Psychotherapy (Heilpraktikergesetz)

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Since 1993, non- medical practitioners with a license limited to the field of psychotherapy have been authorized in Germany, in addition to psychological and medical psychotherapists as well as child and adolescent psychotherapists, to practice medicine in the field of psychotherapy, but - unlike this - without an entry in the doctor's register and without participation in the medical contract Supply .

Demarcation

Practice of medicine in the sense of the Heilpraktikergesetz is any professional or commercial activity to identify, cure or alleviate illness, suffering or physical harm in people, even if it is carried out in the service of others ( Section 1 (2) HeilprG).

This does not include both counseling psychology and the activities carried out by psychological psychotherapists and child and adolescent psychotherapists under the Psychotherapists Act, even though they also practice "therapeutic psychotherapy" ( Section 1 PsychThG).

Requirements and permission

General applicants

Anyone who practices medicine professionally without being licensed as a doctor or psychotherapist requires permission as a non- medical practitioner from the competent state authority. An issued permit is valid nationwide. Conditions for the permit shall be at least 25 years, the successful completion of at least the secondary school or equivalent qualification as well as the physical and mental fitness for the job, which by a medical certificate and police clearance certificate must be verified. In order to obtain the permit, the applicant must undergo a review of his knowledge and skills in accordance with Section 2 (1) (i) HeilprGDV in order to determine whether the practice of medicine would pose a risk to public health .

In order to be granted a non-medical practitioner license limited to the field of psychotherapy, evidence of appropriate knowledge of a psychotherapy procedure must be provided that meets the general criteria for psychotherapy procedures and enables patients to be treated psychotherapeutically in accordance with the diagnosis. This qualification also requires basic knowledge of all scientifically recognized psychotherapy procedures. Evidence of such training and further education is required by some verifying health authorities in order to pass the examination.

The design and execution of the exams are governed by state law . The review contains questions about basic knowledge regarding mental illnesses and personality disorders, diagnostics , legal and professional studies and the forms of therapy. The exam consists of a written and an oral part. Admission to the oral examination is only granted if the written examination has been passed. Evidence of training is basically not a prerequisite for admission to the knowledge test, there is no mandatory standard training.

While knowledge of psychiatry , psychology , psychopathology and psychotherapy only plays a subordinate role in the review for non-medical practitioners without restriction to psychotherapy, the review for non- medical practitioners (psychotherapy) takes place exclusively in this specialist area.

Psychologists

Graduated psychologists (university degree with diploma or master’s degree ) can acquire the naturopathic license limited to the field of psychotherapy through a special, simplified licensing procedure. You do not have to take a separate exam if you meet certain requirements. It is decided according to the files. Different authorities are responsible for this depending on the federal state . The legal basis for this special approval process is the Heilpraktikergesetz and the Implementation Ordinance .

Job title

Often used job titles for people who practice psychotherapy with permission according to the Heilpraktikergesetz are:

  • Naturopaths limited to the field of psychotherapy
  • Naturopaths restricted to the field of psychotherapy
  • Naturopath for psychotherapy
  • Naturopath (psychotherapy)

Anyone who practices psychotherapy with a permit under the Heilpraktikergesetz (Heilpraktikergesetz) may not use the professional title psychotherapist . This job title is protected in accordance with Section 1, Paragraph 1, Clause 4 of the Psychotherapists Act. Only psychological psychotherapists, child and adolescent psychotherapists and medical psychotherapists may use this professional title.

history

In addition to the medical profession with a license to practice medicine in Germany, since 1939 it has only been legally possible with a permit under the Heilpraktikergesetz. A permit to work in a limited area or sub-area of ​​medicine cannot be found in the wording of the Heilpraktikergesetz. The right to a limited grant of permission resulted from the constitutional interpretation of the Heilpraktikergesetz by the jurisprudence of the Federal Constitutional Court and the Federal Administrative Court .

Originally, the request of the naturopathic permit limited to the field of psychotherapy was that qualified psychologists could also get access to medical care. Because until the psychotherapy reform and the entry into force of the Psychotherapists Act on January 1, 1999, it was only reserved for doctors to fully practice psychotherapy.

In a judgment, the Federal Administrative Court confirmed as early as 1983 that the Heilpraktikergesetz also applies to qualified psychologists with further training in psychotherapy to a limited extent in the field of psychotherapy, and that in this case no knowledge test is required due to the "state-recognized and verified academic training". Since the Heilpraktikergesetz (Heilpraktikergesetz) does not provide for training for the granting of a permit, since then everyone has the option of obtaining a permit to work in psychotherapeutic medicine without appointment who can prove the requirements specified in the law - therefore u. a. a secondary school leaving certificate, the completion of the 25th year of life as well as a verification of the health authorities carried out proof of safety.

Since the reform of 1999, licensed physicians have had to prove their psychotherapeutic expertise within the framework of further specialist training in order to be able to work in psychotherapy. In addition, psychologists and educators, based on a 5-year course, can acquire specialist knowledge as part of a multi-year training course and obtain a license to practice medicine when they pass the state examination . With the entry in the doctor's register of the statutory health insurance associations made possible by this, you can participate in the statutory health insurance system together with the contract doctors . The original intention of the legislature to involve psychologists in medical care has thus become obsolete. Since then, critics have been calling for the abolition of the naturopathic permit, which is limited to the field of psychotherapy. So plead u. a. Representatives of the medical and psychotherapist chambers for the abolition of the transitional solution, which was actually designed as an "auxiliary construction", in connection with a fundamental reform of the Heilpraktikergesetz. Some of the non-medical practitioners who treat without limitation also criticize the so-called "small non-medical practitioner certificate" and speak out in favor of an upgrading of the non-medical practitioner profession through uniform and legally regulated training. As part of the upcoming reform of psychotherapist training, the abolition of this regulation is currently also up for discussion (as of 2018).

activity

Methods

Naturopaths are free to choose the therapy methods. A therapy method used by alternative practitioners does not have to be scientifically recognized. The freedom of therapy includes the duty of care to know the limits of the methods used.

Confidentiality

Non-medical practitioners are subject to the duty of confidentiality , which has arisen as a secondary obligation from the treatment contract since the Patient Rights Act came into force in 2013. The obligation to conclude a treatment contract also results from the Patient Rights Act. The duty of confidentiality results in a right to refuse to give evidence in civil proceedings according to Section 383 (1) No. 6 ZPO .

Non-medical practitioners, on the other hand, are not subject to the obligation of confidentiality under criminal law under Section 203 (1) No. 1 StGB, because although they practice a non-academic medical profession, their professional practice or the use of the professional title does not require any state-regulated training. Even in criminal proceedings, you have no right to refuse to give evidence under Section 53 of the Code of Criminal Procedure (StPO), as u. a. applies to doctors, psychological psychotherapists and spiritual counselors.

Billing

Psychotherapy at the legal basis of the medical practitioner in accordance with the law is § 15 and § 28 , para. 1 SGB V no power of the legal health insurance .

Fees for alternative practitioners are freely negotiable in accordance with Section 630a of the German Civil Code ( BGB) . The GebüH (List of Fees for Alternative Practitioners) provides a calculation aid for remuneration for alternative practitioners' services. However, the fees mentioned there are from 1985, as the list has not been updated since it was set up. It is also criticized that the application of this schedule of fees represents a price agreement that is prohibited by cartel law, since it lacks the legal force of a statutory fee schedule.

The assumption of costs by private health insurers depends on the benefits insured in the respective tariff. Public service aid agencies do not usually cover the costs of psychotherapeutic alternative practitioners.

According to § 4 No. 14 letter a UStG curative treatments in the field of human medicine, which are in the context of the exercise of the activity u. a. be carried out as alternative practitioners, VAT-free.

Professional associations

The Association of Independent Psychotherapists, Alternative Practitioners for Psychotherapy and Psychological Consultants (VFP) has existed since 1990 . Its aim is to represent the interests of providers of psychological services, in particular for alternative practitioners (psychotherapy) and psychological consultants .

criticism

Alternative treatments

Alternative practitioner treatments are particularly controversial because of the treatment methods used that are not scientifically recognized. Like traditional alternative practitioners, alternative practitioners are limited to the field of psychotherapy and are free to choose their treatment methods. While the effectiveness of the methods used by licensed doctors and psychotherapists would have to be proven by evidence-based research , according to critics, alternative practitioners are "anchored in their" predominantly unscientific world of thought of complementary and alternative medicine "for which there is no scientific evidence.

In Germany there are currently four scientifically recognized procedures that can be billed for licensed psychotherapists:

In Germany not billable but scientifically researched procedures are u. a. the humanistic psychotherapy or systemic therapy (see also the list of psychotherapy and self-awareness methods ).

Not infrequently offered by alternative practitioners, such as spiritual healing , therapeutic touch , reincarnation or regression therapy are in contradiction to evidence-based knowledge and are therefore considered pseudoscientific and are classified as esoteric . While professional law prohibits members of the licensing professions from offering this and similar procedures, there are no restrictions for alternative practitioners due to the lack of professional code.

Lack of training standards

The fact that there is neither a uniform and state-regulated training for alternative practitioners nor is training even required is questioned by representatives of the medical and psychotherapeutic community, but also by some alternative practitioners' associations. The unsolicited training for alternative practitioners is offset by an average of 12 years of study and training on the part of both medical and non-medical licensed psychotherapists. While some associations are positive about a professional reform, representatives of different scientific disciplines therefore advocate the abolition of the profession itself. In the "Münsteraner Memorandum" published in 2017 and widely discussed in public, experts from the Münster circle , including doctors, medical ethicists , lawyers , historians and nursing experts, expressed primarily qualitative concerns and criticized the fact that patients are currently barely able to differentiate between "reputable providers and charlatans":

"Precisely because of the high quality standards that are customary and expected in almost all areas in Germany, people in Germany assume that such standards regulate all important areas of life - including health care by alternative practitioners. [...] It would be unthinkable for someone to control an airplane to entrust the entire competence of a successfully completed workshop on the legend of Icarus. "

A reform according to which so-called "specialist alternative practitioners" based on a state-regulated health profession ( occupational therapist , masseur , speech therapist, etc.) should receive a medical license limited to certain areas (occupational therapy, physiotherapy, speech therapy, etc.) is also being discussed. An exercise of healing practical activity is limited to the field of psychotherapy, however, would therefore no longer possible because of this - similar to the field of dentistry is an academic education requirement -.

Exceeding authority and lack of demarcation

Particularly in connection with the lack of training standards and the lack of a binding professional code, exceeding authorizations (e.g. the allocation of medication or illegal billing with state institutions) has repeatedly made headlines in the past - for example in the case of a non-medical cancer center at Lower Rhine , in which there were several deaths due to incorrect drug administration.

The case of the Ansbach assassin Mohammad D. also caused a stir in 2016, as he had previously been treated by a non-medical practitioner who was restricted to the field of psychotherapy and who had falsely pretended to be a psychotherapist and settled accounts with government agencies. Until this error became known, the media had reported it unchecked and consulted the naturopath as a psychological-medical expert. Also in this context, the behavior of the alternative practitioner was discussed in the media, as he had publicly commented on the therapy after the suicide of the assassin and gave detailed information about the patient's anamnesis on television .

Cases in which psychotherapeutic naturopaths without impact training were appointed as appraisers by courts have already become known several times. In 2014, for example, there was a report on an alternative practitioner who was supposed to prepare a family psychological report for the court as part of a custody procedure . After the father had been denied the ability to bring up children on the basis of the expert opinion and he went to the next instance, the same alternative practitioner submitted a further expert opinion, which led to the confirmation of the lower court judgment. The alternative practitioner could show neither a psychological or family therapy training nor an expert opinion. The decision was ultimately revoked by the Federal Constitutional Court , the suitability of experts who had not been adequately trained was fundamentally questioned and a warning was issued for the lack of quality standards.

This and the case of Mohammad D. are examples of the fact that even state institutions have difficulties in distinguishing (psychotherapeutic) alternative practitioners from members of state-regulated health professions.

Downplaying mental versus physical illness

It is also critically questioned that the so-called "small alternative practitioner's license" suggests that the knowledge and skills required to treat mental illnesses are considered inferior to those of physical ailments and that, given the limited but nevertheless far-reaching powers of an alternative practitioner, the examinations at the health department are insufficient be. The alternative practitioner examination is merely a safety test without a grading scale and should not be confused with a specialist examination - such as a state examination.

Web links

Individual evidence

  1. ↑ a b BVerwG, judgment of January 21, 1993 , Az. 3 C 34.90, full text = NJW 1993, 2395 ff.
  2. ^ Information from the health department, non-academic health professions, alternative practitioners (psychotherapy) of the Recklinghausen district [1] Retrieved on April 7, 2014
  3. ↑ Information on therapie.de [2] Retrieved on April 7, 2014
  4. ↑ See § 1 Heilpraktikergesetz
  5. ↑ a b For example for North Rhine-Westphalia: Guidelines for the implementation of the Heilpraktikergesetz RdErl. D. Ministry of Women, Youth, Family and Health v. May 18, 1999 , for Lower Saxony: Guideline for the implementation of the procedure for granting a permit according to the Heilpraktikergesetz
  6. ↑ Health Department of the Kassel Region: Information for those interested in the alternative practitioner examination. - ( Memento of the original from August 14, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved April 8, 2014 @1@ 2Template: Webachiv / IABot / Gesundheitsamt.stadt-kassel.de
  7. ↑ § 2 Paragraph 1 Letter i) First Implementing Ordinance for the Heilpraktikergesetz (HeilprGDV 1)
  8. ↑ Information sheet - Granting of permission to practice medicine professionally without certification as a non-medical practitioner limited to the field of psychotherapy. (PDF) Karlsruhe district , February 2013, accessed on May 30, 2014 .
  9. ↑ Information Sheet for psychologists / psychologists to application for license to practice psychotherapy after Heilpraktikergesetz. (PDF) State capital Dresden , July 4, 2014, accessed on July 4, 2014 .
  10. ↑ a b Jurisprudence of the Lower Saxony judiciary - permissibility of the use of the professional title "Heilpraktiker für Psychotherapie". Lower Saxony Ministry of Justice , February 7, 2011, accessed on February 12, 2016 .
  11. ↑ BVerfG, decision of May 10, 1988, Az. 1 BvR 482/84 and 1166/85, BVerfGE 78, 179 - Heilpraktikergesetz.
  12. ^ Requirements for medical psychotherapy | therapie.de. Retrieved May 13, 2018 .
  13. ^ Judgment 11 - Paracelsus, the alternative practitioner schools . In: Paracelsus, the alternative practitioner schools . ( paracelsus.de [accessed on May 13, 2018]).
  14. ↑ PsychThG - Law on the Professions of Psychological Psychotherapists and Child and Adolescent Psychotherapists. Retrieved May 13, 2018 .
  15. ↑ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: Federal Chamber of Psychotherapists wants therapeutic practice ... ( aerzteblatt.de [accessed on May 13, 2018]).
  16. ↑ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: Federal Chamber of Psychotherapists wants therapeutic practice ... ( aerzteblatt.de [accessed on May 13, 2018]).
  17. ↑ Alternative practitioner psychotherapy - abolish or upgrade? - Health check. Retrieved on May 13, 2018 (German).
  18. ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: The reform discussion about the alternative practitioner profession continues . ( aerzteblatt.de [accessed on May 13, 2018]).
  19. ↑ Medical confidentiality. German Medical Association, accessed on February 6, 2019 .
  20. ↑ Uta Schollmeyer: Professional Law of the Non-Medical Health Professions ( Memento of the original from November 17, 2015 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Berlin, 2011 @1@ 2Template: Webachiv / IABot / www.berliner-anwaltsverein.de
  21. ^ Statutory health insurance, chap. 3.2.3.2.1. (PDF) National Association of Statutory Health Insurance Physicians , 2014, accessed on December 31, 2015 .
  22. ↑ List of fees for alternative practitioners (GebüH). Fachverband Deutscher Heilpraktiker eV, accessed on December 31, 2015 .
  23. ↑ The GebüH - a legal disaster. Paracelsus Magazin, November 2015, accessed December 31, 2015 .
  24. ↑ http://www.heilpraktiker.org/files/seiteninhalt/beihilfe-tabelle-0913-web.pdf. (PDF) Fachverband Deutscher Heilpraktiker eV, 2013, accessed on December 31, 2015 .
  25. ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: Heilpraktikerwesen: Self-determination and danger . ( aerzteblatt.de [accessed on May 13, 2018]).
  26. ↑ German Medical Association: (Model) professional code for doctors working in Germany. In: http://www.bundesaerztekammer.de/recht/berufsrecht/muster-berufsordnung-aerzte/muster-berufsordnung/ . Deutsches Ärzteblatt, 1997, accessed on May 13, 2018 .
  27. ↑ Manfred Ruoß, Matthias Ochs, Karin Jeschke, Lea Peplau: Job situation, satisfaction and future prospects of new approvers PP / KJP: results of a survey from 2011. In: http: //www.psychotherapeutenkammer-berlin. de . Psychotherapists Journal, February 1, 2012, accessed May 13, 2018 .
  28. ↑ Alternative practitioners in the criticism: "No longer accept the current madness" . In: Spiegel Online . August 21, 2017 ( spiegel.de [accessed May 13, 2018]).
  29. ↑ dpa: Why experts want to abolish the profession of alternative practitioner . ( noz.de [accessed on May 13, 2018]).
  30. ↑ Alternative practitioners in the criticism: "No longer accept the current madness" . In: Spiegel Online . August 21, 2017 ( spiegel.de [accessed May 13, 2018]).
  31. ↑ Why gentle medicine can harm your health . In: stern.de . May 17, 2016 ( stern.de [accessed May 13, 2018]).
  32. ^ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: Expert group proposes reform of the naturopathic profession . ( aerzteblatt.de [accessed on May 13, 2018]).
  33. ^ Anne Hemmes, Christoph Scheule, Richard Schlosser, Anna Tillack and Lisa Weiß, Bayerischer Rundfunk: New Findings: The Assassin and the Therapist | BR.de . July 28, 2016 ( br.de [accessed May 13, 2018]).
  34. ^ WORLD: Controversial practice: Doubts about the therapist of the Ansbach assassin . In: THE WORLD . July 30, 2016 ( welt.de [accessed May 13, 2018]).
  35. ^ NDR: On the criticism of trauma therapist Axel von Maltitz. Retrieved May 13, 2018 .
  36. ↑ Ingrid Grohe: Assassin was looked after by a controversial association . In: Augsburger Allgemeine . ( augsburger-allgemeine.de [accessed on May 13, 2018]).
  37. ^ "Panorama": Alternative practitioners as court expert | gwup | the skeptics. Retrieved on May 13, 2018 (German).
  38. ^ NDR: Justice: Minimum standards for court opinions? Retrieved May 13, 2018 .
  39. ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: Training for alternative practitioners: German university medicine sees ... ( aerzteblatt.de [accessed on May 13, 2018]).
  40. ↑ www.unimess.de: Alternative practitioner review - attorney René Sasse, Dortmund. (No longer available online.) Archived from the original on November 4, 2017 ; accessed on May 13, 2018 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.sasse-heilpraktikerrecht.de