[Psychotherapy for everyone? On the indications for psychotherapeutic treatment].

BACKGROUND: The effectiveness of psychotherapy for the treatment of most mental disorders is empirically very convincingly documented; however, there are not enough therapists by far available globally to enable all people suffering from mental disorders to be adequately provided with psychotherapy. AIMS AND METHODS: Considerations are made regarding which illnesses, disorders and problems in general should be treated by means of psychotherapy, who should best conduct the treatment and in which way the dissemination of evidence-based psychotherapeutic approaches could be improved in spite of scarce resources.
RESULTS: The more severely pronounced a health problem is, the greater is normally the therapeutic benefit of a given intervention. This applies to psychotherapy as well; however, to date severely ill people in particular are often not treated with effective psychotherapeutic interventions. One of the reasons is that there are only few validated treatment protocols for multimorbid patients with both mental and physical illnesses. Another reason is that treatment of such patients requires specific medical knowledge as well as other special skills and experiences that not all psychotherapists have at their command.
CONCLUSION: The indications for psychotherapy should always be made with a sense of proportion, taking into consideration the currently available scientific evidence and clinical experience. In the future, the training of psychotherapists, scientific investigations of psychotherapies and clinical service provision should increasingly concentrate on patients with severe mental disorders and/or with psychological and physical comorbidities.