Therapy in English in Germany: Insurance, Cost, Referrals, Waiting Lists

Published September 2026

If you live in Germany and want therapy in English, the system looks generous from the outside. Statutory insurance covers psychotherapy in full. In practice a place takes months. The therapy runs in German. And the rules for paying privately are easy to get wrong. This post is meant to save you the months.

I will walk through each route with the 2026 numbers. How the public route works. What the entry steps are. What you pay. What insurance covers and leaves out. How long people really wait, and who measured it. What private therapists charge. And where private online therapy in English fits, including its limits.

One thing to hold onto from the start. The therapists on all of these routes hold the same license, the Approbation. The routes differ in who pays and how long you wait, not in the quality of the person across from you.

How the German system works

Psychotherapy is a regular benefit of statutory health insurance, the GKV. Most residents are in it. The insurers pay for four kinds of therapy: behavioral therapy, depth psychology, psychoanalysis and systemic therapy. To bill them, a therapist needs two things. The Approbation, which is the state license. And a Kassensitz, which is a seat in the insurance system. The number of seats is capped by a planning rule, the Bedarfsplanung. That cap is why places are scarce. It is not a shortage of trained people. Plenty of licensed therapists work in private practice because there was no seat for them.

The insurers pay for the treatment of an illness. You need a diagnosis, and it goes into your insurance record. Stress at work, a hard year abroad or a marriage under strain does not qualify on its own. Couples therapy and coaching are never covered on any route.

The entry steps

You do not need a referral from your doctor. The required entry point is the psychotherapeutische Sprechstunde, a first consultation of at least 50 minutes with a licensed therapist. It was introduced in 2017 and has been required before any treatment since April 2018. You can book one directly with a practice, or through the 116117 appointment service, which by law must offer you one within four weeks. At the end you get a form called the PTV 11. It says whether treatment is needed and how urgently. Keep it. You will need it for every later step.

Then come two to four trial sessions, the probatorische Sitzungen, with the therapist who will treat you. Short-term therapy is two blocks of twelve sessions. The application goes to your insurer during the trial sessions. For short-term therapy, if the insurer has not answered within three weeks, it counts as approved. Long-term therapy needs a formal application and an outside reviewer's report. The limits are 80 sessions for behavioral therapy, 100 for depth psychology, 300 for psychoanalysis and 48 for systemic therapy. Sessions are 50 minutes.

What it costs you

On the statutory route you pay nothing per session. The bill goes from the therapist to the insurer.

If you have private insurance, the PKV, the rules come from your contract. The PKV's own patient portal says about 50 sessions a year is typical. Most plans want written approval before you go past the first few sessions, and some pay only part of the fee above a limit. The upside is choice. A private plan pays any licensed therapist, with or without a Kassensitz, so the wait is far shorter. Check your plan before the first session, not after.

There is a third route. Most people have heard of it and few understand it. Kostenerstattung, under section 13(3) of the SGB V, means your statutory insurer must pay for private treatment when it cannot provide care in time. It works only with a therapist who holds the German Approbation. It also takes proof. The PTV 11 marked as urgent. A written record of the practices you contacted and their answers. The 116117 service's reply. And a report from your doctor. The law sets no fixed waiting period, and insurers often push back. If you go this route, document everything and expect to appeal. I have written more on this route, and on paying privately, in a separate post on therapy in Germany without insurance.

What insurance covers, and what it leaves out

Statutory insurance covers therapy for a diagnosed condition. It has to be one of the four approved methods. And it has to come from a licensed therapist with a seat, or through Kostenerstattung. It does not cover couples therapy or coaching. It does not cover problems that do not count as illness. It does not cover a Heilpraktiker for psychotherapy, a lighter state credential that is not a licensed therapist. And it does not cover a therapist trained abroad who works outside the German registers. That includes me.

Private insurance covers less or more depending on the plan. Some plans cover a Heilpraktiker. Couples work is not a medical treatment, so plans do not cover it. All of them want a diagnosis.

The real waiting times, and who measured them

The best numbers come from the Bundespsychotherapeutenkammer, the federal chamber of psychotherapists. It analyzed insurance billing data for about 300,000 people who had a first consultation in early 2019 and were told they needed therapy. They waited 142 days on average before treatment began. Four in ten waited into the second half of the year. More than one in ten waited a full year. The chamber's position paper for the 2025 federal election put the average wait for a place at 20 weeks. In rural regions it can run past six months.

Two things happened in 2026 that matter for the wait. In March a 4.5 percent cut to what insurers pay psychotherapists was set for April. A court suspended it in July while the case is heard. And in July a cost-cutting law for the statutory insurers put outpatient psychotherapy under a budget. The chamber expects fewer places and longer waits once it takes effect.

The first consultation is not the long part. The 116117 service has to find you one within four weeks. The wait sits between that consultation and the start of treatment, and it is measured in months.

What private therapists charge

Licensed therapists in private practice bill under a fee schedule, the GOÄ. At the usual 2.3 rate a 50-minute session is 92.50 euros for depth psychology and 100.55 for behavioral therapy. At the 3.5 ceiling it is 140.76 and 153. Many practices set their own rate by written agreement. In Berlin, Munich and Frankfurt most quote 100 to 150 euros a session, and 100 to 200 for couples. A Heilpraktiker usually charges less. Private therapists in the big cities can often start within a few weeks.

Where English fits inside the public system

A licensed therapist can treat you in English on the statutory route, if they speak it and have room. Finding one is the problem. The 116117 appointment service does not take language into account when it matches you with a practice. The KV Berlin, which runs the service for the city, says so on its own site. The regional chambers' directories and some regional practice searches let you filter by language, and the English list in most cities is short. If you want covered care in English, put your name on several lists at once and start something in the meantime.

Sources

• 116117: the psychotherapeutische Sprechstunde and the appointment service, checked September 2026.
• SGB V section 13(3): Kostenerstattung, checked September 2026.
• Bundespsychotherapeutenkammer: 142.4 days average wait to the start of therapy, checked September 2026.

How the same questions play out in 33 other countries is in the country-by-country reference.

How I fit, and where I do not

I am a US-trained therapist working online in English with people across Germany and beyond. I am a private option. I do not hold the German Approbation. So my sessions are not covered by statutory insurance, do not qualify for Kostenerstattung, and are not paid back by private insurance. I do not prescribe medication and I do not provide formal diagnoses. What I offer is a start within days rather than months, sessions in your own language, and open-ended depth work rather than a fixed number of sessions. The fee is discussed on the free call. The practical terms are on the fees page. The trade is plain: you give up reimbursement, and you get time and language back.

If reimbursement matters to you, look for a licensed therapist who works in English, and ask about their wait. If money is tight and you can wait, the statutory route is real and free. Put your name down today, then decide what to do in the meantime. There is more on the Germany page, on the Berlin, Munich and Frankfurt pages, and on how online therapy compares to meeting in person.

Common questions about therapy in Germany