What actually is psychotherapy?

Whether it’s a stubborn flu virus, a recurring headache or a sprained wrist, our primary care physician is the first place we trust. Do we hesitate to see him or perhaps even feel uncomfortable? Most would answer these questions with a resounding no. But why are many people still so uncomfortable today about also seeking professional help for psychological problems? Countless studies prove that psychotherapy can bring about remarkable changes and restore valuable quality of life. So, why shouldn’t we want to benefit from this possibility of support as well?!

How does psychotherapy work? And what is treated?

The term psychotherapy generally includes the targeted treatment of psychological as well as psychosomatic complaints. Examples are:

  • Affective disorders such as depression, mania as well as bipolar disorders
  • Schizophrenia, schizotypal and delusional disorders such as psychosis
  • Neurotic, stress and somatoform disorders such as phobias, anxiety or obsessive-compulsive disorders
  • Behavioral disorders with physical disturbances and factors such as eating or sleeping disorders
  • Personality and behavioral disorders such as borderline or pathological gambling.

The aim of a therapeutic treatment is to improve the thinking, feeling and acting of the person concerned in the long term and to overcome acute crises. Existing resources are to be activated with the help of the therapist and alternative ways of acting are to be learned. By “helping people to help themselves,” patients should also have learned a buffet of strategies after therapy in order to be able to deal appropriately with stresses as well as difficult situations.

Stages and length of the therapy path

The so-called “initial interview”

In the initial interview, the therapist will first ask the patient to freely tell about the reason for coming and his or her problems. The therapist will also ask some follow-up questions, but it is of great importance how or in what order the patient describes his complaints. At the end of the session, the therapist will feedback whether the patient is at the right place with his symptoms and whether psychotherapy seems appropriate.

The Probationary Sessions

In the following two to five sessions, the therapist will collect diagnostic material and try to get an overview of the patient’s entire complaint picture. It is also a matter for him to get a first idea of how therapy can help the patient alleviate his symptoms. The patient, in turn, can use the hours to get a feel for whether the chemistry between him and the therapist is right and whether a relationship of trust can be established. If both parties come to the conclusion that they would like to work together, the therapist will apply to the health insurance company for short-term or long-term therapy.

The “work phase”

On a usually weekly basis, work begins on the individual treatment plan. The therapist will use specific techniques to help address old and new feelings and implement new behaviors. Insights can be encouraged, motivated, but also appropriately confronted.

End of psychotherapy

When the established goals of therapy have been achieved, the time has come to say goodbye. Initially, the time intervals between sessions can be increased in order to test and consolidate the changes that have been worked out.

The duration of psychotherapy depends on the therapy goal and can vary greatly depending on the problem. For example, short-term therapy comprises a maximum of 24, long-term therapy even 60 or more therapy units with about 50 minutes of conversation time.

Not all psychotherapies are the same: forms of therapy

There are various forms of therapy, all based on their own theories and treatment approaches. Which one is most suitable for the individual depends on various factors, such as the severity of the symptoms. The decisive factor is also how well the patient can adapt to the respective method.

Behavioral therapy: It is assumed that problematic or inappropriate behavioral or thought patterns are learned through experience. The goal is to replace the negative patterns with new and, above all, beneficial ones.

Psychoanalysis: The repression of feelings and conflicts has prevented healthy development in the past. The goal is now to uncover and thus resolve inner conflicts.

Depth psychology-based therapy: Here, too, it is assumed that the current complaints are based on an inner psychological conflict. However, the focus is on the so-called “central conflict” and the search for causes in the personality or the past.

Systemic therapy: The illness of an individual person stands here as a symptom for a disturbance in the interaction of an entire system (e.g. the family). Relevant attachment figures are to be included in the recovery process.

When does therapy make sense?

The start of psychotherapy is always advisable when thoughts, feelings and behavior impair the quality of life. In bad cases, the job can no longer be performed or social contacts are affected. There are also mental illnesses, such as narcissistic personality disorder, in which those affected can live very well with their symptoms. In those cases, it tends to be relatives who suffer from them and encourage the sufferer to seek therapy. Medically unexplained physical symptoms are also an indication for seeking professional support. Affected persons often have a long diagnostic path behind them and experience strong helplessness and despair. On one hand, mental illnesses can be the cause of physical symptoms, on the other hand the mental suffering can arise from them.

A predominantly affirmative answer to the following questions can facilitate the decision for psychotherapy:

  • Do the complaints influence everyday life?
  • Is there an increasing loss of interest?
  • Is there more emotionality than usual?
  • Is the environment worried?
  • Has there been a traumatic experience in the past?
  • Is there an increase in the consumption of stimulants or other harmful substances?

Who is treating where?

After the question of the need for psychotherapy has been answered, a decision should be made as to where and in what setting therapy will be conducted. In principle, psychotherapy can be carried out by a psychological psychotherapist or a psychiatrist. The psychotherapist is the one who carries out the usually weekly talk therapy with the patient and works with the conscious discussion as well as the causes of the problems. The psychiatrist, on the other hand, as a medical doctor, also takes care of the physical diagnosis and the prescription of medication. In principle, it is advisable for most clinical pictures to begin with psychotherapy and, if necessary, to use medication as an adjunct.

The question of where therapy should be carried out depends entirely on the severity of the symptoms. Outpatient therapy is recommended for patients with a higher functional level who can still manage their daily lives independently. Inpatient stays provide a protective setting when patients are in very poor health, have been unsuccessfully participating in outpatient psychotherapy for some time, and are exhibiting behavior that is dangerous to themselves or others.
Psychotherapy, whether outpatient or inpatient, can be covered by statutory health insurance or take place as part of a private therapy or in a private clinic. In some cases, the facilities and therapists specialize in certain psychological disorders, which should be taken into account when looking for the right contact person.

Finally, it is important to emphasize once again that obtaining a professional opinion on an existing complaint is always advisable and that there should be no hesitation in taking advantage of the opportunity to receive help and regain quality of life.

  • Deutscher Ärzteverlag GmbH: https://www.aerzteblatt.de/archiv/33595/Ambulant-oder-stationaer-Indikationskriterien, accessed 02.04.2022.
  • Helle, Mark: Psychotherapy. Berlin, 2019.
  • Reimer et al: Psychotherapy. Heidelberg, 2007.

Categories: Therapy

Verena Klein
Author Verena Klein
"LIMES Schlosskliniken specializes in the treatment of mental and psychosomatic illnesses. With the help of the blog, we as a clinic group would like to examine the various mental illnesses in more detail and present different therapies as well as current topics."

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