How often should you see your therapist

Psychotherapeutic consultation and initial consultation

The first access to psychotherapy

Taken with kind permission from the recommendable book "Psychotherapy - Using Offers Sensibly" by the North Rhine-Westphalia Consumer Association.

06/13/2017 From Fritz Propach

In the meantime, the psychotherapeutic consultation is the first step into psychotherapy. In this "official function", the initial consultation has been replaced as an independent initial access or is now taking place as part of the consultation hour. Because with a few precisely defined exceptions, those with statutory health insurance are now obliged to attend the psychotherapeutic consultation.

In the therapist search of you can find the therapists who offer a psychotherapeutic consultation the fastest if you set the filter "GKV: Kassenzulassung" under "Billing".

However, any therapist with whom the patient would like to start therapy can have an initial consultation with him. Exactly how the conversation looks and how it is billed is at the discretion of the respective therapist: some therapists have a short initial consultation of around 20 minutes, with others the initial consultation is longer. With some therapists, the initial discussion is more about regulating formal matters and getting to know the patient for the first time, while others already get a detailed picture of the patient and also address therapeutic issues. Accordingly, every therapist handles the billing of the first consultation differently: some do not bill it at all, with some therapists the patient pays for the first consultation himself, other therapists bill it during the probatory sessions.

The initial consultation and psychotherapeutic consultation mainly pursue one goal: To clarify whether there is a mental illness that requires treatment and what it should look like, or whether self-help and counseling offers could be sufficient for the existing problem.

Therefore, the following explanations and practical tips for the detached initial consultation are still valid and helpful for the psychotherapeutic consultation.

Tips for the psychotherapeutic consultation as the first contact with the therapist

You may have received the appointment for a psychotherapeutic consultation via an appointment service point, or you may have already spoken to your therapist on the phone and tried to get an idea of ​​him or her based on a few characteristics and information. It is obvious that you want to know early on what kind of person is sitting in front of you.

Normally, we quickly develop a feeling for whether and how likeable someone is to us. Sympathy also plays an important role in psychotherapy; after all, it's about very private and personal matters that we don't want to discuss with everyone. So take your time to form an opinion about what you like or dislike about this therapist.

Most of the questions you will hear at the beginning are very similar. They are used so that the other person can get an idea of ​​you, your complaints and the treatment contract. At the beginning it is often said: "What brings you here?" Or: "What problems / difficulties do you have?" The therapist will then first let you talk about something and, if necessary, ask you if he has not understood something but does not go into detail. In order for him to be able to orient himself in general, information on the type, extent and duration of your difficulties is generally sufficient. Most of the time, it is also briefly discussed how the symptoms developed, how you have dealt with the difficulties so far and whether you have already attempted other therapy.

Usually the therapist will try to get into conversation with you by asking questions and making comments. Of course, you don't have to know the right answer to every question and describe your complaints in full. Some therapists also ask how you came across them (whether there were any referrals or who referred you from) and why you want to start therapy now. They want to find out, among other things, how urgent treatment is for you. Likewise, a therapist can ask you what to expect from therapy. Topics that are geared towards the future (for example: "What do you want to achieve through the therapy? Do you have a treatment goal? If so, which?"), Help him to recognize and name his treatment mandate more clearly. After all, from the psychotherapist's point of view, it is first and foremost a type of business contact in which he is supposed to provide a service. To do this, he must know the expectations of the client - i.e. your expectations as a patient.

Perhaps it makes sense for you to think about a few questions that you would like to ask the therapist before the initial consultation. For example, you can inquire about the therapeutic approach or the experiences of the therapist: How do you proceed? How do you rate the chances that my problem will go away again? How do the meetings work? Do we make agreements for the time between two meetings? For a better overview, you will find a short checklist with aspects that you can address in the initial interview. As soon as possible, ask for as much information as possible that can help you decide whether or not to continue therapy with this therapist.

Checklist: questions for the first interview with the psychotherapist

  • Are there any costs for this conversation?
    You should clarify this question before the first meeting, for example when making an appointment by telephone. With registered therapists, the costs for initial consultations are usually covered by the health insurances.
  • Are you entitled to settle accounts with the health insurance company?
    If possible, you should also clarify this before the initial consultation, but at the latest during the initial consultation. As a member of a statutory health insurance company, you should not be hasty in signing a therapy contract with which you undertake to assume the costs. If therapists present you with such a contract, it usually means that they are not entitled to bill the health insurance company.
  • How do you proceed and what therapeutic method do you use?
    In order to benefit from the answer, you should at least have an overview of psychotherapeutic methods beforehand and have checked for yourself which approach is likely to suit you best.
  • What will the course of the meetings be like?
    Let me explain this to you calmly: Are you only talking about problems? Does the therapist limit themselves to asking questions for you to answer? Do you also talk about possible solutions? Are special techniques used? Are agreements made? etc.
  • How long do you think it will take for positive changes to materialize?
    Many therapists do not like to commit themselves to questions about further development and try to keep many options open. Please address this anyway to make it clear that you are interested in changes within a foreseeable period of time. For a number of mental disorders, there is definitely information about when one can expect noticeable improvements on average.
  • What difficulties should I expect when I start therapy with you?
    This question also relates to the way the therapist works. It speaks more for the seriousness of a therapist if he does not promise you the blue sky, but can also name a few when you have questions about possible difficulties (additional expenditure of time, temporary additional psychological stress, overcoming unfamiliar behaviors, etc.).

At the end of the session, the therapist will ask you if you are interested in starting therapy. At this point you should make yourself aware that you do not have to make a decision at this point. The health insurance companies view the first four to five appointments as trial sessions (»probatory sessions«), which should help you find a suitable therapist.

If you already have a bad feeling in the first session and, for example, do not feel properly understood, then you are free to consult other therapists. Take advantage of this opportunity, because your therapist has to agree with you personally; he must either arouse your interest or be sympathetic to you, preferably both of course. Keep in mind that it is your decision who you want to start therapy with and do not be afraid to have an initial consultation with different therapists if in doubt. If you are undecided or are hesitant to disappoint the person you are talking to, then you can say that you still need some time to think it over. The health insurance will cover the costs by arrangement, provided that a change of therapist is made during these first sessions.