Introduction

Inpatient psychotherapy is a common approach to treatment of psychogenic disorders in Germany, where more beds for inpatient psychotherapy are available in special hospitals for psychogenic and psychosomatic disorders than in all other countries together (Schepank, 1987; Schepank and Tress, 1988). In contrast, child and adolescent psychiatric hospitals have very few specific psychotherapy units for children and adolescents. Therefore, inpatient psychotherapy in childhood and adolescence is usually undertaken on general child and adolescent psychiatric wards.

Fig. 32.1 shows the age and sex distribution of inpatients treated at the Hospital for Child and Adolescent Psychiatry, University of Marburg (Germany). The majority (73%) of inpatients were 12 years old or older. A breakdown of patients by diagnosis (Fig. 32.2) shows that over half were admitted for the treatment of disorders which are overwhelmingly psychotherapeutically managed, e.g. anorexia nervosa, neuroses, specific emotional disorders, adjustment disorders. This serves to demonstrate the central role of psychotherapy in the management of children admitted to child and adolescent psychiatry departments.

Indications for inpatient psychotherapy

After the indication for inpatient treatment has been decided upon (see Chapter 2 for choice of treatment), the issue of selecting an appropriate treatment modality needs to be addressed. It is possible to distinguish four different treatment modalities:

• inpatient treatment,

• partial hospitalization (day-patient treatment),

• treatment in the usual environment (home-treatment), and

• outpatient treatment.