Therapy in Germany: How to Find Help? | Easy German Podcast 618

Hello Kari.

Hello Manuel and hello Rieke.

Hello.

Our guest Rieke is back. You were on our podcast a few episodes ago. Today, by the way, this is also available as an episode on YouTube.

And we talked about mental health.

In the last episode, we discussed what mental health is in the first place.

What is stress? What factors influence psychological and mental health?

And what can you do to seek help?

And we want to delve a little deeper into this topic today.

Topic of the week

Yes, our topic of the week is again mental health in Germany.

But today we want to talk a bit more concretely about how you can actually get help.

In Germany, we have a healthcare system that many people probably view positively.

We have health insurance that pays for certain treatments.

But we want to take a closer look at how this specifically works in the area of mental health.

Before we start, perhaps let's first ask this question again: when should I seek help at all?

Last time we talked about it, mental health is something very individual.

Some people have certain illnesses, some people experience stress differently than others.

when do I know that I should seek help?

So, through therapy or perhaps even medication

or by going to the doctor in the first place.

How do I know that?

Yes, exactly, sometimes it's not so easy to decide for yourself.

In principle, it's like this: if I have the feeling,

that I'm not doing well mentally

and I can't cope with it on my own anymore

and not even with the support of friends or family

or perhaps I don't have any support either

and I just notice that I can't get out of it on my own anymore, then that would be the point,

that I seek help. And the first point of contact could be, for example, the family doctor.

Or one could also search for a therapy spot oneself, meaning at outpatient

therapeutic practices, look for addresses there.

We didn't mention that at all in the intro to this episode. You are a doctor and

work in psychiatry. This difference between psychology and psychiatry we already explained in the

last episode. So you're a doctor, you can also prescribe medication.

Can I also come to you as the very first person if I'm not feeling well? So, who should I

turn to? You've mentioned several options. Is there a first thing, a first point of contact?

Well, it always depends on the severity of the symptoms. One point of contact that always exists is the emergency department. If I'm in such a psychological state of emergency that I can no longer tell what's what, that I might even have dark thoughts or suicidal thoughts, that I need help immediately in such an acute crisis situation, then that would be the very first point of contact.

Emergency department. What does that mean? That's the emergency room of a hospital.

Can I always go there? You can always go there, in case of life-threatening emergencies.

Okay, maybe we could link a few links under this video as well. There are

also telephone emergency services. Would you recommend that too? Absolutely. That would be, so to speak, the,

what I just mentioned as an example would be the last resort. If it's so bad that

nothing else works, if it's a life-threatening psychological emergency,

then I go to the hospital emergency room. Before that, there are of course many steps that one

still has. Yes, intermediate steps. For example, what you said, quite rightly, the emergency numbers

exist in our country, for example, 116, 117. You can call that, that's the statutory health insurance

emergency service, statutory health insurance emergency service, a difficult word, what is that exactly?

That's the on-call service of the statutory health insurance association. That is

statutory health insurance doctor, what is a statutory health insurance doctor? Statutory health insurance at the checkout in the supermarket? That

are, for example, the family doctors. Yes, those who practice as statutory health insurance doctors.

That means, have a practice that essentially works with the health insurance and thereby,

yes, they treat the patients.

So these are the doctors who treat people who are in the statutory

health insurance. That's the majority of people in Germany.

You can also get private insurance, but if you're in the normal statutory

health insurance, then you'll be treated by a statutory health insurance doctor, and

they have an association. And this association has a hotline, you can

call them. They have an emergency service. That applies to other, to all illnesses too. Exactly.

this does not only apply to mental illnesses, on the contrary, all illnesses are included.

are included. So it's like a general practitioner, who I would go to, but only,

when they're not available, at night or on the weekend. And this is not for an emergency. So in an

emergency, in Germany you call 112, then the ambulance comes. But this 116, 117, you can

also call it if you're looking for a therapy appointment, for example. So it doesn't have to be an emergency

right? No, you would rather contact the health insurance companies directly, because they have

an appointment scheduling service. So they can arrange an initial appointment, an initial consultation,

a psychotherapeutic initial consultation for you. You can contact the health insurance companies directly for that.

Okay, then let's go back a step. So let's assume I don't have an emergency right now,

but I suspect something is wrong with me or I suspect that I might need a diagnosis

or therapy. You've often said the word general practitioner. What is a

general practitioner?

A general practitioner

is

the doctor,

who I go to,

when I have complaints

that can be treated on an outpatient basis, meaning outside

of a hospital.

Or who I

go to, so that they can clarify

what kind of treatment the complaints require

or if further diagnostics are needed.

So, this is the first

point of contact, who I go to

to talk to a doctor.

Manuel, do you have a general practitioner?

I do now.

Funnily enough, we had a podcast episode.

There was a rerun a while ago, when we were sick.

And I said I didn't have one.

Because I, I hadn't had a GP for a long time,

but fortunately, I now have a GP too.

And then I can go there,

spontaneously, when I'm sick.

Because that's the problem when you don't have a GP,

in Berlin, many practices are so full that they say, we only accept our own patients, so to speak.

If you're new to Germany and haven't heard of this before, do you think one should look for a GP now, even if you're not sick, so that you have someone to contact later?

Well, you can try, but as you just said, it's sometimes a bit difficult to get appointments if you don't have acute symptoms to see a practice. At my age, you can also have a health check-up every f years or so.

Two years, right?

Well, I think it starts from the age of 35.

Exactly.

That old.

I deliberately didn't say that.

Exactly, but I actually went there back then and said,

I would like to do that.

And then they accepted me.

Yes. Okay. And let's just assume or think, I'd like to clarify something with someone who is a doctor, and I don't have a GP yet. Can I go to any practice, provided they have appointments, and say, hey, I don't think I'm feeling well?

Well, if we're talking about mental health, I would recommend calling the practices or sending an email to ask for an appointment and explain the situation, and then call if necessary.

Or you can go to the walk-in hours if there's something. Some practices have acute walk-in hours where you can come in without an appointment.

Exactly, you can do that too. And it just makes sense to do a bit of research yourself, especially when it comes to psychological complaints. And sometimes you might have to look in the neighboring district and expand your radius a bit.

Sophie, our member Sophie wrote to us, I would like to know which mental health treatments are covered by statutory health insurance and how the process works to find a psychiatrist.

Well, in the German healthcare system, we have these statutory health insurances, as we just mentioned. You are even compulsorily insured in Germany. Every person must have health insurance. That's different from other countries.

What do these health insurances cover and how does it work?

In principle, if a doctor makes a psychological diagnosis,

through diagnostics, then the health insurance also covers the treatment.

If it's a treatment according to the so-called guideline procedures.

That's again a super complicated word.

It actually means the three forms of psychotherapy, probably four, that are covered by health insurance in Germany.

These are different. Cognitive behavioral therapy is one of them. Then there is also psychodynamic psychotherapy.

Many of us might associate that with Freud.

That's this talk therapy, where the focus is different than with cognitive behavioral therapy.

Behavioral therapy is more about looking at what the current problem is

and where I want to go and what I can do to solve the problem, to put it bluntly.

Psychodynamic therapy places more focus on the past.

What childhood or early childhood experiences might have created problems or triggered symptoms now, or are perhaps responsible for them, or at least have an influence.

Those are two of the methods. And then there's systemic therapy, which also considers environmental factors like family, social networks, so how these environmental influences contribute.

And as a patient, you can choose which of these therapy forms you want to undergo; health insurance covers them all.

Exactly. So if someone has an official diagnosis, let's say, as an example, I have an initial appointment at a psychotherapy practice. There's a psychotherapist who makes the diagnosis officially. Then the therapist writes an application to the health insurance company for cost coverage.

coverage. And usually it is

that if the therapy method

is one of these therapy methods that

is recognized, then

the health insurance company covers it.

That means, if we go back again,

I might perhaps first

go to the family doctor. The family doctor

then says, yes, I think you should

go to a

psychiatric

practice or to a psychi... Where do you go

next then? You just said

psychotherapy practice.

Who is actually allowed to make diagnoses?

And diagnoses can be made by doctors, male and female, and also by psychologists, male and female.

And it has to be a recognized practice if you go.

Often the problem in Germany is that you can't find a practice with an opening.

So how would you proceed? You always hear that practices are full, especially in Berlin.

Because if you really say, okay, I need help, who can you turn to?

Should you really call many practices, write emails, go there?

So what do you think is effective there?

Well, I also wish it were different, the situation with utilization and open therapy spots.

Unfortunately, that's just how it is, and that's why the tip really is, call, call, call, email, email, email.

To look for yourself somehow, to Google practices on Google, and then to contact practice after practice to see if there are open spots. One tip is always the training institutes. So, aspiring psychotherapists are trained in training institutes.

And you can also just Google there.

There are actually quite a few in Berlin.

And sometimes, I wouldn't bet my life on it,

but sometimes it can be that you get an appointment a little faster there.

These are then, so to speak, therapists in training,

who are supervised by an already licensed psychotherapist

and who then treat patients there as part of their training to become therapists.

Those are kind of the two sides.

So on the one hand, it's great in Germany, you actually have, if you're insured and you have to be insured, a right to go to the doctor or to a psychologist.

You get a diagnosis and then the treatment is paid for by the health insurance company.

And it doesn't matter whether the treatment lasts two weeks or two years, the health insurance company covers it.

But the available spots are few.

And I know from many people, when you are in a psychological emergency situation,

when you are really feeling bad, it is very difficult to muster the strength and energy

to do all the things you just described.

That's kind of the catch.

Absolutely.

There are then, of course, also intermediate stages between inpatient hospital treatment and outpatient practice.

For example, day clinics.

That's exactly Maggie's question, which comes next.

What treatment options are there at all?

Are there hospitals in Germany, she writes, in which people with mental problems can get help?

Does statutory health insurance pay for such treatment?

Who decides then, what?

So there are outpatient treatments, where you just go during the day.

There is also just therapy, where you go once a week, and there are actual

Hospitals. What's available and who decides what to do?

It really depends. So if I'm someone, let's say, as an example, I call a

day clinic and ask if there's a spot available, because I already have, for example, a diagnosed

depression that has been known for years and has now gotten worse. Then, usually, there's an initial consultation in the day clinic and then, after the consultation, you decide together if it's the right thing or not.

And if the decision is yes, then an admission date is planned.

That would be an example.

A day clinic is a place where you go during the day and go home in the evening.

Right, it's like inpatient treatment from a therapeutic concept perspective, with the difference that you sleep at home. So you're also on sick leave for that period, just like in a hospital.

What else is there?

Then there would be outpatient practices. That would be the example we just mentioned.

Outpatient means I go for therapy, and it might last for two hours a week or even more, depending. Who decides what's actually needed as treatment?

That would be decided after the initial consultation or after the first four sessions.

The first sessions are primarily for getting to know each other, and also for the patient to see if it's a good fit with the therapist.

And then you would decide whether it makes sense to apply for, for example, short-term therapy or not.

And the therapist then submits this application to the health insurance company.

Stacey asks, what is the connection between physical and mental health in Germany?

If you get a difficult or life-changing diagnosis, for example, we're talking about a physical diagnosis here,

Let's say you get a cancer diagnosis. Will you also receive psychiatric treatment and support, or are these healthcare systems completely separate, and do you have to seek help separately? That's a very interesting question.

A really exciting and super important question, because obviously there are phases in life when you have physical illnesses, and it's okay to feel mentally unwell then. It's more of a normal reaction of the body. And yet, and at the same time, you might also need support.

With a cancer diagnosis, for example, there are psycho-oncologists employed on cancer wards in hospitals, for example.

Psycho-oncologists. So first, what is an oncologist?

Oncology is, so to speak, the study of cancer. So everything that deals with the treatment and care of cancer.

And psycho-oncologists are essentially psychologists specializing in oncology.

Does this exist in every medical field then? So are there also psycho-cardiologists?

No, it's actually very specific to oncology because the stress factor is so immense. With a cancer diagnosis, based on experience, there are specifically psychologists who work in oncology and are then called psycho-oncologists.

Amanda writes, I often hear about a shortage of doctors, long waiting times,

problems with insurance and financing. Just a few examples of the

various hurdles that might prevent people from seeking psychiatric help. Are there any tips

on how to seek help and overcome these hurdles? We've just discussed

that, but Amanda asks, what resources are not yet well known or perhaps

underestimated. Looking at what you've already said, are there perhaps still resources available?

Yes, I think I would almost repeat what I said, especially regarding the training institutes

as a small tip, if one is looking for a therapy place. And of course,

staff shortages etc., the healthcare system is not different in the field of psychiatry

than in somatics, probably.

What does somatics mean?

Exactly, somatics is, so to speak, the medicine

that targets physical illnesses.

So, for example, internal medicine,

everything that has to do with the internal organs.

I could perhaps add,

we had this question in the last episode,

what can you do

if a friend

tells you that he or she has mental health problems.

And then the question was, what can one do?

And I think one thing you can do is to support them with these things.

Because we have heard multiple times in these questions and in our answers, yes, there

are many different services, but unfortunately there isn't one place where you

report to and then there's a process that's always the same and works automatically.

Instead, you said, you have to call therapists.

And keep calling until someone says, yes, I have an appointment.

You can call day clinics yourself and ask.

There's 116, 117, there are a thousand numbers you have to call.

If you're new to Germany, it's a huge hurdle to make phone calls in German.

Then there's no appointment.

And I think something you can do is, if you have friends or acquaintances,

is to say, can you help me with this? Can we meet once a week for an hour

and you help me make these calls or do web research or come with me to this

initial consultation at the day clinic or hospital? Because that's just an insane amount of bureaucracy.

and you need perseverance and you just have to try out many different things,

I think.

Yes, absolutely right. Great idea to support that as well, especially in these

bureaucratic, very nerve-wracking, time-consuming things.

There is also, for example, a case that I know of, where if you can prove

that you can't find a therapy spot that the health insurance would cover, the statutory

health insurance, then you eventually have the right to accept a therapy spot

with a therapist who only bills privately, who does not work with statutory

health insurance and the statutory health insurance must then still

pay for it, because you prove, I've been looking for six months and can't find anything.

A huge hurdle to achieve that, but if you... I know someone who has achieved it,

but I know it takes a lot of persistence and perseverance. So my insider tip

would be, ask people for help. So, we talked about the taboo in the last episode.

It doesn't have to be a taboo. Talk to people and say, hey, if you want to help me,

you can help me with this.

You just said there are private therapy spots. That's actually something

that I also find very interesting. So you can, there are all sorts of offers

to pay for it yourself. Is it easier to find then? Is it in doubt,

if you find the hurdle too high and have the money, should you just look for someone yourself

who offers it privately. Privately now means outside of statutory health insurance.

How would you assess that?

I mean, the offers exist, of course. It's just, you have to know, it's incomparable in terms of cost.

What does an hour of therapy cost in Germany?

That's a good question. I would actually have to research that too.

But roughly, I'd say 100 to 150 euros at least per hour.

Yes, so indeed.

Roughly.

And that is, of course, something that you have to be able to afford.

And in principle, you also have to be careful who offers it.

There are trained psychotherapists with a private practice. But there are also people who have no training at all

Have further training and say, now I'm a live coach.

For example, the coaching scene.

Nothing against live coaching.

No, absolutely nothing.

I've done live coaching before, there are certainly good offers.

Totally, totally.

But it doesn't replace therapy, as a rule.

Exactly, you just have to know, so to speak, that it's not the same thing.

So a coach or coaching is not psychotherapy.

And that's why you always have to look a bit at what's behind it or who is offering what.

Maybe you can tell us again, when does the health insurance pay?

You just said, when there's a diagnosis.

There might also be cases where I'd say, I want to do therapy myself to get to know myself better.

or maybe I have something that's bothering me,

but it's not something that completely restricts me in life.

Maybe I have an anxiety disorder and I can cope with it quite well,

but I still want to work on it.

What's the difference there?

So from when can I expect help from the health insurance

and when should I perhaps seek help on my own or myself, which I pay for privately?

In principle, it's like this: if I turn to someone and I'm not sure at all,

whether I have a confirmed diagnosis, then that is precisely the task, to find out,

also within the first session. And then you can always decide how to proceed.

That's why these first sessions, I think, are super important. And generally, I would always

encourage, if I notice I'm not doing well, to turn to someone.

If it then turns out, okay, I can manage with it myself, I don't need

therapy after all, all the better. But you can find that out. And of course, the aspect,

that if you cope well with life stressors, it doesn't have to be a mental disorder. So as

I said, life stressors are also normal and you don't have to be top fit under them.

And it's okay to feel bad under certain circumstances in life.

The important thing is if it doesn't get worse again.

If I notice that it's not getting worse again, then that would be the point to seek help.

Manuel, you already mentioned how high the hurdles actually are.

Especially when you don't come from Germany and maybe don't speak German that well yet.

Then you have to call people, you have to be able to talk about it in the first place.

Our member Marketta has a question about this.

From my own experience, I know it's not easy to talk about mental health problems, even in your native language.

That's why I want to ask if there are also services in other languages.

What about when you're in Germany but don't speak German very well yet?

Are there services available then too?

There are services, and of course it's very difficult to do psychotherapy in a non-native language.

So, as I said, it's already hard enough to talk about feelings or things like that.

So, yes, there are services in foreign languages.

How do you find them?

Well, the best way is to just Google it.

There are outpatient clinics that have foreign language services, affiliated with large hospitals.

You can get information there.

At least for Berlin, there's a search engine where you can filter by language for therapists.

Exactly, outpatient therapists sometimes also offer bilingual treatment.

Simply because they themselves might have another native language or also somehow have other.

good skills. And would you still recommend that, even if you don't speak German very well yet,

you can do therapy in German? Well, it depends on what kind of therapy, if we assume now,

it's a crisis situation, for example, because of which I am now in the hospital, then patients too

can benefit who don't speak the native language.

They benefit from content like movement therapy,

yoga, music therapy. That all works without

having to speak the language perfectly fluently.

Where it gets a bit more difficult is indeed individual talk therapy.

So there it actually is, I think, more difficult.

I think everyone has to decide for themselves how their language skills are.

But per se, I think you're well-advised to seek out such points of contact

again, perhaps.

What do you think of such online offers?

In the USA, there are startups like this, maybe in Germany too, where you can then via the

Internet chat with any therapists at any time.

Mostly, I think, they are chat offers rather than actual phone calls.

There are both, right?

Or there are both.

Writing, speaking.

Yes, that already exists in Germany to some extent. In principle, it's totally good with the therapy place shortage, it's simply a good way to counteract it a bit. I think it's totally good. You also have to look again, what kind of offer is it? Who is behind it? Are they chatbots communicating with me?

or is it really therapy?

Yes.

With real therapists.

Yes, and I think, well, it's probably better,

to do something like that online in your native language,

than to sit in talk therapy,

where you don't understand half of it.

Yes.

On the other hand, I believe that these online things,

even if it's a real conversation with a real therapist,

it might have a different quality

if it only takes place online.

A therapist once told me...

to me, when I asked him, because I wanted to work with him, whether we

could perhaps work online.

And he said, you have to work with someone who drinks the same water as

you.

It has a different quality when you're sitting in the same room.

I found that exciting.

Yes, that's interesting.

I've often asked people that too, and I've heard both, that some people

have said, like, it's totally fine, you can also have a good relationship with people

build, even if you see each other on Zoom.

see in our daily work life. We also have employees whom we once

met in person in our lives and that works. But it can also be

that it doesn't work, probably. And at the same time, we know that sometimes

a meeting where you sit next to each other unfolds a different dynamic. And that's it,

I believe. I believe it's not black and white at all, it shouldn't exist or anything,

but maybe you should just keep in mind that if you find someone on-site

it's probably even better.

And as I said, there are contact points, so foreign language

institute outpatient clinics or special services, also with foreign language

therapy, which are also affiliated with clinics. So it's worth it to

google it or look on the internet.

Many topics today that we discussed. Thank you, Rieke, for being with us.

I would suggest for you who are watching and who actually haven't yet

know all the contact points. We will

research together again and here

under the video and in the shownotes

prepare some useful links

for you.

And if you have further

questions, you are welcome to write us comments.

Either on YouTube directly

under this video or on

easygerman.fm and when we

have collected enough comments, maybe

we'll just invite you again and

do another

episode. Thank you for being here, Rieke.

Thank you for the invitation. It was very nice with you.

See you soon.

Bye.

Bye.