Searching for psychotherapy in Germany

In Germany psychotherapy is usually covered by the statutory or private health insurance. Unfortunately, one might not find it easy to find a therapist with available appointments and have to tolerate long waiting periods. Some hints and a general understanding of how one can apply for psychotherapy might help to be more successful in finding a place for psychotherapeutic treatment and reducing waiting time. This text provides you with information about these issues. You can also take a look at the booklet “Paths to Psychotherapy”, which is published by the Federal Chamber of Psychotherapists in Germany and can be found here: https://www.bptk.de/wp-content/uploads/2019/09/2019-09_bptk_patientenbroschuere_englisch_web.pdf

Note that we'll explain but often not translate specific German words, if they are only used in the German healthcare system and there are no exact English equivalents. We have placed these words in quotation marks.

The Psycholocical Counselling Center for Students in Hannover (Psychologisch-Therapeutische Beratung für Studierende, ptb) provides counselling but does not offer psychotherapy. The difference between psychological counselling and psychotherapy can be especially found in the quantity of sessions and the duration of the process. Also, psychotherapy needs a diagnosis and aims to cure diseases, whereas counselling does not require a diagnosis and often follows a more preventative approach.

In which cases should one seek for psychotherapy?

Psychotherapy is used in a variety of methods designed to heal psychological illnesses. In Germany (as in other countries) almost half of the people will suffer from a psychological illness at least once in their life-span, about one in three adults every year. The most frequent psychological illnesses are: depressions, anxiety disorders (e.g. panic attacks, social phobia, simple phobias like arachnophobia…), addictions (to alcohol, illegal drugs, prescription drugs but also to gambling or gaming). Eating disorders (e.g. anorexia or bulimia) or adjustment disorders (emotional or behavioral problems after psychological strain such as death of a beloved one, unemployment, emigration, end of a relationship, mobbing…) are seen very often among the population too. However, psychotherapy is not limited to those topics. There is no clear line between psychological problems that definitely need psychotherapy and those that can be dealt with by the patient himself or herself or with the help of friends or life partners. However, if the problem lasts for a long time and if it reduces the quality of your life, psychotherapy definitely is an option. If you are in doubt, whether your problem is severe enough to look for psychotherapy do contact a psychotherapist. She or he will find out, if psychotherapy is the right thing to do or if other measures (more or less intense than psychotherapy) are to be taken. With that question you might also address the ptb.

(Psychiatric) Emergencies

In some cases, people might not need psychotherapy but urgently need instant help. In case of an emergency, please refer to the relevant institutions, such as psychiatric hospitals or the social psychiatric service of Hannover. The psychiatric hospitals offer the most urgent treatment. Every psychiatric hospital is responsible for a certain part (“Sektor”) of Hannover and the surrounding communities. A list of which clinic is responsible for which parts can be found here: https://www.hannover.de/Leben-in-der-Region-Hannover/Gesundheit/Beratungsstellen/Beratungsstellen-und-Kliniken-finden

List of psychiatric hospitals:

Also, the counselling centers of the social psychiatric service in Hannover can be referred to. There, a team of medical doctors, psychologists, social workers and others takes care of the patients. Like the clinics, every counselling center is again responsible for a certain “Sektor” of Hannover and the surrounding area. Again, the list of responsibilities can be found here: https://www.hannover.de/Leben-in-der-Region-Hannover/Gesundheit/Beratungsstellen/Beratungsstellen-und-Kliniken-finden.

In other cases, searching for (and finding) outpatient psychotherapeutic treatment can be a very good idea to work on overcoming psychological problems.

Who is Who in psychology, psychiatry and psychotherapy? Who offers psychotherapy?

Many professions in Germany are, in some extend, connected to psychotherapy. Only a few can offer psychotherapy which is paid for by the statutory health insurance companies (“Gesetzliche Krankenversicherung”). The following list might help you to differentiate between the miscellaneous professions:

A general practitioner or primary care physician (“Allgemeinmediziner”, “Facharzt für Allgemeinmedizin“) is a medical doctor who can be consulted in most cases of medical Problems. Usually, they are the first people you will look for, if you have some kind of medical issue. They also might prescribe some psychotropic medication. In more difficult cases, they will refer you to specialized doctors or other health care providers.  Usually it is possible to get an appointment with them the next day or in a couple of days. However, you do not have to go and see one of them, if you are looking for psychotherapy. If you want to look for a doctor near you, you can check the registry of local doctors: https://www.arztauskunft-niedersachsen.de/ases-kvn/

A psychiatrist (“Psychiater”, “Facharzt für Psychiatrie”, since 1994: “Facharzt für Psychiatrie und Psychotherapie”) is a specialized doctor for psychiatric problems. In Germany, they often are also specialized in neurology too and therefore are called “Facharzt für Psychiatrie und Neurologie”. It is indicated to see them, if you need psychotropic medication and your general practitioner doesn´t want to prescribe those, because for example the problem is more complex and/or the most common medication does not work properly. They usually do offer short conversations about psychiatric problems but no psychotherapy.

A specialist for psychosomatic medicine (“Facharzt für Psychosomatische Medizin und Psychotherapie“; until 2003: “Facharzt für Psychotherapeutische Medizin”) deals with medical problems, which are at least partially caused by psychosocial and/or psychosomatic factors. He or she might for example be consulted, if a specialized pain treatment is necessary.

A psychotherapist (“Psychotherapeut”) is the one, that offers psychotherapy for all kinds of mental disorders like for example depressions, anxiety disorders, obsessive-compulsive-disorders or posttraumatic stress disorders. Some of them are “Psychologische Psychotherapeuten” (psychological psychotherapists), meaning, that they have studied psychology before they became a psychotherapist, others are “Ärztliche Psychotherapeuten” (medical psychotherapists) meaning, that they studied medicine, before becoming a psychotherapist. Both kinds of psychotherapists have passed a long and very thorough, state-regulated education and examination. The latter can also prescribe psychotropic medication. The majority of the psychotherapists are “Psychologische Psychotherapeuten”. Psychotherapy of both kinds of psychotherapists is only covered by the statutory health insurance companies, if she or he has got a so called “Kassenpraxis”. That means, that they have the possibility to bill with the statutory health insurance. If they do not have a “Kassenpraxis”, they might be great therapists, but can only offer psychotherapy if you have private insurance or pay yourself. Costs can be more than 100,00 EUR/50 minutes, but there is no general rule about that. However, in some cases your statutory health insurance will accept to pay a psychotherapist, who does not have a “Kassenpraxis”. That might be the case, if you can prove, that you can´t find a psychotherapist with a “Kassenpraxis” in a reasonable time. The individual conditions for that can be requested from your insurance. That is the so called “Erstattungsverfahren” (refund procedure). It does NOT mean, that you have to pay the therapy yourself at first and get the money back later – the invoice will directly be paid by your health insurance.

There are also nonmedical practitioners or alternative practitioners, sometimes also called psychotherapeutic naturopaths (“Heilpraktiker”) who offer psychotherapy. They might also have good knowledge and might also be able to carry out psychotherapy in a good way but the title itself is not a guarantee for that, since one does not have to have a good qualification in order to get that title. Also “Heilpraktiker” are not covered by the statutory health insurance companies.

Although psychotherapy in most cases will take place in an outpatient setting, it can also happen in a clinic, either in a day hospital or as an inpatient treatment. This might be necessary, if one is no longer able to live on their own, if it is necessary to have someone looking after the patient 24 hours per day, if the circadian rhythm is strongly affected, if it is good for the patient to be out of their normal environment for a certain time or if a very complex treatment is needed. If the patient has strong suicidal tendencies inpatient treatment should be well considered.

Who pays for psychotherapy?

If you have a contract with a statutory health insurance company (“Gesetzliche Krankenversicherung”), they will pay for psychotherapy carried out by a psychotherapist (“Psychologischer Psychotherapeut” or “Ärztlicher Psychotherapeut”, see above) with a so called “Kassenpraxis” (see above). If you can proof to your health insurance (the requirements of proof can differ from company to company), that you cannot find one within a reasonable time, they will probably also pay for a psychotherapist without a “Kassenpraxis”. This procedure is called “Erstattungsverfahren”.

If you have private health insurance, you will have to look in your contract, to find out, what the insurance company pays for and what is not paid for. Many private health insurance companies only pay for a very limited amount of psychotherapy, some do not cover psychotherapy at all.

If you want to pay for psychotherapy yourself, you will have to pay about 100 EUR/50 minutes or even more, but there is no rule for that, so the costs might vary from psychotherapist to psychotherapist.

What methods will be paid for by the statutory health insurance?

In Germany, there are four psychotherapeutic methods, that are paid for. These include cognitive-behavioral therapy, psychoanalysis, psychodynamic therapy and systemic therapy. The systemic approach has only recently been added to the list of paid for methods, so finding a therapist who uses this approach might be even harder than for other methods. To get more information about the different methods, you can take a look here: https://en.wikipedia.org/wiki/List_of_psychotherapies.

All the methods can be carried out as individual therapy or as group therapy. Combinations between individual and group therapy are possible.

Okay, now I know a little about the background of psychotherapy in Germany, but how do I actually start searching for a psychotherapist?

·         You do not need a referral from a medical doctor

·         You will have to search for and contact the therapists by yourself. You can find lists of psychotherapists here: https://www.arztauskunft-niedersachsen.de/ases-kvn/ or here https://psych-info.de/

·         The first step is to find someone, who provides you with a “Psychotherapeutische Sprechstunde”. Every psychotherapist (“Psychologische Psychotherapeuten” or “Ärztliche Psychotherapeuten”) can do that, but not everyone will have free time-slots. A “Psychotherapeutische Sprechstunde” is one or up to 6 25-minutes-sessions or three 50-minute-sessions that are used to find out, if psychotherapy is indicated or maybe a consultation of a medical specialist, a hospital stay or something else would be a better choice. There, it is also decided, if an outpatient psychotherapy is needed very urgently (which might help to get support sooner).

·         If you want to find someone, who provides you with a “Psychotherapeutische Sprechstunde”, you can simply call different psychotherapists, until you find one, who has got the capacity to provide you with it, or you may get some help from the so called “Terminservicestelle” (phone: 116 117 (without area-code) in every city in Germany). This is an organization, that is supposed to help you if you want to find a medical specialist or a psychotherapist.

·         Unfortunately, if it comes to finding psychotherapy, the “Terminservicestelle” will only help you to find someone, who gives you a “Psychotherapeutische Sprechstunde”. That does not necessarily mean the person will provide the subsequent psychotherapy. Also, in some cases, the “Terminservicestelle” does not have any appointments to offer or it cannot be reached by phone, since a lot of people are calling. There are reports, that you might be on hold for up to an hour.

·         At the end of the “Psychotherapeutische Sprechstunde”, you will get a form (“PTV11”) that you will need in the further process. If there is an indication for a very urgent start of psychotherapy you will also get a special code. Only with this code for urgent treatment, you can call the “Terminservicestelle” again and ask for help for finding a psychotherapist who carries out the psychotherapy.

·         If you want to search for a “Psychotherapeutische Sprechstunde” or psychotherapy by yourself, you can get lists of psychotherapists paid by the statutory health insurance for different places. On the Internet, you can look for: arztauskunft-niedersachsen.de (only for the federal state of Niedersachsen), psychotherapiesuche.de or psych-info.de. Here you can also search for psychotherapists with the knowledge of foreign languages. Unfortunately, these search engines themselves are only available in German.

·         After having had the “psychotherapeutische Sprechstunde”, the next step will be the “probatorische Sitzungen” (between 2 and 4 50-minute-sessions). These are needed, if a longer psychotherapy (up to 60 sessions for behavior therapy, up to 60 for depth psychology therapy and up to 160 sessions for analytical psychotherapy – all of them can be extended) is necessary. If you get a so called “Akutbehandlung” (acute therapy, up to 24 25-minute sessions or 12 50-minute-sessions), you do not need the “probatorische Sitzungen”. The purpose of the “probatorische Sitzungen” for you is to get to know the psychotherapist in order to be able to decide, if you want to work with him/her. The psychotherapist will need the “probatorische Sitzungen” to develop a therapy plan. Therefore, it is necessary, that these are carried out by the psychotherapist who will also carry out the psychotherapy. If you try several therapists, you will get the “probatorische Sitzungen” for each one.

·         If you have decided, which psychotherapists (distance to your home, gender, method…) you would prefer, you will have to make a whole bunch of phone calls. Sending an email is usually not enough. You should try to reach the psychotherapist within their telephone consultation hours. If you only leave a message on the answering machine, you will probably not get called back. Note, that the only person at a psychotherapeutic practice is very often the psychotherapist him- or herself. There are no assistants, since a psychotherapeutic practice has far less patients than the practice of a medical doctor. The telephone consultation hour can be found on the search engines listed above or you will find them on the answering machine of the psychotherapist – so sometimes you will have to call twice.

·         When you reach a psychotherapist:

o   Point out, that you do have a high degree of psychological strain. Don´t say something like: “my father/colleague/friend says, I should see a psychotherapist”.

o   If there is someone who told you to go and see a psychotherapist (especially a professional person like a counsellor or medical doctor) you can also tell the psychotherapist about that, but only in second place!

o   If it is the case, tell the psychotherapist, that you also do have time in the morning or early afternoon. Appointments in the morning might be more likely to be available than appointments in the evening.

o   It can also be helpful to tell the psychotherapist, that you are a student. Some (but not all) psychotherapists especially like to work with students.

o   If so, tell the psychotherapist that you’ve already had your “Psychotherapeutische Sprechstunde”

·         If you have told the psychotherapist about your plan to get psychotherapy, you will get one of three possible answers:

1.       “I´m sorry, but I do not have any possibilities and my waiting list is closed”. With this answer the phone call is almost over. You might want to ask how long it might take until there will be a possibility to get therapy from this psychotherapist. And you can also ask, if that therapist knows someone else, who could offer psychotherapy sooner.

2.       “Oh, I´ve got a possibility next week/in a couple of weeks”. This answer is quite rare and you are lucky. But make sure, that the appointment is not just one for the “Psychotherapeutische Sprechstunde” (if you already had one). If a therapist has got time in the next days or weeks, it does not mean that she or he is a bad one. There are many reasons, why one has free capacities. Maybe she or he simply does not conduct a waiting list.

3.       “I´m sorry, but right now I don´t have a free time slot for an appointment but I can put you on the waiting list”. In that case: ask how long the waiting time will probably be. If it´s a lot longer than one year, it probably doesn’t make sense to get on that list. If it is one year or shorter, let the psychotherapist put you on the list and write down the time, that it will probably take. After about two thirds of the time, you might call again and inform the therapist that you are still interested in getting therapy. Try to get on several waiting lists, for you might not want to do psychotherapy with the first available psychotherapist (see below).

How long will it take to get psychotherapy started?

In October 2011 a study found out, that it took about 3 months on average, which is not satisfying. Since then, the situation has not gotten better. In 2022 6 months from the beginning of the search to the beginning of the therapy seem to be average. However, with a bit of luck and with a greater number of calls you make, the chances of getting a spot increase!

How do I know, if the therapist is the right one for me?

There is no general rule about who is the right one for your specific problems. Maybe, you have chosen, which kind of therapy (behavior therapy, psychoanalysis, psychodynamic therapy and systemic therapy, see: https://en.wikipedia.org/wiki/List_of_psychotherapies) is the right one for you and if you would like to work with a specific gender. After that, you should make use of the “probatorische Sitzungen” (see above) and get to know the therapist. For psychotherapy a feeling of trust and being safe with that person is needed. If you are not sure, whether you can trust the therapist, tell her or him about your doubts and see how he or she reacts. In some cases, talking about trusting the therapist can help to gain more trust fast. If you find the therapist really unpleasant for some reason, you might want to look for someone else. With a new therapist, you will get the “probatorische Sitzungen” again.