How do I find a therapy place in Germany?
Mental health in Germany
Mental health is often invisible. It’s often not as visual as a broken leg or broken glasses. But once there is a mental health problem, it is difficult to address. There is often still a stigma attached to it. A person doesn’t have strong nerves or is simply too weak. The list of prejudices against mental health problems is long.
However, especially since the coronavirus pandemic and the lockdowns, the topic of mental health has been in the media spotlight more frequently. The lockdown in particular, being “closed off” from public places and socialising, was not possible for many people for some time.
For many people, their homes were not always safe places, which has been exacerbated by the lockdown situation.
Last year, the German Institute for Economic Research published a study showing that queer people suffer from mental illnesses significantly more often than heterosexual people. The constant stress that queer people are exposed to or have been exposed to over a longer period of time makes them more prone to anxiety disorders, depression or even heart disease.
At the same time, the geopolitical situations in and around Europe and the world have meant that many people have moved on from their countries of origin, out of fear for their lives and in the hope of a better future. In many cases, refugees have not travelled between countries in the same way as tourists, for example. The journey that refugees have had to make to apply for asylum in a safe country is often characterised by traumatic experiences. These people also had or still have to struggle with this additional burden.
Looking at all these different factors that can contribute to mental health problems, it is clear that it is absolutely necessary for people to find a place for therapy where they feel comfortable and are on a good road to recovery.
Therapy in Germany: Who is entitled to therapy?
In Germany, there are generally two basic requirements for being able to take advantage of therapy in any form: Via your own health insurance or as a private payer. In addition to hospitalisation, i.e. a stay in a clinic or treatment in a practice with regular appointments, the health insurance companies pay for therapy. As soon as someone is in paid employment, studying or, in the case of refugees, has a residence permit in accordance with § 23 Para. 1 or § 24, § 25 Para. 4 S. 1 or § 25 Para. 5[1] AufenthG. After 18 months of residence in Germany, it is possible to claim health insurance benefits in the same way as employees, with the costs being covered by the social welfare office. (This is not a legally binding statement and should be legally checked by experts in each individual case).
Diagnoses of mental disorders could include
- Anxiety disorders
- Eating disorders
- Depression
- personality disorders
- psychosomatic disorders
- addictions
- behavioural disorders
- obsessive-compulsive disorders
In most cases, health insurance companies and practitioners are guided by the ICD, currently in its 11th edition. The International Classification of Diseases is an internationally recognised catalogue that is updated at relatively regular intervals.
People who pay privately naturally have the advantage of being able to choose from a much larger selection of therapy centres and also take advantage of forms of therapy that are not covered by health insurance. At the same time, no diagnosis is required. As long as the patient has enough money and a therapist has time, “therapy hours” can also be utilised in this way.
How do I get a therapy place?
The prerequisite is that you have found a therapist with whom you can have the four probationary hours that every patient is entitled to before a decision on a therapy application is made. These four hours can be used with any therapist. There are now many indications that a positive therapeutic relationship can be decisive for the success of therapy. In any case, patients are free to choose their practice as long as there are free therapy places available in the practice. If discrimination occurs during therapy and the therapy is to be discontinued, patients are free to discontinue their previous practice and care immediately and start looking for a new practice.
However, it is also the case that even before the application is submitted, the patient can access twelve “emergency hours” of acute treatment. In theory, anyone who requires immediate treatment and whose state of health could deteriorate drastically if no action is taken can claim these hours. Either the emergency hours are sufficient and the patient is stable enough to continue living without therapeutic support or it can serve as a kind of stabilisation before the actual long-term therapeutic treatment.
As soon as you have found a therapist with whom you feel comfortable, you can talk to them about the therapy contract. At this point, it would be helpful if you asked a general practitioner for a medical referral for psychotherapy. As a rule, your practitioner will ask you a few questions about your mental health and you will then receive a referral for psychotherapy.
What do I do if I can’t find a therapy place with a health insurance fund?
When contacting the health insurance company, you can submit the protocols and inform them that you were unable to find a therapy place in your area at short notice and that your health insurance company should offer you a therapy place in your immediate vicinity within a set period of time. If you have also tried the Association of Statutory Health Insurance Physicians, also enclose their letter if they were unable to find you a treatment place.
As soon as the deadline has passed, you can go to a therapist without health insurance authorisation. It should be clarified directly that the therapist will contact your health insurance company and inform them that a therapy place is available. In the same step, the application should be made in accordance with Section 13 (3) SGB V.
An objection can of course be lodged in the event of a rejection. You can find a sample letter for the cost reimbursement procedure on the website of the Federal Chamber of Therapists.
However, it must be pointed out that even this application for the cost reimbursement procedure does not guarantee a place in therapy, as there is again no clear legal backing.
What does a therapy contract say?
Among other things, it can stipulate that they will work together on the goals on the condition that the health insurance company will pay for the hours requested by the therapist. It also states that a possible extension of the therapy will be discussed in good time before the previous hours are used up and what obligations both parties have when working together. The following points can also be mentioned in the therapy contract:
- That the patient should bring their health insurance card with them every quarter
- The frequency (e.g. fortnightly in advance) at which the therapy sessions are scheduled
- How long a therapy session lasts (usually around 50 minutes)
- Common rules for successful cooperation
Therapy in Germany: What forms of therapy are available?
| Behavioural therapy | depth-psychological based psychotherapy | analytical psychotherapy | |
|---|---|---|---|
| Approved therapy hours | |||
| For first-time application | 60h | 60h | 160h (80h for group therapy) |
| First therapy extension | 80h | 100h | 300h (150h for group therapy) |
Behavioural therapy
This form of therapy is about recognising certain behaviours and basic attitudes and providing the patient with skills so that they can lead a significantly better life after successfully completing therapy and can cope with future events independently.
In contrast to psychoanalysis, the aim of behavioural therapy is often to recognise problems in current everyday life, not to analyse the causes from childhood too deeply and for too long, but to help the patient to help themselves. This often involves emotions, ideas and certain perspectives that can make the patient’s everyday life more difficult.
With the help of positive experiences, role plays, behavioural exercises and much more, methods are provided in psychotherapy that are intended to support the patient’s thought process. The choice of methods is always made in consultation between the patient and therapist and is often specified in the therapy contract.
One method that is used particularly frequently for anxiety disorders is so-called confrontation therapy:
"In confrontation therapy, patients (sic!) are confronted with objectively safe objectively safe situations, but which trigger strong subjective discomfort (e.g. fear or disgust), until the discomfort decreases. Until the 1970s, systematic desensitisation was the most popular treatment method for clinical anxiety. clinical anxiety. In systematic desensitisation, patients (sic!), while they are in a relaxed state, are in a relaxed state, are exposed to fear-inducing stimuli confronted with fear-inducing stimuli within a mental image."
Another example is cognitive behavioural therapy: this is less about the patient’s active actions and more about the emotions, attitudes, thoughts and values within the patient. With this method, the patient should learn to scrutinise and actively reshape their own views.
It is also always possible that different methods are used, depending on what is most helpful for the patient in the respective therapy.
depth psychology-based psychotherapy
This form of therapy is a further development of psychoanalysis, the method that goes back to Sigmund Freud. Unlike behavioural therapy, the aim is to explain and solve current problems by looking for causes in the past.
In depth psychology-based psychotherapy, it is assumed that many of the current behaviours and problems that people have are based on unresolved situations from childhood and adolescence. Unresolved conflicts and unmet needs often give rise to inner conflicts that have been carried into adulthood and thus influence our lives on a daily basis. Even if we are perhaps no longer aware of it.
Due to the time limit of depth psychology-based psychotherapy, the therapy focusses on the most important events.
Unlike behavioural therapy, this form of therapy does not provide any skills or suggestions for action.
analytical psychotherapy
In addition to the individual “basic forms of therapy”, it is of course always an advantage to look at what additional training the therapists have and to clarify directly with the therapists at the very beginning whether the therapist can provide the patient with sufficient professional support. For example, if trauma(s) have taken place, it would be a great advantage if the therapist also has specialist knowledge of trauma. This should ideally be clarified right at the beginning, although it is of course also possible that issues may arise during the therapy that were perhaps not clear at the beginning.
Why are there so few therapy places in Germany?
Demand planning is designed to avoid creating an oversupply in conurbations such as large cities, while at the same time providing sufficient places in more rural areas. As soon as a demand of 110% is reached, a certain area is closed and no further authorisations are released for the area. This demand planning applies not only to therapists, but also to general practitioners, for example.
If we now realise that demand planning is based on calculations from 1999 and that a great deal has happened in society since then, it is actually clear that something urgently needs to be done about the distribution and reallocation of health insurance fund seats.
At the same time, this leads to a situation where when therapists with a licence to practise retire, they sometimes “sell” it for enormous sums of money. Or rather, legally speaking, the health insurance licence cannot be sold, as it cannot be sold by law. Only the practice can be sold and therefore ultimately also the health insurance licence. This means that the allocation of practice licences to new therapists is also subject to very classicistic hurdles. It is very easy to find “practice calculators” on the internet, which are designed to help you get the most money out of your own practice. And for retiring practitioners, the sale naturally also serves as a pension plan.
What is the therapeutic relationship?
Put simply, the therapeutic relationship refers to the relationship between therapist and patient. In contrast to less frequent visits to other practices, which generally do not last as long, intensive discussions take place between patient and therapist over a certain period of time, during which patients may also wish to discuss very intimate and stressful topics. It is very important that a safe and non-discriminatory space is created where the patient feels safe enough to disclose certain information, emotions and thoughts. However, there are other important aspects that can be summarised in this way:
What is important for a good therapeutic relationship?
- Empathy
- Respect
- warm-heartedness
- Ethical behaviour
- Abstinence in the sense of not taking advantage of the relationship with the patient
- Compliance with confidentiality
- Necessary expertise for the respective mental health problem of the patient
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