What is considered to be emotional suffering by psychotherapy patients and their therapists in Eastern versus Western Germany? : A mixed-methods study

Abstract

PURPOSE This study examined what aspects of life in Eastern and Western Germany are considered by patients, therapists and society to cause (or indicate) emotional suffering so that outpatient psychotherapy is sought and warranted.

METHODS In Germany, psychotherapy is covered by health insurance after patients submit an application accompanied by a written report from the therapist. We took a random sample of such applications and performed a qualitative text analysis of the reports, identifying all text units where some form of emotional suffering, distress or handicap was described. A coding system was developed based on the units, and all units were subsequently coded. The proportion of units per category was compared between reports from Western and Eastern Germany using chi-square tests.

RESULTS Out of 500 randomly selected reports, 25 were from Eastern Germany. An age- and sex-matched sample from Western Germany was added. From these 50 reports, a total of 716 text units describing some form of emotional suffering were extracted (359 units from reports from Eastern Germany and 357 from Western Germany). Thirteen categories of emotional suffering emerged. In Eastern Germany, emotional suffering was considerably more frequently described in terms of somatic symptoms and in feeling nervous and tense. Patients from Western Germany were more often described as feeling depressed and hopeless, helpless, anxious and without drive (ϕ = 0.19, p = .02).

CONCLUSION There is evidence that there are differences between Eastern and Western Germany in how emotional suffering is expressed and/or described.