Psychological psychotherapist

from Wikipedia, the free encyclopedia

The job title psychotherapist (PP) called in Germany a psychologist who for one with Diploma or Master -lined study of psychology ( course of study Psychology ) at least three years full-time education or at least five years part-time training as a psychological psychotherapist after Psychotherapeutengesetz (PsychThG) completed and the authorization to conduct psychotherapy independently ( license to practice medicine ). On February 27, 2019, the cabinet passed a bill to reform psychotherapist training, including a. contains the elimination of the professional titles “psychological psychotherapist” and “child and adolescent therapist” in favor of the general professional title “psychotherapist”; However, the term "medical psychotherapist" is retained.

Profession

Legal requirements

Psychological psychotherapists treat mental disorders in adults, children and adolescents (limited recognition). Child and adolescent psychotherapists only treat children and adolescents up to the age of 21, but not adults. However, they have more extensive training in psychotherapy for children, adolescents and young adults. These are professional titles that have been legally protected in Germany since 1999 by the Psychotherapists Act , which require state approval to practice medicine ( approbation ). In addition to the Psychotherapists Act, psychological psychotherapists are subject to the health professions laws of the federal states, in North Rhine-Westphalia for example the Heilberufsgesetz Nordrhein-Westfalen.

education

The prerequisite for training as a psychological psychotherapist is initially a university degree in psychology up to a diploma or Master of Science degree , including a final examination in clinical psychology . The standard duration of this academic training is 10 semesters of university studies in psychology . Together with the 3-year training as a psychological psychotherapist, at least 8 years of training should be estimated. In practice, however, psychological psychotherapists need an average of 12 years to obtain a license to practice medicine.

In order to be able to legally regulate further training nationwide, it had to be given the status of "training", since further training courses fall under the competence of the countries. The following psychotherapeutic procedures are approved for training as a psychological psychotherapist for at least 3 years :

During the psychotherapy training, the trainee is called "Psychotherapist in training" (PiA). The training is regulated on the basis of the Psychotherapists Act in the "Training and Examination Regulations for Psychological Psychotherapists".

After completing a psychology degree with a diploma or master's degree, the training can be completed as at least 3 years of full-time training or as at least 5 years of part-time training (Section 5 PsychThG). According to the Psychotherapists Act, the following content should be acquired within the training years (Section 8 PsychThG):

  • 600 treatment hours of practical training with at least 6 patient treatments under at least 150 hours of supervision
  • 600 hours of theoretical training
  • 1,800 hours of practical work, of which 1,200 at a psychiatric clinical facility and 600 hours at a facility for psychotherapeutic or psychosomatic care recognized by a social insurance institution

The training can be completed at university-affiliated institutions as well as at state-recognized private training institutes. As a rule, the training institutes only offer training in one process. Some institutes offer training in all approved psychotherapy procedures.

Doctors receive their license to practice medicine i. d. Usually after successfully completing a 6-year medical degree. You can therefore practice medicine independently during your specialist training. Since studying psychology does not entitle you to practice medicine, psychologists trained in psychotherapy are only allowed to practice medicine to a limited extent. According to current legislation, psychologists only acquire their license to practice medicine after completing their training. This practice is seen as the main reason why psychologists tend not to get paid during the practical work of their training. At the same time, they have to pay for their training costs of around 20,000 to 40,000 euros privately.

In the meantime, several court rulings have been issued against clinics that refused to pay psychologists in psychotherapy training during their practical work.

Difference to medical psychotherapists

Licensed specialists with additional psychotherapeutic qualifications also work as psychotherapists. The psychotherapeutic specialists ( specialist in psychosomatic medicine and psychotherapy , specialist in psychiatry and psychotherapy , specialist in child and adolescent psychiatry and psychotherapy) have completed at least 5 years of specialist training after studying medicine and obtaining the license to practice medicine, in which the Acquisition of psychotherapeutic knowledge had to be proven. In contrast to psychological psychotherapists, psychotherapeutic specialists generally did not have a degree in psychology , but rather a medical degree. To clarify, if necessary, whether z. If, for example, there is an organic cause of illness (hormonal disorder, brain tumor ...) in behavioral patients, psychological psychotherapists and medical psychotherapists refer their patients to appropriate specialists (internists, oncologists ...) in order to report incorrect therapy and the associated health risks avoid.

Authority

According to the Psychotherapists Act , the activity of psychological psychotherapists is limited to the determination, healing or alleviation of disorders with disease value for which psychotherapy is indicated. Psychological psychotherapists are not authorized to perform original medical activities such as prescribing medication or certificates of incapacity for work. With the decision of the Federal Joint Committee (G-BA) within the framework of the implementation of the Statutory Health Insurance Supply Strengthening Act, psychotherapists can prescribe services such as sociotherapy, psychotherapeutic rehabilitation measures, hospital treatment and patient transport.

Cash register approval

Psychological psychotherapists who work in their own practice often also have a health insurance certificate , i.e. H. a treatment by them is paid for by the statutory health insurances (if necessary after submitting a corresponding application for the assumption of costs) . This approval can be granted by the Association of Statutory Health Insurance Physicians after the license to practice medicine and an entry in the medical register . For the psychological psychotherapists there is a requirement planning that defines how many therapists are allowed to settle in a district. Therefore, in many areas, a free branch is no longer possible. It is now common practice to buy cash register admissions from retired colleagues.

Depending on the type of training (psychological psychotherapist for adults; child and adolescent psychotherapist), a psychological psychotherapist can bill for services through health insurance companies and private health insurance companies for the following groups of people:

  • Adults (from the age of 18),
  • Children and adolescents (up to the age of 21; before starting therapy, it should be foreseeable that the age limit will not be exceeded during therapy).

The requirements planning of the Association of Statutory Health Insurance Physicians has repeatedly met with criticism in the past. The main complaints were the long waiting times until treatment by a psychological psychotherapist. On average, those affected wait three months for an initial consultation with a therapist and another three months for therapy to begin.

With the statutory health insurances, the reimbursement of costs only applies to treatments that comply with the psychotherapy guidelines. These include treatment and application modalities as well as the restriction to three previously approved therapy methods. The counseling psychotherapy and the systemic therapy are accordingly not paid for by the statutory health insurance companies.

Private treatment

The assumption of costs by private health insurers depends on the service agreements of the insurance contract concluded. The Federal Court of Justice denies a coverage obligation as long as the General Insurance Conditions do not contain any regulation. The fees for psychological psychotherapists and child and adolescent psychotherapists are based on the fee schedule for psychological psychotherapists and child and adolescent psychotherapists (GOP), which refers to the fee schedule for doctors . Different fees can be agreed with the patient within certain limits.

income

According to the report by the Federal Statistical Office on the cost structure of practices of psychological psychotherapists from 2017, the average net income (total income minus costs, but without taking into account the, in some cases, mandatory preventive expenses ) per resident practice owner was in 2015 at 63,000 euros, whereby the billable fee within the statutory health insurance is just under 160,000 euros per year (43 weeks with 36 hours each) according to a sample calculation by the umbrella association of the federal health insurance companies .

Organizational form Average annual net income per practice owner 2015 (rounded to the nearest thousand)
Practices of psychological psychotherapists 63,000 euros
Of which: individual practices 66,000 euros

Differences between psychotherapist, psychiatrist and psychologist

Among laypeople, the professional titles psychotherapist, psychologist and psychiatrist are often incorrectly used synonymously . In fact, however, they are very different:

  • Psychotherapists are psychologists or doctors who have a license to practice medicine and who practice psychotherapy within the meaning of the Psychotherapists Act and the psychotherapy guidelines. This includes the diagnosis and treatment of mental health problems using scientifically recognized methods of psychotherapy.
  • Psychiatrists are specialists in psychiatry and psychotherapy . Psychotherapy has been an obligatory part of specialist training for psychiatrists since 1994. The specialist in psychiatry and psychotherapy must be distinguished from the other two psychotherapeutic specialists, the specialist in psychosomatic medicine and psychotherapy and the specialist in child and adolescent psychiatry and psychotherapy. In Germany, resident psychiatrists (unlike psychotherapists) are essentially paid their fee not based on the time spent talking, but based on the number of patients per hour.
  • Psychologists are people whohave successfully completeda degree in psychology with a diploma or master’s degree. The term psychologist is legally protected and may only be used by the aforementioned group of people. Psychologists are not trained to treat patients, but they can gain authorization to do so through training as a psychotherapist. Psychologists work in numerous professional fields, such as B. in business, in human resources , in research, in advertising, in education, as a traffic psychologist , in advice centers, etc.

Expiring or earlier job titles

When the new advanced training regulations for doctors came into force in 1989, the following transitional provisions applied: Anyone who used the designation “psychiatrist” or “doctor for psychiatry” or “doctor for neurology and psychiatry” could keep them. At the request he received to lead the Specialist title "specialist in psychiatry and psychotherapy" the right when he previously additional designation could result in "psychotherapy", the one after the former training conditions has provided acquired, training.

Anyone with the specialist title for “child and adolescent psychiatry” and the additional title “psychotherapy” received the right to use the specialist title “child and adolescent psychiatry and psychotherapy” upon request. Anyone who had the sub-specialization designation child neurology and psychiatry in connection with the specialist designation neurology and psychiatry or the specialist designation paediatrics and also the designation specialist for psychotherapy was given the right to use the designation "specialist for child and adolescent psychiatry and psychotherapy" upon application .

Anyone who had the additional designation “psychoanalysis” or “psychotherapy” when the continuing education regulations came into force could retain them. Upon application, he was given the right to use the designation “Specialist in Psychotherapeutic Medicine” if, after acquiring the additional qualification, he had mainly performed psychotherapy for a period of at least five years.

Division of professional groups

In Germany (as of 2013) there are around 13,500 resident psychological psychotherapists. This means that they make up about half of the providers of therapeutic psychotherapy and carry a large part of outpatient psychotherapeutic care.

Professional positions

On the part of psychological psychotherapists there is a demand for an extension of powers to activities such as the determination of incapacity for work (sick leave), the competence to prescribe remedies ( speech therapy , sociotherapy and occupational therapy ), as well as the competence to prescribe psychotropic drugs , the possibility of referral to Specialist.

With regard to the medication ordinance, the German Medical Association takes the position that the ordinance of psychotropic drugs requires "great expertise" for reasons of patient safety and liability reasons in order to identify and treat undesirable drug effects and interactions. The abundance of these tasks requires "in addition to pharmacological knowledge extensive knowledge in almost all clinical subjects, which only professionally trained doctors have". In addition, a comprehensive differential diagnosis (including physical illnesses) must be made before any medication, for which only doctors are suitable, according to the German Medical Association.

An expert opinion commissioned by the Federal Ministry of Health advocates an expansion of competencies for psychological psychotherapists, among other things with regard to the issuing of certificates of incapacity for work, referrals to specialists and the "regular" prescription of inpatient treatment (in psychiatric and psychosomatic clinics).

With the decision of the Federal Joint Committee (G-BA) in the context of the implementation of the Statutory Health Insurance Care Strengthening Act, psychotherapists are entitled to prescribe services in sociotherapy, psychotherapeutic rehabilitation, hospital treatment and patient transport. The G-BA is adapting the relevant guidelines.

With regard to the training conditions, there are also demands for improved remuneration by the Professional Association of German Psychologists (BDP) and other groups. The focus is on the high training costs and the comparatively low remuneration during the training period. In particular, unpaid 1,800 hours of work in a psychiatric or psychosomatic clinic meet with criticism.

Situation in Austria and Switzerland

In Austria and Switzerland there are also (psychological) psychotherapists who also specialize in the treatment of children and adolescents. However, these do not bear the German job title. In addition to completing a university degree (e.g. psychology, medicine, pedagogy) in Austria - unlike in most other European countries - there are other access options for psychotherapy training in the form of basic professions (e.g. social worker, teacher at higher levels Schools, qualified nurses). Due to the broad access, basic professional training takes place within the framework of the psychotherapeutic propaedeutic course before the actual subject-specific psychotherapy training .

See also

Web links

Individual references, sources

  1. ↑ Section 95 (2), Section 95c SGB ​​V
  2. ^ Draft of a law to reform psychotherapist training. (PDF) Federal Government, February 27, 2019, accessed on February 27, 2019 .
  3. ↑ Psychotherapists Act
  4. ↑ Healthcare Professions Act North Rhine-Westphalia
  5. ↑ Answers to frequently asked questions about training as a psychological psychotherapist. May 30, 2017, archived from the original on December 1, 2017 ; accessed on November 22, 2017 .
  6. ↑ www.bdp-verband.org ( Memento from December 30, 2008 in the Internet Archive )
  7. ↑ www2.psychotherapeutenkammer-berlin.de
  8. ↑ Opinion of the Scientific Advisory Board on Psychotherapy for the recognition of systemic therapy ( Memento from August 27, 2010 in the Internet Archive )
  9. ↑ Training and examination regulations for psychological psychotherapists
  10. ↑ When and under what circumstances is a PIA liable in Gerlach Professional law and professional ethics in psychotherapy , p. 38 ra-gerlach.de
  11. ↑ a b PIA for just conditions. Retrieved March 22, 2017 .
  12. ↑ a b Elke Spanner: What is avarice? Retrieved March 22, 2017 .
  13. ^ Philipp Alvares de Souza Soares: Long dry spell. In: faz.net. November 24, 2011, accessed December 9, 2014 .
  14. ↑ Christina Hucklenbroich: Psychotherapists at a cheap rate. In: faz.net. July 30, 2010, accessed December 9, 2014 .
  15. ↑ a b Full commitment - no salary. In: Spiegel Online. September 20, 2011, accessed December 9, 2014 .
  16. ↑ A hanging game in training. In: Spiegel Online. September 20, 2011, accessed December 9, 2014 .
  17. ↑ ArbG Brandenburg, 5 Ca 1911/13, judgment of April 30, 3014. Retrieved March 22, 2017 .
  18. ^ LAG Hamm, judgment of November 29, 2012, Az. 11 Sa 74/12
  19. ↑ www.vpp-pia.de ( Memento from December 15, 2013 in the Internet Archive )
  20. ↑ www.hensche.de
  21. ↑ www.bundesaerztekammer.de
  22. ↑ gesetze-im-internet.de
  23. ↑ presseportal.de ( Memento from December 19, 2013 in the Internet Archive )
  24. ↑ KVB: In future, psychotherapists may also prescribe. March 16, 2017. Retrieved July 8, 2017 .
  25. ↑ Guide of the Bavarian Association of Statutory Health Insurance Physicians for the provision of psychotherapeutic services ( Memento from December 22, 2013 in the Internet Archive ) (PDF; 577 kB)
  26. ↑  Manfred Lütz: The mentally ill often cannot find therapy places. In: zeit.de. March 20, 2014, accessed December 9, 2014 .
  27. ↑ BPtK, waiting times in outpatient psychotherapy ( Memento from February 1, 2012 in the Internet Archive ) (PDF; 68 kB)
  28. ^ Psychotherapy guidelines , accessed on March 18, 2013
  29. ^ Judgment of the Federal Court of Justice of February 15, 2006 on the question of the obligation to cover psychotherapy services by health insurance companies
  30. ↑ Fee schedule for psychological psychotherapists (GOP)
  31. ↑ § 2 Schedule of Fees for Doctors i. V. m. Section 1 (1) GOP
  32. ↑ Cost structure of the practices of psychological psychotherapists (PDF file)
  33. ↑ Psychotherapist remuneration according to the National Association of Statutory Health Insurance Funds
  34. ↑ Guideline of the Federal Joint Committee on the Implementation of Psychotherapy ( Psychotherapy Guideline ) [1] Retrieved on March 31, 2014
  35. ↑ Psychotherapists Act of the Federal Republic of Germany [2] Retrieved on March 31, 2014
  36. ↑ Christian Heinrich: Profession special: Psychiatry: Attention in chord . In: Die Zeit (Ed.): Die Zeit Online . No. June 24 , 2014 ( zeit.de [accessed June 10, 2018]).
  37. ↑ Career opportunity check psychologist. Education and Knowledge, Nuremberg 1999, ISBN 3-8214-8244-3 .
  38. ↑ Paragraphs of the further training regulations ( Memento of October 10, 2013 in the Internet Archive ); Medical Association Berlin
  39. ↑ Study on health services research (PDF; 357 kB)
  40. ↑ Bundestag, petition final statement
  41. ↑ Statement on 7th Medical Orientation ( Memento from February 1, 2012 in the Internet Archive ) (PDF; 63 kB)
  42. ↑ www.bptk.de
  43. ↑ KVB: Psychotherapists are allowed to issue prescriptions for the first time. June 8, 2017, accessed July 31, 2020 .
  44. ^ After you the deluge: BDP on the training situation for psychological psychotherapists
  45. ↑ psychotherapeutenwiki.de
  46. ↑ G. Stumm, E. Jandl-Jager: Psychotherapy: Training in Austria. Falter-Verlag, Vienna 2006, ISBN 978-3-85439-334-4