Mental Health - Psychotherapy, but how?

Anyone in need of psychotherapeutic help faces a jungle that is barely manageable: there are psychiatrists and psychotherapists, psychologists and non-medical practitioners, and an equally complex list of possible forms of therapy.

This includes:

  • Psychoanalysis / Analytical Psychotherapy
  • behavior therapy
  • Gesprächspsychotherapie
  • Deep psychological well-founded psychotherapy
  • gestalt therapy
  • psychodrama
  • Systemic therapy

There are also a number of mixed forms that each therapist uses individually. So if you want to find the right therapy and the right therapist out of this variety, you should at least be able to find your way around a few cornerstones.

A law as an anchor

Since 1 January 1999, the Psychotherapists Act is in force, which protects the title "psychotherapist" by law. Psychological psychotherapists can thus obtain a health insurance license if they have received state recognition as a medical or psychological psychotherapist.

Basically, you can distinguish three types of psychotherapists:

  • Medical psychotherapist
  • Psychological psychotherapists
  • Other psychotherapists

Medical and psychological psychotherapists have studied medicine or psychology and then completed a several-year part-time further education, which then leads to the specialization "psychotherapy". The medical profession also distinguishes between psychotherapists and psychiatrists. A psychiatrist does not necessarily have a psychotherapeutic education, but is especially familiar with the treatment of severe personality disorders and psychoses, which are often treated with medication.

However, some psychiatrists also have a psychotherapeutic training and offer even outpatient psychotherapy or form practice communities with psychotherapists. Training as a psychotherapist is offered and carried out by private therapy institutes and societies. In order for the therapist to be able to obtain a license to practice and register, the relevant training institute must be recognized by the state.

The qualification is crucial

The third group of psychotherapeutic providers are psychologists with psychotherapeutic training other than psychotherapeutic psychotherapists. There are also naturopaths who have undergone psychotherapeutic training. But other occupational groups such as educators or social workers can work psychotherapeutically with a suitable additional training. For this reason, it is particularly important to get informed about the professional and especially psychotherapeutic training of the respective therapist before starting a treatment.

Ethical principles

Psychotherapists have certain professional and ethical rules. They are subject to strict confidentiality and must have their therapeutic work reviewed by supervision, a kind of in-house quality control. The views and dignity of every person who entrusts to them must be respected and their boundaries and values ​​respected.

There is also a so-called "abstinence requirement": therapists should not and may not enter into private relationships with their patients for their own benefit. This procedure hinders the progress and success of the therapy. If in doubt, the therapist must stop treatment and refer his client to another therapist.


Psychotherapy is like any medical treatment in Germany, a benefit of the health insurance. The patient may seek out any psychotherapist of his choice admitted by the Association of Statutory Health Insurance Physicians. The health insurances cover the costs for the three cash-approved procedures Psychoanalytic Psychotherapy, Psychology-based Psychotherapy and Behavioral Therapy. Other forms of therapy are usually not taken over by the health insurance companies.

Self-awareness, personal development, couple therapy and marriage counseling are excluded from the catalog of benefits of health insurance. The aid also reimburses the costs of psychotherapeutic treatment by psychotherapists and child and adolescent psychotherapists. The current regulations are similar to those of the statutory health insurance, some details such as the hourly quotas should be requested individually.

Big differences in private health insurance

In general, most private health insurance companies cover the costs of psychotherapeutic services. Within the individual tariffs of the respective insurances, however, there are large deviations, so that a detailed discussion with the insurance before taking a therapy is recommended. Under certain conditions, a cost over the Federal Social Welfare Act is possible.

Trial sessions are possible and useful

Who wants to take a therapy, selects a therapist and uses the first few hours to get to know each other. The therapist will make the diagnosis during this period and make a preliminary decision on the indication and prognosis of a possible treatment. Psychotherapy is granted from the sixth session, in the case of psychoanalytic psychotherapy, from the tenth session as an application. This means that the health insurance company will cover the costs after checking the need for treatment.

How am I?

Whether the respective therapist is the right one and with which procedure he would like to treat his client, one should test out in a preliminary discussion and the trial sessions. Anyone who goes into therapy expects help and support. At the same time, one should not give one's own perception when entering the practice, but write down for yourself:

  • Is the therapist nice to me?
  • Do I feel close to him, in practice?
  • Is the practice easily accessible to me?
  • Votes Distance, Time, Parking?
  • What are the contact arrangements?
  • Can I call outside office hours?

During the conversation it can be stated:

  • Is he taking time for my request? Does he answer my questions in detail?
  • What education 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 each other?
  • How long will the therapy take?

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 malaise?
  • Am I feeling better after the sessions?

Apart from a psychoanalytical long-term therapy, which is designed for years, a psychotherapeutic treatment - depending on the severity of the disorder and the methodological approach - usually takes between 20 and 100 hours. So if you feel after 10 - 20 sessions not better and none positive change is foreseeable, one should consider whether therapist and therapy are right.

application process

From the sixth or tenth session, a cost commitment from the health insurance must be obtained for billing. The client has to submit a treatment request. The application is then anonymized and supplemented with a technical justification of the therapist. An appraiser of the respective health insurance checks the application. In addition, a report from the family doctor is needed, which excludes physical causes of the disease.

How many sessions are approved depends on the therapy method proposed. The duration of a single session is typically 50 minutes. The continuation of a therapy must always be re-established in each treatment section. Anyone who has questions about therapists and psychotherapy will find contact persons not only in the psychotherapeutic professional and professional associations but also in the national psychotherapeutic chambers, which are responsible for the development and adherence to professional and ethical standards.

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