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Mental health

Berlin needs help: How to get therapy in Germany

Why is it so difficult to get therapy in Berlin? For English speakers, the German mental health system is notoriously tough to navigate. We break it down.

Illustration: Rebecca Hendin

Berlin needs help

Berliners are miserable. What might seem like a very subjective statement is actually a hard fact. In 2021, Berliners were awarded the undesirable title of being the unhappiest people in all of Germany by the SKL Glücksatlas.

What exactly is it that makes it so unbelievably hard to find psychotherapy in Berlin?

While, as of 2022, Berlin is no longer considered the unhappiest state, they’re still in the bottom three. This is hardly good news, but when you give it some thought, it’s not all that surprising. While Berlin is a city that invites people from all over the world, it’s also a place that can feel closed off: the endless lines at the Bürgeramt, the near-impossibility of finding permanent housing, underpaid work, and, well, sometimes just the closed doors of an Edeka on a Sunday morning.

It’s hard to pinpoint the exact causes of unhappiness exactly, but for people born here, it might be the history of wars and crises, and later the shock of being reintegrated into the global system and subsequent waves of gentrification. For newcomers, it could be because leaving your place of origin and settling into a new home can be difficult due to transient friendship circles and, sometimes, growing apart from friends and family back home.

It’s not that Berliners aren’t trying to get help, but finding psychotherapy is particularly difficult here. In fact, the system is set up to make it hard: access to psychotherapists who are covered by public health insurance is intentionally restricted, the pathways to therapy are littered with paperwork, and there’s very little information on how to navigate the system in German, let alone in English. Therapy has come to resemble an informational Wild West: Berliners are trading secrets like they once did Covid vaccine appointments, trying workarounds and jumping through hoops to get the help they need. Scores of Berliners are looking for resources to take care of their mental health, and what these Berliners rapidly realise is that it’s far harder than you’d ever imagine.

Why Is It So Hard to Get Therapy?

Illustration: Rebecca Hendin

But what exactly is it that makes it so unbelievably hard to find psychotherapy in Berlin? The problem is not that there aren’t enough therapists – it’s that there aren’t enough Kassensitze, or licences, for therapists covered by public health insurance companies. Without a licence, therapists have to ask their patients to pay themselves or to jump through many complicated hoops to get the therapy paid for.

While the Kassenärztliche Vereinigung (Association of Public Doctors) couldn’t provide the exact number of people who are currently waiting for a therapy spot in Berlin, they confirmed a sharp increase in placement requests over the last few years, especially since the beginning of the pandemic. The number of people looking for psychotherapy in Germany rose by 40%, and a majority had to wait over six months for treatment, according to the RBB. The fact is: there clearly aren’t enough public licences to meet the demand for therapy.

When our team set out to understand how exactly Berlin got to this point, we immediately hit on a key term: Bedarfsplanung. It literally translates to ‘plan of need’, but ‘coverage plan’ would probably be more accurate. The Bedarfsplanung is there to ensure sufficient health service coverage based on need across Germany, and it does so by setting a maximum number of licences per region. The idea is that without this restriction, many doctors and therapists would move to urban centres, where we would end up with an overabundance of medical coverage and gaps in rural areas – ironic, given the situation now.

Ann Marini from the Gemeinsamer Bundesausschuss (GBA) describes it as an estimate of how many psychotherapists a given patient will have to see in their lifetime. This is done for all types of healthcare, not just therapy. “The psychotherapists are in a category that is comparable to a gynaecologist or paediatrician,” says Marini. “This is a doctor I might need more often in my life, but perhaps not quite as often as a general practitioner.” According to Marini, a psychotherapist should be easily accessible but probably doesn’t have to be located as close to patients as other doctors, all of which is taken into account in the Bedarfsplanung.

If that sounds fairly logical, think again. What sounds sensible from a bureaucratic point of view is a nightmare from the perspective of a prospective patient. This approach has helped engineer a veritable labyrinth of public healthcare, one where various organisations are tugging different strings and an underground market has emerged to fill the gaps.

Licence to Save Lives

The Kassenärztliche Vereinigung (KV) Berlin is the association of public doctors in Berlin. Their federal counterpart is the same organisation that runs the 116 117 service you can use to make therapy appointments (see page 52). The KV is basically a lobby group pushing for the interests of doctors; the German law has also tasked them with making sure that the supply of health services is “sufficient, appropriate and economical”. In other words: they should make sure there is enough – but only to the degree that it doesn’t cost too much. To do this, they update the regional coverage plan: the regional KVs record and evaluate the local supply of and demand for psychotherapy, then they write the plans in agreement with the public health insurances. New licences can be added where needed, and regional and local differences can be taken into account. Sounds reasonable, except, this isn’t actually happening.

What sounds sensible from a bureaucratic point of view is a nightmare from the perspective of a prospective patient.

Berlin got its last updated coverage plan in October 2020. According to this plan, the city’s need for psychotherapy is more than covered – to the tune of 172% of the declared need. Of course, that is predicated on the arbitrary base figures established in 1999. No new licences were issued. Marini, speaking on behalf of the GBA, denied any responsibility for adjusting the licence limits, saying it was up to the regional KVs to do this. In fact, though, the GBA also has the power to increase the amount of licences at the federal level. And they have done so before: in 2019, they added around 800 for all of Germany. According to president of the Federal Psychotherapy Chamber (BPTK) Dietrich Munz, at least three times as many were needed. And that’s before the whole country went a little mad being locked down during the pandemic.

There is more than enough reason to doubt that keeping therapists from deserting rural areas was and is the only reason for restricting licences. After the new psychotherapy law was adopted in 1999, all those formerly-excluded psychological psychotherapists suddenly hit the market. The medical therapists who had been practising under the existing Bedarfsplanung might well have gotten worried about their position and income security. The same basic mechanism is at work today. “I think there’s also a lot of anxiety, like people thinking if we were not restricting this then maybe we wouldn’t earn the fee anymore that we are now earning so that we would as a psychotherapist be impoverished,” therapist and member of the board of the Association of Psychological Psychotherapists Marianne Lederer* tells us.

At this point, it’s clear that the people making the plans – the KVs who represent doctors’ interests, and the public health insurers who pay for it – have no real interest in increasing capacity. But why? Psychotherapist Sam Henna* has a theory: “It is political. Who would bear the greatest risk by creating more licences? Maybe this still has something to do with the stigmatisation of mental health care in the political arena. Political parties don’t want to talk about it.” He recalls being at a public healthcare conference in 2013, where Josef Hecken infamously said, “You don’t need a psychotherapist for every citizen, sometimes a bottle of beer will do.” Hecken’s comment sparked outrage and he later apologised, but the idea that Germany simply doesn’t need therapy is still a widespread mentality, especially among older generations.

Lederer points out that politicians also fear that therapy will become too popular. “There was a feeling that when there are more licences, then there is more supply-induced demand. So the more therapists are available, the more people will go and want to be treated. This will cause the public health insurance companies to have to pay too much money.” When the first Bedarfsplanung was created, the parties in charge were the SPD and the Greens, led by chancellor Gerhard Schröder – the same government that created Hartz IV. Austerity measures were a cornerstone of their policy making. When launching his infamous “Agenda 2010” in 2003, Schröder famously said, “We will have to cut state benefits, promote personal responsibility and demand more personal performance from each individual.” What he meant was: deal with things yourself.

Would therapy really be too expensive to provide for everyone who needs it? Henna doesn’t think so. “There are studies that show every euro that you invest into mental health has a good return of investment. For every euro that you invest, you get a minimum of €1-2 back. It’s not a net loss in the long run. But first, it will cost a lot of money. You have to make a starter investment because the need is there and the health costs would rise. On the other hand, there would also be immediate savings: fewer sick days, fewer chronic illnesses… it would pay off relatively quickly.” One such study was published in 2011 by public insurer Techniker Krankenkasse. By their calculations, every euro invested into psychotherapy pays off threefold for society as a whole within a year.

Josef Hecken infamously said, “You don’t need a psychotherapist for every citizen, sometimes a bottle of beer will do.”

But there’s another reason the numbers don’t add up, and that’s the workload for each therapist. The insurance companies say it’s plausible for a therapist with a full licence to see 60 patients a week. Let’s do the maths here: they’d need to see 12 patients a day, and sessions are usually 50 minutes. And that’s before all the paperwork and scheduling. During our investigation, we spoke to therapists with half a licence (meaning they see 12 to 30 patients a week). Even with 30 patients, they were working more than 50 hours a week – in a job that has a sizable mental toll. The health insurance companies wildly overestimate the actual capacity for psychotherapy treatment in a given planning district. Do we need to torture therapists into 60+ hour work weeks in the name of better public health? We could, but you’d quickly see a follow-up on this investigation entitled ‘Therapists Need Help’.

Gatekeepers of Health Care

Illustration: Rebecca Hendin

The GBA is a federal institution that decides which medical services are covered for the 73 million publicly-insured people in Germany, and to what extent. They decide where the insurance money goes and how many hours of therapy one can get. The decision-making body of the GBA has 13 members: five representing doctors, therapists, dentists and hospitals; five representing the health insurers; and three impartial members, one of which heads the commission. The current head is Josef Hecken, who has been active in regional and federal politics for the CDU since the 1990s – he is easily the most powerful man in German healthcare. And as a third of the group, the health insurers themselves have a rather big say in deciding where the money goes. Here’s who doesn’t get to vote on any of it: the patients. While patient organisations can lobby for changes and give their input, they are excluded from the decision-making process. Let that sink in: 13 people make all the decisions for the healthcare of 73 million people. Even the Federal Constitutional Court has called this process undemocratic.

The GBA is not only responsible for allocating funds. They also created the very first Bedarfsplanung for psychotherapy at the end of 1999 to establish a base number of licences. The people in charge then simply tallied the existing number of licensed therapists across Germany at the time, and this number has been the basis for the Bedarfsplanung ever since. Needless to say, this hasn’t aged well. The process was undertaken just nine years after Germany’s reunification, and East Germany’s mental health coverage was still much more sparse than that of the West for a host of reasons, while in West Germany, publicly-funded therapy was still a relatively new thing.

Even back then, the base number of licences across Germany was much lower than the actual need. Another snag is that this plan came into effect less than a year after Germany passed its new Psychotherapy Law, which gave psychologists access to public therapy licences. Before this, only medical doctors were allowed in the system. By the time the first Bedarfsplanung was made, many of these new therapists entering the market had not yet gotten a chance to secure their licence.

Today, the GBA continues to create and update the federal guideline for Bedarfsplanung. They do not, however, create the actual Bedarfsplanung themselves. Creating these plans for psychotherapy, as well as all other types of doctors, is down to the Kassenärztliche Vereinigung.

The Underground Market

Imagine you’re a fresh-faced psychotherapist in Berlin, ready to help people who are struggling with mental health issues. You’ve finished your five-year medicine or psychology degree, gone through your three-year postgraduate training and passed the state exam to get you to the finish line. You’ve then waited the seemingly arbitrary five years to “mature” and now need what has become a precious commodity: a licence to treat publicly-insured patients.

When Henna first tried to get a licence, he recalls, he found the process to be a strange, semi-official, sort of “underground” market. When a therapist first requests one, the local KV sends them a list of psychotherapists who are due to retire. They can then get in touch with their lawyer and start negotiations to “buy” a retiring therapists’ licence. The KV confirmed this, but clarified that therapists cannot officially buy a licence from anyone. They also can’t legally buy an existing practice or patient list due to privacy laws. “In reality, what gets sold is the so-called ‘good will’ – you could say, that’s the willingness to ‘play along’ with the reallocation of this licence,” Henna explains. “The young person that tries this approach is supported and gets the licence approval. Because in Berlin no new licences are issued, this means that this is the only way – the only realistic way for most of us to get a licence.”

In other words, it’s a bit of a gentlemen’s agreement. After taking the agreed-upon contract to the KV, their committee asks the retiring psychotherapist if both parties “have come to an agreement”. If so, the biggest obstacle to getting a licence is cleared – and so is the biggest expense. This ‘agreement’ can run between €40,000 to €100,000 or more, depending on whether you get a half or a full licence, and where you want to practise. “I even had a case when I was applying where the retiring therapist held an auction,” Henna says. Those prices are on top of the application and lawyer fees, which will likely mount throughout the long negotiation process – something that could take several tries.

From the perspective of a newly-trained mental health professional, the whole thing seems deeply unfair. Young psychotherapists are often paying indirectly into older colleagues’ retirement funds, when the latter never paid a dime for their licence back in the day. It’s not like the five years of medical school, three years of unpaid training and five years spent waiting to get to the licensing stage was time spent getting rich, right? Sure, there are cheaper ways to do this, Henna says: just get married to a therapist with a licence, or inherit one from mummy or daddy when they retire. “A person who is directly related, a spouse or a child, is privileged. Privileged applicants get a licence before all others. That means that in this case, it also doesn’t matter if someone has made a contract of sale. If it’s the son or the daughter, they will get the licence, even if someone else is more qualified.” Nepo babies rejoice.

Ultimately, it’s difficult to pinpoint the exact reasons for why this structure exists. The system is very opaque, and with the KV not willing to explain, it’s not easy to understand who exactly is fighting to keep it like this. But there are those players who clearly stand to benefit monetarily from this underground market: the retiring therapists, who are represented by the KV and probably don’t mind a buffered retirement. And then there are the lawyers who made it their business model to negotiate the contracts between outgoing psychotherapists and incoming ones buying the therapy licence. It’s not too difficult to connect the dots.

For both the patient and the therapist, the mental health maze in Berlin is depressing – which might make some people want to find someone to talk about it all… The good news is, even with all the political mess that is keeping the number of desperately-needed licences from being increased, there is a way that you can get your private therapy sessions covered by your public health insurance – help is on the way.

*Name changed

Jöran Mandik and Matilde Keizer are hosts of Radio Spaetkauf, Berlin’s English-language local news show, where Anne-Marie Harrison is a producer. Together the trio is the team behind Get Help Berlin, a podcast where they share personal stories and professional insight on finding therapy. Check it out wherever you get your podcasts.

A Step-by-Step Guide to Getting Therapy (and getting it paid for)

To help you make sense of the process, Jöran Mandik has broken it down into manageable chunks. And remember, the magic word is Kostenerstattungsverfahren.

1: Call the 116 117 Federal Health hotline for an initial consultation

Let’s get analogue and make a phone call. If you manage to navigate the automated menu, you’ll be connected to an actual person. They’ll ask your name, date of birth, address and what gender therapist you’d prefer. Then, they search their database and try to find an appointment for an initial consultation with a therapist near you. They’ll give you a 12-digit referral code – write this code down. If you’re struggling with mental health issues, making a phone call can be a real challenge. The good news is, you can use the 116117 App to avoid any human interaction! It lets you search for therapists and make an appointment for initial consultation yourself. The app will ask you for a referral code, which you can also request this through the app if you don’t already have one from your GP.

2: Go to your initial consultation

Your initial consultation will be a session with the therapist you found through step one. If they have capacity for you as a new client – great! Unfortunately, and maddeningly, it is very likely that they won’t. However, what they will give you is the PTV 11 form – a very important document. On it, the therapist will note a pre-diagnosis, a recommendation for the type of therapy best suited to you, and state that you need therapy acutely. They will also stick another code on there – this one is called an urgency code.

3: Call 116 117 – again

Now that you have your sacred PTV 11 form, you need to call back 116 117. They are supposed to find you a placement within four weeks (which rarely ever happens). In any case, make sure to record the time and date of this call.

4: Make a spreadsheet and start emailing

If you like sending emails, you’re gonna love this step! First up, make a spreadsheet. Enter the time and date of your second 116 117 phone call. Next, Google public therapists in your area and start emailing them to see if they have a place available. Try to email around 20 therapists. If a therapist tells you they have space, you’re in luck. Otherwise, you should mark all of the rejections on the spreadsheet. Be detailed about it, as the more info you have, the better. Record the dates of the emails, the replies, the reasons given, the non-replies and so on. After four weeks, call back 116 117 – make a note of this too.

5: It’s time to start the work-around

As well as emailing public therapists, start contacting private therapists. This might seem counterintuitive, but that’s because we haven’t gotten to the magic word yet: Kostenerstattungsverfahren. This quintessentially lengthy German word translates as ‘cost reimbursement procedure’, and it is the key to getting private therapy paid for in Berlin. If you can prove to your insurance company that the public health system has failed you and been unable to provide therapy, then your health insurance is legally obliged to pay for a private therapist. This is where your marvelous spreadsheet comes into play – you can use it as evidence of how the system has failed you and make a claim to get your therapy reimbursed.

6: Put together the paperwork and apply

Many private therapists will already have experience taking clients through the cost reimbursement route. They’re often experts in the process and will be able to guide you through the next steps. Together, you will compile the paperwork for your health insurer. This will include your spreadsheet, your PTV 11 form, an application form, a statement from your new therapist, two notes from your GP and a cost estimate. You can either send it all to your health insurance company, or your therapist can do it for you. If it all goes according to plan, within a few weeks, you’ll receive a letter from your health insurance company confirming that they will pay for your treatment.

Good luck with your search, and whisper it with us one last time: ✨Kostenerstattungsverfahren

Therapy fact sheet

When is the Price Right?

If you look up therapists online, it might seem like there are plenty to choose from. But many therapists are only covered by private health insurance, meaning you have to pay out of your own pocket if you have public health insurance, and they’re not cheap: a 50-minute session typically costs around €100. Thankfully, there are free therapists as well – or at least those you don’t have to pay extra for if you pay into a public health insurance fund. These public therapists are the ones who are especially hard to find. In Berlin, there are close to 3000 therapists with a Kassensitz, and at least 1200 without.

Lost in Translation

If you’re not a native German speaker, you’re probably more comfortable discussing your innermost thoughts in your own language. Therapie.de, the go-to search engine for finding therapists, lists 1842 therapists within the city, and about a third of them speak English. Therapy in other languages, however, is much harder to find: 82 of these 1842 therapists speak French, and 62 speak Spanish. Surprisingly, given Berlin’s demographic, only 27 offer therapy in Turkish, and a meagre eight therapists list Arabic in their profiles on the website. It’s not impossible, but if you need therapy in any language other than German or English, you’ll have a tough time finding it.

Play by the Rules

It’s a stereotype, but it’s true: Germany is a country that loves rules and bureaucracy. With therapy, there’s plenty of both – including limits on therapy length. First, there is Akuttherapie, acute sessions you can receive in a time of crisis. With few hoops to jump through, this type of therapy gets approved fairly quickly for up to 12 hours and can be a good ‘quick fix’. Then there is a Kurzzeittherapie, short-term therapy, which consists of 12 to 24 hours (longer-term therapy offers up to 60 hours). Before you embark on these longer types of therapy, you have to do two to four trial sessions with your therapist. If you get along and they have an open spot, they then have to request the upcoming therapy hours from your insurance for approval. If you use up your trial hours while waiting for approval, you have to pause therapy, which can be problematic when dealing with mental health issues. Once your approved batch of hours is used up, your therapist could either say you’re done, or request more hours for you based on your needs – your therapeutic fate is in their hands.

Not All Therapy Is Equal

Different types of therapy are suited to different patients and different diagnoses, and they’re all treated differently by the health insurances. While treatments  like movement therapy, couples therapy or Gestalt therapy are not covered by the public health insurance, these five are:

  1. Psychoanalyse (psychoanalysis) The original Freudian analysis. You’re on the couch, talking with fairly little pushback from the therapist sitting behind you.
  2. Tiefenpsychologisch fundierte Psychotherapie (depth-psychology based therapy or psychodynamic psychotherapy) The classic talk therapy. An evolution of psychoanalysis, where you sit face-to-face and dissect your patterns and issues through discussion.
  3. Verhaltenstherapie (cognitive behavioural therapy) This is where you’re working on unlearning patterns and changing your behaviour.
  4. Systemische Therapie (systemic therapy) This one assumes that everything is connected and thus focuses on contextual frames like family and relationships rather than the individual.
  5. Eye Movement Desensitisation and Reprocessing (EMDR) Covered since 2015, this is especially suited for PTSD patients.

Different types of therapy also go with different maximum hours: for systemic therapy, you get no more than 48 hours; for cognitive behavioural therapy 80; for depth-based therapy 100; and for psychoanalysis it’s up to 300 hours. If your goal is to get as many hours as possible, you can let that influence your choice. But what happens if you’ve used your maximum amount of hours and still feel the need for therapy? That’s when the real bureaucratic hell starts. Technically, you have to wait two years before you can start a new round of therapy. However, if your therapist deems it necessary for you to keep going, they can write an assessment proving to the health insurance that you need more sessions – which may or may not be approved.

Mental Health Resources

Here is a list of institutions that offer counselling in moments of crisis. Need immediate help? Call 0800 181 0771 (Germany‘s suicide hotline).


  • berliner-krisendienst.de district-specific hotlines (in English)
  • telefonseelsorge.de 0800 1110111; general help online and in person
  • nummergegenkummer.de guidance for kids, teens, parents and refugees


  • schwulenberatungberlin.de in-person guidance, groups where topics of addiction, coming-out and more are discussed, care and help for queer refugees (in English)

For women & girls

  • Schwangere in Not 0800 40 40 020; help and guidance for pregnant people (in English)
  • BIG-Hotline 030 611 03 00; for female victims of domestic abuse (in English)
  • Mädchennotdienst 030 61 00 63; guidance and help for girls and young women between the ages of 12 and 20

For kids, teens & parents

  • Kindernotdienst 030 61 00 61; help in emergencies and times of crisis for kids up to 13 and their parents
  • Jugendnotdienst 030 61 00 62; for teenagers
  • Kinder- und Jugendtelefon 116 111; for kids and teens
  • Elterntelefon 0800 111 0 550; for concerns about your child

For depression & anxiety

  • angstselbsthilfe.de guidance for people with anxiety disorders and help finding support groups
  • deutsche-depressionshilfe.de 0800 33 44 533; information for people with depression (in English)

For victims of violence

  • hilfe-in-berlin.de hotline database for victims of criminal offences (in English)
  • weisser-ring.de 116 006; for victims of violence and criminal acts (in English)
  • Gewalt gegen Frauen 0800 0116 016; for female victims of violence (in English)
  • Hilfetelefon für Gewalt an Männern 0800 123 990 0; for male victims of violence, including LGBTQIA+ and refugees (in English)

For addictions & eating disorders

  • drk.de help for alcohol, drugs, gambling addictions, eating disorders, depression, including a hotline for concerned friends and family: 06062 607 67
  • anad.de guidance for people with eating disorders, free online therapy and educational material
  • bundesfachverbandessstoerungen.de for eating disorders, free therapy and guidance