Psychotherapy

Psychotherapy is a form of treatment based on the interaction of two or more people. In psychotherapy, a person talks with a psychotherapist or in a therapy group, for example, about the things they need help processing. Through discussion, they can process difficult experiences and try to find solutions for them. The client of a psychotherapist may be an individual or a couple, family or group.

Psychotherapy is based on interaction between people, but it not just everyday chit-chat. Psychotherapy is a treatment method with clearly defined goals. Discussion aims to remove or alleviate suffering caused by mental disorders or other problems in life. Studies have shown that psychotherapy is an effective treatment for depression, amongst other things.

Conversation help is available from many different groups of professionals, and talking to someone you trust is often helpful. Actual psychotherapy can, however, only be given by a trained psychotherapist. Read more about using the title of psychotherapist and training required for a psychotherapist on the National Supervisory Authority for Welfare and Health, Valvira's site.

There are many different approaches in psychotherapy. The type of practice influences the point of view from which the problem is discussed, for example. Depression, for example, can be viewed from the perspective of childhood experiences or the depressed person’s models of thinking. The angle selected affects how one tries to address the problem. The various approaches often complement each other and can be used in parallel.

In practical work, psychotherapists apply several approaches and previous experiences. Interaction between the psychotherapist and the client and how well it functions are important for the treatment.

Seeking psychoterapy

You can seek psychotherapy

  • privately, i.e. paying for the cost of treatment yourself or
  • through public healthcare, i.e. by means of KELA's rehabilitation allowance.

If you seek psychotherapy independently, you don't need a doctor's certificate. You can contact a psychotherapist directly and discuss the possibility of starting treatment. To ensure quality of therapy, be sure to choose therapist who is entitled to use the professional title of psychotherapist granted by the National Supervisory Authority for Welfare and Health Valvira. Contact information for psychotherapists is available in the health centre of your town, for example Helsingin psykoterapiayhdistys ry. and the Finnish Psychological Association sites have a list of psychotherapists (sites only in Finnish).

When psychotherapy is started independently, the customer pays for it themselves. Prices of psychotherapy vary between service providers. One visit costs from a some tens of euros up to approximately one hundred euros. There are usually 1–3 visits per week.

Brief psychotherapy is limited in time and there is usually one visit per week. The total number of visits varies from a couple of visits to 20–30 meetings. Long-term psychotherapy may be necessary in the case of severe problems. Long-term psychotherapy may last several years with several meetings a week. The approach used in therapy and your individual situation determine how many months or years psychotherapy will last in your case.

If you seek psychotherapy through public health care, you need, amongst other things, a diagnosis made by a doctor and a sufficiently long treatment relationship before being able to apply for KELA's subsidy. To start, you can contact a health centre doctor or occupational health services, for example.

KELA's rehabilitation allowance

People aged 16–67 years may be granted KELA's rehabilitation allowance for individual, couple, group or art therapy. For young people aged 16–25, family or music therapy is available. For children under 16, KELA only covers psychotherapy as a part of family rehabilitation.

Psychotherapy is often too expensive without the rehabilitation allowance. The allowance is only available based on medical grounds. Consequently, psychotherapy must be applied for through a doctor. This site explains how you should proceed if you want to obtain KELA's rehabilitation allowance. For more information about the rehabilitation allowance, see KELA's site.

“A monetary subsidy is available for psychotherapy if a doctor has evaluated that the person in question needs psychotherapy. In addition to an evaluation of the need, it is also assessed whether therapy can help the person to remain fit to study or work.”

Seeking psychotherapy can proceed as follows, for example:

  • A person is depressed or otherwise feels that they need help.
  • They go to occupational health care, health clinic or private clinic.
  • After some visits, they are diagnosed with a mental illness, such as depression requiring treatment. The diagnosis is made by a psychiatrist, occupational health doctor or other doctor. Diagnosis by a doctor is a prerequisite for obtaining psychotherapy subsidised by KELA.
  • After diagnosis, the person starts to receive treatment for their problem, such as conversational help and/or medication. After a minimum of three months' treatment, a psychiatrist or a doctor in the process of specialising in psychiatry evaluates the need for rehabilitation and writes a certificate recommending that psychotherapy is started.
  • This doctor's certificate must include an explanation of why psychotherapy is needed as well as a recommendation of the duration, approach and goals of psychotherapy. A psychiatrist only recommend seeking psychotherapy when they feel it is necessary and useful.

When a person has received a doctor's certificate, they can:

  • Find a suitable psychotherapist.  KELA only grants allowance for treatment given by a psychotherapist who has the right to use the professional title of psychotherapist granted by the National Supervisory Authority for Welfare and Health Valvira (previously TEO). This can be checked with the psychotherapist.  KELA also checks the information of the psychotherapist when processing the application.
  • If the selected psychotherapist is not a psychiatrist, the treatment relationship with a psychiatrist must also continue.
  • Apply for the rehabilitation allowance from KELA.
  • Wait for a decision.
  • If the decision is positive, start psychotherapy subsidised by KELA.

How much therapy does KELA reimburse?

KELA has specified a so-called fixed fees, based on which the reimbursement is determined.  Any additional cost is paid by the customer themselves. The cost of one therapy session varies from a some tens of euros up to approximately one hundred euros. For individual adult therapy, KELA reimburses some 37–45 euros per visit, and for individual therapy for young people, some 52–60 euros per visit.

KELA makes decisions concerning psychotherapy for one year at a time. During one year, KELA reimburses a minimum of 25 and a maximum of 80 therapy sessions. If you need long-term psychotherapy, KELA may grant an allowance for a maximum of three years in total. A maximum of 200 visits are reimbursed if the therapy lasts three years.

What if KELA doesn't reimburse the therapy?

  • You can appeal to KELA to change its decision.
  • If your financial situation allows it, you can seek psychotherapy independently without the subsidy from KELA. In this case, you don't need a certificate from a psychiatrist.
  • It is sometimes possible to receive a subsidy for psychotherapy from health insurance. This option is worth looking into before starting psychotherapy.
  • If you can not pay for psychotherapy yourself, you can continue with your doctor and utilise other sources of conversational support offered by public health care. In addition to your own doctor, you can visit a psychologist, for example, or a nurse specialising in mental health.

“KELA has granted the subsidy for psychotherapy in most cases. In 2009, some 81.7% of rehabilitation decisions concerning psychotherapy for adults were positive. Some 13.9% of decisions were negative. In the case of psychotherapy for young people, 82.7% of decisions were positive and 12.8% negative.”

If you feel like you need psychotherapy but the psychiatrist does not recommend it for you.

If the psychiatrist treating you feels that there are no grounds for recommending psychotherapy, you can:

  • seek psychotherapy independently
  • ask the doctor to explain why they have not recommended psychotherapy for you
  • monitor your situation together with the doctor and later re-evaluate the need for psychotherapy
  • ask for a second opinion from another doctor
  • utilise conversational support offered by public health care

Cooperation with your psychotherapist

The most important factor for the success of psychotherapy is the relationship between the psychotherapist and the client. As a result, it may be a good idea to meet with more than one therapist and make sure that the relationship with the therapist works.

In the beginning, the psychotherapist asks about the person's past and current life as well as the issues they are seeking treatment for. There may be some 1–3 of such interview sessions at the beginning of treatment. Pay attention to what the relationship and talking with the psychotherapist feels like. It is important that you feel valued and heard and that the cooperation works well.

A good psychotherapist actively involved in the therapy session, which may be seen, for example, as a genuine, empathetic interest towards your life. A therapist does not moralise, disapprove or belittle what you have experienced. It is also often considered a good characteristic that a psychotherapist does not offer too much advice or push their solutions, but lets the client decide which possibilities for change they will take. A good therapist knows in what issues they can help their client and where they cannot.

People usually go to therapy because of difficult issues, and processing them often feels hard. This is basically unavoidable. Sometimes the situation may become so difficult that a person might want to stop therapy or change therapists. It would still be good to try to evaluate the atmosphere and functionality of conversation separately from how these discussions sometimes feel.

“Difficult issues are discussed in psychotherapy and going to therapy requires persistence. After a session, however, you may be left with a thought or an idea that helps you forward.”

It is good to talk openly about your feelings and possible problems in the therapy relationship. If you feel that you don't want to continue working with the same psychotherapist, you can also try another therapist. Also in that case, give it some time to get to know the therapist before evaluating what your relationship will be like. This is naturally different if the interaction simply does not feel good and functional.

We sometimes may place unrealistic expectations on psychotherapy or the therapist. It is good to understand that psychotherapy is not a magic trick that removes all problems from life. A psychotherapist is also not superhuman who has answers to all your questions. The role of psychotherapist varies and may be more guiding in some approaches. The goal is, however, to help you find the things and solutions that matter for you. It's about your life, which is why you are the one who has to work for change. In an optimal situation, psychotherapy can help and support you in this.

“I noticed that I am the one who has to do the work. No one can offer ready-made solutions for my life.”