Report to the reviewer

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With the report to the expert , a psychotherapist in Germany notifies the health insurance of an insured person who has applied for the reimbursement of costs for psychotherapy , the diagnosis , justifies the indication for psychotherapy and describes the type and scope of the planned therapy. When applying for long-term therapy, the report also includes a case-based treatment plan. The psychotherapist determines the information to be reported beforehand in trial sessions. The report serves the expert appointed by the National Association of Statutory Health Insurance Physicians as a basis for determining whether the requirements for carrying out psychotherapy at the expense of statutory health insurance are met. The application process and the prerequisites for the assumption of costs are set out in the psychotherapy guidelines and in the psychotherapy agreement.

In a senior appraisal procedure that may take place after an application for a contingent has been rejected by the appraiser, all previous documents (all preliminary reports, all statements from previous appraisers, all PTV 2 forms) must be made available to the senior appraiser.

Theoretical models to produce the report

Important questions to which the report to the reviewer according to Boessmann and Remmers (2011) must give conclusive answers in the psychodynamically oriented therapy procedures:

Overview of the most important aspects of psychodynamics
  • What does the patient have? (Complaints, ICD-10)
  • How is the patient? ( Structure level , disposition to neuroses )
  • Why is he the way he is? (Biography)
  • What is bothering him today? (Current trigger factors and requirements)
  • Why does it bother him? (individual vulnerability, willingness to conflict)
  • Why does it get sick because of it? (individual overstrain of the defense, coping and compensation options)
  • What does he get out of being sick? (Gain in disease, function of symptoms)
  • What has to change in order for the patient to get well again? (Therapy plan)
  • Is the therapist the right therapist for the patient? (Fit)
  • How good are the prospects of the planned treatment? (Forecast)

The main topic of the report is the psychodynamics of the disorder to be treated, which is shown in the overview on the right.

For behavior therapy , Bockwyt (2016) suggests a procedure for preparing the report that meets the quality criteria of validity (validity of the statements), reliability (precision of the statements) and specificity of the statements.

For the behavior analysis in behavior therapy, which corresponds to psychodynamics in the dynamically oriented therapy procedures, the following analysis steps can be carried out for macro analysis:

  1. Analysis of genetically or prenatally related vulnerability factors
  2. Analysis of the child's biographical situation
  3. Analysis of the inner psychic precipitation
  4. Analysis of the child's handling of the child's situation
  5. Analysis of the effects of children's experiences on the development of personality and the design of the various areas of life, including compensation
  6. Identification of current and previous trigger conditions and their effects on experience and behavior (current genesis)
  7. Identification of symptoms on the levels of cognition, emotion, motor skills, and physiology
  8. Analysis of consequences, individual and interactional functionality, reinforcement and maintenance of the behavior / symptoms
    1. Analysis of short-term consequences
    2. Analysis of long-term consequences
  9. Identification of behavioral assets, resources, etc. Ä.

When planning therapy for behavioral therapy, which is divided into the creation of therapy goals and corresponding therapy methods, the therapy goals should be specific, precise, operationalizable, realistic and appropriately ambitious and filled with individual patient content.

Formal requirements for the report

The therapist submits his report to the expert according to the PTV 3 guideline, divides it into numbered sections and adds it, dated and signed, to the PTV 2 form. The content of the report is specified in an information sheet (PTV 3) that is made available by the Association of Statutory Health Insurance Physicians on request and is accessible online.

The headings of the sections of the information sheet should not be repeated in the report; it is sufficient to state the section number. The scope of the report should not exceed 2 DIN A4 pages in the case of a long-term therapy justification and should only contain information that is relevant to therapy and decision-making. If this scope is significantly exceeded, the expert can return the report to the author for shortening for objective condensation.

In addition, if the treatment is carried out by a psychological psychotherapist or child and adolescent therapist, the consultant's report from the doctor must be enclosed.

The guidelines for the therapist's initial application for conversion and continuation were created as an aid for the preparation of reports to the expert. The therapist can therefore make his case-related selection in his report from the information given. The reports should be limited to what is necessary to understand the mental illness, its aetiological justification, its prognosis and its treatment.

Report structure for analytical psychotherapy and behavior therapy based on depth psychology from April 1, 2017

According to the information sheet PTV 3 of the Chamber of Psychotherapists for the creation of the report for psychologically sound, analytical therapy and behavioral therapy in adults, the reports should be structured as follows:

Report on the initial application and conversion application

  1. Relevant sociodemographic data Diagnosis (s) ICD-10
  2. Symptoms and psychological findings
  3. Somatic findings or consulting report
  4. Treatment-relevant information on the life history (possibly also of the caregivers), the medical history, the functional condition model or psychodynamics
  5. Diagnosis at the time of application
  6. Treatment plan and prognosis
  7. Additional information required for a conversion report

Report on the continuation application

  1. Presentation of the previous course of treatment, changes in symptoms and treatment results, achievement of therapy goals
  2. Current diagnosis (s) and psychological findings
  3. Justification of the need to continue, further treatment planning, prognosis, planning of the end of therapy

Report structure in behavior therapy before April 1, 2017

Report on the application for short-term therapy

The report on short-term therapy (KZT) should not exceed 1 to 1 1 ⁄ 2 A4 pages.

  1. Complaints, time and reason for the formation of symptoms
  2. Problem-relevant information on the history
  3. Psychological symptoms and psychological findings
  4. Somatic symptoms and somatic findings (see consulting report, if applicable)
  5. Behavioral analytical problem definition (disorder model)
  6. Diagnosis (ICD-10)
  7. Therapy goals and prognosis
  8. Therapy plan including justification of the indication and the essential interventions

Report on the initial application or conversion application

(The report should not exceed 3 A4 pages)

  1. Information on spontaneously reported and requested symptoms
  2. Biological development and medical history
  3. Psychological findings at the time of application
  4. Somatic findings or consulting report
  5. Behavior analysis
  6. Diagnosis (s) at the time of application
  7. Therapy goals and prognosis
  8. Treatment plan
  9. Information on conversion to long-term therapy

criticism

Therapists complain about the time and emotional burden that the review process puts on them, especially the preparation of the report for the reviewer. They feel at a disadvantage compared to the specialist doctors, who do not have to legitimize their health insurance services with any comparable effort, even though their accounts can also be subjected to an economic audit. A possible rejection by the expert (3 to 4% of the cases) is associated with economic disadvantages, personal injury and effects for the patient concerned. Proponents see the expert opinion as the basis for the minimum remuneration for psychotherapists legally protected in 1999 by the Federal Social Court (BSG) as the only specialist group, as an internal quality control for therapy planning and as a legitimate control of the solidarity system. An alternative test system with comparable efficiency has not yet been developed.

On the other hand, a study by the Techniker Krankenkasse in 2011 came to the following conclusion: "The quality of results from psychotherapeutic treatments is equally high with and without expert procedures, as well as with and without psychometric measurements." The increased financial and workload for test procedures (both expert procedures and the use of psychometric procedures ) is therefore not justifiable. The rejection rate (approx. 3-4% rejections in 2011) also calls into question the usefulness of the appraisal procedure, because such a low rate does not assume a control function. Various professional associations have criticized this study in terms of method and content and accused the authors of professional policy goals; the expert procedure is proven and reliable. In a critical analysis of the TK study in 2011, H. Sasse came to the conclusion that neither their methodological approach nor their understanding of the quality of the results did justice to the psychoanalytically based procedures, so that no reliable statements could be derived.

literature

  • U. Rüger: On the expert procedure for psychoanalytically justified treatment procedures. In: Psychotherapeutic Practice. 3, (2001), pp. 139-149.
  • U. Rüger, A. Dahm, D. Kallinke (eds.): Faber / Haarstrick: Commentary on psychotherapy guidelines. Urban & Fischer, Munich 2008, ISBN 978-3-437-22862-9 .
  • U. Boessmann: Psychodynamic psychotherapy in children and adolescents. Compendium and reports to the reviewer. Deutscher Psychologen Verlag, 2005, ISBN 3-931589-65-X .
  • U. Boessmann, A. Remmers: Treatment focus on psychodynamic therapy planning, goal and time limits. Practical use of the OPD-2, report to the expert. Deutscher Psychologen Verlag, Bonn 2008, ISBN 978-3-931589-84-4 .
  • U. Boessmann, I. Jungclaussen: Report rejected - what now? Practical advice on the most important reasons for rejection with numerous application examples for psychotherapy based on depth psychology. Deutscher Psychologen Verlag, 2009, ISBN 978-3-931589-93-6 .
  • U. Boessmann: Write reports to the reviewer quickly and safely. Compendium and revision course for psychodynamic psychotherapy. Deutscher Psychologen Verlag, Berlin 2012, ISBN 978-3-942761-11-6 .
  • D. Adler: The application for psychodynamic psychotherapy: A guide to reporting (including child and adolescent and group psychotherapy). Psychosozial-Verlag, Giessen 2012, ISBN 978-3-8379-2197-7 .
  • E. Bockwyt: The behavioral report to the expert. Prepare TT applications precisely and individually . Schattauer, Stuttgart 2016, ISBN 978-3-7945-3103-5
  • Michael Dieckmann, Andreas Dahm, Martin Neher (Eds.): Faber / Haarstrick. Comment psychotherapy guidelines . 11th, updated and supplemented edition based on the currently valid psychotherapy guidelines (as of spring 2017). Urban & Fischer, Elsevier, Munich 2018, ISBN 978-3-437-22865-0 .

Individual evidence

  1. ↑ Guideline of the Federal Joint Committee on the Implementation of Psychotherapy (Psychotherapy Guideline). (PDF; 100 kB) p. 25 para. 1
  2. ↑ Guideline of the Federal Joint Committee on the Implementation of Psychotherapy (Psychotherapy Guideline). (PDF; 100 kB)
  3. ↑ Agreement on the use of psychotherapy in contract medical care, annex to the federal collective bargaining agreement for doctors ( memento of the original from May 15, 2013 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.kbv.de
  4. ↑ U. Bössmann, A. Remmers: The initial interview. Practice of psychodynamic anamnesis, diagnostics, indication and therapy planning. Deutscher Psychologen-Verlag, Berlin 2011, ISBN 978-3-942761-03-1 .
  5. ↑ a b c E. Bockwyt: The behavior therapy report to the expert. Prepare TT applications precisely and individually. 1st edition. Schattauer, Stuttgart 2016, ISBN 978-3-7945-3103-5 .
  6. ↑ a b Forms for Psychotherapy. Retrieved March 22, 2017 .
  7. ↑ National Association of Statutory Health Insurance Physicians : Agreement on the use of psychotherapy in contract medical care (psychotherapy agreement). In: Agreement on the use of psychotherapy in statutory health care (psychotherapy agreement). National Association of Statutory Health Insurance Physicians, accessed on January 9, 2016 .
  8. ↑ a b Wittmann, WW, Lutz, W., Steffanowski, A., Kriz, D., Glahn, EM, Völkle, MC, Böhnke, JR, Köck, K., Bittermann, A. & Ruprecht, T. (2011 ). Quality monitoring in outpatient psychotherapy: model project of the Techniker Krankenkasse - final report. Hamburg: Techniker Krankenkasse. online , p. 166
  9. ↑ H.-U. Köhlke: The expert procedure in contract psychotherapy . (PDF; 1.4 MB) A practical study on appropriateness and proportionality
  10. ↑ Why is the debate about the expert review process - especially at this point in time - very problematic? (No longer available online.) In: www.bvvp.de. Federal Association of Contract Psychotherapists, archived from the original on September 28, 2016 ; accessed on September 28, 2016 .
  11. ↑ Proven and reliable expert procedure for outpatient psychotherapy. (pdf) In: www.ifp-berlin.eu. German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology eV, June 28, 2011, accessed on September 28, 2016 .
  12. ↑ Heiner Sasse: Critical study on the model project of the Techniker Krankenkasse "Quality monitoring in outpatient psychotherapy" . In: DGIP (Ed.): E-Book . No. 01 , 2011, ISBN 978-3-935374-01-9 (229 pp., Dgip.de [PDF; 4.8 MB ; accessed on March 2, 2017]).