top of page
  • Writer's pictureV. Romanov

Psychiatrists, psychotherapists, alternative practitioners and co. Who should I see?

Updated: Apr 2, 2023

There is a wealth of information on the internet about psychiatrists, psychotherapists, psychologists, alternative practitioners of psychotherapy and psychological counsellors. There are rather dry texts that list the requirements for practising each profession, as well as those that discuss the advantages and disadvantages of each profession. In addition, you will inevitably come across websites of various practices, communities of practice, clinics, etc., all of which want to present their own point of view and the advantages of their method or the like. Basically, it is tedious work to systematise and distil the information gathered. It is precisely this work that I would like to spare you by not boring you with detailed descriptions, but rather by giving you a basic guide to distinguishing between the professional fields. After reading this article, you should be able to choose the right specialist for your question or problem.

The above-mentioned professional groups can be divided into those with a clear academic background and those where this is not apparent from the professional title alone. The professional titles of psychiatrist, psychotherapist and psychologist are protected by law and may only be used by persons who have successfully completed a relevant university degree and appropriate theoretical and practical training. Alternative practitioners (Heilpraktiker für Psychotherapie), on the other hand, do not require an academic degree, but must undergo a comprehensive examination of their competence by the health authorities. At the same time, an academic background is by no means excluded for alternative practitioners. For example, there are many alternative practitioners of psychotherapy who have a degree in psychology. This is perhaps where the first confusion arises: Why are psychologists with a degree also alternative practitioners of psychotherapy?

The answer to this question lies in the different competencies of each professional group. The main difference lies in the authority and qualification to practise medicine, i.e. to diagnose mental disorders and to medically treat mentally ill people. Only psychiatrists, psychotherapists and alternative practitioners of psychotherapy are allowed to do this. Psychologists and psychological counsellors are not permitted to do so. The reason for this is that in order to practise medicine, a sound knowledge of clinical psychology, psychopathology and psychotherapy must be proven (depending on the professional group, these requirements may vary). If you have a degree in psychology with a specialisation in clinical psychology, you can obtain a licence to practise as a Heilpraktiker (alternative practitioner) limited to the field of psychotherapy in most federal states without an additional examination by the health authorities.

What is the difference between a psychiatrist and a psychological psychotherapist? Put simply, psychiatrists are medical doctors who have studied medicine and then specialised in psychiatry and psychotherapy. Psychological psychotherapists have a degree in psychology, followed by three to five years of psychotherapeutic training in one of the four methods currently recognised by staturory health insurance organizations. Both professional groups have a licence (Approbation) to practise, i.e. the state authorisation to practise the respective profession independently and on one's own responsibility. This is the main formal difference to alternative practitioners of psychotherapy, who are allowed to practise psychotherapy without an academically obtained state licence.

For the layperson, it is probably important to note that psychiatrists, unlike psychological psychotherapists and alternative practitioners of psychotherapy, are allowed to prescribe medication and certify general incapacity for work. Psychiatrists, like most psychological psychotherapists, are licensed by the health insurance funds, i.e. their treatments are paid for by the statutory health insurance funds. The services of alternative practitioners, on the other hand, are very rarely covered by the statutory health insurance funds. However, it should be stressed that treatment by a doctor or psychotherapist is usually only covered by statutory or private health insurance if the patient suffers from a diagnosable mental disorder. Counselling in cases of stress, burnout, conflict or emotionally stressful exceptional situations is usually not covered by health insurance. Strictly speaking, such cases do not require medical or therapeutic treatment, but psychological counselling, which is also offered by psychologists and psychological counsellors specialised in this field.

Unlike psychologists, the title 'psychological counsellor' is not protected by law and, strictly speaking, can be held by almost anyone. However, it would not be wise to ignore or reject this professional group for this reason. Each psychological counsellor is unique in their experience and training and can certainly add value to their clients. Psychological counsellors are usually able to provide evidence of specialised training and are often members of professional associations which have different requirements for their members and also provide professional certification. Counselling is a commercial activity. It can therefore be said that no business can survive in the long term without satisfied clients and referrals.

Alternative practitioners of psychotherapy, on the other hand, are similar to psychological counsellors in that they too are exposed to market conditions. Panel therapists, on the other hand, which include both psychiatrists and psychological psychotherapists, receive a steady stream of patients from the health insurance funds from the beginning of their professional activity. They usually have problems accepting new patients, which leads to longer waiting times for a place in therapy, which can be as long as 6 months, due to the shortage of panel therapists and the ever-increasing number of mentally ill people.

Another difference is that psychiatrists are not paid by the hour, like psychological psychotherapists, but essentially by the number of patients they see per hour. This means that psychiatrists have less time to spend with each patient and are more likely to prescribe psychotropic drugs than traditional psychotherapy. However, there are a number of mental disorders, such as moderate or severe depression, that require treatment with prescription drugs, which require the involvement of a psychiatrist or medical doctor in the therapy, as only a medical doctor has the necessary expertise and authority to prescribe such drugs.

You may think that what you have read makes you even more confused and that you do not know where to turn for qualified help. Don't be discouraged and think about your concerns. If you want to develop personally, fulfil your potential or resolve conflicts with relatives, you can turn to psychological counsellors, psychologists, alternative practitioners of psychotherapy or even psychological psychotherapists. However, if you are feeling so badly, emotionally or physically, that you suspect a mental illness, it is better to seek help where you can get it fastest. Do not try to diagnose yourself by looking it up on the internet, but contact a health professional. Especially if you experience symptoms such as deep dejection, loss of interest, listlessness, guilt, sleeplessness, difficulty concentrating, or even hearing voices and thinking about dying, you should seek professional help immediately. Someone with a medical or alternative practitioner licence and the necessary expertise will either help you themselves or refer you to a suitably qualified professional.

You may be wondering whether it would be better to see your general practitioner or another doctor. You can, especially if you can get an appointment quickly. However, it is important that you give your general practitioner as much information as possible about your symptoms, including any suspicions you may have about mental illness. The problem is that many general practitioners are stretched to the limit by the high volume of patients they see, often have little knowledge or experience of mental illness, and therefore – also statistically – overlook or misdiagnose mental disorders.

Experience shows that the quickest way to get an appointment is to go to a private practice, which includes the offices of alternative psychotherapists. At first glance, it may seem like a disadvantage that you have to pay for the counselling yourself. In fact, you gain a high degree of confidentiality and control. Neither your health insurance fund nor your insurance company will know about the treatment. In this way, you avoid risk surcharges on your private health, life or disability insurance. In addition, the treatment will not prevent you from becoming a civil servant in the future. As a self-payer, you have control over the nature and duration of the therapeutic services you receive and over your choice of therapist. This is not the case with therapy covered by the statutory health insurance. In addition, psychotherapists are not restricted in their treatment methods, and if you want a therapy method that is not offered by the statutory health insurance, you are likely to find it in a private psychotherapist's practice.

With so many therapies on the market, it can be difficult to keep track of them all. If you have any doubts about a therapist's competence, you should visit them in person and ask about their qualifications, professional certificates and evidence of training. If you are satisfied with the therapist's qualifications, you can usually get a feel for the service during the first session and find out whether you like the therapist's style and personality. If you do not like the therapist or the method of treatment, the cost and time involved in one or two sessions is limited and you are free to find another specialist. In general, there is little to worry about with psychotherapists, as professional indemnity insurers keep their risk assessments up to date: professional indemnity premiums for psychotherapists have not been increased for two decades and remain at a low level. This speaks for the reliability of the services offered.

I hope you have enjoyed reading this article and I invite you to ask questions about the content, comment on information, share your own experiences and share the article with friends or acquaintances.

7 views0 comments


Rated 0 out of 5 stars.
No ratings yet

Add a rating
bottom of page