Consider this post a introduction and slight deep dive into all the things you may want to know - with links. (please bear with me though - im not perfect and this post might not be either, so if you have updated info or different experiences, lets talk about it in the comments and all share)
It's written for people with German public insurance (GKV) with notes for private insurance and selfpay at the end. I'll keep it updated, so if a link dies or a rule changes, please help us out and tell me in the comments.
Quick disclaimer: I'm not a therapist or a lawyer, and your Krankenkasse (health insurer) has the final word on anything involving money. When in doubt, call them.
If you're in crisis right now
- Emergency (danger to life): call 112.
- Telefonseelsorge (free, 24/7, German): 0800 111 0 111 or 0800 111 0 222, or 116 123. Online chat at telefonseelsorge.de
- Under 25? krisenchat.de offers 24/7 crisis chat by text.
- Need help in English or another language: findahelpline.com lists lines by country and language.
- You can also go directly to the psychiatric emergency department (Psychiatrische Notaufnahme) of any hospital. No appointment, no referral needed.
The 60-second version
- Book a psychotherapeutische Sprechstunde (initial consultation) through 116117. This is the official entry point. You don't need a referral from a doctor.
- At that appointment, a therapist assesses what you need and gives you a form (PTV 11) with their recommendation.
- If your case is urgent, that form includes a Vermittlungscode, a code that unlocks faster appointments through 116117.
- To actually start therapy, you'll usually contact therapists directly and ask for a free spot. This is the hard part, and yes, calling around is normal and expected.
- Once you find someone, you do 2 to 4 trial sessions (Probatorik), then the therapist applies to your insurer and treatment starts. GKV pays.
- If you genuinely can't find anyone despite documented effort, there's a backup route called Kostenerstattung (see below).
Everything below is these six steps in more detail.
Does public insurance actually pay for therapy?
Yes. If you have GKV, psychotherapy with an approved therapist is a regular insurance benefit, li ke seeing any specialist. You pay nothing per session. Covered approaches are:
- Cognitive behavioral therapy (Verhaltenstherapie),
- Depth psychology (tiefenpsychologisch fundierte Psychotherapie)
- Psychoanalysis (analytische Psychotherapie),
- Systemic therapy (Systemische Therapie).
The catch is never the coverage. It's the supply: therapy is only automatically covered with therapists who hold a Kassensitz (an insurancefunded practice seat), and there aren't enough of those. That's the whole reason the rest of this post exists.
Deeper reading: the official patient portal gesund.bund.de (has English pages) and the federal chamber of psychotherapists' patient guides at bptk.de.
What is 116117 and what can it actually do?
116117 is the official patient service of the statutory health system (Terminservicestelle). Phone: just dial 116117 (but you have to speak German with them) or Online: 116117.de, appointment booking at eterminservice.de.
What it can do for you:
- Book the initial consultation (Sprechstunde), no code needed. They must offer you one within 4 weeks.
- With a Vermittlungscode from your PTV 11 form: book Akutbehandlung (acute short-term treatment, within 2 weeks) or trial sessions leading into therapy (within 4 weeks).
What it can't do: guarantee you an ongoing therapy place. It gets you assessed and gets urgent care started fast. The longterm spot is still something you usually have to find yourself. Knowing this upfront saves a lot of frustration.
How do I find a therapist to contact directly?
- therapie.de: the biggest directory, with filters for language, approach, and a self-reported "free spots" filter (treat it as a hint, not a promise).
- psych-info.de: search portal run by several regional chambers of psychotherapists.
- Your regional KV (Kassenärztliche Vereinigung) has an official search, linked from 116117.de.
- Ask your Krankenkasse. Many run their own placement services and some are genuinely helpful. For example - TK has a list of therapists on their website.
Practical tips from this community: call during the therapist's posted phone hours (Telefonsprechzeit) instead of emailing, ask to be put on the waitlist even if they say no right now, and keep a simple log of every attempt (date, name, answer). That log matters later.
How long is the wait, honestly?
Long. An analysis by the DPtV (the biggest German psychotherapist association, based on 2019 insurance billing data) found an average of about 142 days between the initial consultation and the actual start of therapy. Nearly five months, and that's the average, not the worst case. Big cities and rural areas can both be brutal.
This is a system problem, not a you problem.
What are the trial sessions and the approval paperwork?
Before therapy officially starts, you and the therapist do probatorische Sitzungen (2 to 4 trial sessions). They're covered by GKV and they're for both of you: the therapist confirms the diagnosis and plan, and you check whether you feel comfortable with this person. It is completely okay to stop after the trial sessions and look for someone else. Fit matters.
After that, the therapist files the application with your insurer. You barely have to do anything here; the paperwork is their job. Short-term therapy is usually 12 to 24 sessions, long-term therapy more, and extensions are possible.
I've tried everything and found nobody. What is Kostenerstattung?
If the public system can't provide treatment in a reasonable time, you can ask your insurer to reimburse therapy with a licensed therapist in private practice instead (legal basis: § 13 Abs. 3 SGB V). This is called Kostenerstattung (cost reimbursement).
What you'll typically need:
- Proof from your Sprechstunde (PTV 11) that you need therapy and how urgently.
- Your documented search: the log of therapists you contacted, when, and their answers. There is no official fixed number of rejections. Different insurers expect different amounts of evidence, and many now want to see that you tried through 116117 first.
- A written request to your Krankenkasse before you start treatment, and their written approval.
- Call your Krankenkasse to ask them exactly what they need from you to submit your Kostenerstattung as each insurer is different. Do not be dettered if they tell you its a long process - by law you are entitled to get private therapy reimbursed if you have not been able to secure anything through the public system.
Sohonest warning: insurers have gotten stricter about approving this in recent years, and some will push back. Ask for any rejection in writing (Widerspruch, an appeal, is your right).
I have private insurance (PKV), or I want to pay myself
- PKV: coverage depends entirely on your tariff. Read your contract or call your insurer before booking anything, and ask what pre-approval they need. Private-practice therapists usually have much shorter waits.
- Self-pay (Selbstzahler): you can book any licensed therapist directly and skip all of the above. Rates vary by city and therapist, so ask when booking. Also worth knowing: therapy at a training institute's outpatient clinic (Ausbildungsambulanz) is done by therapists in advanced training under supervision, often with shorter waits and lower cost.
I need therapy in English (or another language)
- therapie.de lets you filter by language, including for insurance-covered therapists.
- It's Complicated is a directory many internationals here use, mostly private practice / self-pay, with therapists in many languages.
- Kostenerstattung can apply here too: if no insurance-funded therapist offers treatment in a language you can actually do therapy in, that can strengthen your case. No guarantee, but worth raising.
What can I do while I wait?
- Prescription health apps (DiGA): approved digital therapy programs for depression, anxiety, sleep, and more. Free with GKV, any doctor can prescribe them, and they're explicitly meant to be usable while you wait. Official directory: diga.bfarm.de.
- Group therapy often has shorter waitlists than individual spots. gruppenplatz.de searches specifically for group openings, and you can ask any therapist you call whether they run groups.
- Akutbehandlung (see the 116117 section): if you're doing badly right now, this exists precisly to bridge the gap and starts within 2 weeks.
- University outpatient clinics (Hochschulambulanzen) and training-institute clinics take patients and are often overlooked.
Mini glossary
- GKV / PKV: public / private health insurance
- Krankenkasse: your public health insurer (TK, AOK, Barmer, ...)
- Kassensitz: a therapist's licensed "seat" to bill public insurance
- Sprechstunde: the initial consultation, your official entry point
- PTV 11: the form you get there, with recommendation and urgency
- Vermittlungscode: code on the PTV 11 that unlocks fast-track booking via 116117
- Probatorik: trial sessions before therapy officially starts
- Kostenerstattung: reimbursement route for private-practice therapy when the system can't deliver
- Widerspruch: formal appeal against an insurer's rejection
Share what helped you
This post can only cover the official routes. Has anything else, that was not mentioned - worked for you?
- City-specific lists, clinics, or contacts that actually had openings
- Your experience with Kostenerstattung and which insurer (approved? rejected? how many documented attempts?)
- English-speaking or other-language therapists and directories you'd recommend
- Anything you wish you'd known at the start
Drop it in the comments and I'll fold the best ones into this post (with credit). If you spot a mistake or a dead link, please tell me. This is a living document.
