What are the additional qualifications for psychotherapists?

Why do you need additional qualifications?

Additional qualifications represent a central opportunity for psychotherapists in further training (PiAs) or licensed psychotherapists to expand their own psychotherapeutic competencies and their own professional horizons. For PiAs, additional qualifications are also very important in that they can increase their position on the labor market and their chances of being licensed. Approved psychotherapists, whether employed or in private practice, must also provide proof of 250 continuing education points over a period of five years to their Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), otherwise they will lose their license. The further training must take place at state-recognized training centers and be financed separately.

The options for completing further training are numerous and varied. The following article is therefore intended to provide you with an overview of central and frequently chosen additional qualifications that can already be completed during the training period. 

Supplementary qualification for child and adolescent psychotherapy

PiAs and psychotherapists have the opportunity to obtain a supplementary qualification for child and adolescent psychotherapy (KJP) during their further training. The qualification may only take place in the area of specialization in which the license to practice has been granted or is to be granted later. The advanced training makes it possible to bill private and statutory health insurance companies for the corresponding psychotherapeutic services after the license to practice and admission as a psychological psychotherapist has been granted. Thematically, the additional qualification focuses on central disorders including possibilities of treatment for children and adolescents, appropriate communication and relationship management, competencies with regard to the co-treatment of caregivers as well as elementary psychotherapeutic competencies for the treatment of young patients. From a structural point of view, the qualification does not represent an independent further training, but rather a pure further training opportunity on the basis of theory and treatment hours to be completed and verified. There is also no final examination. The treatment hours can be completed during the psychotherapy training as part of the practical work, additional self-experience is not required. 

The 200 hours of theory required for the qualification can be taken mostly in block seminars and flexible in time. The practical part is done by 5 treatments completed under supervision with at least 180 hours. Not only different age groups, but also different disorders and genders must be treated. Supervision must be carried out every fourth hour and a total of 15 of the 45 hours must be carried out as individual supervision. It is also possible to have theory hours from adult education and treatment cases from practical work credited towards the qualification. In this case, the exact regulations of the respective institutes must be observed. The latter is also important when it comes to the entry requirements for the advanced training. Often, a certain number of teaching units of theory and self-awareness is a prerequisite, as well as a certain number of hours of practical work. The costs for the additional qualification vary from institute to institute. For the theory part, about 2500 - 3000 euros are to be planned. The supervision costs are charged separately. 

Psychotrauma Therapy

Since traumatic life events play a major role in the development and maintenance of various disorders, it is possible for psychotherapists who are already licensed as well as PiAs in advanced training to expand their competencies through an additional qualification in the field of psychotrauma therapy. Some psychotherapeutic institutions also require this additional qualification for working with patients suffering from post-traumatic stress disorder or borderline personality disorder. 

During the training, participants learn new therapeutic techniques and specific psychotraumatological knowledge. Both theoretical and practical elements are integrated. The standard for the additional qualification is based on the guidelines of the German-speaking Society for Psychotrauma Therapy (DeGPT). In order to obtain the "Special Trauma Therapy" certificate, the DeGPT provides a curriculum comprising 140 hours (teaching units (UE) of 45 minutes each). This includes 7 theory modules with lectures and exercises (112 units), one of three in-depth modules (16 units), trauma therapy-specific self-awareness (8 units), the treatment of patients under supervision (20 units) and a final colloquium. In order to obtain the certificate, at least 4 psychotrauma treatments of cases with different disturbance patterns must be carried out within the framework of at least 50 treatment hours. These must be supervised and documented. Also, a complete diagnosis with at least two trauma-specific test procedures should be proven for all treatments.

In the context of psychotrauma therapy, advanced training can also be obtained for billing approval for Eye Movement Desensitization and Reprocessing (EDMR). EDMR holds a central role as a therapeutic intervention because it can bring about not only symptom reduction but also a synthesis of previously unprocessed experiences in the treatment of trauma sequelae. Despite its effectiveness, it can be counted as a mild treatment method. If one wants to bill EDMR as a health insurance benefit, which has been recognized as a method for the therapy of PTSD in adults by the Psychotherapy Agreement since 2014, one must provide evidence of at least 40 hours of theoretical knowledge of trauma treatment and EDMR. In addition, proof must be provided that at least 40 hours of individual therapy (with at least 5 completed EMDR treatment segments) have been conducted under supervision of at least 10 hours with EMDR.

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Second specialist knowledge

PiAs also have the option of completing the additional qualification for a further specialist qualification in an evidence-based and scientifically substantiated psychotherapy procedure in addition to the specialist qualification actually chosen. With this qualification, an additional billing authorization can also be obtained. A second specialist qualification represents an expansion of psychotherapeutic competence in every respect and increases the likelihood of obtaining approval under social law.

To achieve the additional qualification, it is planned to acquire 400 hours of theoretical knowledge in the respective area of expertise, mostly in the form of block seminars. Within this framework, six completed treatment cases including at least 600 treatment hours must be carried out and proven. The sessions must be supervised at a ratio of 4:1. In addition, a further element of further training is self-experience in the procedure, which must extend over at least 120 hours in order to obtain the qualification. A final examination is not required. 

Relaxation method

Relaxation techniques are a central tool in the psychotherapist's toolbox, as they can help to reduce the patient's basic level of tension if practiced regularly. During therapeutic sessions, patients can be made more receptive to content or their level of tension can be reduced after particularly emotionally upsetting sessions. This competence can also be useful for patients in stressful life situations outside of therapy. In this context, contents of the classical relaxation methods are applied, such as Jacobson's Progressive Muscle Relaxation, Autogenic Training or imaginative methods. The discussion and learning of numerous exercises, which can later be implemented in the sessions, are also an important tool for therapists when it comes to becoming aware of their own handling of stress. As with all other additional qualifications, the qualification for relaxation methods ultimately enables therapists to carry out the method and to charge for it. Proof of successful participation in two courses of 8 double hours each at an interval of at least 6 months is required. The costs for the additional qualification amount to approximately 500 €.

Group therapy

In behavioral therapy, group therapy is an important tool and can provide patients with an interactive approach to their disorder. Not only can they experience support and appreciation from other patients, but they also gain access to knowledge about the disorder that is not only conveyed in individual therapy, but is rather learned in the context of observing others. In the context of group therapy, interpersonal skills can also be developed and strengthened. According to the psychotherapy agreement, there are also certain prerequisites for the additional qualification of group therapy, which makes it possible to perform and bill for corresponding services after licensure. These include 24 double hours of theory and 60 double hours of group psychotherapy in at least two different groups. In addition, 40 double hours of self-awareness in the group and 40 hours of supervision must be completed.

Schema Therapy 

Schema therapy originates from traditional cognitive behavioral therapy and is integrative including imaginative, experiential and gestalt therapeutic strategies. Schemas" in the context of the approach are dysfunctional life patterns, which were developed during growing up and since then continuously hinder the psychological development of the patient. The goal of therapy is to identify these dysfunctional schemas and to reduce their effect on current experience in the course of treatment. 

To achieve the additional qualification in standard form, according to the guidelines of the International Society of Schema Therapy (ISST), at least 25 hours of theory must be completed, at least 15 hours of supervised role-play in groups, and 20 individual supervision sessions of 50-60 minutes each or 20 units of individual group supervision. The respective supervisor must be recognized by the ISST. In addition, two cases with at least 25 schema therapy sessions each must be presented, whereby one of these patients must have a borderline personality disorder. The minimum number of schema therapy sessions is 80. It is also important to make a certification video. This should include a tape showing a personality disorder and rated with a score of at least 4.0 on the Schema Therapy Competency Rating Scale (STCRS), a specifically initiated rating scale. Such a final rating must be made by an advanced and certified Schema Therapist:in who has not served as the Trainee:s supervisor and the two are also not very familiar with each other on a personal level. Self-experience and group supervision are optional elements in the additional qualification for schema therapy, but are recommended by the ISST. For the theoretical units there is a charge of approx. 1500 €, the billing of the supervision is also independent here.

Our conclusion

Additional qualifications form a central element of everyday therapeutic life, as they are obligatory to a certain extent after licensure and can already be helpful within further training to increase the position on the labor market as well as the chances of licensure. In addition, costs can be saved because, for example, supervision can also be used for the additional qualification within the framework of further training. The additional qualifications are offered by state-approved training centers, whereby the financing is the responsibility of the psychotherapists themselves. Examples of further training would be the additional qualifications for child and adolescent psychotherapy, psychotrauma therapy, a second specialist qualification, relaxation techniques, group therapy and schema therapy. It is important to note that each type of continuing education has its own criteria regarding the requirements for participation and ultimate certification. Also the costs for the qualifications are accordingly variable, whereby PiAs frequently receive reductions. The offers of the respective institutes are usually flexible in terms of time and can thus be integrated into the further training, albeit with decisive additional effort.