psychotherapy developed out of psychoanalytical therapy. The basic idea of people as well as the understanding of how psychological illnesses develop are similar: Depth psychology-based psychotherapy also assumes that an internal psychological conflict is the reason for the current problem. However, depth psychotherapy concentrates its treatment on processing the so-called “central conflict” and, on this basis, looks for possible causes in the patient’s personality or past.
With insights into the context and reasons for their problems, patients are to strive for changes in their experiences or behavior, and the psychotherapist actively supports them in this. Treatment is done while sitting and lasts between six months and two years.
(Cognitive) Behavioral Therapy
Behavioral therapy assumes that people have varying susceptibility to psychological illnesses based on psychological and social characteristics that have developed over the course of their life history and also based on genetic and physical factors. With this background, stressful experiences or stress can trigger a psychological illness for the first time. Other factors can protect people from psychological illnesses: for example, trusting, stable relationships; the ability to accurately perceive oneself and others; or the meaning they see in their life and tasks. Reactions from the environment to psychological problems, their coping behaviors, and the internal dynamics of psychological illnesses influence how the illness progresses.
In behavioral therapy, the psychotherapist will first work with you on an explanation for why you are psychologically ill. You decide on concrete therapy goals and, from the causes and conditions of the illness, derive specific treatment measures. A behavioral therapist will encourage you to look more closely at how you see others or how you behave in certain situations and to ask yourself how that influences your well-being and what you can change about it. For example, they will help you to recognize negative thoughts and their influence on your feelings and behavior and to develop helpful thoughts in your everyday life and try out new behaviors. This could mean, for example, going with the psychotherapist outside of their practice or clinic into situations that scare you. Or that you analyze and work with your psychotherapist on the way you see yourself and how you shape your relationships. The psychotherapist will support you in better understanding the behavioral patterns you have acquired over your lifetime and changing so that your problems are alleviated.
In behavior therapy, you will sit across from the psychotherapist. The number and frequency of therapy sessions are agreed on by the patient and psychotherapist depending on the type of problem. The treatment usually lasts between six to twelve months, sometimes longer.
There are various types of systemic therapy, but all of them place a focus not only on the individual patient but also include the most important contacts, for example the family, and the patient’s environment. An individual patient’s psychological illness is viewed as a symptom for a problem in the systemic behavioral or communication patterns, that is, in the family or broader environment.
The psychotherapist will try to identify the disruptions in the system and look for solutions together with the patient. Systemic therapy assumes that the improvement of psychological complaints is initiated in the therapy sessions, but that the decisive changes will occur between sessions. That is why the time between the therapy sessions might be longer. At the start of therapy, they could be one to two weeks apart and at the end there could be six or eight weeks between sessions. Systemic therapies usually don’t last longer than 25 sessions, but long-term therapy could also be done. The individual therapy sessions take place as single or double sessions.
This form of therapy is part of the humanist approaches and is also sometimes referred to as “conversational.” The focus is not placed soley on the patient’s symptoms or development history but on the person as a whole in their living environment. Client-centered psychotherapy assumes that each person has the ability to develop positively. Patients with a psychological disorder are therefore themselves best suited to analyze their personal situation and find solutions for their problems. In client-centered psychotherapy, the patient is considered the “expert of him/herself.” That is why self-discovery is the focus of therapy. With the help of client-centered discussions in which the importance of feelings is given particular attention, the patients are to understand and learn to accept themselves.
In client-centered psychotherapy, the patients and psychotherapists sit across from one another. The treatment usually lasts between six to twelve months with one therapy session per week.
Gestalt therapy according to Perls is also a form of humanist psychotherapy. Here, as well, the assumption is that people essentially strive for the good and holistic. In this method, patients are confronted with experiences that have not been fully processed or needs that have been repressed, whereby the therapy concentrates on the patient’s state in the here and now.
The psychotherapist attempts to motivate the patient and thus to support them in confronting their problems and taking responsibility for their own actions. The goal of Gestalt therapy is the development of the patient holistically as an individual and making them aware of all parts of their personality, feelings, and needs (the so-called “good Gestalt”).
Who pays the costs for psychotherapy?
Statutory health insurance (Gesetzliche Krankenversicherung)
Psychotherapy is included in the statutory health insurance coverage. That means that statutory health insurance providers cover the costs for types of therapy considered “guideline procedures” (analytical psychotherapy, depth psychology-based psychotherapy, behavior therapy). However, psychotherapy must be requested - that means that after a trial session you will have to submit a request for the approval of additional sessions. You can get the form you need and additional information from your psychotherapist. Usually, the psychotherapists take on most of the administrative tasks for you. You only need to read and sign the form. If the health insurance company has approved your request for psychotherapy, it will completely cover the costs of the psychotherapy. You will not need to pay anything.
The statutory health insurance providers can reject your request. You can object to the rejection. If your objection is also rejected, you can file a claim with the Social Court, which is free of charge.
Private health insurance (private Krankenversicherung)
There are no standard regulations for the coverage of private health insurance. What is important is what the insured and the insurance company agreed on in the insurance contract. Many private health insurance companies refuse to insure mentally ill people, however, or limit the coverage in the case of a psychological illness. Private insurance companies also usually only reimburse the costs for treatment with scientifically recognized procedures (“guideline procedures”). In any case, you would be well-advised to have the insurance company confirm in writing that it will cover the cost of treatment before you begin.
No health insurance or you pay out of pocket
If you do not have health insurance and are in financial hardship, you can also submit a request to the Social Welfare Office (Sozialamt) that your psychotherapy be paid. If you pay the costs yourself, you are usually treated like a patient insured with private health insurance. The costs of treatment are determined by the fee scale for psychotherapists. Before starting treatment, you should come to a clear agreement - in writing if at all possible - on the type, duration, and costs of the treatment.
Alternatives to long waiting lists
The Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) and health insurance providers are legally mandated to enable you to have psychotherapy. However, if you cannot find a psychotherapist who accepts patients with statutory health insurance within an acceptable waiting period, you can acquire the service yourself. Your health insurance company is required to reimburse the costs (Sec. 13(3) Social Code V (SGB V)). The courts have ruled that waiting times of over six weeks are unreasonable, and it is also unreasonable (for medical reasons and for reasons of humane medical treatment) for you to contact more than five physicians who accept patients with statutory health insurance.
If you have found a psychotherapist who is not approved for accepting patients with statutory health insurance but who can provide you with a therapy spot, then you will first have to clarify with your health insurance provider whether they will cover the costs of treatment. Ask the health insurance representative responsible for you how you can successfully submit a request for cost reimbursement for psychotherapy. Emphasize that you urgently need the therapy and that you were not able to get a treatment spot with a psychotherapist who accepts patients with statutory health insurance within the next few months. For the request, you can send a letter in which you describe the reasons you would like to do a psychotherapeutic treatment with a psychotherapist who does not usually accept patients with statutory health insurance. You should include the following with your request:
· Certification of necessity or urgency from a psychotherapist or physician that the psychotherapy is necessary, urgent, and cannot be delayed any longer.
· Proof that you cannot get a therapy spot with a psychotherapist who accepts patients with statutory health insurance within a reasonable waiting period. Some statutory health insurance providers require written rejections, for others it is sufficient to document your telephone calls (notes about the date, time, and result of the call with the psychotherapists approved for accepting patients with statutory health insurance).
Your psychotherapist should also briefly provide justification for your request and then submit the forms for the “Approval of Non-Contractual Probatory Sessions and Psychotherapy.”
When submitting your documents to the health insurance company, for the protection of your data you should make sure that no details about your illness are given. Treatment can begin once your health insurance company has consented in writing to cover the costs.
Out-patient clinics at educational institutes for psychotherapists
People who want to become psychological psychotherapists must first complete a Diplom or Master’s degree in Psychology before starting the training to become a psychological psychotherapist.
The first part of training is at least one and a half years (1800 hours) of practical work that is usually done in psychiatric clinics.
The second part is then done as out-patient treatment in an out-patient clinic at the educational institute - under the supervision of experienced psychotherapists.
People who have statutory health insurance have the possibility to get a therapy spot relatively quickly (average waiting time 1 month).
How do I know which therapist is the right one for me?
Listen to your intuition! It is important that you feel comfortable with your psychotherapist and that there is a basis for trust. A positive and trusting relationship between the patient and psychotherapist is an important prerequisite for therapy to be successful.
According to scientific studies, most patients can already judge very well whether they get along with their therapist after only a few trial sessions. That is why you should first arrange for an appointment for a trial session. For therapists who are approved for treating patients with statutory health insurance, the health insurance provider will cover the costs.