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HEALTH

How to find available therapists in Germany

It’s no secret that mental health care can be particularly tricky to access in Germany. Here are some helpful tips for anyone who is struggling to book an appointment for therapy.

Mental health button
Button reads "mental health". Seeking acute help through psychotherapy. is one way to take care of your mental health. Photo: picture alliance/dpa/pro psychotherapie e.V. | momius /stock.adobe.com

The process to find psychotherapy in Germany’s urban centres is arduous – licensed therapists often have impossibly long wait times, and private practices don’t accept public health insurance.

A major reason that public insurance funded mental health care is hard to find in Germany comes down to regulations. Specifically the ‘coverage plan’ (Bedarfsplanung) that basically limits the number of licences available for publicly insured therapists in a region.

Germany’s maddening bureaucracy probably won’t be fixed any time soon. So residents in need of therapy will need to find a way through the system as it is.

So here are a few helpful tips for finding therapists, as well as how publicly insured patients can have private practice therapy costs reimbursed.

Look for therapists enrolled at academies

You’ll probably have a better chance getting an appointment with therapists who are currently in training, because not everyone knows that this option exists.

You can search for “Akademie für Psychotherapie”, to find one in your location. The Berliner Akademie für Psychotherapie, is one in the capital city, for example.

If you arrange an appointment this way, you can expect to be connected with a grad student therapist in training who needs to complete their supervised practice hours. In this case, you would see your therapist as usual, and they will be going through your session with an experienced therapist afterward.

The main advantages to seeking a therapist in training is that it may be cheaper and you can probably more readily find an appointment. A potential disadvantage is that the therapist you’ll be seeing is less experienced. 

But according to a Stockholm University study, student therapists who receive regular feedback from supervisors may be just as effective as licensed therapists at treating patients.

How to get reimbursed for going to a private practice

As mentioned above, therapists covered by public health insurance are few and far between, especially in many urban centres, and therefore regularly come with long wait times. But for those willing to do battle with the bureaucracy, there is an option to have your costs reimbursed for seeing a private practice therapist.

Specifically, public insurance providers are obligated to provide full reimbursement of costs in the event of a “supply emergency”. 

Waiting times of more than three months are considered unreasonable. So generally, patients can claim a supply emergency if they have contacted several therapists, and none of them offered available appointments within that time frame.

But you’ll want to make sure that your process is properly documented so that you won’t be stuck with the out-of-pocket costs.

First, you’ll need to document your need for psychotherapy. To get this, make an appointment for a psychotherapeutic consultation with a practice in your area, and be sure to collect a written recommendation for treatment (a PTV 11 form). 

If you don’t know where to start with this, look to the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) for a database of therapists. You can also call 116 117 or use the 116 117 App.

After you’ve got your PTV 11 certificate, you’ll need to document your futile search for a licensed therapist. To do this, contact at least three to five therapists that have public health insurance approval. Keep a list of the names of therapists you contacted, as well as dates and times of contact and how long the waiting list for treatment is. 

Additionally, you should try to arrange treatment through the aforementioned Association of Statutory Health Insurance Physicians, and receive confirmation if it’s not possible. So you’ll need to call 116 117, or use the 116 117 App again. But this time go through the process to have them try to find you placement with a therapist. This should take a maximum of four weeks, but rarely happens.

Finally, if you have documented all of the above and have still not found a readily available therapist, then you can seek out a private practice. You’ll need to enroll as a self-paying patient initially, but then you can submit an application for an outpatient reimbursement (Kostenerstattungsverfahren) along with the previously collected certificates and proof of your search. Private practice therapists are usually familiar with this process, and may be able to help you with the application as well.

READ ALSO: What are the main reasons internationals in Germany turn to therapy?

Free phone consultations for students

Students in Berlin can also take advantage of a free 50-minute conversation with a therapist through StudierendenWERK.

For students elsewhere, it’s worth checking what kind of mental health support services your school offers. Many German universities offer mental health support to some extent, and if school counsellors can’t provide the care that you need, they may be able to offer helpful information about where such services are available in your area.

READ ALSO: Here’s how you can get mental health help in English in Germany

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OPINION AND ANALYSIS

OPINION: Why it’s becoming harder to get a doctor’s appointment in Germany

Germany's health service is known as one of the best in the world but securing a timely appointment with a doctor is getting harder. A creaking system and the culture around excessive doctor visits are part of the problem, argues Brian Melican.

OPINION: Why it's becoming harder to get a doctor's appointment in Germany

Germans have always been known for being health-conscious – some would even say hypochondriacs. That has its down-sides (see Covid…), but also some notable advantages. One is the ability to go to any doctor’s practice and request treatment, skipping general practitioners, referrals, and all of the attendant bother.

As a result, in any well-to-do area of a major German city, you’ll have a bewildering array of medical practitioners within walking distance, from general physicians (Allgemeinmedizin) and orthopaedic practices (Orthopädie) to ones that will have you Googling (HNO stands for Hals-Nase-Ohren – ears, nose, and throat – by the way. You’re welcome.)

The strength of this patient-choice system is that it allows people to manage their own care. So if one doctor can’t see you, you go and find another. And if you’ve moved towns or fall ill away from home, you can still access care. In theory, this spreads demand and keeps people with non-urgent complaints out of casualty wards. Yet in practice, the system is now creaking audibly. 

In recent months, I’ve tried to get appointments for several routine procedures with doctors’ offices I have been visiting for years – and the earliest I could get anything was, to my surprise, now several months off. Both dentists and dermatologists are currently, it would seem, planning their schedules for September and October. And when a rather unpleasant case of shoulder pain struck earlier this year (fittingly, just ahead of my 39th birthday…), the earliest appointment I could get at any of the three(!) local orthopaedic practices was at least a month off.

This isn’t just me getting unlucky here. In a recent representative survey, only 25 percent of respondents reported having no trouble getting a doctor’s appointment. The rest are having to wait anything between two weeks and two months – and I’m clearly now one of the 15 percent who report even longer delays. 

I’m not alone in thinking – knowing – that it didn’t used to be this way. So what has gone wrong? 

READ ALSO: Seven things to know about visiting a doctor in Germany

Structural changes in medical practice: fewer doctors working fewer hours

First off, there are changes afoot among Germany’s niedergelassene Ärzte – literally ‘settled doctors’ with surgeries, called so in order to distinguish them from hospital medics. For one, these doctors are getting old and retiring – just like the population they serve (or rather: have served). And as younger cohorts are less numerous, physicians looking to pass on their practices are having difficulty finding takers – especially in disadvantaged urban areas or out in the sticks.

A patient undergoes a consultation with his doctor.

A patient undergoes a consultation with his doctor. Photo: picture alliance/dpa/AbbVie Deutschland GmbH & Co. KG | AbbVie Deutschland GmbH & Co. KG

Even where there is no shortage of potential successors, ever fewer of them actually want to set up in business for themselves. For most young medics’ taste, there’s too much paperwork, too much commercial risk, and far too much work involved in running their own surgery. Instead, they prefer to merge with others or sell on to management companies who will, in turn, employ them (often part-time, with no annoying evenings or weekends on call). 

The results of all of this are as follows. Within the space of just one year, between 2022 and 2023, the number of surgeries fell by 1,987 – a drop of over two percent. Meanwhile, in 2023, for the first time ever, more than one third of Germany’s 150,000 non-hospital doctors were employees, not self-employed. That’s twice the number in 2013. Moreover, over the same period, the number of medics opting to go part-time has gone up by 235 percent to 60,000. This means that, if your local surgeries haven’t closed, the likelihood is that the doctors there are now working fewer hours – and so there are fewer appointments left to go round.

READ ALSO: Do doctors in Germany have too little time for their patients?

This would be bad news for any society, but it hits particularly hard in Germany. As a rapidly-ageing society with a relatively unhealthy population (high rates of smoking and obesity), our demand for medical services – often for complex chronic illnesses – is rising just as provision is declining.

Cultural differences in consulting doctors

Another problem is that Germans are accustomed to a historically high number of available doctors – and as serial worriers (and passionate sick-note seekers) make excessive use of them. Your average German racks up almost 10 consultations a year – not including visits to the dentists! The OECD average is closer to six. And the stoic Swedes, strong silent types that they are, go the doctor’s just 2.3 times a year.

Even if I wanted (or needed) to, I simply couldn’t to get to the quack’s almost once a month: I don’t have the time and they don’t have the appointments. But in conversation, I notice that others clearly do manage to find both. Increasingly, I’m wondering how many of them, unlike me, have private health insurance. 

This brings us to the third major issue facing non-hospital care in Germany. When the figures in the representative survey I quoted above are broken down, it transpires that almost 60 percent of people who are insured in the state system (gesetzlich versichert) are now waiting longer than two weeks for an appointment; among those who are privately insured (privat versichert), that figure is only 37 percent.

Doctors ‘keen on private patients’ 

Doctors are keen on private patients because their insurers pay more for the same procedures and will also cover all sorts of supplementary stuff – from the clinically-proven through to the just plain wacky. As such, practices reserve as many appointments as possible for private patients and try to keep the rest of us at bay.

Given that around four in five people in Germany are in the state system, however, this leaves the majority of patients competing for the minority of slots. If you want to see how the other fifth live, try “accidentally” clicking privat on surgeries’ online booking tools: you will now see a range of appointments available within days while the rest of us are being fobbed off for weeks or even months.

Not only is this, as my grandmother used to say, enough to make you want to join the Communist Party – it’s wildly inefficient. By restricting the hoi-polloi to slots often months off, doctors are creating their own appointment-management problems: sometimes, the complaint in question will have disappeared by the time the consultation rolls around; more often, it will have actually been dealt with – not infrequently by the same physician – if the patient presents as an acute case earlier.

As such, slots weeks away are booked, only to be cancelled later by conscientious patients (and left blocked by others), while those same patients crowd into waiting rooms begging to be seen urgently at an open surgery. (That’s how I got my shoulder looked at.)

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

The cynic in me says that, in the long run, this might not be such a bad thing. If the increasing scarcity of doctor’s appointments gets Germans thinking about whether they really, really need to be seen for yet another case of the common cold (“No, Christian, it isn’t pneumonia this time, either!”) or various nebulous self-diagnosed ills (Kreislaufbeschwerden (circulatory problems) is the day-off-work-one I love to hate), maybe it’s not a bad thing.

Swedes don’t die unnecessarily because they avoid the doctor’s: in fact, they live a good year longer than us on average. The German in me, though, says: “My shoulder hurts. Maybe I’ve got early-onset arthritis. I should probably go and get it checked out…” And even though I don’t go too often, I’ve got used to being able to see a specialist when I need one. It’s a shame that this is becoming markedly more difficult.

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