Summary: This overview article is intended to provide you with an introduction and initial orientation if you are thinking about starting inpatient psychotherapy. I will look at individual points in more detail in future articles. My comments are based on my experience of almost 12 months in three different clinics over the last 16 years.
Not a normal clinic
Most of the people I met in clinics were there for the first time and for many it was the last step in a long period of suffering. This fits in with a “regular” hospital stay, i.e. a physiological-medical clinic, for example when the appendix ruptures or a serious accident has occurred. In my opinion, psychotherapeutic clinics are also treated in this way by the payers: So if the need is great or there is a “serious” case.
At the same time, the stay in a psychotherapeutic clinic (if only referred to in the following as “clinic”, the term always refers to a psychotherapeutic clinic) has a different meaning than it does in regular clinics. Because – and this is a difficult message for most people to understand – an absolute cure cannot be expected. The reason for this can also be summarized as follows: A 50 year old will not fundamentally change in three months. But he can redefine the direction of his path – and take the first steps.
However, it can also happen that someone with many years of therapy experience goes to a clinic. This is where they can perhaps take their last important steps.
At the same time, I don’t want to be pinned down by these statements. Human beings and their psyche are not construction kits and they certainly don’t work like a computer, even if many people like to use the analogies “hard disk” and “processor”. This short article cannot be about grasping this complexity, rather I would like to contribute to a more fruitful understanding of your own psychotherapeutic path than without this information.
But it largely doesn’t matter where you are in your process, I’m sure you can draw something for yourself from your following lines.
I would now like to briefly address the formal framework: the cost units.
Health insurance vs. pension insurance
The formal conditions should only take up a small amount of space here, as I would like to concentrate on the individual and personal factors involved in inpatient psychotherapy. However, it makes a difference who the so-called “cost bearer” of a hospital stay is. Health insurance companies usually allow more leeway in the choice of clinic, whereas pension insurance companies, as far as I know, only allow clinics that are contractually affiliated with them as treatment locations. In the case of pension insurance, the whole thing is also called a rehabilitation measure, i.e. what is commonly understood as a “Kur” (German).
An acute referral must be necessary in order to receive the benefit from your health insurance and to be able to choose accordingly. You should discuss the details of this with your outpatient therapist or GP. Ultimately, only a licensed doctor can write a referral. It is therefore advisable to know someone who already has experience with clinics.
The need: Why am I going?
It may seem trivial, but it is often not clear to the patient why he/she is going to the clinic in the first place. Many people can easily see what is not working in everyday life, where they are having difficulties or where something may be hurting emotionally. Nevertheless, it is often difficult to describe these issues in concrete and, above all, emotional terms.
Psychotherapy is a lot of emotional work. Knowing that you are dealing with grief, anger or anxiety is already a big step. So be as clear as possible about which emotions are driving you. If this is causing you difficulties, then it may be that access to your emotions is your issue.
In short: be clear about the issue you are going to the clinic with.
However, your “topic” CANNOT be: “My doctor forced me to stay in hospital!”
The decision: Voluntariness
It is best if you want to go to the clinic voluntarily and the decision was not made by your doctor or your partner. Involuntariness will only cost you time in therapy: you will need longer to arrive, to accept the therapy, to understand what is on offer, to come into contact with the patient community, in short: to be able to accept the therapy.
If you don’t volunteer, it will take weeks before you actually start psychotherapeutic work. By then, your stay may already be half over. The clinic may even send you home again because the therapists realize that you are not making any progress.
By volunteering, you lay the important foundation for the even more important basic attitude with which you take advantage of the offers.
The basic attitude
The most important thing is clearly your attitude when you go to a clinic. After all, successful psychotherapy has a lot to do with the extent to which you can engage with what is on offer. The following paragraphs are difficult to digest, especially for newcomers, because psychotherapeutic clinics turn the therapy principle familiar from traditional clinics on its head, so to speak.
While in a normal hospital stay the “system” (usually) makes the diagnosis, in a psychotherapeutic clinic you have to deliver it yourself: be open. If the medication works in a normal clinic even if the patient doesn’t actually want it to, the first golden rule here is: accept it. And while in a normal medical clinic the patient lies there passively, as it were, and lets the therapy take its course (getting an X-ray, having blood taken, undergoing an operation, being given medication and taking it, and so on), the therapy in a psychotherapeutic clinic is largely dependent on you. It is therefore about helping you to help yourself.
Self-help
If you think that the therapists at a clinic will help you by letting you sit back and just listen to what they have to say, then you are unfortunately on the wrong track. You won’t be given a toolbox or anything similar that you can then use at home to cheerfully “solve” one or two things or even reformat your “hard drive”.
In my opinion, this attitude is widespread, but – unfortunately – it doesn’t work that way. The therapists in a clinic are not much more than companions who try to show you the way. They are similar to their outpatient colleagues. The only difference is the directness, which for some may come across as harshness. In the protected environment of the clinic, you are treated less carefully and your issues are pointed out to you more directly.
So a lot of work is required of you – and it will be very exhausting. Especially emotionally, because tears may flow. So even before you arrive, you can pat yourself on the back for having the courage to take such a step.
Now it would be helpful to take courage once again, namely to accept the offers.
Accept
“What’s all this nonsense?” – this is often the reaction of newcomers in a clinical context. Many things seem very questionable and sometimes even esoteric to them. Yet the core of therapeutic success lies not least in accepting what is on offer. In contrast to drug treatments, however, a lot can be broken here – initially and certainly not with one exercise. Rather, it is the other way around, where an effect cannot occur at all because the patient blocks it internally.
I recommend simply seeing the therapeutic offerings as an experiment for yourself: “What happens to me (emotionally) when I do this and that here and there?” Of course, it must seem a bit clever to say that someone who has difficulty accessing their own feelings (especially men) can only perceive the effect of therapy to a limited extent. But if you don’t at least try to give yourself over to therapy in this sense, then this effect won’t even begin to work.
So if the therapist asks you and your fellow patients to walk around the room like an elephant, do it as well as you can. But don’t just play, try to feel what it’s like for you. And above all: have fun! And if you have the opportunity to warm up through dancing in a therapy session in broad daylight, then dance however you feel like it. But ask yourself: are you really following your desire? Or what if you were to completely freak out and dance like there’s no tomorrow?
But “accepting” the therapy means much more: maybe you don’t like the food? – Accept it. Maybe your fellow patients are annoying you? – Accept it. Maybe you think your therapist is terrible? – Accept it.
This is also part of the experiment: be honest with yourself about what the offers, the framework conditions and the setting as a whole trigger in you. Try to formulate your associated emotions as clearly as possible – and talk about them. Be open!
Openness
You can certainly get through your time in the clinic very well by simply being largely passive in every therapy session. This will make it more difficult for the therapists to work with you. However, if you are open, i.e. if you allow a glimpse into your inner self and try to be authentic, you will provide many approaches to point you in the right direction.
The exercise here is to tell your story – because all acute issues are usually connected to your past in some way – as unsparingly and unembellished as possible. This is not so easy for many people, as we are largely trained NOT to speak openly in everyday life.
So try to be able to talk as openly as possible about everything – really everything!
The different therapies
The microcosm
In a clinic, the world “outside” is recreated in a certain way. This may be an unintended consequence of decisions that have nothing to do with this circumstance. For example, the fact that new patients usually arrive every week is due to the same weekly routine and because a clinic always wants to admit new patients.
According to the “outside world”, this means that you will always meet new people—and that’s where the fun begins; or the challenges, because, as in normal life, interpersonal conflicts arise.
Accepting these circumstances means that you should be very attentive to what everyday hospital life does to you. Whenever something happens (especially internally, i.e. emotionally), it is important to listen. The microcosm of the clinic thus offers the opportunity to consider issues that also concern you in everyday life separately here, as if under a cheese bell.
This can also include the above-mentioned wild fidgeting while dancing. Where should you try it out if not here? If you are completely wrong, you will hear about it here – but it will be conveyed in a benevolent way and, above all, you will gain knowledge (if you can accept it). The therapists will help you to find the right focus (because some things are more important than others).
Look forward to hopefully having the same “problems” at the clinic as at home. The dynamics on site will make it easier for you to work on the related issues than just reporting on them indirectly in stories about home.
Group therapy
Most therapy sessions in clinics are organized as group therapy. Around ten to fifteen people come together and are guided by the therapists. I am sure that there are also economic reasons behind the decision to use this format, but group therapy also has very clear advantages: Your behavior in the group exposes your everyday behavior much more clearly than a 1:1 situation with you and your therapist.
There are also so many informal moments that speak for themselves, such as when someone keeps interrupting or gets upset after a comment. That’s good, as long as it’s genuine. In other words, try not to pretend in the group. Be as authentic as possible!
The group will usually thank you with more integration.
Individual therapy
In most clinics, individual sessions are held in addition to the group sessions. They are usually as long as a normal session paid for by the health insurance companies, i.e. 50 minutes. These sessions serve to focus on a topic or to discuss issues that you are afraid to address in the group.
At the same time, the individual sessions will not be used to discuss things conclusively, just as the all-encompassing end of the therapy can only be achieved by yourself. In other words, the joy many patients feel at finally having the therapist to themselves, as it were, is usually disappointed in that the topics discussed there are (or should be) continued in a group context.
Consultation hour
Some clinics also offer a consultation hour in the therapy plan. During this time, patients can also see other therapists and discuss a topic with them. However, these consultations are more informative than therapeutic in nature. The therapists themselves will also set boundaries in this regard and communicate the concerns for which the consultation is intended.
Creative therapies
The world of creative therapies is very diverse. To put it simply, you could say that everything that is not a talking therapy is also a creative therapy.
The therapeutic services are also divided into stabilizing and uncovering therapies. Revealing approaches aim to make previously unconscious connections or mechanisms visible or tangible for the patient by allowing them to experience themselves clearly in the therapeutic setting, for example in a behavioral pattern.
Stabilizing therapy approaches, on the other hand, do not aim to “dig further”, but rather to support coping with everyday life by providing positive experiences, for example through creative activities.
Creative therapies include, for example, music, theater, art or body therapy.
Psychoeducation
As the name suggests, psychoeducational groups are primarily intended to convey educational content. The patient should learn more about their diagnosis or the clinical picture and related aspects.
In the best case scenario, the clinic does not rely on frontal teaching, but also incorporates therapeutic elements. Ultimately, this also follows a group principle.
In the room
In most cases, you will be given a single room in a psychosomatic clinic. In fact, there are also clinics that allocate (a few) double rooms. You can argue about the reasons behind this, although I can see mainly economic and only a few therapeutic reasons for double rooms. However, if you are given a double room, the following would also apply here: try to accept this circumstance. It will certainly provide you with many moments that can be used therapeutically (see also the point on conflicts).
Either way: In your room, you have space for yourself in every sense of the word. You can withdraw, indulge in your thoughts, cry (if you are unable to do so in front of others) and also decorate the room. The works produced in the creative therapies (such as expressive painting) can be displayed in the room. I think it is important that you don’t paint pictures to look great, but that they help you as an inner anchor for emotional states or for certain experiences.
Understanding this space – your room – as the center of your therapeutic work can help to make your stay richer. You will write your weekly reports in this room, but perhaps also keep a diary (which I advise you to do). You may spend more time there than you thought, precisely because psychotherapeutic work is so strenuous. Therefore, you should feel comfortable here – and if you are not so comfortable, this could be a chance for you to check out what a room can mean and what you can do with it.
The fellow patients
One of the most important moments in the clinic is the patient community. Interpersonal contact is often what feeds the therapy work. The acute situation that arises from your fellow patients is therefore much richer in experience than if you mainly talk about your past in therapy.
Fitting into the patient community, finding your place there and keeping it is a major challenge for most people. And when I say “keep”, I don’t mean fighting or competing, but the well-founded feeling of really having arrived and feeling comfortable.
These contacts in the community will accompany you for many weeks, so it is worth engaging with these contacts with a watchful eye, whereby this eye should also be directed inwards, because the same moments that you often experience as problematic or cause you difficulties “on the outside” will certainly occur or be repeated here in the clinic. So conflicts may well arise.
Conflicts
Conflicts will probably even arise for sure. This is because every person, all of us, come into conflict with a fellow human being almost every day. Why should it be any different in a clinic?
The desire not to come into conflict with anyone is therefore already a good indication that the perception of the environment and coping with the challenges it presents is undertaken with an idealized attitude. In short, this would be a first topic for therapy.
At the same time, this is also an opportunity, as it is not usually possible to look at these dynamics and “treat” them immediately in this accompanied form in everyday life. In short: conflicts are opportunities! They hold all kinds of insights for and about you.
Friendships
Not everything is always “bad” and friendships often develop in clinics. This is encouraged by the fact that the largely open and intimate interaction with each other brings people closer together. Things usually get very personal right from the start, even if others only tell their story and why they are in the clinic in the first place.
Something like this connects quickly and you feel cared for and understood. This is good and important, also because fellow patients can also help others to help themselves. Everyone benefits from the experiences of others.
The whole thing can only be detrimental to the course of therapy if the friendships develop into a kind of youth hostel atmosphere like on a school trip. Then fun and entertainment quickly become more important than the therapeutic work, which would also be a waste of time.
The framework conditions invite you to do so: there are rules that can be broken; there are supervisors who can be cheated – and there is the opposite sex or other sexes to get closer to.
Love & intimate contacts
Yes, sexual contact can occur during longer hospital stays and sometimes patients fall in love with each other. Here too, the conditions of the very open and private encounters during therapy contribute to this.
The clinic cannot ultimately prohibit sexual contact and certainly cannot monitor this prohibition. A liaison will also go unnoticed apart from the usual requirements regarding night-time rest or similar disturbances. But it should still be discussed. Because this is also a social contact that is not the order of the day. Or to put it another way: what role does this sexual contact play in relation to your therapy topics? For example, there are people who deal with their inner pain through sexuality. In this respect, sex is nothing more than an inner distraction (mind you: sex. I’m not talking about needed hugs or caresses).
The best way to address something like this is in a one-to-one conversation. The therapist will then be able to decide how to deal with the issue further.
It is much more dramatic if you fall in love in the clinic. Because then the entire success of the therapy is at stake, as people in love are generally not treatable. The whole inner emotional structure is upset and you are then no longer accessible to therapeutic approaches. As beautiful as being in love is, it would be very counterproductive in a clinic.
While eating
There may be more important topics for many, but at least people go to the dining room three times a day. In fact, the focus here is more on contact with fellow patients than on the quality or selection of the delicacies on offer. It is therefore pointless to summarize the various offers here. There are clinics that emphasize vegetarian to vegan diets, there are clinics with three different dining rooms, which in turn represent three different focal points in the food selection.
The dining room should also be used as a factor in the formation of the patient community. Clinics often give you a fixed seat in the dining room. This usually brings you together with patients with whom you would otherwise have less contact via your other groups. The same applies here: get involved. It only costs unnecessary energy to establish your own seating groups.
Sport
Every clinic has different sports facilities, some even have almost none at all. In my experience, the rehabilitation clinic (DRV Bund: i.e. “cure”) had the best offer because it even had a complete sports hall. However, this again fits into the picture because rehabilitation measures focus on what I call “getting fit”.
In other words, psychotherapy is so exhausting for the body that I didn’t do much sport anyway. Of course, everyone has to decide for themselves, but when in doubt, the pillow was closer than the running shoes.
Nevertheless, exercise is never wrong, only the individual measure has to be found.
Structure
The strict and – typically German – early start to the day aims to give patients a sense of daily routine and structure. Many come to a clinic and have lost this completely in some cases because the stress is so great that there was simply no energy for the day. At the same time, it is largely proven that clear daily structures are also good for mental health.
As a rule, the day begins at 7:00 a.m. with breakfast before the therapies start at 8:30. Basically, it can be assumed that everyone has an individual therapy plan, depending on their own indication. This can mean that there are longer breaks of one to two hours in between and then a full day can go on until 17:00. Here too, the motto is: go for it!
The free time in between is necessary from time to time to let what you have just experienced sink in. It is worth writing in your diary here. It can also be therapeutically useful to have a lot of time, for example if you as a patient give the impression that you tend to distract yourself during therapy sessions. Instead, the therapists want you to engage with yourself, even confront yourself.
Special offers
“Don’t rush from relaxation to relaxation!” said the senior physician at the first clinic I attended. This was especially true for those who like to “distract themselves” or “use everything”. You can often tell the attitude and approach to the actual therapeutic work from the language used.
So ask yourself whether you are really getting involved in therapy or whether you have a tendency to see offers as a distraction. The environment, your fellow patients and the therapists will reflect this to you.
In short, anything that is more optional should be checked to see if you really need it. There are clinics that offer wellness rather than therapy services, even for patients with health insurance. This may seem nice, but what’s the point if you miss the chance to sit quietly in a corner and let the therapy experience “sink in” while you’re busy trying to figure out how to use the continuous shower instead?
Addictions
Distracting yourself, running away from the inner torment, having to do, take or prepare things eagerly can (!) be indications of an avoidance attitude. Taken to the extreme: addictions and dependencies can take many different forms. Playing computer games, being glued to your cell phone or watching movies can be just as addictive as smoking marijuana or drinking alcohol.
To put it bluntly: try to recognize where, how and with what you may be trying to distract yourself or fight your fears. The content can be very different – sports or actionism as well as exaggerated cleanliness or always wanting to help others etc. can also be such mechanisms (in some clinics, individuals have to sign so-called “anti-helper contracts”.
But taking your prescribed medication can also have this effect: Knowing that you forgot to take your sleeping pill can lead to even more panic. I just want to illustrate the connection between compulsiveness and the fact that this can be transferred to all sorts of things.
Packing
It is best to assume that you will be in the clinic for several weeks (maximum 12). This can mean that the seasons change significantly, especially in late spring and early spring. I would therefore take at least one set of clothing for all weather conditions. In general, however, it is advisable to wear loose, casual and sporty clothing. Unless special regulations apply (such as during a pandemic), you will spend a lot of time on the floor and with pillows and blankets. Tight jeans tend to get in the way.
Nevertheless, I always had “nice things” with me, because at some point you have to leave the hospital grounds because nobody can stand it. This could be a visit to a restaurant with others, a hike or a trip to another city. Of course, everyone can wear what they want there, but it’s nice if you have the clothes with you that you would otherwise wear in such situations.
Apart from that, the clinics usually provide extensive information about what is available (washing machines, dryers, irons) and what you need to bring (hairdryer, bath towel, bathrobe etc.). But a multiple plug has always worked well for me.
Arrival
The clinics are often located in small towns or a little (!) further away from the nearest settlement. That’s why I always found it good to be able to come in my own car – if only to be able to transport the amount of luggage. You should therefore also expect to accumulate more (pictures, clothes bought there, etc.) and that your own luggage will therefore tend to be larger.
Much more important, however, is the attitude with which I arrive! The clinic will let you know when you will be admitted. But HOW you arrive is up to you! You could say that therapy begins on the day you arrive, even if the clinic introduces you to its daily routine rather gently. By this I mean that there are a lot of formalities to take care of first and that the first three days may well pass before your individual therapy plan “takes effect” (for details, see the separate article on arrival).
However, it makes a huge difference if you make (or can make) it clear to yourself before you arrive what your intention and goal for your stay should be. And what your inner attitude is with which you want to experience it all.
Return journey
In good clinics, the day of departure is “initiated” up to 14 days in advance by making special transfer offers that do not – only – take care of the formalities. The focus here is on the challenges that you will encounter again and that could possibly lead you off the “course” you took in the clinic.
You may have to take precautions to ensure that everyday life doesn’t overtake you again straight away. Above all, this means that your environment needs to be able to adjust, but also that you need a vacation after therapy. This may sound grotesque, but psychotherapeutic treatments of this intensity are exhausting, very exhausting. In any case, you won’t come out of the clinic “recovered”. But that’s okay. You are healing inside.
Aftercare
The path has been trodden and for the most part it is not over. Perhaps it never will be. How could it? We continue to change as human beings. Therefore, in my understanding, psychotherapy is not so much about the ultimate and final cure, but about being able to regulate yourself as a human being, to look after yourself and to make the best of your life. Many of us have forgotten or never really learned these skills. Or something came up that caused us to lose touch with ourselves.
Also, because many pots are usually opened during the clinic period (three months is a long time, but rather short compared to a human life), which cannot be treated “completely”, it is usually advised to find an outpatient therapist to continue the threads from the clinic, so to speak.
Those who are already undergoing psychotherapeutic treatment need to worry less about this. At the same time, it may be advisable to strive for a change in therapy (different approach, different therapist, different intervals…). In any case, your own path now continues – hopefully with a better feeling for you and your environment!
