Patients in a therapeutic setting are particularly vulnerable and looking for support in a emotionally difficult situation. The patient needs to be able to trust and confide in the therapist.
Of course, there is a power imbalance between the psychotherapist and the patient. Because of this power imbalance, the rights and dignity of the patient must be particularly protected. This is achieved by German law in several ways.
A psychological psychotherapist is legally obliged (§203 StGB) to maintain full confidentiality about the personal affairs of the patient. The duty of confidentiality is quite comprehensive. Therefore, the patient must grant the therapist exceptions to this confidentiality directly or implicitly at various points in therapy. This is done, for example, by signing the application to the health insurance company. In practice, this means that spouses or parents (in the case of adult patients) cannot receive any information about the treatment, not even with regard to the fact that treatment is taking place (see also Wikipedia: obligation to secrecy). There can be exceptions for example if a patient is suicidal. Then the psychotherapist must discuss with the patient in advance who may be informed in the event of an emotional crisis. The specific negotiation of this procedure is part of the therapy for people at risk of suicide.
Patients generally have the right to view their own medical records. This means they are allowed to view the reports to the health insurance, the reports of the referring physicians, from rehabilitation centres or hospitals.
Most psychotherapists have a habit of taking notes during the session. Each psychotherapist is obliged to document the content and course of the session. These notes also contain personal impressions of the therapist. Due to this nuance, the patient cannot request access to this type of document.
Rules of abstinence state that a therapist must not get involved in any private relationship with a patient. This applies in particular to sexual relations.
It also means that a therapist may not accept any other benefits, even if the patient is happy to offer them voluntarily. The therapist may not become friends with patients, even those who have been out of therapy for some time. It could be that the patient will need therapy or neutral advice again at a later time.
Of course, these rules are subject to interpretation and exceptions are made occaisonally. Whether this is a violation of the rules must be considered on a case-by-case basis: some may accept small gifts, others will not.
Many therapists may accept a token of gratitude such as a bottle of wine or some chocolates at Christmas, but many are of the opinion that this also violates the abstinence rule.
In Germany, it is clearly defined by law who is allowed to treat patients. These laws only permit doctors, state-approved psychological psychotherapists and alternative practitioners to treat patients. These strict regulations are intended to ensure that the practitioner has learned his or her subject. Doctors and psychological psychotherapists are also organised in chambers which determine training, further education and professional regulations.
Patients' rights are monitored by the Chamber of Psychotherapists of the respective state. They also have a complaints office. The addresses of these state chambers can be found via the National Chamber of Psychotherapists.