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doropfiz 11.12.2020 02:50

Psychotherapy, what it is and how to get it
 
If you are in urgent need, please see these threads with contact info for
For an excellent EF thread, with loads of empathy, kindness, encouragement and good advice, please see this thread which, at the time Olygirl rightly hoped would become a "go to" thread. https://www.englishforum.ch/family-m...epression.html
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.

doropfiz 11.12.2020 02:52

Re: Psychotherapy, what it is and how to get it
 
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.)

doropfiz 11.12.2020 02:53

Re: Psychotherapy, what it is and how to get it
 
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 they 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.

doropfiz 11.12.2020 02:54

Re: Psychotherapy, what it is and how to get it
 
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.

doropfiz 11.12.2020 02:55

Re: Psychotherapy, what it is and how to get it
 
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

doropfiz 11.12.2020 02:56

Re: Psychotherapy, what it is and how to get it
 
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, and if need be (depending upon the patient's medical insurance cover) a letter of motivation for the costs to be covered.

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.
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.

doropfiz 04.03.2021 18:22

Re: Psychotherapy, what it is and how to get it
 
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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