Understanding what psychotherapy and counselling means to your work in private practice in Berlin.
When I moved to Berlin in 2013, I had just graduated from the University of Copenhagen and received a diploma stating that I could call myself Master of Science in Clinical Psychology. Since Germany and Denmark are neighboring countries with a lot in common, I thought that starting work as a psychologist would be straightforward and follow a similar path as to back home.
In Denmark, when you have any difficulties that are psychological, you go see a psychologist. And if you visit your GP first, well then they refer you to a psychologist. To become a psychologist of the kind that does talk therapy, you do a master in psychology, choosing clinical psychology as your field. Then, when you’ve completed your master thesis, you go straight out into the world to “treat” people. After two years of working full-time and receiving 160 hours of supervision, you then have your license and will be able to work with the health insurance. This means that in Denmark psychologists are mostly the ones doing therapy.
So, what about psychotherapists? In Denmark, they exist as well, but since psychotherapist isn’t a protected title, this profession isn’t very highly regarded.
Coming to Berlin, it was a big surprise to learn that here the situation is reverse: The profession that has the highest degree of quality control and protection is “psychotherapy”. Those who offer psychotherapy are either psychologists who have done a 3 to 5-year training program, which gives them the title “psychological psychotherapists” or they have done the Heilpraktiker für Psychotherapie exam making them a non-medical practitioner of psychotherapy.
From a legal perspective, any other professionals can’t say they offer psychotherapy. Therefore, mental health professionals who move to Berlin from countries where their titles have different legal connotations, often end up calling themselves “counsellor” since this isn’t a protected title in Germany.
What to consider when you’re working in private practice
If you’re working in private practice — even though clients might not notice it — there is a difference between offering “counselling” and “psychotherapy”. To understand this difference, I talked to psychodynamic counselor and systemic therapist Juliane Meyer-Clason, who I consider an expert in navigating the realm of “counselling versus psychotherapy”.
What she explained is that the difference between counselling and psychotherapy has a dimension concerning policy, a legal dimension, and a dimension regarding the therapeutic procedure.
Starting with the matter of policy, this has to do with above-mentioned rigid standards for the training of psychological psychotherapists. The German Psychotherapist law (PsychThG) explains how people should be trained in order to be able to treat patients. This means that “mere” psychologists who have learned many important things about the treatment of psychological disorders, still aren’t considered qualified to treat patients. It also means that in Germany there is a clear hierarchy, where psychological psychotherapy comes out as the winner, and psychological counseling as the loser, or at least the inferior little sister. There are no official standards for the training of counsellors, and this is why everyone can call themselves psychological counsellors.
The legal dimension comes into play when you take a closer look at the German Psychotherapist law (PsychThG), which states that psychotherapy serves the diagnosis and healing of psychological disorders and psychiatric illnesses. In other words, psychotherapy is the treatment of a diagnosable mental health issue, seen as having pathological significance (in German: Krankheitswert).
So, if you are only offering counselling this confronts you with the question: at which point is my work considered psychotherapy and, thus, illegal?
Add to this legal conundrum, a further aspect which is that the German Psychotherapist law also states that “Psychotherapy does not include psychological activities aiming at the processing and overcoming of social conflicts and other issues outside of the healing process.”
Both of these legal descriptions of what psychotherapy is and what it isn’t, demonstrates how impossible it is to neatly distinguish it from counselling. The line between treatment of mental health issues which are diagnosable (psychotherapy) and non-pathological issues (counselling) is simply too blurry.
This is where the dimension regarding the procedure becomes relevant to look at.
Because is it really possible, as a psychotherapist, to treat a diagnosable mental problem without also looking at the social conflicts of the client?
And as a counsellor serving the processing and overcoming of social conflicts and other non-pathological issues, can we imagine surgically excluding the overcoming of mental problems which might have pathological significance. There obviously is an overlap between the procedure and methods of counselling and psychotherapy, and it’s likely that a client wouldn’t be able to distinguish between the two services, even if he knew about the official, standard differences. It can also happen that a process changes, so that a counsellor helping a person overcome a non-pathological conflict, recognizes that there also is a diagnosable mental issue at play. And then what?
Guidelines to playing it safe and being professional
From discussing these questions with Juliane Meyer-Clason and other colleagues in private practice, I discovered there are two main guidelines that are important to keep in mind if you want to make sure you stay within the legal boundaries of your practice:
Caution with use of titles and terms. To prevent inadvertently making false advertisement, unless you have the German license to practice psychotherapy, don’t say that you practice psychotherapy. There is, however, another term used by professionals which is „Therapeut(in)“ or simply therapist. If you a professionally trained in, say, Gestalt therapy, solution-focused therapy, systemic therapy, or some other kind of therapy, it is perfectly legal to use this title. But since “therapists” don’t have the German, state-regulated license in psychotherapy like “psychotherapists” or non-medical practitioners of psychotherapy do, they can’t say they offer psychotherapy nor therapy. They can ‘only’ offer counselling.
In other words, you can be a therapist, not allowed to offer therapy, but rather counselling.
Awareness of boundaries and limitations. In my opinion, humility in the mental health care profession is just as important as on-going training and supervision. With this specific topic, humility relates to knowing when the service we provide won’t suffice. It is knowing when the client needs a different kind of support or an extra set of ears.
Also, it is a commonly recognized sign of quality in work to be well-trained and member of professional associations. Memberships in associations can serve as some sort of „guarantee“ for you work, since clients can look up information about the training, its duration, and the association in general. Furthermore, they can call and complain about your work and, since being a member of a professional association means that you adhere to its ethical standards, this should protect clients in some way.
This, to me, is not just playing it safe. It’s also being a true professional.