Partial inpatient psychotherapy: information & specialized clinics

Partial inpatient psychotherapy in a psychosomatic day clinic is still a relatively recent development in psychotherapy. It is a more cost-effective, independent and effective treatment alternative to full inpatient treatment. Day psychotherapy is intended to facilitate social reintegration. It closes the gap between outpatient and inpatient therapy.

Here you will find further information and selected obesity specialists and centers.

Article overview

Semi-inpatient psychotherapy - Further information

In medical care, a distinction is made between outpatient and inpatient treatment.

Outpatient therapy means that the patient only visits a practice or clinic for a short time. The patient attends an appointment and then goes home again. They do not stay in the clinic overnight.

An inpatient admission, on the other hand, is a longer stay. The patient is given a bed in the clinic and is provided with meals. For the patient, inpatient therapy means moving to the clinic until the therapy is completed. The advantage of an inpatient admission is the round-the-clock care for the patient. On the other hand, the costs are higher.

Partial inpatient therapy is a mixture of outpatient and inpatient treatment. The patient spends more time in the clinic than with outpatient appointments. At the same time, they do not move their entire life to the clinic. This would be the case with an inpatient admission.

The patient is often in the psychotherapeutic day clinic for 8 hours a day from Monday to Friday. At night and at weekends, they are at home in their familiar surroundings.

History of day-care psychotherapy

The beginnings of day-clinic psychotherapy lie in the treatment of traumatized British soldiers during the Second World War. This is also where the roots of today's analytical group psychotherapy can be found.

In Germany, the first attempts at a day clinic failed until the 1980s. One exception is the Düsseldorf Psychosomatic Day Clinic, which has been in existence since 1982. It became known underthe title "The forty-hour week for patients". This clinic is still the prototype of a psychoanalytically oriented day clinic today.

It was not until 10 to 15 years later that there was an upswing in the development of day psychotherapy in Germany. The first psychosomatic day clinic in Munich opened its doors in December 1999.

The general cost pressure in the healthcare system was a major impetus for this development. Partial inpatient treatment in a psychosomatic day clinic is considered more cost-effective.

Advantages of partial inpatient psychotherapy compared to full inpatient treatment:

  • Transitional treatment ("step down care") shortens long periods of inpatient therapy
  • Initiation and facilitation of social reintegration
  • Avoidance of the disadvantages of full inpatient treatment: unfavourable regressions under the "hospital cheese bell", stigmatization
  • Mature, physically healthy patients do not need a hospital bed
  • Patients prefer to live in familiar surroundings, but can still benefit from the advantages of intensive multimodal psychotherapy.

The range of psychosomatic day clinics

Partial inpatient psychotherapeutic care is not very homogeneous. Psychosomatic day clinics are more oriented towards classic psychiatric approaches. They can also focus on psychotherapy. Here again, a rough distinction is made between

Some of the differences between the psychosomatic day clinics are disorder-related, i.e. they specialize in diagnostic groups such as

Other differentiations address specific target groups according to life contexts.

Examples include mothers with children. They would often be excluded from intensive inpatient treatment, which is in itself indicated.

The older generation ("60 plus") also makes little use of psychotherapy, but is prescribed plenty of psychotropic drugs. The latter can be taken as an indication that there is also a comprehensive need for psychological treatment in this group of people.

In terms of terminology and content, psychosomatic day clinics should be distinguished from

  • addiction treatment,
  • youth welfare,
  • care for the elderly etc. and
  • day care centers as a whole

should be distinguished.

Night clinics should also be distinguished. Their patients are in education or work during the day. They spend the night and the weekend in the socially protected setting of a clinic.

How the psychosomatic day clinic works and how it helps

What has proved successful in full inpatient treatment should also be used in day psychotherapy. This is, for example, a multi-professional team of therapeutically trained

  • doctors,
  • psychologists,
  • nurses and social
  • social education workers.

Therapies from specialist therapists from one or more disciplines should also be offered, e.g.

  • Concentrative movement therapy
  • art therapy
  • music therapy
  • Sports and movement therapy
  • physiotherapy
  • Relaxation therapy
  • occupational therapy
  • milieu therapy

Important here are

  • the focus on appropriate and usually limited therapy goals,
  • regular coordination with the patient and within the team and
  • timely preparation for discharge with clarification of subsequent outpatient therapy.

Daily change between psychosomatic day clinic and everyday environment

Day clinic patients experience a daily change from the family/everyday environment to the therapeutic community and back again. This is associated with

  • Separation processes,
  • proximity-distance regulations,
  • intensified conflicts of loyalty, etc.

Conflicts from outside are brought into the psychosomatic day clinic, and sometimes vice versa. As a result, the patient experiences the conflict areas of everyday life outside the clinic. They can bring these into the therapy at the same time.

The steps towards change that have been worked out can be examined every evening and at the weekend to see how useful they are. This is a decisive advantage over full inpatient admission. Inpatient therapy enables rapid improvement due to the relief ("vacation from everyday life"). The conflicts of everyday life fade into the background. After discharge, however, there is often a rude awakening.

Partial inpatient psychotherapy makes it easier to maintain important contacts in the outside world. This can also be a mentally supportive pet.

Because of the daily changes, it can also be useful to involve the family or part of the family at an early stage.

Group therapy in the psychosomatic day clinic

Experiences with others, for example in the context of group therapy, are particularly important. Healing impulses from the group can be, for example

  • Supporting each other
  • Pointing out issues that you do not see yourself
  • Seeing that you are not alone with a problem
  • finding understanding
  • being able to communicate without criticism, judgment or malice

However, many patients initially shy away from group therapy treatment. They feel uncomfortable describing their own problems to strangers and having these people discuss them. After group therapy, however, many state that the group was one of the most helpful for them.

Gruppentherapie
Group therapy takes effort, but often helps the most © RFBSIP | AdobeStock

Therapists welcome group work. In the group, patients can learn to understand themselves and others better.

A much-discussed question in psychosomatic day clinics is whether disorder-related therapy is generally superior. Such concepts are very much in vogue. However, psychosomatic day clinics are often unable to offer special groups for organizational reasons. There is a lack of evidence for better results from disorder-related therapies in this context.

It is important to avoid isolating individuals within the group. The so-called "Ark-Noah principle" can help with group composition.

Daily morning and closing rounds in the psychosomatic day clinic

Another typical element of day treatment in a psychosomatic day clinic are daily morning and closing rounds. They serve as warm-up/greeting and farewell rituals. They also help to give the individual and the group stability and a fixed framework.

Therapeutic framework in the psychosomatic day clinic

The psychosomatic day clinic serves as an interface between the everyday world and the therapy room. Behavioral patterns that may also be problematic in other circumstances tend to emerge here. They should be observed, addressed and worked through therapeutically. This leads to an increased experience of repressed parts of the self and repressed feelings. This then serves to improve self-perception and conflict resolution.

This is not fundamentally different from other clinical psychotherapy. However, there is a particular intensity to the conflict situation, as the patient is currently experiencing it. In inpatient psychotherapy, they only report them from memory.

As a "part-time therapy", the psychosomatic day clinic offers help for structuring from outside with its daily program. At the same time, it also requires self-activity to structure oneself in the remaining time periods. This promotes the patient's independence and facilitates the transition to the time after discharge from the clinic.

Patients receiving day-clinic treatment are on sick leave for the duration of the day-care psychotherapy. In the final phase of treatment, on the other hand, it is possible to gradually reintegrate the patient into the workplace with the support of a day clinic.

Options for partial inpatient psychotherapy

The requirements for participation in day-care psychotherapy should be examined on an individual basis.

In principle, a clinical picture must be so severe that purely outpatient psychotherapy is no longer sufficient. On the other hand, the patient must not require 24-hour care. Treatment usually lasting around 8 hours from Monday to Friday in a psychosomatic day clinic must be sufficient.

Suitable group of people

The psychosomatic day clinic requires stable motivation for the therapy. The patient must be able to pull themselves together every day and decide to attend the clinic. The drive must therefore not be too dampened. The daily journey to the clinic should be physically and mentally possible.

In the evening and at weekends, there must be sufficient inner (self-structuring) or outer stability (environment) to prevent excessive demands or a slide into addiction or other types of destructiveness. The same applies to food intake in eating disorders.

Partial inpatient psychotherapy has roughly the same effectiveness as full inpatient therapy. There are already scientific findings on this. According to this, severely personality-disordered people benefit from day-clinic treatment in the long term. However, these test subjects had been undergoing treatment for several years.

In comparison, treatment in Germany usually lasts between 4 and 12 weeks, often between 6 and 8 weeks. Following this, patients are then transferred to outpatient therapy where possible.

Unsuitable group of people

A psychosomatic-psychotherapeutic day clinic is not suitable for

  • (still) substance addicts,
  • psychotic patients or
  • those at risk of self-harm (suicidal tendencies, traumatizing or particularly destructive environment), or
  • if the combination of the sometimes stressful therapy with family roles leads to excessive demands.

Family roles include, for example, childcare or caring for family members. In such cases, household help may be necessary (with financial support from the insurance companies).

Conclusion on partial inpatient psychotherapy

Inpatient psychotherapy is still a relatively recent development in the context of increasingly differentiated psychotherapy.

The principles and methods of treatment originate to a large extent from inpatient multimodal psychotherapy. Partial inpatient psychotherapy owes its emergence in part to its disadvantages, which include

  • high treatment costs,
  • unfavorable regression or
  • social ostracism

include high treatment costs, unfavorable regression or social ostracism.

On the other hand, it has since developed into an independent, effective and cost-effective form of therapy. It can also bridge the gap between outpatient and inpatient therapy.

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