Psychotherapy (from ancient Greek ψυχή psyche "soul", and therapeia "treatment", from θεραπεύειν therapeuein "heal, serve") generally refers to the "targeted professional treatment of mental (psychological) disorders or psychologically caused physical disorders with psychological means". The procedures, methods and concepts used are shaped by different schools of psychotherapy. According to a cross-method definition by Hans Strotzka that is often quoted to this day , psychotherapy is
"... a conscious and planned interactive process for influencing behavioral disorders and states of suffering that are considered to be in need of treatment in a consensus (if possible between patient, therapist and reference group), with psychological means (through communication ) mostly verbally, but also averbally , in the direction of a defined goal, if possible jointly developed (symptom minimization and / or structural change of the personality) using teachable techniques based on a theory of normal and pathological behavior. As a rule, this requires a stable emotional bond. "
The psychotherapy research verified these advanced concepts and procedures then interdisciplinary in terms of efficacy testing and process research . The attempt is made to bridge the gap between science and practical application through a better understanding of the active principles and processes of change.
The word psychotherapy is derived from ancient Greek ψυχή psychḗ 'breath, breath, soul' in combination with θεραπεύειν therapeúein 'care, care' as well as from ancient Greek θεραπεία therapeia “healing”. One of the first to use it was Daniel Hack Tuke in 1872 , at the end of the 19th century it was used in connection with hypnotism and spread by F. van Elden from 1889, who used it to describe psychotherapy in the modern sense. The first attempts at a psychotherapeutic treatment in today's sense showed the connection of the psychological and somatic point of view by the French doctor and philosopher Pierre Cabanis in the late 18th century, who tried in 1802 to explain “moral”, i.e. psychological, phenomena physiologically. The French doctor Jean-Martin Charcot should also be counted among the early protagonists .
European cultural history knows hypnosis as one of the oldest “psychotherapeutic procedures” . From Sigmund Freud's psychoanalysis , the various depth psychological long- and short-term forms of therapy have developed (see also analytical psychotherapy , focal therapy , psychotherapy based on depth psychology , which have differentiated into many different forms of therapy ). In addition, behavior therapy has emerged as a method with its various forms, in which, in contrast to the depth psychological forms of therapy , the focus is not on the treatment of causes and self-awareness, but rather on the treatment of symptoms (see, among others, cognitive behavioral therapy , couples therapy , family therapy ).
A distinction must be made between psychotherapy and psychological counseling , which is used in a wide variety of areas of psychology, but is not part of medicine.
Term and legal regulations
The practice of psychotherapy is legally regulated in Germany and may only be carried out by doctors with the appropriate additional qualification, by " psychological psychotherapists " (i.e. psychologists with psychotherapeutic training and license to practice ) and by alternative practitioners with psychotherapeutic training.
Legal regulations for the term psychotherapy can be found in the Psychotherapists Act and in the Psychotherapy Directive . In both cases, however, it is not regulated what is legally understood by psychotherapy, but only in which restricted form psychotherapy falls under the Psychotherapists Act or under the Psychotherapy Directive.
The Psychotherapists Act regulates who is allowed to practice therapeutic psychotherapy under the professional title of “psychotherapist”. The Psychotherapists Act therefore does not cover psychotherapy carried out by psychologists or alternative practitioners within the framework of the Alternative Practitioners Act . Psychotherapy, which may be used under the professional title of psychotherapist, is "any activity carried out using scientifically recognized psychotherapeutic procedures to identify, cure or alleviate disorders with disease value for which psychotherapy is indicated."
Psychotherapy, which can be billed to the statutory health insurance companies according to the psychotherapy guidelines, "(...) uses methodically defined interventions that systematically change the mental disorders diagnosed as illnesses and build up coping abilities of the individual." "Psychotherapy, as the treatment of mental illnesses (...), presupposes that the disease process is understood as a causally determined process that is investigated with scientifically founded methods and defined in a theoretical system with a disease theory. According to the Psychotherapists Act, the Scientific Advisory Board for Psychotherapy is responsible for the recognition of therapeutic procedures. "
The members of the Scientific Advisory Board on Psychotherapy , sent to the Advisory Board from the German Medical Association and the Federal Chamber of Psychotherapists , are commissioned to assess the scientific recognition of psychotherapy procedures. In Germany, four psychotherapy methods have been recognized as "scientifically founded" psychotherapy. The Federal Joint Committee decides which procedure will be included in the psychotherapy guideline and thus reimbursed by the statutory health insurance companies. Currently (as of 2020), reimbursement is possible for behavioral therapy , psychotherapy based on depth psychology , psychoanalysis and systemic therapy .
- Behavioral therapy: Behavioral therapeutic procedures are usually based on the model of classical or operant conditioning. Their aim is to achieve extinction (deleting problematic behavior), counter-conditioning (building up alternative reactions) or habituation (getting used to the stimulus that previously triggered the reaction). Often times, patients are given specific methods to help them overcome their problems. The aim is also to train and promote skills (e.g. self-confidence training) and to enable better self-regulation. For example, cognitive behavioral therapy tries to make the person concerned understand his thoughts and assessments, correct them if necessary and translate them into new behaviors.
- Psychodynamic procedures: In the context of psychodynamic procedures such as psychotherapy based on depth psychology and psychoanalysis, there is a confrontation with unconscious motivations and conflicts that are based in the life story - mostly in childhood. The goal is to achieve a deeper understanding of oneself and to clarify the background and causes of existing suffering so that it can be resolved or weakened.
- Systemic therapy: Systemic therapy was scientifically recognized in 2008. In 2018, its benefits and medical necessity were recognized as a psychotherapy method.The Federal Joint Committee (G-BA) decided in its meeting on November 22, 2018 that systemic therapy for adults will be covered by the statutory health insurance companies in the future.
The scientific recognition of conversation psychotherapy for in-depth training, which was pronounced in 2000, was withdrawn in 2017 as part of a renewed review. In terms of social law (reimbursable by the health insurers), conversation psychotherapy has never been recognized. This is why violent arguments have been and are being waged. In the GDR it was the predominant form of psychotherapy and was also recognized under social law.
Authorized to practice psychotherapy in the sense of medicine are:
- for adults
- Medical psychotherapists (licensed doctors with additional psychotherapy training)
- Specialists in psychosomatic medicine and psychiatry and psychotherapy
- Psychological psychotherapists (graduate or master psychologists with further training in psychotherapy and a license to practice medicine )
- Heilpraktiker (The granting of permission for professional practice of medicine without appointment, colloquially "Large Heilpraktikerschein", includes or includes the limited granting of permits in the field of psychotherapy and physiotherapy. Source: Office for Health and Consumer Protection, Heilpraktikerbereich, District Office Lichtenberg von Berlin, letter dated August 23, 2011)
- Alternative practitioner for psychotherapy (alternative practitioner limited to the field of psychotherapy, colloquially "small alternative practitioner certificate")
- for children and teenagers
- Specialists in child and adolescent psychiatry and psychotherapy
- Child and adolescent psychotherapists
- Psychological psychotherapists (however, not all licensed psychological psychotherapists have a health insurance certificate for children)
- partially alternative practitioners (large and small HP) for disorders without disease value
In Austria, psychotherapy is regulated in both the Physicians Act and the Psychotherapy Act of 1990. The latter defines the professional profile of the psychotherapist, the admission to training, the training itself, job title, professional duties, list entry, psychotherapy advisory board as well as criminal provisions and the relationship to other regulations.
A special feature of psychotherapy law in Austria is that, according to the understanding of the legislature, "the practice of psychotherapy ... is an independent scientific discipline", that psychotherapy is therefore understood as an independent science and not as a sub-discipline of medicine, Psychology or some other science.
In Austria, 23 procedures are recognized and approved as "psychotherapy". See table below . More indications are also approved than in Germany.
The entry requirements for the psychotherapist profession are much broader than, for example, in Germany. In Austria u. a. a degree in medicine, education , philosophy , psychology, journalism and communication science or theology or a degree for teaching at higher schools gives access to training as a psychotherapist.
A two-stage theoretical and practical training course, which lasts at least five years and consists of a general part, the psychotherapeutic propaedeutic and a specialist course, is decisive for registration as a psychotherapist . 23 methods are currently permitted, which are listed in the table below (in contrast to Germany, in Austria it is not procedures - ie “families of methods” - but individual methods that are permitted, which sometimes leads to misunderstandings).
In Switzerland, 23 procedures are approved as "psychotherapy". Two paths lead to authorization to work as a psychotherapist, one for doctors and one for psychologists. Both require a (technical) university degree and postgraduate psychotherapeutic training. Psychological psychotherapy is regulated by the Psychological Professions Act , and the practice of psychotherapy by psychologists is regulated in Chapter 5 “Practice of the psychotherapy profession”. Doctors acquire the specialist title "Psychiatry and Psychotherapy".
There are a variety of schools and methods of psychotherapy, but not all of them are scientifically recognized . Some of the methods offered as psychotherapy procedures are not scientifically recognized because there are no reliable efficacy studies or they are considered to be refuted, and are more likely to be assigned to the para and pseudoscientific area. Many methods are further developments, specializations or splits from psychoanalytic , depth psychological , humanistic or behavioral therapy procedures. Not all psychotherapy procedures are recognized by the state everywhere and are financed by all health insurance companies. The role of the individual methods in the health system of the German-speaking countries is very different (see table).
- (1) Hypnotherapy: Individual treatment for adults recognized in Germany, must be carried out by a doctor or a psychological psychotherapist who has the billing authorization for it.
- (2) Talk therapy and systemic therapy: recognized in Germany for adults (according to professional law).
In parts of academic psychotherapy research, the aim is to establish psychological therapy / psychological psychotherapy as a form of psychotherapy that is detached from therapy schools and that is treated (and evaluated) according to the aspects of evidence-based medicine . In other words, what is used is what has to be scientifically proven to be the most effective for a certain disorder and taking into account the patient's situation (Grawe 1994). Critics point out the complexity of the therapeutic situation, which research has so far only rudimentarily captured. In this respect, integrative psychotherapy procedures that combine general with specific effective factors are increasingly recommended.
Psychotherapy: description and demarcation
Psychotherapy is distinguished from other methods and procedures in the scientific field of psychology .
In the second edition of the Handbook of Psychotherapy and Behavior Change from 1978, psychotherapy researchers David Orlinsky and Kenneth I. Howard described psychotherapy under the following aspects:
Jerome D. Frank provided a cross-cultural definition in his widely acclaimed book Persuasion and Healing :
Orlinsky et al. add in the fifth edition of the Handbook of Psychotherapy and Behavior Change (2004) that psychotherapy today also includes or can include:
- some form of remedial or advanced teaching related to socio-emotional functioning
- a non-violent form of social control of deviant behavior
- a mediation of meaningful personal orientation and philosophy of life (or “spiritual” development).
From a different point of view, psychotherapy can be seen as a refinement and professionalization of personal helpful skills that are sought when the individual's social network fails (e.g. in a crisis) or is barely available (in rapidly changing and highly mobile ones Societies), or if the required level of “therapeutic” competence exceeds the level customary in normal social networks. This form of personal help is offered as in modern urban societies
- professional offer
- by persons whose specialist knowledge in helping skills has been formally recognized by training institutes, licensing and reputation,
- towards people whose problems affect mental health in the narrower sense.
Models of psychotherapy and its mode of action
Non-specific action factors according to J. Frank
In 1961, Jerome D. Frank described four factors in psychotherapeutic activity which, in his opinion, are effective across schools:
- A relationship between therapist and patient in which the patient experiences the therapist as competent and ready to help.
- The particularity of the therapeutic situation as a place of healing (with insignia such as the professional accreditation of the therapist, couch, etc.) and the associated healing expectations.
- Providing an explanation ( attribution ) for the patient's problems and how they can be remedied.
- Performing a therapeutic ritual (an activity that is believed to cause healing).
According to Frank, this is primarily about remoralizing the patient who has been demoralized by the symptoms and is therefore looking for help.
Orlinsky and Howard therapy factors
In their “ Generic Model of Psychotherapy ” (published for the first time in 1986 and revised since then) , David Orlinsky and Kenneth I. Howard described general (cross-school) process variables that affect the outcome of the therapy:
- The formal relationship ("therapeutic contract", organizational aspect)
- Therapeutic activities ("therapeutic operations", technical aspect)
- Therapeutic relationship ("therapeutic bond", interpersonal aspect)
- Self-relatedness (intrapersonal aspect)
- direct influences of the session ("in-session impacts", clinical aspect)
- temporal patterns ("temporal patterns", sequential aspect, temporal sequence)
Effect factors according to Grawe
According to Klaus Grawe , the following basic effective factors of psychotherapy can be demonstrated across the therapy schools:
- Therapeutic relationship : The quality of the relationship between the psychotherapist and the patient / client contributes significantly to a better or worse therapeutic outcome. see also reparenting
- Resource activation : The peculiarities that the patient bring to the therapy are used as positive resources for the therapeutic approach. This concerns the existing motivational readiness , skills and interests of the patient.
- Updating the problem : The problems that are to be changed in the therapy can be experienced immediately. This can e.g. This can be done, for example, by the therapist and client seeking real situations in which the problems arise, or by using special therapeutic techniques such as intensive storytelling, imagination exercises , role-play , etc. to update the problems in terms of experience.
- Motivational clarification : The therapy uses suitable measures to ensure that the patient gains a clearer awareness of the determinants (origins, backgrounds, sustaining factors) of his problematic experience and behavior .
- Problem solving : The treatment supports the patient with tried and tested problem-specific measures (direct or indirect) in order to have positive coping experiences in dealing with his problems.
When evaluating empirical results, Asay and Lambert (2001) came to the conclusion that the variance in the therapeutic change in the client increased
- 40% through client variables and extra therapeutic factors,
- 30% through the therapeutic relationship,
- 15% due to the form of therapy and
- 15% is explained by expectation and placebo effects.
Models of person-centered psychotherapy competencies
If psychotherapists (independent of school) work through their very personal skills, there should also be models that try to depict this. Two of these are Hill's Helping Skills Model (2014) and Anderson's Facilitative Interpersonal Skills Model (2009).
Helping skills model
In Hill's model, three competencies are named: exploratory skills (e.g. reflections), insight-oriented skills (e.g. interpretations) and action skills (e.g. giving homework). These represent areas of orientation that should be implemented flexibly and in a context-sensitive manner. These helping skills areas should be able to be taught very well and improve a whole lot of therapist characteristics: The trained therapists should have become better at implementation in a study, felt better as practitioners, were less afraid, had more self-efficacy, felt feel more comfortable in the role of practitioner, less self-critical, and better able to bond with their patients.
Facilitative interpersonal skills model
Anderson's Facilitative Interpersonal Skills Model (FIS) takes a different approach: The therapists are presented with a standard set of realistic therapy situations and their reactions to them are assessed by behavioral monitors in several areas, including: a. Relationship skills. Is this competence z. B. highly pronounced, relationship assessments in the therapies become more positive, the therapy results more successful and the symptoms less (ibid.). The assessments measured there are not intended to correlate with the helping skills model. "Apparently, FIS predicted helpers who gained confidence in their helping skills without being able to predict demonstrated learning of helping skills". Although the FIS model works with realistic situations, the effect of the assessment does not seem to affect demonstrated skills, but rather felt: "FIS predicted helpers who gained confidence in their helping skills", i.e. possibly felt competent therapy rather than objectively shown .
Five factors model of psychotherapy competence
This five-factor model comes from an integration of already proven effective factors, which means that it should not yet appear in research in precisely this form. In contrast to the Hills Helping Skills model (see above), five instead of three person-specific areas of competence are propagated.
1. Heart skills (warmth of the heart, empathy, compassion)
It has been proven many times that the therapeutic relationship is one of the most important areas of influence and general active factors in psychotherapy. Carl Rogers is very well suited here to illustrate knowledge about cardiac competence effects. Rogers became famous for the three (relational) areas that he identified as essential effects of therapy:
- The empathy. Castonguay & Hill emphasize that teaching therapists how to create good relationships in general is not always helpful, but rather how to enable their specific clients to grow and change. Roger's criteria correlate highly with therapeutic success, but cannot fully explain the success.
- The unconditional acceptance as an attitude.
- The authenticity, congruence and genuineness of your own behavior. “Psychotherapy is not a substitute, but a rehearsal for life. In other words, while it requires a close relationship, the relationship is not the goal - it is a path to the goal ”. The relationship is a "vehicle that enables and supports the special counseling techniques (...)". The reason why Roger's three skills for empathy, acceptance and authenticity are not sufficient to explain therapeutic success is perhaps simply that the heart Skills only cover one area of competence (instead of five, as advocated here).
2. Ear skills (concentration, openness)
Good therapists should also be good at listening with concentration and at the same time openly (compare the concept of “extraordinary presence”). Concentrated means being guided by a theory - and open means being able to listen or perceive without theory. While expectations and model knowledge can make listening more sensitive, open listening can make the space for theory-free, spontaneous hearings freer and larger. In this respect, listening in psychotherapy is perhaps something two-dimensional, always moving in the mix between targeted and free-floating listening (Freud is said to have called it free-floating attention ). Beyond these two dimensions, complex listening is also conceivable, i.e. H. the attempt to grasp the content of what has been said, but also to see the non-verbal with the eye skills (note facial expressions and gestures) and at the same time hear the paraverbal with the ear skills (tone of voice, pauses in speech, pitch, sentence interruptions and breaks as the language of the unconscious etc.). The ability "to listen and to respond to more than the manifest content of the words - to listen for narrative shifts, pauses, tonal variations, emotional coloring, plot lines, minor characters, and false notes, (...) is arguably another variable that separates the good from the great therapist ". If psychotherapists listen poorly, this is due, among other things, to their own fears, fatigue, intellectualization or the formation of reactions. The ability to be present and to be able to listen openly should actually be a (statistically independent) ability that can be differentiated from empathy and is of its own.
3.Eye Skills (Goals, Patterns, Here & Now)
3.1. Keep an eye on therapy goals
Since there are also blind and visually impaired therapists, it should be said in advance that this refers to mental visual faculties, not necessarily physical ones. You can keep an eye on something mentally, for example therapy goals that are approached in a planned and directed manner.
3.2. See relationship patterns clearly
Relationship patterns can (and should) be seen; H. Patterns of interaction between parents and patient, current caregivers and patient, and of course between the therapist and patient in the sense of a transference and countertransference (the background is the PCT person triangle). Yalom even basically assumes that patients go to therapy because of deficiencies in their ability to relate and that their relationship problems will sooner or later become apparent to the therapist: "There is hardly any need for biographical digressions in order to perceive poorly adapted behavior patterns, because they will soon appear in the brightest colors in the here and now of the therapeutic session ”(italics in the original). He concludes from this that one should look for repetitions, “here-and-now correspondences” in the relationship with the therapist, in order to then discuss them precisely there. A therapist who helps patients understand that their problems arise from difficulties in social contact is even scientifically proven to be more successful than those who rarely do so.
3.3. See (and use) the here and now clearly
Thirdly, what is currently relevant in the here and now (the most urgent thing in the present moment) can be seen sharply (“awareness of what the client is experiencing and needs in the moment”). Yalom considers the here and now to be something enormously essential; it should always be used, taken into account and everything in the here and now grist to the mill of therapy. Kernberg also recommends limiting interpretations of negative transferences to the here and now and to the current relationships outside of therapy.
3.3.1. The here and now at the start of therapy
Schwartz & Flowers emphasize that right from the start one should not overlook the patient's expectations, previous therapy experiences, level of change, reactance or self-image (image of women, men). Otherwise there is a risk of not picking up a patient from exactly where he / she is, but of “rushing or slowing someone down”, e. For example, if you let children experience too strong feelings too early, although “the grass doesn't grow faster if you pull on it”.
3.3.2. The here and now in a relationship breakdown
Something relevant in the here and now can also be a break in a relationship, in two different forms: withdrawal (external, internal) or attack (expressing anger or dissatisfaction). That too needs to be seen with sharp eyes, from moment to moment.
3.3.3. The here and now of the situation (systemic & meta-perspective)
Sometimes therapists neglect to pay attention to the situation or system around a person. There are a great many systems active and influential around a patient (and psychotherapy); As examples: In addition to the clinical ward rules, caregivers, pension systems, living and financial systems (or collective, political systems) there are also dysfunctional family systems, migration, transgenerational trauma or social groups (groups) shaped by drugs. In a nutshell: The seeing mindfulness of a psychotherapist would be blind (and would disregard the knowledge of the fundamental attribution error) if they were to forget the systems around a person.
4.Hand skills (acting effectively / effectively intervening)
The term “hand” is meant metaphorically in the sense of “lead, execute, act”. After all, there is no psychotherapy in which one only feels, sees or listens with empathy, but rather (more or less) concrete action, i.e. a. spoken, expressed and addressed, asked, advised, reacted, confronted, criticized, emphasized, intervened, commented, clarified and interpreted. This requires a lot of tact when choosing the technology, the dosage, sensitive timing and an adapted cycle or frequency of utterances per unit of time. Not only that, the voice volume, pitch, intonation, vocabulary and speaking speed can also be adjusted.
4.1. Content (direction and focus) of the intervention
It could be helpful to see four out of five influencing factors, as evidenced by Klaus Grawe, as a “direction” that needs to be instinctively addressed at the right moment. Firstly, instinctively activating the patient's resources, letting him / her feel problems lively (updating the problem), focusing on justifications and motivation (motivational clarification) or striving for problem solutions. The person-specific competence would then be to choose the most helpful direction at the right moment. Of course, there could also be other, further directions (for example structural directions from Operationalized Psychodynamic Diagnostics, such as affect differentiation, object perception, relationship regulation and communication).
4.2. The timing of an intervention ("cold" versus "hot")
Yalom says very clearly that one should forge iron while it is cold. That is, he would like to address his patient's problematic interpersonal behavior when it no longer occurs (it has “cooled down”, so to speak; “Interpretations are most effective when the patient's affect has weakened so much that he becomes more dispassionate about his behavior can look at "). In addition, Yalom also takes the position of addressing it when it is particularly noticeable or noticeable repeatedly. A change in patients is only possible if at some point he / she also takes responsibility for their own shares, "that is, to understand how they themselves contribute to their own misery". Perhaps it works better with a “cool head”, as Yalom suggests in its cold iron metaphor. Previous research says, "effective therapists are verbally fluent, express emotion appropriately, are persuasive, communicate hopefulness, are warm and empathic (...) and focus on patients' problems".
4.3. The creativity of the interventions
The therapist's creativity and willingness to adapt is very important; Yalom even says, "The therapist must strive to create a new therapy for each patient". "Successful therapists responsively adapt their treatment approach, resources and strategies specifically for each client and session, so the brand of treatment is variable rather than constant across clients".
5. Learning skills
5.1. Learning through supervision
"We suspect that one of the factors that differentiates more and less effective therapists is the text to which they seek and make use of supervision". Supervision requires a certain openness to feedback - and tolerance for self-doubt. And being able to question oneself professionally actually correlates with better therapy results (p. 46). “Awareness of our weaknesses can also motivate us to improve our skills by keeping up to date with the latest research literature, consulting with colleagues and participating in workshops”.
5.2. Learning through patient feedback
Collecting patient feedback should increase the success rate. "Through feedback, [therapists] become better witnesses of their own behavior and learn to correctly assess [their] effect on the feelings of others". "In addition to useful feedback and helpful models, expertise requires an ongoing effort to increase and maintain excellence". Excellence comes from effort; the amount of cognitive effort while therapists listened to tape recordings of their sessions was significantly correlated with the therapy outcome. Therapeutic competencies "may be best characterized as a complex set of skills, developed through extensive practice of more primordial skills, which serve as building blocks for more complex and advanced skill sets". The five skill areas described here are possibly primordial skills on the basis of which psychotherapists can be trained.
Definition of a therapist effect
The subject of “person-centered psychotherapy competencies” implies that there must be a therapist (competence) effect. "The term therapist effects encompasses conceptual, clinical, and statistical phenomena that refer to 'the contribution that can be attributed to therapists when evaluating the efficacy of a psychological intervention'". Such an effect should z. B. show that some therapists consistently achieve better results than others. This effect should be relatively stable over time and the different patients, but this does not mean that training and exercise would not change the effect; when therapists improve themselves through conscious practice, the success rate also increases.
Components of the therapist effect
The following are not relevant for the person of the psychotherapist: gender, age, experience and qualifying degree. According to previous studies, the theoretical school orientation, self-reported interpersonal skills and manual adherence are not correlated with the success of the therapy. "The factors that influence [a successful] relationship include credibility, reliability and the competence of the therapist".
Size of the therapist effect
Anyone who carries out a therapy explains about 5 to 8 percent of the differences in therapy results and in particularly heavily stressed patients, similar to what Kernberg said many years ago, the effect increases to up to 16 percent. In some works there is talk of a 30 percent explanation of variance by the therapist and depending on what the dependent variable is exactly, it should even go up to 70 percent.
Computer-assisted psychotherapeutic interventions
Since about 2000 research into the use of modern media for psychotherapeutic purposes has increased significantly. The following areas of application can be distinguished:
- Teletherapy : In teletherapy, classic psychotherapy is implemented using modern communication channels (video telephony, chats, etc.).
- Virtual Reality : “Virtual Reality Technologies” (VR) make it possible to create computer-based models of the real world with which one can interact on the basis of a human-machine interface (usually the smartphone).
- Computer-based online interventions (syn. Internet interventions, online therapy): Provided online programs can be described as an interactive form of self-help (self-help 2.0) and usually consist of a combination of text, audio and video modules.
- Computer-assisted psychotherapy (syn. Mixed therapy, blended therapy): Classic psychotherapy can be supported by online and app elements. Their use has already been investigated for individual therapy as well as for group therapy.
There were first pilot projects for this in the Netherlands . In the Federal Republic of Germany , relevant psychotherapeutic services could not be billed through the statutory health insurance. This restriction was lifted due to the COVID-19 pandemic in 2020.
Differentiation from other professional relationships
The psychotherapeutic setting is formally clearly distinguished from other forms of professional (work) relationships due to its legal and theoretical framework, but there are often different definitions in the individual countries. In Germany, the Psychotherapists Act clearly distinguishes psychotherapy from non-medical psychological interventions. Psychotherapy is any psychological “activity to determine, cure or alleviate disorders with a disease value” using “scientifically recognized procedures”. On the other hand, “psychological activities that deal with dealing with and overcoming social conflicts or other purposes outside of medicine” do not belong to psychotherapy. So in Germany z. B. Counseling sessions with teachers, social workers and pastoral care sessions are not psychotherapy. Coaching also differs significantly from psychotherapy.
Methodologically, therapy, counseling, pastoral care and self-awareness often overlap right down to core areas. However, in Germany, according to the Psychotherapists Act and psychotherapy guidelines, the goal of psychotherapy is clearly defined as the diagnosis and cure of mental disorders, while non-medical psychological procedures aim exclusively at clearing general life problems and resolving social conflicts. On the continuum between the “treatment of the sick” to the “development of resources”, psychotherapy can only be delimited in an unsatisfactory manner. In addition to the psychological, various therapeutic directions also integrate spirituality, social, political etc.
Formally, according to German law, this is not psychotherapy, but psychological counseling or other methods,
- if no disorders or diseases are to be influenced;
- if it concerns self-help groups , self-awareness groups , supervision , training or coaching groups as well as general life counseling;
- when the principles of diagnosis and healing are not applied;
- if no scientific theory or verifiable beliefs are based,
but the "treatment" is based exclusively on the experience gained personally or passed on in a certain group;
- if there is no (written or oral) agreement on psychotherapy;
- when goals of a therapy process are not set or these goals are not openly discussed;
- if only medication is used;
- if there is no personal interaction between the patient or client and the counselor or therapist (if, for example, “therapeutic communications” are only distributed in the form of newsletters, audio or video cassettes, etc.);
- if only the charismatic personality of the treating person is used as an effect and no healing is promised.
Education and state recognition
Not all psychotherapy procedures are recognized by the state everywhere and are financed by all health insurance companies. Behind this are different views on indication and effectiveness , but also professional conflicts of interest (between doctors, psychologists and other professions), and the competition between the psychotherapy schools. In Switzerland and Austria, the therapist's methodological freedom and responsibility is much broader than in Germany.
In Switzerland no distinction is made between methods. The qualifications of the therapist and the possession of a cantonal practice license are decisive. Doctors trained in psychotherapy (specialist in psychiatry and psychotherapy FMH) can settle the psychotherapeutic service directly with the health insurance companies. The psychological psychotherapists only if they settle accounts through the delegating doctor. Therapy methods are approved by the Swiss Charter for Psychotherapy as a conference of further training institutions and professional associations within the Association of Swiss Psychotherapists (ASP), the Swiss Professional Association for Applied Psychology (SBAP), and the Federation of Swiss Psychologists (FSP) valid method approval is therefore still based on the acceptance criteria of these associations. The cantons are responsible for approval to run a psychotherapy practice (practice license). Since April 1, 2013 the Psychology Professions Act (PsyG) regulates . the equivalence of university degrees in psychology and advanced training titles within the scope of the PsyG, such as psychological psychotherapy. Since the PsyG came into force, people who want to practice psychotherapy on a private basis and on their own professional responsibility must have a master's degree or an equivalent university degree in psychology and have completed accredited psychotherapeutic training. The transitional provisions in Article 49 PsyG apply to all those persons who already have a cantonal license to practice psychotherapy or who have completed or started their psychotherapy training in Switzerland before the PsyG came into force.
A specific source occupation is required for admission to psychotherapeutic training. These include degrees in medicine, psychology, psychotherapy science (PTW), pedagogy, philosophy, journalism and communication science, theology or a degree for teaching at higher schools. Qualifications from an academy for social work, a training institute for high-level social professions, a pedagogical academy or a training institute for marriage and family counselors with public rights are also entitled to access. A short course or university course in music therapy also qualifies for admission to training. Anyone who does not belong to these professional groups can apply for official approval to the Federal Ministry of Health . This is decided on the basis of a suitability report obtained from the Psychotherapy Advisory Board. The basic training, the preparatory course , lasts about two years. The specialist course can only be completed after completing the preparatory course. It is used for training in one of the recognized methods and lasts at least three years. 23 psychotherapeutic methods are currently recognized in Austria.
Since 2005, the Sigmund Freud University in Vienna has offered a degree in Psychotherapy Science (bachelor's degree: 6 semesters; master's degree: 4 semesters). In the bachelor’s degree, you can choose between the key areas of “psychotherapy” (preparation for a master’s degree) and “psychosocial counseling” (qualification for relevant practical work). The master’s degree in psychotherapy science “builds on the bachelor’s degree and aims to deepen the theory, methodology and history of psychotherapy, general and method-specific pathology as well as the diagnosis of disorders and their treatment concepts”. However, this is not a training course within the meaning of the Austrian Psychotherapy Act, i. H. basically does not aim at obtaining the professional qualification as a psychotherapist. Such courses are currently available in Vienna, Berlin, Linz, Ljubljana, Milan and Paris.
Only doctors can obtain authorization to practice psychotherapy independently with the ÖÄK diploma for psychotherapeutic medicine . This advanced training diploma , also known as the PSY3 diploma , is awarded by the Austrian Medical Association (ÖÄK). The time required to obtain the PSY3 diploma is usually 7 years because the completion of the PSY1 and PSY2 diplomas is a prerequisite for starting the PSY3 curriculum.
Psychotherapy has been part of statutory health care provision since 1967. Before the Psychotherapists Act came into force on January 1, 1999, only medical psychotherapists could be members of the Association of Statutory Health Insurance Physicians, but since then also psychological psychotherapists and child and youth psychotherapists. There are few other countries in the world where the statutory health insurance companies' obligation to provide benefits for the treatment carried out by psychotherapists is as clearly regulated in favor of mentally ill patients and their therapists as it is in Germany.
In the German health system, only three methods are currently approved for psychotherapy financed by statutory health insurances:
The Analytical Psychotherapy in turn consists of three different currents:
- Psychoanalysis according to Sigmund Freud ,
- Analytical psychology according to Carl Gustav Jung and
- Individual psychology according to Alfred Adler .
Psychotherapy at the expense of the health insurance companies must be approved by the health insurance fund in Germany. For this purpose, the patient must submit a health insurance application. When applying for long-term therapy, the psychotherapist must enclose a report to the expert with this application . It depends on the positive opinion of the expert whether the health insurance pays the costs for the treatment.
- Psychotherapy research
- History of Psychotherapy
- Offense handling
- First interview of psychotherapy
- List of psychotherapy and self-awareness methods
- List of eminent psychotherapists
- List of psychotherapeutic terms
- List of psychotherapeutic journals
- Feminist psychotherapy
- Supportive psychotherapy
- Abuse of power in psychotherapy
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Risks and Side Effects
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- Federal Joint Committee: Psychotherapy
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- Psychotherapists Act of the Federal Republic of Germany, Section 1, Paragraph 3, Sentence 3 - gesetze-im-internet.de
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- see Psychotherapists Paragraph 3
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- Psychotherapy recognized in Austria
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