Psychotherapy, what it is and how to get it

Family, Education, Health and Pets
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If you are in urgent need, please see these threads with contact info for emergency services : https://www.englishforum.ch/family-m...s-general.html crisis centres : https://www.englishforum.ch/2579087-post16.html

For an excellent EF thread, with loads of empathy, kindness, encouragement and good advice by many different users with a wide range of experience , please see this thread: https://www.englishforum.ch/family-m...epression.html At the time Olygirl rightly hoped would become a "go to" thread for people seeking help with their mental health.

Although that thread is primarily about depression, it can stand, by analogy, for any kind of stress or psychological/mental illness. About this, see also Suzie-Q's post: https://www.englishforum.ch/3119005-post20.html

This thread sets out my understanding of what psychotherapy is - or can be.

I describe the qualifications of a medical doctor, and that some go on to specialise as psychiatrists. a psychologist and set out that some (but by no means all) of each of those go on to train to become psychotherapists and to provide psychotherapy, of which there are many different schools.

I write about the role of the GP (general practitioner, in German Hausarzt) and how to find psychotherapy.

I hope that other posters will be along to expand (or correct, please, if need be) what I've written here, whether as professionals in these fields, or as patients or relatives.

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Qualifications

Psychiatrist

To become a medical doctor, one studies medicine at university, and in senior years does a range of practical training blocks in several hospitals. There is a set of major final exams at the end, which qualify one to be called a doctor (in German, Arzt).

Some doctors stop at that level (which takes 6 years to achieve) and work in hospitals, drop-in clinics (for example, at a railway station, for non-life-threating emergencies) or in the kind of doctor's practice which is staffed by a range of doctors. There, they work as general practitioners (called GP, and in German, Hausarzt).

Others go on to do a specialisation. They do this with yet more blocks of training, but then specifically in their field. They participate in workshops and have guidance by senior doctors in that area. They also write a doctoral thesis for which they must have done independent research, and must successfully defend that thesis (put the case, withstand contrary opinions, explain their arguments against the criticism) to a panel of internal and/or external examiners.

There is even a specialisation to become a GP, i.e. in more detail, on a higher level. Other specialisations include all the medical ones like cardiologist and gynaecologist, etc., and one of these is a psychiatrist.

Psychologist

To become a psychologist, one studies at university, a degree in humanities or in social sciences, or science, with the subject Psychology as one's major. This is first a Bachelor's degree, and thereafter a Masters.

Some continue to do a Doctorate, in which they, too, write a doctoral thesis for which they must have done independent research, and must successfully defend that thesis, etc. (as set out above, for the medical doctors).

Depending on the branch of psychology, one can do more or less of certain kinds of practial training, with supervision. Industrial psychology (about persuasion and mediation in business settings, and advertising) will need a different kind of training than clinical psychology (listening to people talk).

A psychologist is not a medical doctor. This is relevant in these ways: without the medical training, a psychologist may inadvertently overlook a physical ailment from which the patient is suffering, and that influences the patient's psychological state a psychologist has no authority to prescribe medication, at all psychologists typically earn significantly less than psychiatrists the Swiss medical insurance generally pays only a reduced proportion of the fees of a psycholgist, or only for a certain limited number of appointments per year. (This can be circumvented if a psychologist works under the authority of a psychiatrist... this is called "delegiert" in German.)

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Services Provided

Here begins the difference, but also the huge overlap. These are things that a psychiatrist can do, that a psychologist cannot: prescribe medication write doctor's certificates write doctor's reports, e.g. for other doctors, or for medical insurers. confidently send bills to the medical insurance, which will be covered enable a psychologist to work under their authority, "delegiert" (see previous post).

People from both professions can do other work besides providing psychotherapy. This post is specifically about psychotherapy .

Psychotherapist

If they do provide psychotherapy, then both psychiatrist and psychologists are very likely, sooner or later, to attend some of the exact same courses. The borders are blurred, and a good psychotherapist can be either a psychologist or a psychiatrist , it matters not (except for the reasonse above).

The differences will lie not in their being a medical doctor, or not, but primarily in their wide range of training, attitude, style, belief, etc..

To qualify as a psychotherapist , they ought to have gone through their own therapy. This means that they will have spend quite some time (at least months, possibly years) during their training in the role of the patient of a senior psychotherapist (who may be a psychistrist or a psychologist).

The purpose (or hope) is that, ideally, by the time a psychotherapist begins treating other patients, they will have dealt with, or at least identified, their own problems, their insecurities, their fears, and so on. This doesn't mean that the psychotherapist is perfect, but it should mean that they have learnt to know themselves, so that they have fixed some of their own pain and some of their own hang-ups, and know their own issues well enough to be able to keep them in check, so that the psychotherapist's own inner difficulties don't get in the way of a patient's therapy.

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Types of Psychotherapy

Here, too, there is a wide range, depending on the school of thought in which the therapist trained, by other courses that influenced them, by their personal experiences, etc.

Naturally, what I write here is just a brief outline of a few types or schools. I hope that others who know more, whether as therapists or as patients (sometimes called clients), will expand on this.

One path is psychoanalysis . This is a way of allowing the patient to talk freely about anything, and through association of ideas, to journey, bit by bit, deeper into the psyche, uncovering deep patterns formed in one's very early years, to understand how those formative experiences may have influenced one, and to look at one's urges and longings, to see how they are guiding one's actions.

The path that is more or less at the opposite edge of psychotherapy is cognitive behavioral therapy (CBT). On this path, instead of going back to analyse what caused the issues, the therapy focuses on the here and now, to help the patient to develop strategies to feel better. The idea here is to identify and then un-learn behaviours that don't help, and instead to learn new ways of thinking about an issue, to be aware of one's feelings, and the tension, and to learn methods to apply, right away, to breathe more freely and to get one's thinking out of a rut, and into a better place, which will lead one's emotions to a place of better balance, too.

Swisspea has written about the science of CBT, here: https://www.englishforum.ch/3249906-post50.html

Another path of psychotherapy is process oriented psychology (POP). It aims to uncover the patterns that keep recurring in the present, and to find out what it would take to learn better ways of interacting, to be happier. Some of this may be deep issues from the past, some may be learned behaviours, and some may be inadequacy and lack of knowledge about how one is influenced by others or influences them. The idea is to find new tools to empower one to pause when one gets that feeling of "oh, no, here we go again", and then to see if one can change direction to feel calmer and also to shift the direction for the others, away from antagonism towards empowered cooperation.

Yet another psychotherapeutic approach is systemic therapy . This model seeks to include all the elements of a patient's life into the psychotherapeutic process. This could include home life, family members in and out of one's onw home, the dog, the garden, friends, neighbours, training for the marathon, the dynamic in the club, etc. The aim is to identify the voices that tend to push one back into an old role, or to find out whether one has left too much power with a specific person or in a constellation of people or situations. Systemic therapy can also help to identify patterns in the way the client relates to others in different contexts, and what needs to change, to obtain more space, or more intimacy, or more collaboration, or greater self-realiance, in order to develop fully and freely.

There are other schools, too.

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Approaches to Providing Psychotherapy

Some psychotherapists specialise in a particular field of suffering , such as palliative care of cancer patients, or short-term group therapy for young people, or trauma therapy, or phobias, etc. Within this, they may use any of the official methods.

Some psychotherapists are purists , and remain true to the principles of the particular type of psychotherapy that they learnt, for all of their working years. In doing so, they generally become better and better at using that method, as experts bringing a wealth of experience in exactly that direction.

Some psychotherapists are eclectic , and deliberately attend courses of all sorts, so that they can open themselves to having the tenets of what they've learned thus far challenged. This is partly so that they themselves can stretch and grow, but also so that they can better understand a patient who might arrive having had psychotherapy of another kind. Those who work eclectically hope to be able to spontaneously apply aspects of one, later of another school of though, depending on whichever may be helpful in a particular psychotherapeutic relationship.

Duration

Some psychotherapy is brief, perhaps just 2 or 3 sessions, especially when the patient knows clearly what the issue is, and just wants to clear the air and ask for quick advice. Psychoanalysis can go on for years, as the patient investigates and owns their inner depths. Many others psychotherapies are somewhere in between, usually for several months at least, because it takes that time to build up a good working relationship.

Setting

Psychotherapy can be in-patient (you stay in the clinic for some days or weeks) or out-patient. I have written about this, in terms of doctor's certificates, here: https://www.englishforum.ch/3119671-post26.html

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How to Get Psychotherapy

Typically, start by going to see your doctor . By this, I mean your general practitioner (GP, in German Hausarzt). This is the usual first place to go, when in need of any kind of medical and/or psychological help.

The GP is the starting point and the coordinating hub. The GP's job is to listen as the patient sets out their symptoms and the outline of their worries, and then to decide, together with the patient, whether the person needs physical tests, or psychological support for a short while, or something urgent, or something that lasts longer. Sometimes, a good conversation with a GP, perhaps several over a few visits, can be very therapeutic, especially if the patient already has built up a relationship of trust with the doctor, or else if the doctor is wise from rich life experience, and/or particularly perspicacious. And those conversations may very well suffice to help the patient find their own way again. As far as I know, there is even an official billing/tariff point for a GP to bill for psychotherapy.

If the matter is urgent and the patient seems to be desperate, or clearly going to be long-term, the GP may arrange for a place in a clinic.

If more therapy is needed, but a clinic unnecessary, and if the GP's practice doesn't feel like the right place for the conversation, the GP will recommend that the patient goes to someone else. Ideally, the GP will know a suitable psychiatrist or a psychologist to whom to refer the patient.

This may be a psychiatrist , if the GP thinks that it is imperative that someone makes a proper diagnosis, and if the GP thinks that medication may be necessary, or simply because of the convenience and security of knowing that the medical insurance will certainly cover those consultations . Or it may be a psychologist . As long as the person is qualified as and working as a psychotherapist , it does not really matter whether their original qualification was that of a psychiatrist or a psychologist. That specialist may recommend a colleague who is better suited to the patient or to the material, either straight away, or after having seen the patient once.

If the GP does not know to whom to refer the patient (and yes, that happens), the GP will encourage the patient to search, themselves, but will write a letter of referral for the psychotherapist, or correspond with the medical insurance.

Some patients have to do the search themselves, and some prefer to. Some need the backing of their GP, and some of their medical insurance, and some intend to foot the bill themselves. It's a good idea to collect recommendations from friends, or from fora, or to wade through therapist's websites, or search on

https://www.therapievermittlung.ch/t...utinnen-suche/

https://psychotherapie.ch/wsp/de/mit...zelmitglieder/

and contact the psychotherapist directly.

Here is another link, from the FMH, which is the Swiss equivalent to a Medical and Dental Professional Board. You can search by discipline. This is for doctors (and hence, in this context, for psychiatrists) and not for psychologists.

https://www.doctorfmh.ch/en/list-results

I hope others will add useful links.

In any case, it is important to find a good fit. Different criteria are important to different people. The patient should feel comfortable with the language, gender, location of the practice and transport logistics, physical space in the practice, voice and intent of the psychotherapist, etc. It usually takes one, two or at the most three sessions for the patient and the therapist to decide whether or not they wish to continue together.

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Here's a phone service, for brief questions, offered by a psychologist.

https://gz-zh.ch/

Scroll down to PSYCAFÉ PER TELEFON

It looks like this is, in non Covid times, a drop-in café, and at present it's a phoneline. Dates and times are on a drop-down menu.

Rough translation: Psychologist Şirin Yoker offers her help in German, English or Turkish. She takes time to answer your questions about psychotherapy and life counseling, such as: Could psychotherapy be helpful with my problem? An acquaintance has a psychological problem, where can he get support? What types of psychotherapy are there? What can psychotherapy do, what can't it do? How and where can I find a suitable therapist? Is the therapy paid for by the health insurance? You can come by without obligation and ask questions. If necessary, helpful addresses will be given.

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Costs of psychotherapy

As a general rule, the bills of a psychiatrist are covered by the regular medical insurance (because they are medical doctors) psychologist are sometimes covered, or covered for a limited number of appointments per annum, or covered at a lower % of the costs (e.g. 75%). This varies across medical insurance companies, and possibly also according to any top-up modules in the insurance bundle that was bought.

In all cases, just like with any other medical service, the patient will first have to fulfil their self-pay amount (called " Franchise "). The amount of this variable, depending on the level chosen when taking out the insurance. The lowest possible franchise is Fr. 300 per annum, and that attracts a higher monthly premium. If one chooses a higher franchise, the premiums will be lower. Each person has to estimate how much risk they can reasonably carry, themselves. pay 10% of the psychiatrist's bill and at least 10%, possibly up to about 30% of a psychologist's bill, at least up until a certain limit per annum.

Some psychologists work together with a psychiatrist, by whom their work is - very lightly - supervised. This is called " delegated " (in German: delegierte) psychotherapy and the doctor does the billing. In this way, one can see a psychologist, and still get prescriptions for medication from the psychiatrist. In such cases, the costs are more likely to be borne by the medical insurance, although, at last, this is slowly changing, so that psychologists can make direct arrangements with the insurance companies.

Some medical professionals bill directly to the insurance company , which then asks for any self-pay portion, from the client. Others send their bills to the client , who must pay the bill and ask the medical insurance company to reimburse them the amount (less self-pay).

Because the insurance cover is not all standardised, before starting therapy , one should always check the following: ask the therapist whether they are recognised by the medical insurance double-check that info with the medical insurance, ask the medical insurance what % one will have pay, oneself, and ask the therapist for their rates, so as to decide whether, if the medical insurance refuses cover or agrees to cover only part, one is able and willing to cover the remaining cost out of one's own pocket.

Sometimes, it takes a letter of motivation before the costs to be covered. This will depend upon the patient's medical insurance cover. Such a letter might be written by the GP, or a referring doctor, or by the therapist themselves. It's always worth trying.

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Admission to a psychiatric clinic

Acute crisis - how to be admitted to a clinic

In a crisis, patients can be admitted rapidly, usually within a few hours or at most a few days. Ideally, the psychiatrist will organise the admission. However, even without a doctor, there are other ways to start the process:

at a Crisis Centre (called Krisenzentrum or Krieseninterventionszentrum, in German). This is a short-term mini clinic, with a low threshold for admission, and some even take in patients without a doctor's referral. There, they will help the patient find a place in a clinic.

at a general hospital. Although one might have to wait to be seen, at first, they are likely to help to find a bed in a clinic.

directly at a clinic, as some accept acute admission.

Open, semi-locked or locked wards

Most wards are open . The door is not locked, and patients can walk in and out freely... although they must report their leaving, and when they'll be back, to the nurse before they go.

In acute cases sometimes the wards are semi-locked . While the door may be locked, but it is opened freely by the staff, as long as the patient has a reason to go out, and the conditions for their safety and return have been discussed.

A patient can be in a locked ward voluntarily , because they themselves know that they (or the world around them) would be safer if they're there. involunatarily , because a doctor admitted them, against their will.

Involuntary admission and locked wards

In Switzerland, there are only two reasons that a patient can be kept in a locked ward, against their will : if they are seriously, acutely suicidal if they pose a serious threat to the safety of others. Even then, the patient has a right to apply for this status to be reviewed and possibly lifted, and that review must, by law, be done within a few days.

Voluntary admission

Almost all psychiatric hospitalisation in Switzerland, nowadays, is voluntary. This means that the patients themselves decide whether or not they wish to enter a clinic. In such arrangements, the patients are always free to discharge themselves and leave the clinic completely.

Planning admission in advance

If there is no acute crisis, the patient themselves, perhaps with help from someone else, (such as their doctor or psychotherapist, or a family member or friend) makes the arrangements for the admission. Usually, they will need a letter of referral from a psychiatrist or another kind of doctor.

How to choose a clinic

A patient can choose to have a look at several clinics, at least online, to work out what would be best. The psychotherapist may have specific recommendations, and may have a working relationship with some of the clinics.

Some medical insurance policies restrict patients to hospitals (and a clinic is classified as a hospital, too) in the canton of residence. It is worth checking this with the medical insurance, before making enquiries at clinics. Others allow all cantons. Some make exceptions if a particular clinic, in another canton, has the right programme for a patient's needs.

Depending on one's level of insurance and on the space in a clinic, patients sometimes stay in single rooms or shared rooms, with one or two other patients. These rooms look more like hotel rooms than medical hospital wards.

If there is no rush, it's quite usual to view the clinic. There, one meets with a nurse or a therapist, to hear about their concept and timetable, and to ask questions. One may be taken on a small tour of the buildings and grounds, to see what they have on offer. The task, then, for the patient and the clinic staff, will be to decide whether they feel this could be a helpful setting for the patient to do the serious work of facing their psychological issues.

Timing

If the admission is acute, it can usually be achieved, as described above, immediately or within a day or two.

If the admission is planned, the enquiries can take a few days, and once the decision has been taken for a specific clinic, a patient may then have to wait for a few days or even a few weeks, until a bed becomes available. Sometimes, the possible waiting time becomes the deciding criterion when choosing between clinics.

The stay may last a few days or a few weeks, more rarely a few months. The medical insurance must approve, in advance, and typically issue a guarantee (in German this is called a Kostengutsprache) for a week or a few weeks, and then, depending on the progress, this can be renewed for a further period.

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Waiting times

In general, in Switzerland, and most especially in an emergency , it is possible to obtain psychotherapeutic help - or at least to make a start - within hours or days.

Some factors, however, can cause waiting times. Your insurance model Some insurance models allow you free choice of doctors. If, however, you have bought narrow cover that limits you to treatment within your canton of residence, or that requires you to first consult with either your GP (Hausarzt, médecin de famille, family doctor) or with an phone/online doctor at your medical insurance company (Krankenkasse, caisse maladie) before you get any medical help, then having to go through those steps can take a little more time. This may be longer if, then, your GP is then permitted (according to your cover) to refer you to only a certain limited list of psychotherapists. Where you live, and how far you're prepared to travel Depending upon the area in which you live, especially if in a rural area, you may have to wait for some weeks until you can see a psychotherapist. See also, above, about perhaps being bound to your own canton. If you are willing - and able - to travel into one of the larger cities, you will be able to reduce your waiting time. If you've chosen one, specific therapist That therapist will, after all, probably already have a full diary, and will need to wait, themselves, until there's a gap when a patient completes therapy or leaves. Even if your insurance model is narrow, in real emergencies , you do not have to wait through all those steps. You can go directly to a hospital or, better still, a crisis intervention centre (see opening post) or call the emergency doctors' service (for example SOS-Ärzte https://www.sos-aerzte.ch/ ), or 143 (the Helping Hand, a general hotline in times of any kind of distress, and who will then guide you whom to call). Afterwards, you can inform your medical insurance that you did so because of an acute psychological crisis . It stands to reason that the first intake person who sees you during the emergency is likely to then refer you to someone else for any ongoing psychotherapy.