[The frequency and duration of psychoanalytic therapy in social insurance settings. Comments on a controversy]

In early 1993 Germany's health care insurance system decided to exclude high-frequency analytic therapy involving four to five sessions weekly from the list of medical treatment covered by the health insurance provisions. In the present journal the controversy about the frequency and duration of analytic therapy and the efficacy of high-frequency, long-term analytic treatment as opposed to low-frequency psychotherapy has been reflected in the form of a critical commentary (Kaiser, 9/1993) and a review article (Trimborn, 11/1993). Thomä rejects the assumption that high frequency and long duration are invariably necessary conditions for success, advocating greater flexibility in making frequency and duration dependent on the actual changes achieved in the patient's condition by ongoing therapy. The author calls for the employment of differential, "adaptive" indication criteria, his main criticisms being levelled at the form of psychoanalytic training that fails to school young analysts in the selection of the procedures best suited to individual patients. As it is a generally accepted fact that psychic changes take time, the author concludes that successful therapy is not a matter of frequency but a function of extension over time, thus making duration of therapy the operative factor.