What can I expect in psychotherapy?

21. May 2019

Mental illness can affect us all. From top managers to self-employed craftspeople, from entrepreneurs to new mothers. Our stories and stresses are highly individual and life can sometimes exceed our resources. The good thing is that we are not on our own when we face a mental health crisis. We don’t have to take mental illness out on ourselves; in fact, we can and should get help. There are people who specialize in just such situations and know how to give advice: We are talking about psychotherapists.

With this article we provide an overview of different forms of psychotherapy, the process of such therapy and how to find the right therapist!

Psychotherapy: healing the soul

Psychotherapy is initially about overcoming psychological illnesses. These illnesses include, for example, depression, anxiety disorders, burnout, obsessive-compulsive disorders, post-traumatic stress disorder, or eating disorders. Additionally, in psychotherapy, people are strengthened in their personal resources and acquire new skills to better deal with difficult situations in the future. The therapy thus illuminates not only the weaknesses, but also the strengths of people seeking advice.

About the courage to seek help

It is sometimes not so easy to admit to yourself that you need help. After all, you’ve always stood in the middle of life and now all of a sudden you’re supposed to go to a “shrink”? What will family, friends and colleagues say? The beginning of psychotherapy is often accompanied by worries and fears. But the beginning of psychotherapy is a strong achievement! You take responsibility for yourself and thus also for your environment.

And you are not alone: every third German suffers from a mental illness in his life. Of those affected, every second person makes use of psychotherapy. You can find more facts & figures on the website of the DGPPN (German Society for Psychiatry and Psychotherapy).

Different approaches in psychotherapy

Basically, psychotherapy involves interpersonal communication. It is a conversation between patient and therapist, in which the therapist uses various interventions to advise the patient in his or her individual life situation. There are different forms of therapy, which are also called different “schools of therapy”. In Germany, there are three methods that are officially approved by the legislature. Approved in this case means that the costs for the therapy are covered by the respective health insurance.

Behavioral Therapy

The work takes place in the present.
Based on principles of learning theory: Stressful behavior and thinking patterns are learned and can also be unlearned.

Depth psychology based therapy

Analysis of underlying past causes of the disease.
Assumes a dynamic subconscious that controls our behavior and thinking.

Psychoanalysis

Experiences deep in childhood are addressed and processed.
Restructuring of the personality and the subconscious is aimed at.

As a rough orientation, it can be said that in behavior therapy, current symptoms of the mental illness are discussed first and foremost, and the past (initially) remains in the background. In psychoanalysis and depth psychology-based therapy, causes of symptoms that lie in childhood and adolescence are also explored in depth. In the meantime, however, the focus of treatment is largely on the personality level, so that the biographical anamnesis is usually focused on and illuminated in every procedure.

Since 2018, another therapy method has been approved: systemic therapy. However, the final handling is still being discussed in the expert committee for psychotherapy. A result is expected in 2020. The systemic approach to therapy looks at the patient in his or her interpersonal systems, such as the occupational system or the family system. The interactions between the individual persons in the system are illuminated.

Which form of psychotherapy do I choose?

We humans are different and also have different preferences with regard to forms of conversation. Above all, the interpersonal relationship between patient and therapist must be coherent. It is not possible to predict exactly which form of therapy is most suitable for whom. Sometimes the choice of the therapy form also depends simply on the place of residence and the offer prevailing there. In any case, it is worth getting to know the therapist personally, because when the chemistry is right, the form of therapy fades into the background.

Outpatient or inpatient psychotherapy?

Also in this topic, no blanket recommendation can be made: Depending on the severity of the disease, treatment in a clinic or but the treatment in a practice is preferable. For example, if the affected person is severely impaired in his daily life or does not find sufficient resources in his environment to recover, this is a good indicator for inpatient treatment. Psychotherapy in a clinic differs from outpatient therapy in that the individual sessions are shorter, but take place more often during the week.

In addition, those affected have the opportunity to exchange ideas with like-minded people in psychotherapeutic group therapies. In addition, an inpatient stay can enable holistic treatment of the mental illness. This is achieved through further therapy offers such as occupational therapy, relaxation therapy or sports therapy.

How does psychotherapy work?

Often, psychotherapy is recommended by the family doctor or specialist and the patient receives an appropriate referral. However, it is also possible to contact a psychotherapist directly. Therapists or clinics in the vicinity can be found via the Internet or telephone directory. The initial contact is usually quite uncomplicated by telephone or email.

The initial consultation

During the initial consultation, the patient and therapist get to know each other very gently for the first time. Formalities are discussed, such as the clarification of confidentiality on the part of the therapist. The therapist gets an initial picture of the patient’s symptoms and collects important personal data. Further appointments for the probationary session are made. Don’t worry: it’s not straight to the point!

Probatory sessions

First, the so-called probationary sessions take place, which means psychotherapy “on trial”. Every patient has a right to five probationary sessions, whereby the initial interview already counts towards this. These first sessions are always covered by the health insurance. If the chemistry is right, the therapist and patient decide to continue working together. The therapist then submits an application for therapy to the health insurance company, which then ultimately decides whether the therapy offered is suitable and meaningful in the individual case. If this is the case, the costs for a varying number of therapy units are covered by the health insurance (depending on the direction of the therapy).

Diagnostics

Your therapist has the task of carrying out a comprehensive diagnosis with you. So don’t be surprised if you get some questionnaires to take home and fill out. This is for the therapist to gain information and make a diagnosis. In addition, the psychotherapist will request a so-called consultation report from your family doctor, in which it must be confirmed that there is no causal physical illness.

Therapy sessions

Psychotherapy sessions take place one to three times a week, depending on the school of therapy, and last 45-90 minutes. The session often begins by asking about the patient’s current mood. Often, particularly tricky recent situations are then identified, which therapist and patient work on together.

The rest of the procedure consists of, for example:

  • Discussing alternative courses of action
  • Considering health-promoting strategies
  • Processing fearful memories

For example, a patient who suffers from panic attacks and therefore avoids certain places and situations learns how to manage his anxiety symptomatology in a way that maintains a sense of control. Gradually and very carefully, he is confronted with fearful situations so that he gradually becomes accustomed to them and can live his life free of fear again.

Completion of therapy

How long people are in psychotherapy is completely different. For some mental illnesses, such as anxiety disorders or depression, even so-called short-term therapies with 12 or 24 therapy units are promising. Of course, long-term therapy can follow if necessary. Here again, it depends on the therapy school how long the therapy is scheduled. In behavioral therapy it is 60 hours, in psychoanalysis even 300.

The Federal Association of Statutory Health Insurance Physicians provides more information here. Together with the therapist, you will realize when it is time to stop therapy. The ultimate goal is for you to be able to participate in life again with satisfaction.

Worth knowing about psychotherapy

Psychotherapy is new territory for most people. You have already learned in this article, which psychotherapy schools there are and how a therapy is approximately. Often, the abundance of offers and the somewhat complicated path to the appropriate therapy but still leaves you perplexed. In addition, you will be confronted with many very similar-sounding job titles along the way. We shed light on the darkness of the search for psychotherapy and explain who you will be dealing with in the psychotherapy jungle!

Waiting for psychotherapy?

Currently, the need for psychotherapeutic treatment exceeds the actual supply situation in Germany. In the past, there were often very long waiting times for treatment, especially in rural areas. At the same time, those affected often need help quickly. The Psychotherapy Information Service has taken on this problem and provides support in finding therapists. In addition, therapists can provide free therapy places online here, so that treatment can begin as quickly as possible.

Depending on the federal state, you can also contact the Association of Statutory Health Insurance Physicians to search for free places. Of course, there is also the option of private treatment. Some therapists only treat patients with private insurance. In some cases, however, the statutory insurers also cover private treatment. It is best to find out more about this from your health insurance company.

Who actually does what?

Many occupational fields deal with the subject of psychology or mental illness. The names of the activities are very similar. Nevertheless, it is important to be able to distinguish who is responsible for which task. Learn about the different job titles:

Specialist in psychiatry and psychotherapy

Medical degree and permission to prescribe medication.
Originally called a psychiatrist. He takes over the adjustment of medication, monitors the course of treatment and is in close contact with the therapists.

Psychological psychotherapist

Studies in psychology followed by training as a psychotherapist.
Is qualified to treat persons with mental illness. The exact form of treatment depends on the field of training (see above). He is not allowed to prescribe medication.

Medical psychotherapist

Medical studies followed by training as a psychotherapist.

Specialists in psychiatry can also undergo therapy training. In this case, you may also prescribe medication in addition.

Psychologist

Psychology studies without subsequent training as a psychotherapist.
Takes over diagnostics in part, but is not allowed to offer psychotherapy.

Psychological consultant

Exclusively advisory function.
May provide counseling support for short-term stressful situations, but is not permitted to treat diagnosed mental illness.

Alternative practitioner for psychotherapy

Training as a non-medical practitioner.
Has not necessarily studied, but has completed a Heilpraktiker training. He is not allowed to bill the health insurance.

Taking the First Step

Whether you are affected yourself, or a loved one around you. You have already taken the first step by addressing the issue and gathering information. Informed patients and loved ones can already facilitate the therapy process. Beginning psychotherapeutic treatment is a milestone in the course of a mental illness. Ups and downs are part of it. We are (fortunately) not rigid robots without feelings. Take it on, it will be worth it! For the healing journey through your psyche, I wish you a lot of strength, a large portion of courage and a little bit of luck!

Categories: Therapy

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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