Dauer und Umfang ambulanter Psychotherapie und Implikationen für die Versorgungspraxis

Abstract

Time structure of outpatient psychotherapy is important for clinical practice, as well as for theoretical and cost-effectiveness reasons. In this paper, important time variables (session number and frequency, therapy duration, utilization of the allocated session contingent, extension of therapy) are studied in a sample of n=714 German insurees in outpatient psychotherapy over a four-year period. Session number and duration of therapy were modelled with survival analysis, Cox regression was used to study the influence of covariates assessed at the beginning of therapy. Results are reported separately for the three therapy approaches financed by the German health insurance system: psychoanalytic psychotherapy (AP), psychodynamically-oriented therapy (TP) and cognitive-behavioral therapy (VT). Results show median session numbers of 25 (VT), 42 (TP) and 101 (AP) and a therapy duration of 12.8 (VT), 16.7 (TP) and 23.5 (AP) months. Initial therapeutic alliance was negatively associated with therapy duration and session number in AP. In TP and VT, a negative association between age and treatment duration was observed. 72.5% of the total session contingent was utilized and 38.4% of the participants applied for additional therapy sessions. An extension of psychotherapy happened more frequently 1) in psychoanalytic treatments and 2) in participants with higher initial psychological distress. Results show that the utilization of therapeutic resources differs from both theoretical concepts and fixed contingents allocated by health insurances. Potential implications for the allocation of psychotherapeutic resources are discussed.