What to expect —
and what not to
This page is intended to offer orientation: what psychotherapy is, how the German statutory health insurance system works, which forms of therapy exist — and why I have chosen certain ones. It is not a piece of advertising, but an attempt to inform honestly.
What psychotherapy is — and what it is not
Psychotherapy is not counselling. It does not give advice, does not recommend life decisions and does not explain what someone else ought to do. At first that sounds like a limitation — it is in fact its very core.
What psychotherapy does: it creates a space in which a person’s experience, thinking and feeling can be looked at more closely — within a relationship that itself becomes part of the process. Symptoms, inhibitions, repetitions in relationships or decisions are rarely accidental. They have a history. Psychotherapy tries to make that history accessible — not in order to get rid of it, but in order to understand it. Out of that understanding, room to move can emerge.
Nor is psychotherapy a quick fix. The system sometimes promises more than it can deliver — short waiting times, rapid improvement, measurable results. The reality looks different. What runs deep takes time.
The recognised forms of therapy at a glance
The Gemeinsamer Bundesausschuss (Federal Joint Committee, the highest decision-making body of the German statutory health system) recognises four forms of psychotherapy as services covered by statutory health insurance (GKV). They differ not only in technique, but in fundamental assumptions about what psychological suffering is and how change comes about.
Analytical Psychotherapy
I offer this form of therapyAnalytische Psychotherapie (analytical psychotherapy — psychoanalysis within the statutory system) assumes that psychological suffering arises from unconscious conflicts — from early and later relational experiences that have been internalised and structure present experience without our being aware of it. Drive dynamics, object relations, the experience of self, the intersubjective field between patient and therapist — these are the dimensions in which analytical work takes place.
The setting is more intensive than in other forms of therapy: several sessions per week, often over a period of years. The work may take place on the couch — where this form seems suited to making deeply inscribed psychopathogenic structures accessible. Change comes about not through insight alone, but through lived experience within the therapeutic relationship.
I work within a pluralistic analytical framework: classical drive theory, object relations theories, self psychology, relational and intersubjective approaches — depending on what the pathology and the course of treatment require. In the case of personality disorders, disorder-specific modifications are incorporated.
Psychodynamic Psychotherapy
I offer this form of therapyTiefenpsychologisch fundierte Psychotherapie (psychodynamic psychotherapy, TP) shares the theoretical framework of analytical therapy, but works in a more focused way: fewer sessions, a clearer orientation towards goals, a stronger concentration on current conflicts and their unconscious background. The setting is usually once weekly, seated face to face.
TP makes sense when a circumscribed conflict stands in the foreground — without aiming at a comprehensive working-through of the personality structure. Here too, the point is not advice or instruction, but understanding: What lies behind the current symptoms? What history does this conflict have?
Behavioural Therapy
Recognised form of therapy, not my approachBehavioural therapy (Verhaltenstherapie) is one of the most widely offered and best-researched forms of therapy. It works on the premise that mental disorders are learned patterns — in thinking, feeling and acting — which can be changed if they are worked on systematically. The focus is on current symptoms, concrete goals and structured interventions.
I do not offer behavioural therapy — not because I doubt its value, but because I follow a different conception of the human being and a different understanding of psychopathology and change. For me, the key lies not primarily in changing patterns, but in understanding them — in what stands behind them.
Systemic Therapy
Recognised form of therapy, not my approachSystemic therapy views mental disorders in the context of relational systems — family, couple relationship, social environment. It works in a resource- and solution-oriented way, actively involves family members and uses circular questioning and other methods to make patterns of interaction visible.
Here too: a recognised and effective form of therapy that I do not offer myself. My work is oriented more strongly towards the inner life of the individual — towards what unfolds in the dyadic relationship between patient and therapist.
How to get into therapy
The Psychotherapeutic Consultation
Before any therapy begins, there is the psychotherapeutische Sprechstunde (initial psychotherapeutic consultation): a first conversation to clarify whether a mental illness is present and what kind of help makes sense. This consultation is not a trial session — it serves orientation. It results in a form (PTV11) that is relevant for the further process with your health insurance fund.
Trial Sessions and Application
If patient and therapist decide to work together, probatorische Sitzungen (trial sessions) follow — usually two to four conversations for mutual assessment. After that, an application for cost coverage is submitted to the health insurance fund. For short-term therapy the procedure is simplified; long-term therapy requires an external expert review (Gutachterverfahren).
Costs and Insurance
Analytical and psychodynamic psychotherapy are statutory health insurance (GKV) services free of any co-payment. Privately insured patients should clarify the scope of coverage with their insurer in advance — reimbursement varies by tariff. Self-paying patients are also possible; fees are based on the official fee schedule for psychotherapists (GOP).
Concurrent Psychiatric Treatment
Sometimes psychotherapy alone is not enough — for instance when medication is needed, when symptoms are very acute, or when concurrent psychiatric treatment seems advisable. Psychiatrists are medical specialists who may prescribe medication and can treat you in parallel to psychotherapy. In Munich there are several psychiatric outpatient clinics (psychiatrische Institutsambulanzen) with shorter waiting times than office-based practices. Psychiatrists & psychiatric outpatient clinics in Munich →
On the care situation — an honest assessment
There are too few psychotherapy places in Germany. That is not a footnote but a structural problem: waiting times of six months to over a year are not the exception. My practice, too, currently has longer waiting times; the waiting list is closed at present.
Getting in touch early is nonetheless sensible — and in acute phases the waiting time should not be bridged passively. The Krisendienst Bayern crisis service (0800 655 3000) can be reached around the clock.
The care situation is currently deteriorating further: an analysis of the structural causes can be found on Couch & Agora (in German): “Flattering Statistics, Distressing Reality” — and on the current political developments: “Cuts to Psychotherapy Fees”.
Psychotherapy and other offerings
The market for psychological support is hard to see through. Alongside licensed (approbiert) psychotherapists there are Heilpraktiker für Psychotherapie (non-medical practitioners with a licence restricted to psychotherapy), coaches, counsellors and philosophical practitioners — with very different training paths, legal powers and quality standards. The following distinctions are meant to provide orientation.
What distinguishes licensed psychotherapy from treatment by a Heilpraktiker?
Licensed (approbiert) psychological psychotherapists complete a university degree in psychology, several years of state-regulated specialist training with continuous supervision, personal training therapy and self-experience, as well as a state examination. The methods they use must be classified as scientifically recognised by the Scientific Advisory Board on Psychotherapy (Wissenschaftlicher Beirat Psychotherapie). They are subject to professional law, oversight by their professional chamber, statutory confidentiality and a binding complaints system. Admission to the statutory health insurance system requires an independent review by the Kassenärztliche Vereinigung (regional association of statutory health insurance physicians).
Heilpraktiker für Psychotherapie are not required to present a university degree. Their licence from the public health office merely requires that there be no indications of a danger to public health — an exclusion criterion, not a proof of qualification. There is no compulsory chamber membership, no binding continuing-education requirement, no obligation to have the methods used scientifically reviewed, and no institutionalised complaints system.
That this branch of the profession persists in its present form within the German healthcare system can be explained historically — by the origins of the Heilpraktiker Act of 1939 and by political compromises made when the Psychotherapists Act was introduced in 1999. From the standpoint of patient protection, it is hard to justify.
What is the difference from coaching — and from life coaching?
Coaching is not a uniform format. In clearly defined contexts — decision-making processes, role clarification, developing room for action — it is a legitimate offering in its own right. Coaching has its own dignity; it is not an inferior substitute for therapy, but a different format for different questions.
“Coach”, however, is not a protected title. There is no state-recognised training, no minimum qualification, no statutory confidentiality, no chamber oversight, no binding complaints system.
Particularly problematic is what has established itself under the label of “life coaching”. Here a largely unregulated market addresses problems bordering on the therapeutic — trauma, depressive exhaustion, anxiety, attachment patterns, self-esteem issues — without bearing the legal and institutional responsibilities of a healthcare profession. Those who enter this field with a mental illness requiring treatment do not receive treatment. They purchase an offering that promises therapeutic effect without meeting the structural preconditions under which therapeutic action can be responsibly undertaken. This is a criticism of a market form that lives off real gaps in care — and that is further fuelled by the current political developments concerning statutory health insurance fees.
What is the difference from psychological counselling?
Psychological counselling by qualified psychologists is a sensible and often too little known offering. People in distressing life situations that do not amount to illness — separations, grief, professional disorientation — can benefit considerably from professional counselling. As an offering between everyday support and clinical treatment, it has a legitimate place of its own.
“Psychological counselling”, however, is not a legally protected term. Anyone may use it, regardless of qualification and training background. Where a mental disorder requiring treatment is present, counselling is no equivalent to psychotherapy. The dividing line runs not along the provider’s qualification, but along the nature of the concern.
What is the difference from philosophical practice?
Philosophical practice is an intellectually independent format that deserves to be taken seriously. It accompanies people with existential questions — about meaning, identity, life orientation, moral conflicts. The philosophical conversation works with conceptual clarification, with the tolerating of contradictions, with the slowness of reflection. For people who wish to devote themselves to fundamental questions of life and orientation without a mental illness being present, it can offer a frame that psychotherapy does not provide.
The boundary lies where existential questions are the expression of a mental disorder requiring treatment. A severe depression, a manifest anxiety disorder, a structural personality pathology — these are not philosophical problems, even if they can present themselves as such in thought and speech. Philosophical practice is not a protected term; there are no uniform training standards and no external quality control.
The “unthought known” in us calls for an other who writes our inner book with us.
Christopher Bollas, The Shadow of the Object (1987)