What diagnosis would a therapist make?

Psychotherapeutic Practice Dr. med. A. Cherdron

Frequent fears and feelings in advance

For many people, the step of going to a psychotherapist is linked on the one hand with fears (what will be expected there) and on the other hand with the feeling of having failed personally. Many people - especially men - perceive going to the psychotherapist as a personal defeat, as a "failure" and are ashamed of it. Depressed people in particular tend to blame themselves for their condition or are convinced that they have to "do it themselves".
Furthermore, there is the notion in many minds that the psychotherapist is sitting with “crazy” or at least highly bizarre people, to which countless jokes (“Does a madman come to the doctor ...”) and cartoons have contributed. In contrast, the experience often made by patients is that when they “come out” to friends or acquaintances or at work, the answer to a psychotherapy that has been started is: “That is good, I also did that before a few people Years and it helped me a lot ”. We should also remember the examples of many celebrities who have recently publicly confessed to previous mental illnesses and / or successful psychotherapeutic treatment.
Mental problems and illnesses are often generally equated with the "mental illnesses", with which the illnesses from the schizophrenic group of forms are described. These are illnesses in which the patient's thinking is severely impaired, in the sense of a delusional experience or a delusional reinterpretation of the world (“I am Napoleon”) or the feeling of being threatened or persecuted (“Paranoia”). These illnesses belong in the hands of a psychiatrist ("neurologist") and can primarily only be treated with medication and often only in a psychiatric clinic. Although there are many points of contact between psychiatry and psychotherapy, in a psychotherapeutic practice you will not usually meet “crazy people” and you don't have to be afraid of being classified as “crazy”, just as it is not possible in psychiatric clinics in "One Flew Over the Cuckoo's Nest".

The so-called "first meeting"

After the appointment has been made by telephone, the so-called "first meeting" takes place. In the initial consultation, the therapist usually asks the patient to tell about the reason for his arrival and his problems as freely and in an unstructured manner as possible. The therapist may only ask a few direct questions in the initial consultation, as it is more important for him to experience how the patient describes his problems or the order in which he reports on his complaints. Towards the end of this first conversation, the therapist should give the patient feedback on whether he is “at the right address”, whether his symptoms can really be treated psychotherapeutically or whether other (medical) specialist disciplines have to be consulted to confirm the diagnosis.
If the therapist has the feeling that the patient cannot be treated by himself due to technical considerations (is another form of therapy more suitable? Is a hospital stay indicated?) Or his own "bias" (common personal points of contact or involvement with the patient), then he should explain this to the patient and, if possible, give him another point of contact. It is often a painful moment for patients when the therapist tells them that it is better to get help elsewhere (“I have to tell my whole story again”). Psychotherapy means a bit of strenuous work for patients, often for at least a year, so that it is always important to find the "optimal" therapist in order not to have to shrug off the shoulders after a year that a different therapy method or a therapist with a different focus would have been better.

The so-called "trial sessions" or "probatory sessions"

If further psychotherapy with the patient appears sensible and "promising" to the therapist after the initial consultation, he will suggest that the patient make another appointment. With statutory health insurances as well as with private health insurances and aid agencies, it is guaranteed that a total of five so-called “probatory sessions” can be reimbursed without any major bureaucratic effort. In the probatory sessions the therapist will collect “diagnostic material”. Just as the internist may determine blood values, write an EKG, listen to the lungs and need an X-ray in order to make his diagnosis and choose the right therapy, the psychotherapist also has to collect “findings” and “diagnostic material”. In the case of depth psychological therapists and psychoanalysts, the therapist will ask, among other things, the biography of the patient, will try to reconstruct the nature of his relationship, will observe how the patient deals with his feelings and ask him about the reason for his problems according to his own ideas . Often the therapist offers the patient so-called “trial interpretations”, that is, an idea, a model for the patient's medical history.
The aim of the probatory sessions is that the therapist can clarify the clinical picture and the problems of the patient and gain certainty that a psychotherapeutic work with him, the patient, can lead to an alleviation or a disappearance of the symptoms.
The patient, in turn, can and should also use the probatory sessions for himself. On the one hand, he should check whether he has the feeling that he can do something with what the therapist has told him about the therapeutic procedure and the course of the treatment, that it corresponds to his personality and whether he - with all open questions and an uncertainty as to where the “psychotherapeutic journey” will go - feeling that the therapist can help him. Second, the patient should check whether the “chemistry” between him and the therapist is right. Several studies have shown that an authentic and primarily positive “chemistry” between patient and psychotherapist (regardless of which therapy method is used) is a decisive factor for the success of psychotherapy.
Often it does not take until the fifth session for the patient and therapist to jointly come to the decision to apply to the health insurance company for psychotherapy.

Applying for psychotherapy at the health insurance company or aid agency

For patients with statutory health insurance, the therapist can apply for short-term therapy, for which he can apply for 25 sessions, relatively unbureaucratically after filling out a form. However, since the vast majority of psychotherapies last between 50 and 80 sessions (in some cases significantly longer), it is usually necessary to apply for long-term therapy at the health insurance company. For this, the therapist must write a detailed, mostly 4-5 page, anonymized report for the health insurance company, which has this strictly confidential report checked by an external expert to determine whether psychotherapy is indicated, sensible and “promising”.

The aid agencies have joined the so-called “expert procedure” of the statutory health insurances and also demand a detailed report and a treatment plan from the therapist after the fifth trial session. The uncomplicated and unbureaucratic application for short-term psychotherapy is not possible at the grant offices.

As a rule, private patients are also reimbursed for the costs of psychotherapy, but the private health insurance companies do not have any uniform regulation. Quite a few private health insurance companies pay a certain number of hours per year (around 20 or 30 sessions per year), some private health insurance companies reimburse the first 25 sessions in an unbureaucratic and uncomplicated manner and only then request a detailed report from the therapist. Some private health insurance companies only reimburse psychotherapy sessions after they have been checked in the so-called "expert procedure" (see above). Private patients should inquire about the exact regulation within the period of the probatory sessions from their health insurance company.

Note on data protection

An important issue is data protection in connection with the strictly confidential psychotherapeutic data. Patients on assistance in particular (civil servant candidates, patients in exposed positions) are often afraid that their data will be accessible to everyone. My many years of experience is that there is no cause for concern here, in particular the confidential reports are anonymized, encrypted and the content of the reports cannot be viewed by any clerk from aid agencies or health insurance companies due to the appropriately labeled and sealed envelopes.

Agreements between therapist and patient

In the course of a planned psychotherapy, the therapist and patient will agree on some organizational matters. As a rule, an attempt will be made to find a regular, fixed weekly appointment (unless, for example, the patient's professional circumstances do not permit this regularity). The therapist will ask the patient to do so and encourage him to tell everything that is going through his head during the lesson, regardless of whether it seems unimportant, ridiculous, embarrassing or irrelevant. He will also draw the patient's attention to the (worldwide standard) cancellation fee regulation, in that the therapist will invoice the patient for a therapy hour that has not been canceled in good time (usually less than 48 hours), unless the therapist has the Hour can be given elsewhere.