Psychotherapy: an overview of the procedures

Analytical, systemic and behavioral therapy based on depth psychology: There are four scientifically recognized forms of psychotherapy. What is behind which process

Psychotherapy: A relationship of trust between the patient and the psychotherapist is important

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For example, depression, anxiety disorders or personal crises can make psychotherapeutic treatment necessary. The problem of even getting a free place with a psychotherapist is one thing. The question of which procedure is right for you is also difficult.

Four therapeutic methods are generally scientifically recognized: behavioral therapy, analytical and depth psychology-based psychotherapy, and systemic therapy. However, only the costs for the first three are covered by the statutory health insurance. It was decided in 2018 that the costs for systemic therapy will also be reimbursed in the future. However, the details have not yet been finally settled, which means that patients still have to pay for them themselves. "Every psychotherapist has a certain procedure as a focus," says Dr. Nikolaus Melcop, President of the Chamber of Psychotherapists (PTK) Bavaria. A fifth method, counseling psychotherapy, is only scientifically recognized for certain psychological problems.

Psychotherapy: which procedure should I choose?

Which form of therapy is suitable in each case depends on the individual prerequisites of the person concerned, on the psychological problems, on the level of suffering. However, the interests and personal inclinations of the patient are also important: Does he want to come to terms with his past or primarily fight the problems in the here and now? Does he want to work with active exercises in everyday life or should the conversation in the therapist's practice be the center of the treatment? A criterion when choosing a psychotherapist is not only the focus of the procedure, but also which diseases he specializes in.

"The relationship aspect is also important," says Melcop. That means: Do the patient and the psychotherapist get along at all? A relationship of trust between the two is a prerequisite for success. If the chemistry isn't right, a change makes sense. The patient and the psychotherapist have the right to trial appointments. They serve to get to know each other and to establish a therapy goal. The statutory health insurances pay two to four of these sessions for adults. However, the prerequisite is that the psychotherapist has a health insurance certificate. Trial sessions can take place with different psychotherapists.

There is one thing that patients have to be aware of before starting therapy: the psychotherapist's task is not just to administer a drug and you will get well again. For the healing process to be successful, the person being treated must actively cooperate, especially on himself. This applies to all procedures. Therefore, one should think in advance which goals one would like to achieve in therapy.

Behavior therapy

The basic idea of ​​behavior therapy: Current ailments are based in part on entrenched ideas and reaction patterns that those affected have developed in the course of their lives. However, these can be changed again. Behavioral therapy focuses less on the past and more on the patient's present experience and behavior. The psychotherapist and patient jointly analyze the problem and develop models for change. For example, those who suffer from a phobia should learn to deal with their fears better in the course of behavior therapy. This usually takes the form of small everyday tasks that the psychotherapist gives the patient between sessions. This requires self-motivation and the willingness to actively work on solving one's own problems in everyday life.

Analytical psychotherapy

This procedure goes back to Sigmund Freud, the founder of psychoanalysis. It assumes that people experience certain imprints in childhood and in the course of their development. These decide how to deal with challenges or conflicts. Mental illnesses can be the result of not mastered developmental steps, but also internal conflicts or traumatic experiences.

The psychotherapist takes on a neutral role in the treatment. Its task is to make the patient aware of what has been repressed. This is usually done using the method of free association. "The patient is typically lying on a couch with the therapist sitting behind him, out of his field of vision," explains Dr. Bruno Waldvogel, therapist and psychoanalyst in Munich. The sessions are open, the patient tells what comes to mind. In this way, typical thought and relationship patterns of the patient are repeated during the therapy. In this way, they can be consciously experienced by him and the psychotherapist and can be worked on. On the patient side, the procedure requires a great willingness to look into oneself and describe one's own feelings. Meetings take place around two to four times a week.

Psychotherapy based on depth psychology

In the depth psychological process, the focus is on the patient's unconscious experience and behavior - similar to the psychoanalysis from which it developed. Unresolved inner conflicts or trauma persist up to the present, so the thesis, and cause the psychological suffering there. The word "deep" has a double meaning: it refers to the temporal dimension as well as to the depth of the psychic processes.

But although the cause of mental illness is suspected in the past, this is not the focus of treatment per se. Despite having the same theoretical background as analytical psychotherapy, there are some differences between the two approaches. "In deep psychological psychotherapy, the therapist makes the conversation more active, directing the conversation to specific problem areas and their backgrounds," says Waldvogel. In addition, he and the patient usually sit across from each other and have eye contact. The goal of therapy is also different: while analytical psychotherapy aims at a holistic change in problematic patterns, the depth psychological approach focuses on solving specific problems. Sessions take place about once a week.

Systemic psychotherapy

This term covers a large number of therapeutic procedures that have arisen independently of one another. Accordingly, there is no standardized course of therapy. What the procedures have in common, however, is that the focus is not only on the patient, but that their entire environment is included, for example their family and other important people. Hence the name "systemic".

The cause of psychological problems is assumed to be systemic approaches in disturbed relationship and communication structures between the people involved. The psychotherapist tries to optimize the behavior with the patient. Different methods are used for this. In addition to one-on-one discussions, there are frequent questions in the group where those involved present their views on the status of the relationship and put them up for discussion. The aim is to solve the problems using the patient's existing but hidden resources and skills.

You can work systemically in individual, couple, family and group therapies. Systemic psychotherapy has been scientifically recognized in Germany since December 2008. The costs are to be reimbursed by the statutory health insurance companies in the future, but details are not yet clear. For this reason, the costs are not currently covered.

Conversational psychotherapy

The conversation psychotherapy is not one of the generally scientifically recognized psychotherapy procedures. The use of this form of therapy has so far only been scientifically recognized for certain disorders, such as adjustment and stress disorders. Scientifically high-quality evidence for the effectiveness in anxiety disorders, however, is still missing. The conversation psychotherapy - also called client-centered psychotherapy - assumes that every person has a tendency towards positive development if the natural growth forces are not disturbed in their development from outside. A close relationship and a good relationship of trust between patient and therapist is particularly important for the procedure so that they can clarify the problems in dialogue. In addition, the person affected should be ready to explore himself in order to get to know and appreciate himself anew.

On the part of the psychotherapist, empathy, appreciation for the patient and authenticity are important. "The psychotherapist brings his own feelings into the process and shares them openly with his counterpart," explains Professor Klaus Heinerth. The Munich therapist has specialized in conversation psychotherapy. The starting point of the treatment is the current living situation of the person concerned. Only if necessary do those involved also research the patient's past. Statutory health insurance does not cover the costs of counseling psychotherapy.