Portfolio of services

Psychosomatic illnesses are common diseases. Often they are not diagnosed as such immediately, because they manifest a similar progression to seemingly physical disorders, but cannot be detected using exclusively organic diagnostics. The human organism has many biological and psychological safety and response systems that help to meet all requirements as far as possible. Only when these safety systems are overloaded are error messages about symptoms or complaints triggered. If someone is “feeling unwell” or reports symptoms, the “cause” may well be based on the interaction between the person and their particular life situation.

The following disorders are counted among the psychosomatic illnesses

• persistent functional physical complaints without explanatory organic background
• somatic stress disorder, somatisation disorders, somatoform disorders
• Psychovegetative illnesses, stress disorders
• Adjustment disorders
• Acute or persistent stress responses
• Mental disorders after traumatic event
• Chronic pain syndrome/functional pain disorder
• Chronic headaches and migraine
• Chronic complex tinnitus
• loss of physical functions or atypical disorders without explanatory organic findings (e.g. paralysis, gait disorders, balance disorders), so-called conversion disorders or dissociative disorders
• Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, other eating disorders)
• Experience-related or stress-induced, depressive responses, fatigue syndrome
• Anxiety disorders, phobia
• Panic  and compulsive disorders
• Patients with severe organic diseases and reactive mental secondary illnesses
• Physical illnesses in which mental or psycho-social factors are major contributors to the progression (e.g. arterial hypertension that cannot be regulated, unstable diabetes mellitus, e.g. with concomitant eating disorder, coronary heart disease accompanied by anxiety attacks, certain forms of asthma, neurodermatitis, irritable bowel syndrome)
• personality problems due to past experiences and behaviour patterns that are firmly rooted in the character, which lead to inner emotional and interpersonal impairments and social problems

Contraindications

• Patients with primary substance-associated addiction (alcohol, drugs or medication)
• Psychoses, acute suicidal tendencies
• Cerebro-organic psycho-syndromes

Diagnostic clarification of the causes, background and influencing factors of the disease process and possible health-promoting factors takes place at the beginning of the therapy.

• diagnosis of symptoms, disturbance and background dynamics; inclusion of the organic diagnostic findings
• clarification of personal development over the course of life (biography work); consideration of the internal and external life story
• assessment of ego structure, conflicts, relationship patterns and, if applicable, family dynamics
• clinical interviews, computer-aided test diagnostics, projective methods
• participatory observation of behaviour and experience, diagnostics of interaction and symptom behaviour in common life on the ward and in the day clinic
• resource diagnostics

Individual forms of therapy:

• individual psychotherapy (psychodynamic or behavioural therapy)
• psychodynamic-interactional group therapy
• open-topic interaction and behaviour group therapy
• experience of communication and structuring of interaction within the patient community and with members of the therapeutic team (milieu therapy)
• skills training (social competence, emotional differentiation and regulation)
• role play group, training of social skills, imagination exercises (stabilisation exercises)
• relaxation training (autogenic training, progressive muscle relaxation, biofeedback)
• psychoeducational interventions (info group, book therapy, symptom and disorder-related training, anxiety, pain, depression information)
• art and design therapy
• movement and dance therapy (elements of communicative movement therapy, concentrative relaxation, Feldenkrais), body perception, self-perception and interaction perception
• music therapy
• exposure exercises (e.g. in cases of anxiety and compulsion therapies)
• accompanied eating, psycho-educative accompanied eating information in small groups, nutritional advice
• support from social workers
• trauma therapeutic techniques (narrative therapy, EMDR, screen technique, in sensu visualisations)
• activating and supportive psychosomatic basic and treatment care
• couples and family consultations
• active start in the day (morning aerobics)
• back school
• Nordic walking
• in cases of individual indication: physiotherapy, ADL training, Pelose packs, medical equipment training
• endurance training, bicycle ergometer
• active individual and shared leisure time
• targeted resilience training in everyday situations

Inpatient treatment is considered as an option according to the principle of “outpatient before inpatient”. This means it is factored into the equation if the possibilities of outpatient psychotherapy and medical treatment have been exhausted or if rapid intensive psychosomatic therapy is needed to avert imminent deterioration or even chronicity in response to severe complaints and suffering. Inpatient therapy may be indicated if it is important to achieve certain therapeutic goals quickly, and multimodal therapy involving several methods in a hospital setting is necessary; it is also considered if there are conflicts and burdens at home that require temporary extrication from this situation in order to enable any progress at all. In the event that the person has not yet acquired the capabilities for outpatient treatment, intensive psychosomatic-psychotherapeutic assistance may be required in order to create a foundation for any form of psychotherapeutic work at all. Every situation and every illness is different, so in each case there is a large bundle of aspects that must be taken into account during clarification of the appropriate form of treatment. Therefore, every patient receives detailed advice on the therapeutic options and the actual procedure. We conduct a personal preliminary discussion with each patient in order to inform them about the concrete possibilities of treatment at our clinic and to ensure that they are thoroughly prepared. Afterwards, inpatient treatment can be initiated by any doctor or psychological psychotherapist by presenting a referral slip. In most cases, however, emergency admission is only possible via the acute admission ward at the Clinic for Psychiatry and Psychotherapy.

Psychosomatic psychotherapy, which usually lasts for several weeks, is a planned treatment process that requires some preparation. In an emergency situation that leads to immediate emergency admission, the therapeutic aspects usually differ from those that are applied in a longer course of inpatient psychotherapy. Nevertheless, patients can be transferred from the psychiatric clinic to psychosomatic therapy after appropriate consultation. Both clinics collaborate very closely under the umbrella of the Centre of Mental Health.

In some cases, we decide on the option of full inpatient treatment at the beginning of therapy, followed by a day clinic phase. From the 3rd week of treatment, inpatients are given the opportunity to go on “stress days” in which they are confronted with their domestic, family or professional reality. This is initiated to encourage reflection during the continued therapeutic process and, if necessary, to make additional adjustments. These everyday confrontations are scheduled to achieve certain goals at home and at work after therapeutic preparation, or to train skills. The goal of reintegration into the private or professional environment and the development of the necessary prerequisites for this purpose are important guiding principles within treatment.

We also have the possibility of partial inpatient/day clinic treatment. We run the Day Clinic according to an integrative approach, so that the day clinic patients, like the inpatients, are assigned to one of the four therapy groups, depending on the focus of their treatment. The benefit of this organisational structure is that the treating therapist and the therapy group remain the same when switching from inpatient to day clinic treatment, which ensures a high degree of continuity. The treatment as a day clinic patient is similar to an everyday rhythm. The routine at the Day Clinic day begins at 7:45 am with arrival at the clinic and ends in the afternoon when leaving the clinic at 4:30 pm. Outpatient clinic patients organise their own evenings and weekends at home. However, the clinic can be reached by telephone around the clock.

The rhythm on the ward is essentially determined by the weekly therapy plan, by the alternation of coming and going and by the interaction within the small ward community, which experiences and organises many activities as a group, while still leaving space for individual freedom.

The Psychosomatic Institute Outpatient Clinic extends the range of treatment offered by the clinic and day clinic into the outpatient sector and creates a connecting link between outpatient psychosomatic-psychotherapeutic and psychotherapeutic specialists and psychological psychotherapists on the one hand, and family doctors and specialists in somatic fields who are active in primary psychosomatic care on the other. Establishing a link between somatic medicine and psychotherapy is therefore one of PSIOC’s main fields of work.

It offers the possibility of diagnostic consultations, crisis intervention and preparation, as well as follow-up treatment in the form of full or partial inpatient treatment.

The Psychosomatic Institute Outpatient Clinic can provide individual therapy modules, as well as combination therapies if previous outpatient psychotherapy or specialist treatment have not been successful or if outpatient therapy is not available. Inpatient therapies can be avoided or their duration shortened in this way.

The entire Städtische Klinikum Görlitz has already been certified several times according to the hospital quality standard ISO-9001. Meeting the requirements of this ISO standard ensures a high structural quality of care, especially in the interdisciplinary cooperation between the 17 clinics of the Städtische Klinikum Görlitz as a whole.

Structural quality

The clinic follows the guidelines of the professional psychosomatic association in regard to the range of therapies offered, the number of staff, the spatial requirements and the multi-professional composition of the treatment team.

The employees complete continuous further education and training.

Process quality

At the beginning of the therapy process for each individual patient, a shared decision-making process (shared decision making) regarding the individual therapy goals is established in consensus with the patient (informed consent) after appropriate information has been provided. This process is completed in order to ensure that the orientation of therapeutic focus fully accommodates the special circumstances of the patient. At the same time, an explanatory model is developed to elucidate the reasons and background for the development of the symptoms or the respective clinical symptoms, so that the causes and influencing factors can be addressed in a targeted manner. A senior or chief physician supervises this step in the therapeutic process during a detailed team conference.

Quality of results

The first step is to perform certain measurements and prepare an assessment of the symptoms and their severity. The quality of the coordinated therapeutic work is also determined in the initial phase using a special questionnaire. Some of these measurements are repeated at the end of the therapy in order to assess the changes achieved.
Weekly rounds by the chief physician and senior physician also take place. In addition, continuous intervision of the treatment processes is carried out by the senior physician and head physician, as well as by an external supervisor, in team meetings. Regular multi-professional consultations within the treatment team update and specify the focal points of the treatment process. The course of therapy is also continuously evaluated by the patient and summarised in a weekly report.
Thanks to the basic documentation covering a large number of these points, the data for quality assurance can be obtained from routine data at the clinic. In addition, as a member of the Clinotel hospital network, the Städtische Klinikum and its Psychosomatic Clinic also participate in a nationwide quality and performance comparison (benchmarking), in which many individual aspects of the treatment process are recorded.