24th German Psychotherapists' Day in Berlin: "We should catch the political ball now"

A controversial decision by the G-BA, the cooperation between the Federal Chamber of Psychotherapists and the Bundeswehr, the further development of psychotherapeutic care and the reform of training were the focus of the debate.

The G-BA gave it, the G-BA took it - the Federal Chamber of Psychotherapists (BPtK) was able to assume large number of additional psychotherapeutic practice seats due to the new requirements planning put into effect by the Joint Federal Committee (G-BA) in mid-2013 , in the run-up to the 24th German Psychotherapist Day (DPT) on May 17th in Berlin, she was confronted with G-BA decision that significantly reduced what had been achieved. According to this, psychiatric institute outpatient clinic (PIA) will in future be credited with flat rate of 0.5 to the number of approved psychotherapeutic practices - situation that the BPtK is not prepared to accept, said its president, Prof. Dr. phil. Rainer Richter, at the start of the 24th DPT. "We have to defend ourselves against this decision."

Completely different range of diagnostics and activities

< p> If two psychiatric institute outpatient clinics are counted as one psychotherapeutic practice, this means, in plain language, the loss of 209 practices. "This has very specific negative effects on the care," emphasized Richter and criticized the PIA's crediting of the contractual psychotherapeutic care as an arbitrary measure. Without hearing the BPtK, the Federal Joint Committee, with the consent of the National Association of Statutory Health Insurance Funds, the German Hospital Society and the National Association of Statutory Health Insurance Physicians, brought about decision that endangered basic psychotherapeutic care, especially in the East German planning areas. The BPtK had consequently turned to the Federal Ministry of Health with the request to object to the G-BA decision.

BPtK President Richter pointed out that it would have been the obligation of the standard-setting G-BA First, to get an idea of ​​what such decision would do. Obviously, the range of diagnoses and activities of the PIA is quite different from that of established psychotherapists; here other patients would be treated with different methods. The offer of the psychiatric institute outpatient clinics is explicitly aimed at sick people who are only inadequately reached by other care offers. srg07f3f1.png ">

" The G-BA's decision has very specific negative effects on care. "- Rainer Richter, President of the Federal Chamber of Psychotherapists. Photos: Federal Chamber of Psychotherapists

A controversial decision by the G-BA, the cooperation between the Federal Chamber of Psychotherapists and the Bundeswehr, the further development of psychotherapeutic care and the reform of training were the focus of the debate.

The G-BA gave it, the G-BA took it - the Federal Chamber of Psychotherapists (BPtK) was able to assume large number of additional psychotherapeutic practice seats due to the new requirements planning put into effect by the Joint Federal Committee (G-BA) in mid-2013 , in the run-up to the 24th German Psychotherapist Day (DPT) on May 17th in Berlin, she was confronted with G-BA decision that significantly reduced what had been achieved. According to this, psychiatric institute outpatient clinic (PIA) will in future be credited with flat rate of 0.5 to the number of approved psychotherapeutic practices - situation that the BPtK is not prepared to accept, said its president, Prof. Dr. phil. Rainer Richter, at the start of the 24th DPT. "We have to defend ourselves against this decision."

Completely different range of diagnostics and activities

< p> If two psychiatric institute outpatient clinics are counted as one psychotherapeutic practice, this means, in plain language, the loss of 209 practices. "This has very specific negative effects on the care," emphasized Richter and criticized the PIA's crediting of the contractual psychotherapeutic care as an arbitrary measure. Without hearing the BPtK, the Federal Joint Committee, with the consent of the National Association of Statutory Health Insurance Funds, the German Hospital Society and the National Association of Statutory Health Insurance Physicians, brought about decision that endangered basic psychotherapeutic care, especially in the East German planning areas. The BPtK had consequently turned to the Federal Ministry of Health with the request to object to the G-BA decision.

BPtK President Richter pointed out that it would have been the obligation of the standard-setting G-BA First, to get an idea of ​​what such decision would do. Obviously, the range of diagnoses and activities of the PIA is quite different from that of established psychotherapists; here other patients would be treated with different methods. The offer of the psychiatric institute outpatient clinics is explicitly aimed at sick people who are only inadequately reached by other care offers.Because of insufficient funding, PIAs could not offer any care comparable to standard outpatient psychotherapy. There would only be around 63 euros available for psychotherapeutic services per person and quarter. The psychotherapists were unanimous against these external interventions.

The delegates passed motion with large majority that approved the The board of directors charged with making minimum requirements for reform of the Psychotherapists Act the basis of their further work.

Agreement with the Bundeswehr under fire

The DPT delegates saw little more need for discussion With view to an agreement recently concluded between the BPtK and the Federal Ministry of Defense, according to which soldiers can in future be treated not only by contract psychotherapists, but also by psychotherapists with private practice as part of the reimbursement of costs. At the same time, the Bundeswehr and the BPtK agreed to hold regular joint training events in which interested psychotherapists would be presented with Bundeswehr specifics and the treatment and billing procedure. A first such joint event took place on March 13th in the Blücher barracks in Berlin-Kladow.

In the run-up to the 24th DPT, there were open letters from the New Society for Psychology and the International Physicians for the Prevention of Nuclear War (IPPNW), in which the BPtK's commitment to psychotherapeutic care for soldiers was criticized. Richter resisted this criticism at the DPT. Mentally ill people - including soldiers - have right to treatment. “It doesn't count my political assessment of how useful I find deployments abroad or how useful I find military service in general; it is crucial that mentally ill people are protected from discrimination and stigmatization. ”Psychotherapists who find it difficult to treat soldiers are free not to do so. As therapist, one must be able to accept that mentally ill soldiers will resume their service after successful treatment, “if they want it themselves, even if this includes an assignment abroad”.

The therapy goal could also be refusal

Alfred Krieger, President of the Hessian Chamber of Psychotherapists, complained in the subsequent discussion that the BPtK could have pointed out in its press release on the agreement that successful therapy would not only enable renewed assignment abroad, but also the refusal of such an assignment Use could result.Because of insufficient funding, PIAs could not offer any care comparable to standard outpatient psychotherapy. There would only be around 63 euros available for psychotherapeutic services per person and quarter. The psychotherapists were unanimous against these external interventions.

The delegates passed motion with large majority that approved the The board of directors charged with making minimum requirements for reform of the Psychotherapists Act the basis of their further work.

Agreement with the Bundeswehr under fire

The DPT delegates saw little more need for discussion With view to an agreement recently concluded between the BPtK and the Federal Ministry of Defense, according to which soldiers can in future be treated not only by contract psychotherapists, but also by psychotherapists with private practice as part of the reimbursement of costs. At the same time, the Bundeswehr and the BPtK agreed to hold regular joint training events in which interested psychotherapists would be presented with Bundeswehr specifics and the treatment and billing procedure. A first such joint event took place on March 13th in the Blücher barracks in Berlin-Kladow.

In the run-up to the 24th DPT, there were open letters from the New Society for Psychology and the International Physicians for the Prevention of Nuclear War (IPPNW), in which the BPtK's commitment to psychotherapeutic care for soldiers was criticized. Richter resisted this criticism at the DPT. Mentally ill people - including soldiers - have right to treatment. “It doesn't count my political assessment of how useful I find deployments abroad or how useful I find military service in general; it is crucial that mentally ill people are protected from discrimination and stigmatization. ”Psychotherapists who find it difficult to treat soldiers are free not to do so. As therapist, one must be able to accept that mentally ill soldiers will resume their service after successful treatment, “if they want it themselves, even if this includes an assignment abroad”.

The therapy goal could also be refusal

Alfred Krieger, President of the Hessian Chamber of Psychotherapists, complained in the subsequent discussion that the BPtK could have pointed out in its press release on the agreement that successful therapy would not only enable renewed assignment abroad, but also the refusal of such an assignment Use could result.Juliane Dürkorp, President of the Chamber of Psychotherapists Schleswig-Holstein, missed the statement that “our profession is fundamentally against the war”. Dr. phil. Manfred Thielen, Berlin, considers the “soldiers' contract” to be problematic insofar as the restoration of the ability to serve abroad is the overarching goal of the therapy. He critically questioned the role of the military doctor who decides on the continuation of therapy. "What happens if he realizes that the therapy is going in the wrong direction?" This problem does not only exist with the treatment of soldiers, but also affects the execution of measures.

In view of the discussion about the introduction of the flat-rate remuneration system for psychiatry and psychosomatic medicine (PEPP), Richter was relieved that the total criticism has now subsided. An extension of the option phase for the switch to the new remuneration system is currently planned. The G-BA is to set binding personnel standards by the end of 2016; these should then no longer be undercut by any hospital. Maintaining the previously applicable Psychiatry Personnel Ordinance (Psych-PV) would be extremely problematic from quality point of view. The personnel standards are out of date, guideline-based therapy is no longer possible under these conditions. The extended PEPP introductory phase now enables continuous further development of the system. Richter indicated his willingness to work constructively in the G-BA. "The point is to find remuneration system that is approximately fair," emphasized the BPtK President. PEPP is designed as learning system; Here it is important to recognize false incentives early on and to take countermeasures. However, this only works on the basis of good documentation of the psychotherapeutic services provided.

Controversial discussion about minimum wage for PiA

One of twelve delegates was the subject of controversial discussion at the 24th DPT The proposed resolution, according to which the BPtK board should advocate such regulation in the discussion of the statutory minimum wage for the inclusion of psychotherapists in training (PiA). This will initially serve to alleviate the acute financial hardship of the PiA. Demands for collectively agreed remuneration for the academic degree of the PiA remain unaffected, according to the application. The central question in the discussion was whether it would damage the reputation of an academic profession if one made minimum wage requirements one's own.Juliane Dürkorp, President of the Chamber of Psychotherapists Schleswig-Holstein, missed the statement that “our profession is fundamentally against the war”. Dr. phil. Manfred Thielen, Berlin, considers the “soldiers' contract” to be problematic insofar as the restoration of the ability to serve abroad is the overarching goal of the therapy. He critically questioned the role of the military doctor who decides on the continuation of therapy. "What happens if he realizes that the therapy is going in the wrong direction?" This problem does not only exist with the treatment of soldiers, but also affects the execution of measures.

In view of the discussion about the introduction of the flat-rate remuneration system for psychiatry and psychosomatic medicine (PEPP), Richter was relieved that the total criticism has now subsided. An extension of the option phase for the switch to the new remuneration system is currently planned. The G-BA is to set binding personnel standards by the end of 2016; these should then no longer be undercut by any hospital. Maintaining the previously applicable Psychiatry Personnel Ordinance (Psych-PV) would be extremely problematic from quality point of view. The personnel standards are out of date, guideline-based therapy is no longer possible under these conditions. The extended PEPP introductory phase now enables continuous further development of the system. Richter indicated his willingness to work constructively in the G-BA. "The point is to find remuneration system that is approximately fair," emphasized the BPtK President. PEPP is designed as learning system; Here it is important to recognize false incentives early on and to take countermeasures. However, this only works on the basis of good documentation of the psychotherapeutic services provided.

Controversial discussion about minimum wage for PiA

One of twelve delegates was the subject of controversial discussion at the 24th DPT The proposed resolution, according to which the BPtK board should advocate such regulation in the discussion of the statutory minimum wage for the inclusion of psychotherapists in training (PiA). This will initially serve to alleviate the acute financial hardship of the PiA. Demands for collectively agreed remuneration for the academic degree of the PiA remain unaffected, according to the application. The central question in the discussion was whether it would damage the reputation of an academic profession if one made minimum wage requirements one's own.Martin Klett, Baden-Württemberg, commented: “I'm just imagining that I am an affected PiA - then I wouldn't be able to do anything with these noble words.” Heiner Vogel, Bavaria, also supported the application: “PiA are entitled to more Money, and here maybe there is possibility. ”The delegates of the 24th DPT voted for the proposal with narrow majority of 52 yes votes to 49 no votes.

The further development of psychotherapeutic care was the next item on the agenda. The BPtK president presented “differentiated care concept” for mentally ill adults, which he wanted to be understood as “proposal on which basic elements can be easily discussed”. What is new is the “psychotherapeutic consultation hour”, which is intended to give patients prompt access. The idea is that therapists carry out an oriented initial diagnosis and, if necessary, also provide the indication. According to the concept, an expansion of competencies is necessary for this: psychotherapists would have to be able to refer and admit inpatients, prescribe remedies and rehabilitation services and confirm incapacity for work. The guideline psychotherapy should be supplemented by further services: crisis intervention and also outreach treatment should be possible as well as the guidance of self-help groups and psycho-educational groups. Psychotherapists should also be able to work in simplified manner or with appropriate remuneration in multi-professional outpatient care networks, as required above all by mentally ill people with complex treatment needs. Attempt psychotherapeutic services should also be made possible within the framework of multimodal care in hospitals. The prerequisites for all of this are, among other things, number of legal changes in SGB V and the revision of the psychotherapy guidelines by the G-BA. Richter emphasized: "The psychotherapy guidelines must not be changed in such way that they are endangered." Moreover, not every psychotherapeutic practice has to offer consultation hour and additional services.

Peter Lehndorfer, KJP:" Guideline psychotherapy alone must continue to be possible. "

Social psychotherapy agreement required

The corresponding concept for the care of mentally ill children and adolescents, Peter Lehndorfer introduced, who as child and adolescent psychotherapist (KJP) is responsible for the concerns of this age group on the board. "Here, too, there is provision for psychotherapeutic consultation with appropriate skills expansion," said Lehndorfer. In addition to guideline therapy, it should in future be possible to offer multi-professional initial diagnostics (logotherapy, occupational therapy).Martin Klett, Baden-Württemberg, commented: “I'm just imagining that I am an affected PiA - then I wouldn't be able to do anything with these noble words.” Heiner Vogel, Bavaria, also supported the application: “PiA are entitled to more Money, and here maybe there is possibility. ”The delegates of the 24th DPT voted for the proposal with narrow majority of 52 yes votes to 49 no votes.

The further development of psychotherapeutic care was the next item on the agenda. The BPtK president presented “differentiated care concept” for mentally ill adults, which he wanted to be understood as “proposal on which basic elements can be easily discussed”. What is new is the “psychotherapeutic consultation hour”, which is intended to give patients prompt access. The idea is that therapists carry out an oriented initial diagnosis and, if necessary, also provide the indication. According to the concept, an expansion of competencies is necessary for this: psychotherapists would have to be able to refer and admit inpatients, prescribe remedies and rehabilitation services and confirm incapacity for work. The guideline psychotherapy should be supplemented by further services: crisis intervention and also outreach treatment should be possible as well as the guidance of self-help groups and psycho-educational groups. Psychotherapists should also be able to work in simplified manner or with appropriate remuneration in multi-professional outpatient care networks, as required above all by mentally ill people with complex treatment needs. Attempt psychotherapeutic services should also be made possible within the framework of multimodal care in hospitals. The prerequisites for all of this are, among other things, number of legal changes in SGB V and the revision of the psychotherapy guidelines by the G-BA. Richter emphasized: "The psychotherapy guidelines must not be changed in such way that they are endangered." Moreover, not every psychotherapeutic practice has to offer consultation hour and additional services.

Peter Lehndorfer, KJP:" Guideline psychotherapy alone must continue to be possible. "

Social psychotherapy agreement required

The corresponding concept for the care of mentally ill children and adolescents, Peter Lehndorfer introduced, who as child and adolescent psychotherapist (KJP) is responsible for the concerns of this age group on the board. "Here, too, there is provision for psychotherapeutic consultation with appropriate skills expansion," said Lehndorfer. In addition to guideline therapy, it should in future be possible to offer multi-professional initial diagnostics (logotherapy, occupational therapy).Likewise, outreach treatment, psycho-educational groups, including parent groups, guided self-help groups and therapeutic help, for example in the case of partial performance disorders. According to the concept, social psychotherapy agreement would be desirable that would enable KJP to employ occupational therapists, speech therapists or social workers / pedagogues in their practices, analogous to the social psychiatry agreement of child and youth psychiatrists. "Even children who live in homes and are often mentally ill should be offered psychotherapeutic treatment," added Lehndorfer. Finally, the cooperation of KJP in multi-professional outpatient care networks must also be appropriately remunerated. It was important for Lehndorfer to emphasize: "The sole guideline psychotherapy must continue to be possible." Uwe Keller, during the discussion that followed. Because there is currently no billing number for cooperation. Gerhard Müller, delegate from Bavaria, thinks the concept is "very brave". Basically, many asked for more communication and cooperation in networks, "but nobody wants to do it". Perhaps the implementation of the concept could contribute to motivation, he hopes. Bernhard Morsch, Saarland, fears that KJP "could get in the way of other service providers" with regard to social psychotherapeutic care. "You can only get into each other's enclosure if you take each other's patients away," replied Lehndorfer. The opposite is the case: medical and psychotherapeutic practices have long waiting lists. But: "Who lands where is largely random because the structures are very unclear."

Nikolaus Melcop: "We have to make decisions about structural changes in training."

Job description and competence profile

The reform of training and further education - the constant topic of the past psychotherapist days - was also this time back on the agenda. For discussion, the delegates were presented with job description and the competency profile derived from it, which working group (AG) made up of members of the BPtK executive board and the state council had revised and further developed. "Universities and institutes should now think about whether and how they implement the job description and the competence profile", explained Chamber President Richter.

In addition to the further development of the competence profile, decisions are now made about structural changes - keyword direct training versus postgraduate training - necessary, emphasized Dr. phil. Nikolaus Melcop, President of the Bavarian Chamber of Psychotherapists, for the AG.Likewise, outreach treatment, psycho-educational groups, including parent groups, guided self-help groups and therapeutic help, for example in the case of partial performance disorders. According to the concept, social psychotherapy agreement would be desirable that would enable KJP to employ occupational therapists, speech therapists or social workers / pedagogues in their practices, analogous to the social psychiatry agreement of child and youth psychiatrists. "Even children who live in homes and are often mentally ill should be offered psychotherapeutic treatment," added Lehndorfer. Finally, the cooperation of KJP in multi-professional outpatient care networks must also be appropriately remunerated. It was important for Lehndorfer to emphasize: "The sole guideline psychotherapy must continue to be possible." Uwe Keller, during the discussion that followed. Because there is currently no billing number for cooperation. Gerhard Müller, delegate from Bavaria, thinks the concept is "very brave". Basically, many asked for more communication and cooperation in networks, "but nobody wants to do it". Perhaps the implementation of the concept could contribute to motivation, he hopes. Bernhard Morsch, Saarland, fears that KJP "could get in the way of other service providers" with regard to social psychotherapeutic care. "You can only get into each other's enclosure if you take each other's patients away," replied Lehndorfer. The opposite is the case: medical and psychotherapeutic practices have long waiting lists. But: "Who lands where is largely random because the structures are very unclear."

Nikolaus Melcop: "We have to make decisions about structural changes in training."

Job description and competence profile

The reform of training and further education - the constant topic of the past psychotherapist days - was also this time back on the agenda. For discussion, the delegates were presented with job description and the competency profile derived from it, which working group (AG) made up of members of the BPtK executive board and the state council had revised and further developed. "Universities and institutes should now think about whether and how they implement the job description and the competence profile", explained Chamber President Richter.

In addition to the further development of the competence profile, decisions are now made about structural changes - keyword direct training versus postgraduate training - necessary, emphasized Dr. phil. Nikolaus Melcop, President of the Bavarian Chamber of Psychotherapists, for the AG."We should catch the ball that politics has thrown at us," he said, "even if most of them would just leave it." The coalition agreement of the new federal government provides for revision of the Psychotherapists Act and regulation of the entry requirements for training in this legislative period . “The profession made decision at the 16th German Psychotherapist Day,” replied Dr. phil. Ulrich Müller, Hessen, “but politics didn't catch our ball and has done nothing since then.” This is “Procrustean bed”. As reminder: At the 16th DPT in May 2010, the delegates made decision (PP, issue 6/2010) on postgraduate reform of training. Direct training, i.e. studying psychotherapy, should then be tried out in model courses.

Minimum requirements for reform of the law

"We now have to meet minimum requirements for reform of the Psychotherapists Act (PTG) formulate “, emphasized BPtK President Richter. Because every month without decision reduces the chance of reform in this legislative period. There are already initial considerations. The reform of the Psychotherapists Act

  • takes into account the growing demands from health care and is based on the professional profile derived from it
  • creates appropriate and sustainable framework conditions for quality-assured professional practice in outpatient and inpatient settings Area
  • secures the next generation of psychotherapeutic trainees through appropriate structural and financial framework conditions
  • creates clear legal basis for psychotherapeutic activity within the framework of qualification
  • includes legal definition of psychotherapeutic An activity that - analogous to medical activity - is not limited to treatment procedures or methods.

The PTG guarantees the qualification of psychotherapists through:

  • ein Studies at scientific university, state examination; Graduation at master's level (EQR-7)
  • nationwide license to practice medicine for the uniform academic medical profession "psychotherapist" with focus on children and adolescents or adults
  • in-depth specialist knowledge (entry in the doctor's register) with secure legal status in the Treatment
  • Ability to cooperate with members of other health professions as prerequisite for multi-professional care concepts
  • Appropriate transitional arrangements.

A large majority of the delegates passed motion that instructs the board of directors to make these minimum requirements the basis of their further work.

"We should catch the ball that politics has thrown at us," he said, "even if most of them would just leave it." The coalition agreement of the new federal government provides for revision of the Psychotherapists Act and regulation of the entry requirements for training in this legislative period . “The profession made decision at the 16th German Psychotherapist Day,” replied Dr. phil. Ulrich Müller, Hessen, “but politics didn't catch our ball and has done nothing since then.” This is “Procrustean bed”. As reminder: At the 16th DPT in May 2010, the delegates made decision (PP, issue 6/2010) on postgraduate reform of training. Direct training, i.e. studying psychotherapy, should then be tried out in model courses.

Minimum requirements for reform of the law

"We now have to meet minimum requirements for reform of the Psychotherapists Act (PTG) formulate “, emphasized BPtK President Richter. Because every month without decision reduces the chance of reform in this legislative period. There are already initial considerations. The reform of the Psychotherapists Act

  • takes into account the growing demands from health care and is based on the professional profile derived from it
  • creates appropriate and sustainable framework conditions for quality-assured professional practice in outpatient and inpatient settings Area
  • secures the next generation of psychotherapeutic trainees through appropriate structural and financial framework conditions
  • creates clear legal basis for psychotherapeutic activity within the framework of qualification
  • includes legal definition of psychotherapeutic An activity that - analogous to medical activity - is not limited to treatment procedures or methods.

The PTG guarantees the qualification of psychotherapists through:

  • ein Studies at scientific university, state examination; Graduation at master's level (EQR-7)
  • nationwide license to practice medicine for the uniform academic medical profession "psychotherapist" with focus on children and adolescents or adults
  • in-depth specialist knowledge (entry in the doctor's register) with secure legal status in the Treatment
  • Ability to cooperate with members of other health professions as prerequisite for multi-professional care concepts
  • Appropriate transitional arrangements.

A large majority of the delegates passed motion that instructs the board of directors to make these minimum requirements the basis of their further work.

German Psychotherapist Day will take place in Munich in autumn - organized by the Bavarian Chamber of Psychotherapists.

Petra Bühring, Thomas Gerst

For direct training

For reform of training in the direction of direct training with subsequent further training, independent group of four young psychotherapists who got to know each other within the German Psychotherapist Association. They submitted theses paper to the 24th DPT, which around 400 people, 230 of them psychotherapists in training, had signed by then. "We are very concerned about the tendency to do everything in small steps, the risks are too great," said Felix Jansen, Cologne, to the delegates. "The signals for comprehensive reform are better than ever - it is a" historic opportunity. "Among other things,

  • the clear status as an academic health profession
  • speaks for direct training and further education
  • consistent equality between specialists
  • securing the German special status in Europe
  • full social law powers for psychotherapists
  • remuneration during advanced psychotherapeutic training
  • the clear legal status for the implementation of medical treatment during further training
  • BAföG during training.
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