Scope for action in psychosomatic rehabilitation

In Germany inpatient psychotherapy generally takes place in special psychosomatic hospitals. Their aims are often not clear, just as their place in the whole system of medical care. Although most of them are rehabilitation hospitals from a juridical point of view, they are many times defined as specialised hospitals which do not differentiate between treatment and rehabilitation. This lack of clear definition leads to a number of structural conflicts which largely influence the staff's scope of action and the therapeutic work. In psychosomatic rehabilitation the doctor is taking over three social roles:the role of physician, the role of psychotherapist and the role of the expert in social medicine towards the social security institution. These social roles can be understood as a complex of behavioral expectations arising from different reference systems (social security-, hospital-, treatment-, patient-system) directed towards the social position of the doctor. Within his social position the doctor is thereby involved into certain conflicts. This article will analyze the described structural problems and try to contribute to further development of the concepts in psychosomatic rehabilitation.