The VA is terribly good health care

New regulation for therapy: the standardized psyche

The federal government plans that in future the duration of a therapy will be determined. That contradicts individual needs.

Can and must not conform to any template: the human psyche Photo: Carol Yepes / Moment / getty images

Those who suffer mentally need professional help. On the way there is an inner hurdle to overcome and an outer one: access to appropriate therapy. The second hurdle should now be bigger.

The Federal Ministry of Health would like to supplement the so-called law for the further development of health care (GVWG) with a regulation that is intended to further bureaucratize access to psychotherapy. According to a wording aid from the Ministry for a corresponding amendment request, which is available to the taz, the joint federal committee responsible for this should examine "how the care of the mentally ill insured can be ensured in a needs-based and severity-oriented manner". Trade associations reject this.

"In the future, individual diagnosis and treatment will be replaced by care based on a rough grid," wrote the Federal Chamber of Psychotherapists in a press release. The Bundestag is soon to finally debate the law.

The project is also heavily criticized in social networks under the hashtag #RasterPsychotherapy. The change means that in future the psychotherapist will no longer make a diagnosis and plan the duration of treatment individually within the contingents that are already prescribed, based on the patient's illness and the course of treatment. Instead, a grid should be used to determine at the beginning of the treatment how many hours of treatment will be approved on the basis of a diagnosis.

Diagnosis is a process

This provision is impractical and shows how little the ministry led by Jens Spahn understands mental illnesses and their treatment. You don't have to be a psychotherapist to understand that this doesn't work - at least not in the sense of a successful treatment, since such a procedure would also be absurd in organ medicine.

Even if one assumes that organic illnesses are perhaps somewhat more comparable than psychological illnesses and their causes, which go back a long way in biography: It would also be absurd in an organ medical treatment, according to the motto "For illness x you get y therapy units, and if the knee then still hurts, unlucky ”to proceed.

is a professor at the International Psychoanalytic University Berlin and is training to be a psychological psychotherapist.

This is even more true of psychotherapeutic treatment. It is not uncommon for treatment to begin with a diagnosis that is later expanded, changed or discarded. Because the ongoing treatment and the trust that is being built in the therapist make it possible in the first place to open up what has been avoided so far and to open up. Psychological problems require the holding framework of a therapeutic relationship in order to be able to be dealt with.

That takes trust and trust takes time. Especially when life has so far given little cause for trust, as is often the case with complex mental illnesses. Limitation based on a diagnosis made in advance is counterproductive for this process.

Work on the relationship

Regardless of the color, psychotherapy is always work on and in the relationship, regardless of the differences. This type of work, from which patients benefit most, is at risk or even impossible if it is decided at the beginning how many hours of treatment are actually possible based on the assignment to a diagnosis. Individual treatment is decidedly refused and retraumatisation is encouraged: again no help, again too little time!

The idea of ​​“grid psychotherapy” shows once again that it is not the well-being of the patient that is decisive for Spahn's health policy, but rather the economization of health care as far as possible. In addition, such an approach follows a logic of suspicion. Or would such a change in the law make sense without the assumption that patients have been treated for too long up to now, or that psychotherapists are not competent enough to decide on the duration of treatment?

The consequences of the economization should have become conscious in all of their problems since last year at the latest. The consequences of the austerity policy for inpatient medical care were shown dramatically in the corona pandemic. In clinics, which have been forced to plan according to economic efficiency since the extensive privatization of the health care system, there was a lack of beds and also of those who care for the patients.

No money, no therapy?

It is already evident that mental illnesses have increased due to the corona pandemic; a trend that, so much is known from research, will intensify when "normality" returns and the feeling of having to pull yourself together diminishes.

Many stressed patients get mentally ill when the greatest external stress subsides. To intervene restrictively in psychotherapeutic care in such a situation, of all things, shows in the best case of ignorance, in the worst case of ignorance and cynicism: Those who do not have the money in the future to finance a private psychotherapeutic treatment that lasts as long as it is necessary, threatens to fall through this grid.

At least that is the plan, which would not even make economic sense, since untreated mental illnesses often lead to incapacity for work and in turn cause costs. Perhaps the next amendment to a law that has already been discussed in the Bundestag is ready for this problem.