General Information about Psychotherapy
Which professional groups are allowed to practice psychotherapy?
The following paragraphs refer to the situation in the Federal Republic of Germany.
This website is intended to lay out how non German-speaking persons can access psychotherapeutic help in Germany, under the current state of law and availability of psychotherapists.
The professional title "psychological psychotherapist" is awarded to psychologists who have completed a 5-year diploma or master's degree in psychology and at least 3 years of full-time training or at least 5 years of part-time training as a psychological psychotherapist in accordance with the Psychotherapist Act (PsychThG) and who are entitled to carry out psychotherapy independently (certification). Psychologists who have not completed any further training after graduation are not entitled to treat patients. But they are, for example, in business, in the human resources department of companies, or in consulting.
Medical psychotherapist (m/f)
A medical psychotherapist must have completed at least 5 years of additional training as a specialist in psychotherapy and psychiatry or as a specialist in psychosomatic medicine and psychotherapy after completing his or her medical studies. Doctors who have completed additional training in "psychotherapy" or "subject-specific psychotherapy" with a focus on "behavioural therapy" or "psychodynamic/deep psychological therapy" or additional training in "psychoanalysis" may also offer psychotherapy. These additional training courses are shorter and less comprehensive than the training courses for specialists in the field of psychotherapy.
Child and Adolescent Psychotherapist
University graduates with a diploma or master's degree in psychology, pedagogy or social pedagogy who later wish to work psychotherapeutically with children and young people undergo specialised training to become a child and adolescent psychotherapist. This takes 3 to 5 years and allows the therapist to treat young people up to the age of 21. Doctors who have completed specialist training in paediatric and adolescent psychiatry and psychotherapy after completing their medical studies are also entitled to treat children and adolescents.
Psychiatrists are physicians (medical doctors) with a specialist training in psychiatry and psychotherapy. A psychiatrist may treat his patients not only psychotherapeutically but also, if necessary, with medication.
Neurology generally deals more with physical disorders of the brain, spinal cord, nerves and muscles and less with mental disorders. Neurologists undergo further training to become a "specialist in neurology" after completing their medical studies.
In contrast to medical psychotherapists, psychiatrists and neurologists, psychological psychotherapists and children and adolescent psychotherapists cannot prescribe psychotherapists medication or provide a doctor's certificate!
Alternative practitioner for psychotherapy ("Heilpraktiker")
In addition to the previously mentioned professional groups, some alternative practitioners are also authorised to practice psychotherapy. This requires state permission from the responsible state authority. Prerequisites for the permit are at least a lower secondary school diploma, a mimimum age of 24, and physical and mental aptitude for the profession, which must be proven by a medical certificate and a police clearance certificate. After a written and an oral examination containing questions on basic knowledge regarding mental illness, personality disorders, diagnostics, legal and professional knowledge as well as different forms of therapy, the graduates may offer psychotherapy in the sense of the law on alternative practitioners. These services are covered by some private health insurance companies, but not by statutory health insurance companies. Due to the great demand for psychotherapy among the population, the health authorities have tightened the requirements for the alternative practitioner examination in the field of psychotherapy. Nevertheless, the training of a non-medical practitioner for psychotherapy cannot usually be compared with a university degree and subsequent specialist training. Psychologists who have studied psychology can obtain a medical practitioner's permit for psychotherapy through a simplified procedure. Since there are thus large differences among alternative practitioners in the extent of the training, it is advisable to inform oneself exactly about the completed training of the offerer before starting therapy.
Since only scientifically based psychotherapy is discussed in this portal, only licensed psychotherapists are listed. This is why so-called coaches, life advisors and psychological advisors (not a protected term!) are not included here.
Public health insurance?
If you, as a patient, are dependent on having the cost of therapy covered by your public health insurance, then you can only consider the following secialist groups:
Psychological psychotherapists (licensed) with health insurance approval, as well as those who are established and work with the reimbursement of costs
Psychotherapists for children and adolescents (licensed) with health insurance approval, as well as those who are established and work with the reimbursement of costs.
Specialists in psychosomatics and psychotherapy (licensed) with health insurance approval
Specialists in paediatric and adolescent psychotherapy (licensed) with health insurance approval.
Please note that for colleagues who work with the so-called cost reimbursement procedure, reimbursement of treatment costs by the health insurance company can only be guaranteed after explicit written approval.
How do I find a therapist?
In general, you will find therapists via the Internet or telephone books. Recently, all psychotherapeutic practices with public health insurance approval are obliged to be available by telephone for three hours per week. Your health insurance company can send you a list of psychotherapists in your region upon request. Some health insurance companies specifically support their customers in their search for a therapy place. Recently, the appointment service centres (TSS) of the "Kassenärztliche Vereinigung" have also been commissioned to arrange appointments with psychotherapists. TSS will try to arrange an appointment with a psychotherapist within the next four weeks. However, you will not be able to chose a therapist in this case. If you are dissatisfied with the offered therapist, you will be referred to an outpatient clinic.
If you are looking for a therapist, you should call as many psychotherapist as possible. The initial meeting is always arranged via telephone. This requires a lot of patience. If possible, call during the indicated telephone hours. Your request for a callback is not always successful due to the large number of requests that psychotherapists usually have. Very often, psychotherapists have waiting lists. It is wise to have yourself placed on the waiting list by as many therapists as possible. There is no general limit to the number of initial consultations that you can make use of on the part of the health insurance company.
Detailed information on costs for psychotherapy and insurance coverage
Which therapist do I choose?
Similarly as you trust your dentist or GP because he treats you well and you like him, you should also choose a psychotherapist that you trust and like.
The applied therapeutic method, e.g. psychoanalysis or "gestalt therapy", is not the only important factor for a successful treatment; much more important is the experience of the therapist and the trusting relationship between him and his patient.
What is important for the initial talk?
The initial consultation gives you the opportunity to get to know the psychotherapist personally and discuss the treatment procedure. Unless otherwise agreed by telephone, you do not need to bring anything with you for this interview, except your insurance card (if your psychotherapist has insurance authorisation). All necessary formalities will be clarified in this discussion. With psychotherapists who work with the so-called reimbursement of costs, you must inquire beforehand about the costs for the initial consultation.
Ask yourself after the initial meeting whether you were able to present your request. It is the task of the psychotherapist to help you to make yourself understood, to be able to say everything. Did you feel accepted and understood? Did your therapist take enough time? Did you remain undisturbed by telephone calls and interruptions? Your therapy session, usually 50 minutes, is all yours. Disturbances should be the absolute exception. A therapist should not push his or her patients into anything, force opinions or diagnoses. The first meeting does not obligate you to anything. Afterwards you should decide at home whether you want to continue working with this therapist and then decide with her how to proceed.
Who pays for the cost of therapy?
In general, public health insurance only pay for the treatment of diseases. What a disease is is narrowly defined in the so-called psychotherapy guidelines, which have the character of laws. Psychological problems, such as depression, anxiety or eating disorders, are diseases within the meaning of the law.
If for example you have a constant arguments with your spouse or your children, then you are not ill. If you become depressed due to these problems (lack of drive, constantly tired, physical complaints, etc.), then you have an illness and the health insurance company is basically obliged to pay for the treatment. The legal basis for these matters is laid down in the Social Security Code (SGB V).
There are several ways in which psychotherapy costs can be paid or covered by a health insurance company:
Cost reimbursement according to guideline procedures
Private health insurance
As a self-payer you can freely choose a therapist and usually find one quickly. You pay the fee directly to the therapist as agreed. Approved therapists liquidate according to the scale of fees for psychotherapists (GOP). The fee can then be charged up to 2.3 times the rate that is 100.56 € for behavioural therapy. Fees are discussed on a case-by-case basis and details should be set out in a therapy contract. Social conditions are generally taken into account.
More information about self-payers
If you are insured in a public health insurance fund (AOK, BKK´s) or a substitute health insurance fund (BEK, DAK...) and wish to have the therapy costs reimbursed by your health insurance fund, you can look for a therapist who is licensed to bill the funds. If you cannot find enough information in this database, you can request it from your health insurance company.
More information on Public health insurance
As an insured of a private insurance company, the special contract you have concluded with the insurer is very important. Please enquire in advance whether your private health insurance covers the costs of psychotherapy. As a rule, private health insurance companies also require a consultation report. The same applies to the combination of allowance and private insurance.
More information about private insurance.
How much do I have to pay myself?
As member of public health insurance you generally do not have to make any additional payments.
Duration and course of psychotherapy
The duration of psychotherapy can vary greatly from case to case. In purely formal terms, the health insurance fund distinguishes between short-term psychotherapy and long-term therapy. The short-term therapy lasts 24 sessions (approx. ½ year). The long-term therapy must be specially applied for and can last up to two years. This depends on the scope of the problem to be dealt with and the procedure. The treatment duration of 80 sessions (approx. 2 years) is generally not exceeded. In severe cases (e.g. treatment of massive trauma), a longer treatment is possible if justified to the insurance company. An exception to this rule is psychoanalysis,which can take several years. There are only few practitioners approved for psychoanalysis.
The therapeutic process
At the beginning of treatment, a so-called "psychotherapeutic consultation" is obligatory for members of public health insurance. The necessity of psychotherapy or other measures (hospital admission, counselling centre, or no treatment at all) is determined within this session.
At the end of this consultation, which can comprise up to three sessions, you will receive a form in which the result of this consultation will be recorded. The following further steps could then result - depending on the situation:
-The patient has problems, but these are to be treated by other measures (self-help group, counselling centre, addiction counselling).
-The patient has serious, urgent problems and acute treatment is recommended
- The patient should undergo regular psychotherapy.
Once insurance has approved to cover the cost, the psychotherapist will discuss your history with you, involving questions about the history of your problems, and possibly carry out some test procedures. On the basis of these examinations, the psychotherapist acan assess your problems. Afterwards he or she can plan the further course of treatment with you. You then discuss goals, what needs to change, which behavioral problems and internal conflicts should be addressed. In the course of the therapy, the psychotherapist will check whether the course of the treatment is still appropriate.
Every psychotherapist is obliged to keep a record of the course of the session during or after therapy. These records are of course strictly confidential. The therapist is subject to the same confidentiality as a doctor or a lawyer.
The psychotherapeutic treatment usually ends with the final discussion. In this discussion, the course of the treatment, the implementation of what has been achieved in everyday life and the further development possibilities are discussed once again in summary. The insurance provider (= health insurance company) is then informed about the end of the therapy. In certain cases a so-called relapse prophylaxis is agreed. At greater intervals, supporting, stabilizing discussions are held to ensure the long-term success of the treatment. With long-term therapy (i.e. more than 60 sessions), up to 16 such follow-up sessions are possible. These must also be applied for and approved.
What can I expect from therapy - and what not?
Each session will usually last around 50 minutes, in rare cases 25 minutes. You will usually have a fixed, weekly appointment. The psychotherapist has the right to demand a fee if you are absent without cancelling your session with a valid reason. The details are regulated in a therapy contract.
During the session, the psychotherapist will focus on you. He or she will listen to you carefully and address important things and issues related to your problems. This will help you to find your own ways and solutions. The amount of time spent in therapy is not decisive, what is important is what you make of it. A good psychotherapist is proud when the therapy becomes " no longer necessary ", because you have taken over the responsibility for your own life again. A therapist will give you his/her time, empathy and understanding. Patience and friendliness, but above all competence and experience is what you can always expect from your psychotherapist.