Psychotherapy is a method used to treat existing mental illnesses or to prevent further episodes of a mental disorder. It can take place in an outpatient setting in a clinic or in an inpatient setting in a hospital.

Within the health care system, psychotherapy is not intended for general life counseling, self-improvement, or prevention in the absence of a diagnosed mental illness. However, if you are seeking support during stressful times or want to take preventative measures, consider options such as psychosocial counseling, coaching, paid workshops, self-help groups, professional literature, or digital resources.

• Am I experiencing physical symptoms like unexplained pains, shifts in sleeping patterns, or changes in appetite?
• Do I often face psychological challenges such as constant anxiety, mood fluctuations, feelings of irritability, or even thoughts of self-harm?
• Do I feel out of sorts or not like my usual self?
• Has this state persisted for an extended period?
• Can I pinpoint any reasons for these changes? And if so, do these reasons fully account for the extent and intensity of my symptoms?
• Am I finding daily tasks or routine activities harder than before?
• Are chats with friends no longer offering relief or perspective?
• Do I find myself falling ill frequently?
• Am I harboring thoughts of suicide?

If you answer "yes" to any of these questions, especially the last one, it's essential to consult a professional immediately. Mental health is just as vital as physical health. There's no shame in seeking help when you need it.

Mental health treatment can take various forms, depending on the severity of the illness and the individual's needs. Outpatient psychotherapy is a common approach for those who can manage their daily lives at home. In this setup, you'd attend therapy sessions at a professional's office once or multiple times a week. 

If symptoms intensify or daily functioning becomes challenging, more intensive care may be necessary. Partial inpatient treatment offers therapeutic support during the day at a (day) clinic, allowing you to return home in the evenings. In contrast, full inpatient treatment involves a complete hospital stay, ranging from several days to a few weeks.

For varying degrees of mental health challenges, there are also alternative or supplementary treatments, including:

• Medication: psychotropic drugs can be prescribed to manage and alleviate symptoms.
• Digital health applications: there's a growing range of digital health tools available at https://www.diga-verzeichnis.de designed to support mental well-being and treatment.
• Additional support: beyond the healthcare system, you can tap into resources like self-help groups, workshops, expert literature, and more to further your understanding and coping mechanisms.

Seeking psychotherapy through statutory health insurance can be an intricate process, but here's a structured breakdown to help you navigate the steps:

1. Setting up an appointment:

• No need for a referral from your primary care doctor.
• Contact the psychotherapist directly through e-mail, website contact form, or phone during their consultation hours.
• When reaching out, state your insurance type, briefly describe your concerns (keywords will suffice), and indicate if you're seeking consultation or longer-term therapy.
• Reach out to several therapists simultaneously to improve your chances of securing a consultation or therapy slot.

2. Initial consultation:

• Your health insurance card is processed.
• A minimum of 1 up to 3 consultations is allowed, either within the same practice or various ones. The health insurance covers these.
• The objective here is to discern the need for therapy, potentially diagnose the concern, explain what psychotherapy involves, stabilize the patient initially, and possibly recommend a digital health application.

3. Probationary sessions (2 to 4 sessions):

• These sessions aim to solidify the diagnosis, clarify therapy goals, and determine the compatibility between the patient and therapist.
• It's advisable to interact with multiple therapists for better perspective. However, by the end of these sessions, you should select one therapist and inform others of your decision.

4. Medical consultation:

• Schedule a session with your general practitioner or another chosen specialist.
• The aim is to confirm there's no medical reason to avoid psychotherapy and perhaps share valuable insights about your physical health with the therapist.

5. Official therapy commencement:

• After the insurance company approves the therapy request, regular sessions with the therapist begin
• A crucial aspect is the patient's active participation and transparency to make therapy successful.
• In case there's no noticeable progress, discuss with your therapist. Remember, switching therapists or therapy styles is an option, though you'd need to seek another therapy slot.
• The therapy's duration is collaboratively decided by you and your therapist. It is not necessary to use all the allotted hours.

6. Concluding the therapy:

• Typically, as therapy nears its end, sessions become less frequent.
• Emphasis is usually on preventing a recurrence of the ailment or issues, ensuring long-term mental health stability.

In Germany, the landscape of psychotherapy is diverse. Given that "psychotherapy" is not a legally protected term, several professionals might use this designation. Here's an organized breakdown based on the information provided:

Psychological psychotherapists:

•  Holders of a diploma or master's degree in psychology.
•  Have undergone 3 to 5 years of additional postgraduate psychotherapeutic training.
•  Those in training (yet to be fully licensed) can also offer psychotherapy, but they do so under supervision.

Psychiatrists:

•  They are medical doctors.
•  Have completed a 5-year residency/training in either "psychiatry and psychotherapy" or "psychosomatic medicine and psychotherapy."

Neurologists:

•  They are medical doctors.
•  They have gone through a 5-year residency in neurology after their general medical studies.

Medical psychotherapists:

•  Doctors who have undergone specialist training in any medical field.
•  They have further acquired additional psychotherapeutic training.

Professionals whose services aren't covered by health insurance:

Heilpraktiker (psychotherapy):

•  Could be psychologists with a master's degree or individuals from entirely different professions.
•  Their pathway to offer psychotherapy involves a relatively brief period of training followed by an examination conducted by health authorities.

Source: Informationen zur Psychotherapie des Studierendenwerks Frankfurt

In Germany, the cost of psychotherapy is covered by public or private health insurance if a mental illness is present. Alternatively, psychotherapy can be paid for by the patient. This makes sense if you do not want a mental health diagnosis to be passed on to your health insurance.

In rare cases, a public health insurance company will also cover the costs of treatment in a private practice (= cost reimbursement procedure) if no place can be found in a practice that bills through the public health insurance company. Information on the cost reimbursement procedure can be found here.

In Germany, there are various types of psychotherapy methods. Of these, four are currently recognized under social law, meaning they can be billed to health insurance companies and have been extensively researched scientifically:

• Analytic Psychotherapy
• Depth Psychology-Based Psychotherapy
• Behavioral Therapy
• Systemic Therapy
  
  

Each method proposes different theories for the onset of mental illnesses and has distinct treatment approaches. To ascertain the most suitable method for you, consultation with a psychotherapist is advised. A more informed decision can be reached through multiple consultations or trial sessions with various therapists. Scientific studies indicate that therapy is typically most effective in the initial sessions, with diminishing returns as it progresses. The decision for extended treatment, aiming for long-term stabilization, is determined in collaboration between the therapist and the patient.

These therapeutic approaches share a psychodynamic theory regarding the development of mental disorders, and their therapeutic procedures are comparable. However, they differ in practice and structure:

Assumptions:

• Unresolved inner and interpersonal conflicts are the main causes of mental disorders.
• Symptoms of mental disorders act as manifestations and attempts to address unconscious conflicts.
• The primary therapeutic goal is to highlight and manage these unconscious conflicts.

Analytic psychotherapy typically encompasses classical psychoanalysis; the norm is 3-4 sessions per week. Patients may be lying down, but alternatives like 2 sessions per week while sitting are also practiced. This method encourages patients to engage in uncensored speech, using dreams to tap into unconscious conflicts, and therapists maintain a predominantly neutral demeanor.

Depth psychology-based psychotherapy usually consists of one session per week while sitting. It often focuses less on early life events, placing emphasis on specific issues and conflicts.

2.  Cognitive behavioral therapy:

Assumptions:

• Thinking, experience and behavior are shaped by learning processes.
• Mental illnesses result from unfavorable (learning) experiences.
• Therapy focus: understanding and changing problematic thought and behavior patterns.
• Usually 1 session/week.
• New, complementary therapy methods: e.g. mindfulness-based, acceptance and schema therapy approaches.

3. Systemic therapy:

Assumptions:

• Relevance of the entire (family) system for the development and maintenance of a problem.
• Possibilities for solution and development by changing communication and relationship processes.
• Therapeutic focus: changing existing patterns in the system, activating resources.
• 1 session/week or appointments over several weeks
• Multi-person setting possible.

If you're considering obtaining occupational disability, life insurance, or transitioning to private health insurance, it's essential to be aware that psychotherapy processed through the health insurance system can sometimes be a basis for declining or excluding such insurance policies. Typically, when securing insurance, any psychotherapeutic treatment funded by health insurance undertaken within the last 5-10 years must be disclosed.

Many students contemplating a career in civil service often hesitate to pursue necessary psychotherapy, fearing potential implications on their job prospects. While psychotherapy backed by health insurance could be a reason for the denial of tenure, it's not always the case. Multiple court decisions suggest that a mental health condition or a previously concluded successful psychotherapy isn't an automatic disqualification from civil service. If you're apprehensive about this, it's advisable to discuss your concerns with a psychotherapist or your counselor during a consultation.

For those inclined towards caution, you can choose to self-fund your psychotherapy sessions, ensuring no diagnostic data is passed onto your health insurance company. However, even if you privately fund your treatment, legally, you're still required to disclose any past psychotherapy when questioned by insurers or civil service bodies.

It's also worth noting that psychotherapy, like many treatments, can occasionally have undesired outcomes or side effects. These may include:

• A temporary exacerbation or broadening of symptoms.
• Therapy-induced shifts in social dynamics; for instance, if an individual learns to set boundaries by saying "no," this might not always be well-received by everyone they know.
• Potential emotional reliance on the therapist.

If, during therapy, you observe any worsening or alteration in your symptoms, it's crucial to discuss this with your therapist. Should you have an unfavorable experience with a psychotherapist, don't hesitate to reach out to the complaints office of the psychotherapists' or medical association in your region.

Each therapy method can be conducted in either an individual or group setting. 

In individual therapy, the patient interacts solely with the therapist. Group therapy, on the other hand, involves treating 3-9 patients together. The most appropriate setting often depends on the nature of the condition. Therefore, a consultation is the ideal way to understand which format suits your needs best.

Group psychotherapy encompasses various content approaches. Some groups may have a specific focus, while others operate on an open concept. There are instances where patients with similar symptoms are grouped together, but there are also scenarios where patients with diverse symptoms share the same group. Typically, treatment sessions span 50 or 100 minutes each week. The session quota corresponds to the time quota as in the case of individual therapy using the same method.

Advantages and disadvantages of group psychotherapy include:

Disadvantages:

• Individual less in focus
• Some content may be less pertinent to a person's unique concerns

Advantages:

• Social support
• Sense of belonging/normality
• Mutual learning, etc.

For individual psychotherapy, the advantages and disadvantages are as follows:

Disadvantages:

• Feedback from only one person, specifically the therapist
• Lack of social exchange
• Observation of social interactions is not possible

Advantages:

• May be easier for some individuals to open up
• More attention paid to individual concerns

To benefit from the advantages and disadvantages of both settings, it is also possible to combine individual and group sessions in the same therapy setting. This can be done with the same therapist or with two different therapists.

• For an earliest possible consultation appointment with a therapist (only for statutory health insurance): Terminservicestelle, available online at: 
   https://www.eterminservice.de/terminservice or by phone at: 116 117

• For therapist search through the Association of Statutory Health Insurance Physicians (for those with statutory health insurance or private payers): https://www.kvhessen.de/aerzte-psychotherapeuten-finden/ 
• https://www.therapie.de  (Note: Use the filter criteria to select billing via statutory health insurance (GKV), private health insurance, or other options)
• Psychotherapy Information Service PID: https://www.psychotherapiesuche.de /pid/search
• If necessary, you can also ask your health insurance company for contact details for psychotherapy

In Frankfurt and the surrounding area, there are also several large outpatient clinics for psychotherapists in advanced training, which often have larger staffs:

• Zentrum für Psychotherapie der Goethe-Universität, Varentrappstraße Frankfurt:https://www.psychologie.uni-frankfurt.de/60529300/Zentrum_f%C3%BCr_Psychotherapie
• GAP GmbH, Beethovenstraße Frankfurt: https://www.gap-ffm.de/ 
• FIVE AMB, Reuterweg Frankfurt: https://five-psychotherapie-frankfurt.de/ 
• Sigmund-Freud-Institut Frankfurt: https://www.sigmund-freud-institut.de/index.php/ambulanz/ 
• FPI Frankfurt: https://fpi.de/informationen-fuer-Patienten/ambulanz 
• DPG Frankfurt: https://www.dpg-frankfurt.de/ambulanz.html 
• HAIP, Hanau: https://www.haip-ausbildung.de/psychotherapeutische-behandlungen.html  
• IKVT, Wiesbaden: http://www.ikvt.de/ambulanz.htm 
• AWKV, Friedberg: https://www.awkv.de/therapie/Patienten/