What are the causes of a specific failure

Psychiatry, Psychosomatics & Psychotherapy

Explanation of terms: psychotherapy - when is psychotherapy helpful?

Psychotherapy plays an extremely important role in the treatment of mental or psychosomatic illnesses. It is a conscious, planned process between patients and psychotherapists in order to alleviate or heal psychological suffering, to cope with emotional and interpersonal conflicts and to influence behavioral disorders. Psychotherapy works with psychological means that have their starting point in experience and behavior; the focus is on verbal and non-verbal communication. The goal of most psychotherapeutic procedures with communicative and / or practicing techniques is to show the patient strategies for coping with problems, to teach him how to act and to build his self-confidence. To put it simply, the basic principle is treating the patient through discussions or exercises. The methods are diverse, including individual and group therapeutic measures.

Psychotherapy has changed a lot in recent years. Modern psychotherapeutic procedures - in contrast to the school-oriented psychotherapy used earlier (such as classical psychoanalysis) - specifically address the needs of the patient and their specific symptoms. This means that many forms of psychotherapy are nowadays tailored to the respective symptoms; this is referred to as disorder-specific or disorder-oriented. Accordingly, there are a variety of psychotherapeutic methods with different approaches that can be designed individually.
For example, the following illnesses and states of suffering can be treated psychotherapeutically:

* always in combination with medical treatment

The variety of diseases and disorders makes it clear why there must be different forms of therapy that precisely meet the requirements of the respective symptoms. This is the only way to meet the individual needs of patients and improve the care system for mentally ill people.

Many forms of psychotherapy can be used as individual therapy (only you and the therapist), as a couple (with you, your partner and the therapist) or family therapy (with you, selected family members and the therapist) as well as in a group (with you, other people with similar Problems and the therapist) take place.

In view of the variety of different procedures and methods, it is of great importance to carry out scientific studies to check the effectiveness of psychotherapy. The Scientific Advisory Board for Psychotherapy of the German Medical Association has the task of reviewing the findings of psychotherapy research and preparing reports on the scientific recognition of the procedures.

When is psychotherapy helpful?

There are numerous reasons to consider psychotherapy: from seemingly insurmountable strokes of fate to severe mental disorders. Therapeutic help becomes particularly important when one is no longer able to cope with the problem within a social network and to keep up with everyday life. This is especially true if the problems or complaints have existed for a long time or are getting worse. The question of whether and when psychotherapy is ultimately indicated should be clarified together with a psychiatrist and psychotherapist as well as with the family doctor.

Sometimes mental illnesses are not easy to recognize for those affected or their relatives. Professional advice should be sought, for example,

  • if you notice mental changes in yourself for which there is no sufficient explanation, if you feel different than usual, if you have the feeling that you cannot recognize yourself again,
  • if you suffer from concentration disorders, notice disturbances in the usual flow of thoughts or have increasing difficulties coping with your studies, your job or everyday life,
  • if you withdraw from other people and develop an increased distrust of them,
  • if mood swings, aggression and irritability persist over a longer period of time,
  • when the personal circumstances, problems and worries or a general bad feeling seem so overwhelming and your own coping options are so limited and you have the feeling that you can no longer manage your life's tasks on your own,
  • when fears and worries determine life, anxiety occurs in some life situations, one restricts activities because of this or only exercises them with great effort and with great fears,
  • if you suffer from sleep disorders or physical complaints for a long time for which no organic cause can be found.
  • if you drink a lot of alcohol for a long time and cannot do without alcohol, even if this leads to professional or private problems and makes it difficult to cope with everyday life.

Don't hesitate to get professional help

Some people shy away from seeking professional help with mental health problems. For many people, the step to a doctor for psychiatry and psychotherapy or to a psychotherapist is associated with prejudices and fears, but also with the feeling of having failed personally. Many - especially depressed people - tend to blame themselves for their condition and are convinced that they can overcome their problems on their own. However, even with occasional but recurring mental disorders, one should not hesitate to seek professional advice. Untreated mental illnesses or disorders can easily develop negative dynamics of their own, trigger further health problems and subsequently make it even more difficult to overcome the disorder.

Prerequisite: own readiness

Conflicts and psychological suffering can only be overcome or improved if the patient has the ability to self-criticize and is able to “go into himself”. Patients should realize in advance that psychotherapy can be a painful process at times, as unpleasant experiences and insights are often brought to light. An important aspect for a successful therapy is that you are seriously prepared to deal with your problems over a longer period of time and to work together with a therapist to solve them. In medicine, one speaks of the patient's “compliance” as a generic term for their cooperative behavior within the framework of therapy. A prerequisite for good patient compliance is a trusting relationship between patient and doctor.

In order for outpatient treatment to be carried out successfully, there must also (still) be a minimum level of psychological stability and resilience. Otherwise, an upstream inpatient psychiatric-psychotherapeutic treatment may be advantageous or even unavoidable (e.g. if there is a risk of suicide).

Course of the first discussions

The medical consultation is of particular importance in the treatment of mental illnesses or disorders. On the one hand, it is used to collect information for diagnostic and therapeutic purposes; on the other hand, it is essential to establish a positive therapeutic doctor-patient relationship.

In the first discussions, the current complaints, the time at which the problems first occurred and the extent to which they affect daily life are discussed. The previous life development is also examined, including whether drastic events or stressful life circumstances have occurred. At the same time, the therapist assesses whether psychiatric and / or psychotherapeutic treatment can alleviate or cure the patient's symptoms.

In the case of a desired psychotherapy, the first five hours of treatment should enable the therapist to clarify the patient's problems and their disorders or illnesses. The patient can and should also use the trial sessions to check how the psychotherapist works and whether the “chemistry is right” - that is, whether a positive and trusting relationship can be established with the therapist. Only if this is the case from both sides is the prerequisite for a successful treatment given. An early discussion about the treatment goals and the treatment plan is helpful.

In the initial consultation, the doctor first introduces himself and provides information about his role and the purpose of the conversation. The patient can then freely begin to tell how his personal complaints appear from his point of view. The duty of confidentiality is particularly important in the case of mental illnesses.

Technical support: Prof. Dr. med. Sabine C. Herpertz, Heidelberg (DGPPN)