Germany has a variety of services to promote good mental health. This includes, for example, financial support and access to mental healthcare services for all insured patients. If you are unsure whether you might benefit from treatment, a good place to start is by talking with your general practitioner about the need to visit a specialist. It is also possible to go directly to a psychologist or psychiatrist. Be sure to ask the specialist whether they accept your form of health insurance, as private treatments can be very expensive (around 100 Euro per hour, with multiple sessions usually required). For those requiring inpatient psychological treatment, psychiatric hospitals and psychosomatic clinics are available. Germany also maintains a form of outpatient treatment known as a Tagesklinik, where you receive treatment by day at the clinic but sleep in your own home. If you need more information about maintaining mental health in Germany, please see our chapter on mental illnesses.
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Understanding mental health care in Germany | Stripes Europe
Mental Illnesses
Daily life is full of mental ups and downs. Some people can live well with their problems by talking to friends or letting off stress through a hobby or pastime. Others find it hard to restore that state of inner balance. If, even after several weeks, you find that you are struggling to move past a down cycle, it might help to seek support from a professional psychologist. Arrange an initial appointment with a psychotherapist to discuss your symptoms and receive professional advice about whether more extensive therapy is necessary. Your general practitioner can also help you identify whether you need help from a specialist. Because many mental illnesses are associated with physical symptoms, including stomach pain and poor sleep, doctors are trained to check whether your physical symptoms might have a mental origin. Where necessary, he or she can refer you to a specialist.
Initial questions to ask yourself
If you would like to understand more clearly whether you are a candidate for psychotherapy, answering the following questions may help you:
- Am I not myself? Do I feel different from how I usually feel?
- Does the way I’ve changed bother me?
- Is there an explanation for the change?
- Does the explanation insufficiently account for the
duration and severity of the trouble I’m having?
- Has it become a struggle to perform my day-to-day work?
- Am I constantly worried and anxious?
- Do I suffer from any physical ailments?
- Do I have a sleeping disorder? Do I sleep too little or
too much?
- Do I often feel aggressive, hateful or irritable, or am I very intolerant?
- Am I often on sick leave?
- Do I have suicidal thoughts?
- Do I hardly have anyone left to talk to about my problems?
- Does speaking to friends about how I’m feeling no longer help?
- Is the change in me clearly noticeable to others, as well?
- Have I been feeling like this for more than three months?
- Am I ambivalent about everything?
(Source: Rosemarie Piontek: Mut zur Veränderung Methoden und Möglichkeiten der Psychotherapie. Bonn, 2009)
In Germany, there are various kinds of specialists licensed to treat mental illness. Psychotherapists study psychology at university, followed by several years of psychotherapeutic training. Psychologists (Diplom Psychologe) study psychology, but do not receive the additional training in psychotherapy. In many cases, psychologists can offer support as life coaches or behavioral experts, but their consultations aren’t always covered by health insurance.
Finally, psychiatrists complete a full university study in medicine, with a focus on psychopharmacology. They are allowed to prescribe medication.
Patients under 21 years of age also have the option of visiting a licensed child and adolescent psychotherapist. Providers must undergo highly specialized psychotherapeutic training after university.
Be ready to call more than one psychotherapist, as demand is high for these services and many practices have long waiting times for appointments. Those requiring inpatient psychological treatment can turn to psychiatric hospitals and psychosomatic clinics. Germany also maintains a form of outpatient treatment known as a Tagesklinik, where you receive treatment by day at the clinic but sleep in your own home. To receive treatment in a hospital, you need a referral from a medical specialist. In emergencies, please dial the national emergency services hotline at 112.
What happens during a psychotherapeutic consultation?
At the first psychotherapeutic consultation, which usually lasts around 50 minutes, the psychotherapist will form an assessment whether mental health care treatment is necessary. He or she will talk with you about the problems you are having and how long you been living with them. A questionnaire is often used to help you describe the situation. Even if the psychotherapist decides that a therapy is needed, you might have to wait some weeks. There is strong demand for psychotherapeutic services in Germany, and many practices have a waiting list.
For some mental health issues, the specialist might also recommend group therapy treatments. These usually involve sitting in a circle with 3 to 9 other patients. Each session last about 100 minutes and are helpful for learning and gaining feedback from other patients. Another option is to join a self-help group (Selbsthilfegruppe) to benefit from talking to like-minded patients.
Before you start a treatment with a psychotherapist, make sure that you feel comfortable with the specialist. You are likely to share many hours with this person and trust is essential. Before the treatment starts, the specialist will conduct trial sessions. It is important that you feel that you can work with the psychotherapist and that you feel comfortable opening up to him or her. Remember: it is always your right as a patient to try an initial appointment with another specialist to see if you feel more comfortable.
During the trial sessions, the psychotherapist is likely to discuss a therapy plan with you. Don’t hesitate to ask questions about anything that might seem unclear to you. Once the trail session or sessions are complete, you can agree to the therapy plan and start into therapy.
For some mental health issues, medication is recommended as an accompaniment for psychotherapy. While your psychotherapist can explain the risks and benefits, you will need to visit a certified psychiatrist to receive your prescription.
In Germany, health insurance covers four different types of psychotherapy. Before you go to a trial session, you should check whether you feel comfortable with the therapy the specialist offers.
Psychoanalytic therapy was developed based on the teachings of Sigmund Freud. According to his theory, mental illnesses are caused by inner conflicts. Hidden conflicts, often from our childhood, influence our daily life and can lead to mental illnesses. Through psychoanalytic therapy, a psychotherapist can help you uncover these repressed feelings and relationships, such as describing your dreams, thoughts, and memories. During sessions, patients typically lie on a couch, and therapy can last several years.
Psychodynamic therapy draws on Freud’s theories as well, and also focuses on early experiences and repressed feelings. Sessions usually involve sitting across from your therapist, and treatments last about one year.
Behavior therapy is based on another theory. It assumes that our behavior and our thoughts are influenced by our life experiences. From these experiences we learn and conclude how to behave best. The therapist works with you to identify reasons for your mental problems. Together, you discuss your patterns of thinking and how to change them. As a patient, you are an active part of therapy and you might have to collaborate by practicing learned skills at home. Patients typically sit opposite to your psychotherapist, with one session per week. Treatment usually lasts several months.
Systemic therapy assumes that mental illness can be caused by the way people interact with each other. This type of psychotherapy usually involves your family or partner. The therapist helps you developing solutions for existing conflicts. As a patient, you and your family are empowered to solve conflicts in your daily life. Therapy sessions are usually scheduled for two to three weeks.
At the beginning of the therapy, the psychotherapist will explain to you a potential treatment for your mental health issues. He will describe how long the therapy might take and whether medication is recommended. The specialist will explain the treatment´s benefits and difficulties. It is your right as a patient to ask the therapist to explain all essential aspects of the treatment. Before starting the therapy, you must provide (verbal) consent.
How long will my therapy last?
Psychotherapy usually lasts several months. Depending on the type of therapy being offered, it can also last longer. Successful treatment of a mental illness cannot be rushed. Most therapy sessions last 50 minutes, with sessions scheduled once or twice a week, or at longer intervals. The psychotherapist will recommend a long-term or a short-term therapy. Depending on your mental state, that therapy can also be extended in coordination with your health insurance provider.