Psychotherapy: What it is, how it works, and when it can help with mental health conditions

Psychotherapy is a term we often hear, but what exactly does it involve, and when can it provide valuable support for a mental health condition? This article explains the basics of psychotherapy, its aims and areas of application, and provides an overview of common therapeutic approaches – including in the context of medical or cosmetic procedures and the associated support provided by a psychotherapist working in a practice.

What is psychotherapy?

Psychotherapy is the targeted, professional treatment of mental disorders, emotional problems and states of distress – often diagnosed as clinical disorders – using scientifically recognised psychological techniques and methods.

At its core, the process usually centres on the conversation between the therapist (one of the psychotherapists) and the patient (or a group, in the case of group psychotherapy). The aim is to alleviate or heal psychological distress, to recognise and change destructive patterns of thought and behaviour, and to promote the client’s personal development, self-understanding and mental health. A trusting therapeutic relationship is a key factor in the success of the subsequent psychotherapy.

Aims of psychotherapy

• Alleviation or elimination of symptoms (e.g. anxiety, depressive moods, compulsions) – often referred to as symptom reduction
• Changing problematic patterns of behaviour and thinking
• Improving problem-solving and conflict-resolution skills, even in the midst of an acute crisis
• Boosting self-esteem and self-confidence
• Processing and coming to terms with distressing life events or trauma (e.g. through specific interventions such as EMDR)
• Improving interpersonal skills and social skills
• Promoting self-awareness and personal growth
• Improving overall quality of life and well-being

When is psychotherapy advisable?

Psychotherapy can be helpful for a wide range of mental health issues and disorders. These include, amongst others:

• Depression and burnout syndrome
• Anxiety disorders (e.g. panic attacks, phobias, social anxiety)
• Obsessive-compulsive disorders
• Eating disorders (e.g. anorexia, bulimia, binge eating)
• Post-traumatic stress disorder (PTSD)
• Adjustment disorders following stressful life events
• Personality disorders
• Addiction and dependency disorders (often treated alongside medically supervised treatment)
• Sleep disorders
• Psychosomatic symptoms (physical symptoms with a psychological cause)

Psychotherapy in the context of medical and cosmetic procedures

Psychotherapy can also play an important role in connection with physical illnesses or medical treatments, including cosmetic procedures. Possible reasons for seeking psychotherapy include:

• Coping with a serious diagnosis
• Coping with chronic pain
• Dealing with post-operative complications or issues that trigger a crisis
• Anxiety before or after a procedure
• Dissatisfaction with the outcome of a course of treatment
• Adapting to physical changes
• The presence of body dysmorphic disorder (BDD), characterised by an excessive preoccupation with perceived flaws in one’s own body

Particularly when a medical or cosmetic procedure causes or exacerbates psychological distress, psychotherapeutic support can help to manage this and restore a sense of well-being. Sometimes, acute treatment is necessary.

What types of psychotherapy are there?

There are various recognised psychotherapy methods. Among the most important guideline-based methods approved for use in outpatient psychotherapy in Germany, and recognised by the Joint Federal Committee (G-BA), are:

• Behavioural therapy (BT): It is based on the assumption that problematic behaviour and experiences are learned and can therefore be unlearned or replaced by new, more helpful patterns. It is very action-oriented and focuses on the here and now. Behavioural therapy methods are diverse.
• Psychotherapy based on depth psychology: It is based on psychoanalytic theories (psychoanalytically grounded approaches), but focuses more strongly on current conflicts and their unconscious roots in a person’s life history. This also includes psychodynamic psychotherapy.
• Analytical psychotherapy (psychoanalysis): Aims to address unconscious conflicts and aspects of the personality in a comprehensive manner, often as part of a longer-term process known as long-term therapy.
• Systemic therapy: It does not view a person’s problems in isolation, but rather within the context of their social relationships (e.g. family, relationship). This form of psychotherapy is often used to address family problems.

The choice of approach – whether short-term or long-term therapy – depends on the nature of the condition, the objectives and the patient’s preferences. Psychotherapeutic approaches and methods are defined in more detail in the Psychotherapists Act.

Who carries out psychotherapy?

In Germany, psychotherapy, in the medical sense, may only be practised by licensed therapists. The profession of psychotherapist requires comprehensive training, often beginning with a bachelor’s degree followed by a master’s degree in psychology:

• Psychological psychotherapists: They have completed a degree in psychology, followed by several years’ training in psychotherapy, and have obtained their licence to practise. They work in their own practice or as employees.
• Medical psychotherapists: These are doctors who have completed relevant further training in psychotherapy (e.g. specialists in psychiatry and psychotherapy or specialists in psychosomatic medicine and psychotherapy). They can also offer medically supervised treatment involving medication.
• Child and adolescent psychotherapists: Specialising in the treatment of children and young people up to the age of 21.

Psychotherapists and other therapists registered with health insurance funds can bill statutory health insurance providers directly. Alternative practitioners specialising in psychotherapy have a restricted licence to practise.

The process of outpatient psychotherapy

The first step towards outpatient psychotherapy usually involves contacting a psychotherapy practice and attending an initial consultation. This is followed by trial sessions (up to four for adults, also known as acute treatment or trial sessions), during which the psychotherapist assesses whether a condition requiring treatment is present, which therapeutic approach is suitable, and whether there is a good rapport between the therapist and the patient. These trial sessions also help to determine whether individual therapy or group psychotherapy is the most appropriate option.

If both parties agree to work together, an application is submitted to the health insurance provider (using a form) to request that the costs of the psychotherapeutic treatment be covered. Sometimes a referral report from the GP or a report for the assessor is required. The therapy itself, often one-to-one sessions, then takes place regularly (usually weekly), with each session generally lasting 50 minutes. The number of therapy sessions available (for both short-term and long-term therapy) is approved by the health insurance provider. The aim is to ensure that basic care is provided.

The benefits and effectiveness of psychotherapy

The effectiveness of psychotherapy is well established by scientific evidence for many conditions. Psychotherapeutic treatment can make a significant contribution to alleviating psychological distress, improving quality of life and restoring the ability to work and form relationships. Being open about one’s own problems and a willingness to change during psychotherapy sessions are important prerequisites for the success of the therapy. Seeking professional help from psychotherapists is a sign of strength and self-care.

Frequently Asked Questions (FAQ) about outpatient and inpatient psychotherapy