When the therapist is sick himself

If the therapist can not do it himself, the patients need adequate replacement

09/19/2013

Successful psychotherapy is largely based on the relationship of trust that patients build up with their therapist. However, the familiar psychiatrists and psychologists are sometimes unavailable, for example due to illness. Then the patients have to look for an adequate replacement. Which points should be considered, explain experts of the Independent Patient Counseling Germany (UPD) and the Federal Psychotherapeutic Chamber in a recent press release of the news agency „dpa“.

At regular sessions, patients and doctors build a bond of trust that can not be easily replaced by other psychiatrists or psychologists if the therapist fails. If the therapists become ill for a longer period of time or are no longer available for other reasons (for example, when moving patients or when the psychotherapist is on parental leave), this may result in a risk to the success of the therapy. Because „Psychotherapy is always personal and can not 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 lecturer, patients at the Federal Psychotherapeutic Chamber, Timo Harfst, „at any time the opportunity to change a therapist, for example, if there is no chance of success, you can not get along, but also if a longer interruption is expected, which could endanger the success of therapy.“ As a general rule, patients with mental health problems can either refer their doctor to a specialist or go directly to a psychotherapist. According to the announcement of the „dpa“ currently three forms (depth psychology-based psychotherapy, behavioral therapy, analytical psychotherapy) are billed to the health insurance companies. Before the actual start of treatment, the patients are entitled to so-called probationary sessions to determine whether the affected person can cope with the therapist and if there is any need for therapy at all. If the patients decide in favor of the therapist and if 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 call representation for the emergency case
However, there is no assurance that therapists will actually be available until treatment is completed. „If the therapist fails, perhaps because of illness, he is“, according to Claudia Maw, but to „obliged to report this to the health insurance fund, and should also inform the patient within the meaning of the treatment contract.“ Although the therapists are by no means responsible for providing replacement, they can, according to the UPD expert, designate a substitute as needed, allowing for a temporary replacement of the therapist without a new health insurance application. In principle, psychotherapists have no representation - as is usual with other doctors - provided. The naming of a representation comes only in exceptional cases such as „with a long, serious illness or bereavement in the family“ in question. However, the patients were by no means obliged to accept the offer of representation.

No claim to quick takeover
However, according to the experts, if patients decide to change therapists, they are not entitled to a quick takeover. Because „Psychotherapists are not required to bring forward or accept someone else who has started therapy“, explained the speaker of the Federal Psychotherapeutic Chamber, Timo Harfst. Of course, the therapists would „the urgency and the suffering of the patient“ check and weigh. In fact, there could be a very different level of suffering for patients with similar symptoms, as they react very differently to the termination of a really successful therapy. Because the psychotherapy „for most a safe place (is) at which they open“, For example, a sudden discontinuation could lead to significant patient reactions. If, for example, the therapy is completed in order to overcome earlier loss experiences and frequent relationship interruptions, the sudden failure of the therapist for those affected is often difficult to cope with and rapid follow-up is required.

Therapist change always an individual case decision
However, prolonged interruptions of therapy, according to UPD expert Claudia Schlund, do not necessarily have a detrimental effect on treatment. „One can not say flat-rate that a long break is bad, so I have to weigh: Is a very big step backwards to be expected with a damage to the health? Or is it a point where a break is possible?“, explained throat. It is therefore always a case by case decision. Generally there is no limit to the period in which the hourly quota of a therapy must be used up. However, longer interruptions must be justified in each case, „and after half a year, a new application to the health fund is usually necessary if the patient and the therapist want to continue.“

Extension of therapy possible
If patients decide to switch therapists, they will not only be required to return to probationary sessions and fulfill the remaining contingent of unexecuted sessions, but may also be required to extend the treatment period further, Timo Harfst explained. The initially defined limitation of therapy hours is not the highest limit. „Additional hours may be needed to establish a new therapy contact“, Harfst continues.

Cost transfer tied to the form of therapy
While the change of the therapist is possible at any time, according to the experts, the form of therapy can no longer be changed without difficulty after the start of treatment. „If a form of psychotherapy has been approved, then the promise of the health fund is also tied to the form of therapy“, emphasized Claudia Maw. Those who can not find a suitable therapist for the approved treatment in their immediate vicinity, could also „look around in the private market“, However, this should in any case discuss with his health insurance and prove the statement in order to secure the cost assumption in individual cases.

Report interruptions of the therapy with the health insurance
In any case, the patients should immediately contact their health insurance, if an interruption or even discontinuation of therapy is pending, the news agency reports „dpa“citing Michaela Hombrecher of the Techniker Krankenkasse (TK) in Hamburg. Hombrecher emphasized that she would also be in such a case „be documented by the psychotherapist, provided that he is still in a position to why the change must take place.“ Depending on how much the patients suffer from the loss of the familiar therapist, individual solutions are required. „If no new therapist is found, we may be able to assist in the search“, Hombrecher continues. Sometimes a temporary stay in a crisis board or day clinic becomes necessary.

Health insurance companies support patients when changing therapists
On the part of the health insurance, there is nothing to prevent a transfer of the remaining hours to another therapist, as long as the form of therapy is maintained and the qualifications of the future therapist are met, explained Hombrecher. „If the maximum number of therapy hours has not been exhausted, can“, according to the expert, „also an extension of the therapy can be requested.“ The health insurance companies are extremely committed to making it possible for the affected patients to transition as smoothly as possible. However, it is not guaranteed in all cases that a previously successfully ongoing therapy can be continued with the same efficiency if the therapist ceases to exist. (Fp)