If the therapist cannot do it himself, the patient needs adequate replacement
Successful psychotherapy is largely based on the relationship of trust that patients build with their therapist. However, the familiar psychiatrists and psychologists may not be available due to illness, for example. Then the patients have to look for an adequate replacement. Experts from the Independent Patient Advice Service Germany (UPD) and the Federal Chamber of Psychotherapists explain in a current press release from the news agency "dpa" which points should be considered.
In the regular sessions, patients and doctors build a relationship of trust that cannot be easily replaced by other psychiatrists or psychologists if the therapist fails. If the therapist becomes ill for a longer period of time or is no longer available for other reasons (e.g. when the patient moves or the psychotherapist takes parental leave), this may pose a risk to the success of the therapy. Because "psychotherapy is always personal and cannot simply be taken over by another therapist, as would be possible with other doctors and treatments," explained Claudia Schlund from the UPD.
Change of therapist possible at any time Basically, according to the scientific adviser at the Federal Chamber of Psychotherapists, Timo Harfst, "patients have the opportunity to change therapists at any time, for example, if there is no prospect of success, you cannot get along, but also if there is one a longer interruption is to be expected, which could jeopardize the success of the therapy. ”In general, patients with mental health problems can either be referred by their family doctor to a specialist or they can go straight to a psychotherapist. According to the "dpa", three forms (psychotherapy based on depth psychology, behavioral therapy, analytical psychotherapy) can currently be billed to the health insurance companies. Before the actual start of treatment, patients are entitled to so-called probationary sessions to determine whether the person concerned can get along with the therapist and whether there is any need for therapy. If the patient decides on the therapist and there is a need for treatment, a corresponding application is submitted to the health insurance company, with the approval of which the therapy finally begins.
Therapists can appoint representatives for emergencies. However, there is no guarantee that therapists will actually be available until the end of treatment. “If the therapist fails, for example because of illness, he is,” according to Claudia Schlund, “obliged to report this to the health insurer and should also inform the patient in the sense of the treatment contract.” The therapists are by no means responsible for this to provide for replacement, but according to the UPD expert, they can appoint a representative if necessary, which enables the therapist to change in the meantime without having to apply to the health insurance company. In principle, however, there is no representation for psychotherapists - as is usual with other doctors. The appointment of a representative is only possible in exceptional cases such as "in the case of a long, serious illness or in the case of bereavement in the family". However, the patients are in no way obliged to accept the substitute offer.
No claim to a quick transfer If the patients decide to change therapists, according to the experts, there is no claim to a quick transfer. Because "psychotherapists are not obliged to prefer or take over someone who has otherwise started therapy," said the speaker of the Federal Chamber of Psychotherapists, Timo Harfst. Of course, however, the therapists would examine and weigh “the urgency and suffering of the patient”. Indeed, patients with similar symptoms may experience extremely different levels of suffering, as they react very differently to the termination of an actually successful therapy. Because psychotherapy "is (is) a safe place for most people to open", a sudden drop out could lead to considerable reactions from the patient. If, for example, the therapy is completed in order to overcome previous loss experiences and frequent breaks in relationships, the sudden loss of the therapist is often difficult to cope with for those affected and rapid further treatment is required.
Change of therapist always a case-by-case decision However, longer interruptions in therapy do not necessarily have an adverse effect on treatment, according to UPD expert Claudia Schlund. "You cannot say in general that a long interruption is bad, I have to consider: Is a very big step backwards to be expected with damage to health? Or is it a point where a break is possible? ”Explained Schlund. It is therefore always a case-by-case decision. In general, there is no limit for the period in which the hourly quota of therapy must be used up. Longer interruptions should, however, be justified in any case, "and after six months, a new application to the health insurance fund is usually necessary if the patient and therapist want to continue."
Extension of therapy possible If the patient decides to switch therapists, they are not only entitled to renewed trial sessions and the remaining contingent of sessions that have not been completed, but may also request an additional extension of the therapy period, explained Timo Harfst. The initially defined limitation of therapy hours is not the very highest upper limit. "It may take additional hours to make a new therapy contact," continues Harfst.
Assumption of costs linked to the form of therapy While the therapist can be changed at any time, according to the experts, the form of therapy can no longer be changed easily after the start of treatment. “If a form of psychotherapy has been approved, the health insurance company's commitment is also linked to the form of therapy,” emphasized Claudia Schlund. If you cannot find a suitable therapist for the approved treatment in your immediate vicinity, you can also "look around in the private market", but you should always discuss this with your health insurance provider and provide evidence to ensure that costs are covered in individual cases.
Report interruptions in therapy to the health insurance company anyway, patients should contact their health insurance companies immediately if there is an interruption or even termination of therapy, reports the news agency "dpa", referring to Michaela Hombrecher from Techniker Krankenkasse (TK) in Hamburg. Hombrecher emphasized that in such a case, she would also “be documented by the psychotherapist, provided he is still able to explain why the change must take place.” Depending on how severely the patient suffers from the loss of the familiar therapist , individual solutions are required. "If no new therapist is found, we may be able to assist with the search," continues Hombrecher. Sometimes a temporary stay in a crisis pension or day clinic is necessary.
Health insurance companies support patients in switching therapists There is nothing preventing the transfer of the open hours to another therapist as long as the form of therapy is maintained and the qualification of the future therapist is given, explained Hombrecher. “If the maximum number of therapy hours has not yet been exhausted,” the expert says, “an extension of the therapy can also be requested.” The health insurance companies are extremely keen to ensure that the affected patients can make the transition as smoothly as possible. However, it is not guaranteed in all cases that a previously successful therapy can be continued with the same efficiency if the therapist ceases to exist. (fp)