Therapy in English in Germany: How the System Works and What It Costs

1. What the System Pays For

Psychotherapy with a licensed therapist is a standard statutory benefit. There is no co-payment, no annual cap you have to watch, and no separate approval for the first steps.

Treatment is built in three stages:

• Psychotherapeutische Sprechstunde, the initial consultation. Up to six sessions, no referral needed. This is where someone determines whether treatment is indicated and which kind.
• Akutbehandlung, acute treatment for situations that cannot wait for the application process. Adults get up to 24 units of 25 minutes, which practices usually combine into longer sessions. It needs no approval from your fund, and the hours count toward a later short-term therapy.
• Kurzzeit- or Langzeittherapie. Short-term therapy runs to 24 sessions. Long-term behavioural therapy covers 60 sessions and up to 80 in defined cases, depth psychology 60 and up to 100, analytical therapy considerably more.

Private insurance works differently: your policy decides the number of sessions and often requires approval before treatment starts, so check the terms rather than assuming the statutory numbers apply.

2. The Number That Opens the Door

Call 116117 and ask for a Psychotherapeutische Sprechstunde. You do not need a referral, and the service is obliged to arrange an appointment within a defined window.

The legal maximum between your call and the appointment is five weeks. In practice the average wait for a consultation arranged this way was around six days in 2025, which is faster than most people expect and faster than calling practices yourself.

Bring nothing except your health insurance card. In the consultation you will get an assessment, a document called the PTV 11 if therapy is indicated, and a recommendation for the format.

3. Where the Wait Actually Is

The consultation is quick. The therapy place is not.

Across Germany the wait between that first consultation and the start of treatment runs three to six months, and roughly four in ten people wait between three and nine months. In English, in a city with high demand, expect the longer end.

Two things shorten it in practice. Ask each practice to put you on their waiting list rather than calling once and giving up, since cancellations move fast. And ask in the consultation whether Akutbehandlung is an option, because it starts without waiting for the application to be approved.

While you wait, the public system has a layer most people never hear about. The Sozialpsychiatrischer Dienst at your local health office advises free of charge and without insurance paperwork, and the counselling centres run by Caritas, Diakonie and AWO do the same. None of them replaces therapy, but they bridge the months, and they know the local supply better than any online search.

4. When No Place Exists: The Reimbursement Route

If no licensed therapist has capacity within a reasonable distance and time, German law does not simply leave you waiting. §13 Abs. 3 SGB V obliges your Krankenkasse to reimburse treatment with a private practice when the fund cannot deliver an urgently needed service in time.

The practical threshold most funds apply is no place within about three months despite documented effort. What the application needs:

1. A list of rejections. Note every practice you contacted, the date, and the answer. This list is the core of the application.
2. The PTV 11 from your consultation.
3. A Konsiliarbericht, a medical report from a doctor confirming there is no physical cause and that treatment is indicated.
4. A private therapist willing to bill this way, ideally one who has done it before.

Be prepared for a refusal on the first attempt, since funds routinely reject properly filed applications, and be prepared to object in writing. This route works, but it works for people who document carefully and do not stop at the first no.

5. Paying Privately

Outside the statutory route, a 50-minute session in private practice runs roughly 80 to 160 euros, with the higher end reflecting the standard fee schedule for psychotherapists.

That is real money, and it is worth knowing two things before you commit. Some employers cover a number of sessions through an employee assistance programme, quietly and without your manager learning who used it. And digital therapy programmes prescribed by a doctor are a statutory benefit in their own right, which is a smaller step than a full therapy application when the wait is the main problem.

6. Finding Someone Who Works in English

English-speaking therapists exist in every large German city, and finding one is a search problem rather than a legal one.

The Kassenärztliche Vereinigung of your state runs a practice search that filters by language, and the national therapist directories let you filter the same way. Expat community groups are useful for names but not for availability, since the recommended practices are usually the fullest.

Two practical notes. A therapist with a Kassensitz bills your fund directly, which is what you want; a private practice does not unless the reimbursement route above applies. And if your German is functional but not emotional, say so in the consultation, because doing therapy in a second language is a real factor in choosing the format.

7. What It Does Not Affect

This worry stops people from starting, so it deserves a direct answer.

Using mental health care does not affect your residence permit, your naturalisation, or your employer's view of you. Diagnoses go to your health insurer, not to the Ausländerbehörde and not to your workplace. A sick note tells your employer that you are unfit for work and nothing about why.

There is one narrow exception worth knowing rather than fearing: some private insurers ask about psychotherapy in their health questions when you apply for policies such as disability cover, and answering honestly matters more than the answer itself. That is an argument for understanding the sequence, not for going without treatment.

8. Where to Start This Week

1. Call 116117 and ask for a Psychotherapeutische Sprechstunde.
2. Keep a list of every practice you contact and their answer, from the very first call.
3. Ask about Akutbehandlung in the consultation if you cannot wait months.
4. Check with your employer whether an assistance programme exists.
5. See your Hausarzt as well, both for the Konsiliarbericht you may need later and because they can prescribe other help. Our guide to seeing a doctor in Germany covers how appointments work.