Money is one of the first questions people have about therapy, and one of the hardest to get a clear answer to. Who pays depends on your insurance, on the kind of professional you see and on the kind of help you need. Here is an overview of how it works in Germany, written as plainly as I can.
The information below reflects the rules in November 2026. Insurance contracts differ a lot, so please treat this as orientation and confirm the details with your insurer before you start.
Statutory health insurance (gesetzliche Krankenversicherung)
If you are insured with a Krankenkasse such as TK, AOK, Barmer or DAK, psychotherapy is a covered benefit when a mental health condition needs treatment. The treatment has to be done by a licensed psychotherapist or a medical specialist who has a contract with the statutory system (Kassensitz), and it has to use one of the recognised methods: cognitive behavioural therapy, psychodynamic psychotherapy, psychoanalytic psychotherapy or systemic therapy.
The usual path looks like this:
- Psychotherapeutic consultation (Sprechstunde): up to six sessions of at least 25 minutes for adults, no referral needed. You can find one yourself or through 116117 (Bundesministerium für Gesundheit, n.d.).
- Acute treatment: up to 24 sessions of 25 minutes, if quick relief is needed.
- Trial sessions (probatorische Sitzungen): to see whether you and the therapist work well together.
- Short-term or long-term therapy: applied for with your Krankenkasse by the therapist.
You pay nothing for these sessions yourself. The difficulty is usually finding a free place, which I describe in Waiting times for psychotherapy in Berlin. Waiting for a regular therapy place often takes several months. A detailed, step-by-step guide is in Getting psychotherapy paid by public health insurance in Germany.
What statutory insurance usually does not pay
- Couples therapy as such is not a benefit of statutory insurance. A partner may sometimes be included in individual therapy, but sessions whose goal is the relationship itself are generally paid privately.
- Coaching is not a health care service and is not covered.
- Sessions with a Heilpraktiker für Psychotherapie are not covered, because Heilpraktiker are not part of the statutory system.
Reimbursement for a private practice (Kostenerstattung)
If you have statutory insurance and cannot find a place in reasonable time, you can apply for the costs of treatment with a licensed psychotherapist in private practice to be reimbursed. This is based on § 13 (3) SGB V. The Bundespsychotherapeutenkammer describes these steps (Bundespsychotherapeutenkammer, 2017):
- Attend a psychotherapeutic consultation and ask for written confirmation that psychotherapy is necessary and urgent.
- Contact several therapists with a statutory contract and write down their names, the date of contact and the waiting time they offered.
- Find a licensed psychotherapist in private practice who can start soon, and ask for written confirmation of that.
- Send your application to your Krankenkasse with these documents.
Funds decide each case individually, and some reject applications at first. It is worth asking your insurer early what they expect to see. Again, this route is for licensed psychotherapists (with Approbation and training in a recognised method), not for other professionals.
In short
With statutory insurance, the costs are covered when you see a licensed psychotherapist in the statutory system, or, after a successful application, a licensed psychotherapist in private practice.
Private health insurance (private Krankenversicherung)
With private insurance, your contract decides. Before you start, ask your insurer:
- Which professionals are covered: licensed psychotherapists, physicians, Heilpraktiker?
- How many sessions per year are covered, and at what rate?
- Do I need approval before the first session, or a report from the therapist?
- Is there a deductible (Selbstbeteiligung) that applies?
Many private contracts cover psychotherapy by licensed psychotherapists, often with a limit on sessions. Some also reimburse a Heilpraktiker für Psychotherapie, usually up to the rates of the Heilpraktiker fee schedule (Gebührenverzeichnis für Heilpraktiker, GebüH). Others exclude Heilpraktiker completely. If you are a civil servant with Beihilfe, the rules of your Beihilfe office apply in addition.
Supplementary insurance (Zusatzversicherung)
People with statutory insurance can buy supplementary insurance, for example for Heilpraktiker treatment. These contracts vary widely. Many cap the amount per year, some exclude psychotherapy, and most have waiting periods and do not cover conditions that existed before you signed. Read the conditions carefully, and ask the insurer in writing whether psychotherapy by a Heilpraktiker für Psychotherapie is included.
Paying privately
Paying yourself gives you freedom: you choose the person, the language, the method and the timing. Common reasons for choosing it are a long wait, wanting therapy in English or Spanish, wanting couples therapy, or preferring that the treatment stays outside your insurance records. The last point matters to some people because diagnoses in insurance records may be asked about later, for example when applying for private health or disability insurance. If this concerns you, it is worth getting independent advice.
In some cases, the costs of treatment can be claimed in your tax return. For psychotherapy this usually requires an official medical certificate issued before treatment starts. A tax adviser or Lohnsteuerhilfeverein can tell you whether it applies to you.
Questions to ask any therapist about money
- What does one session cost, and how long is it?
- How do you handle cancellations?
- Do you issue invoices that my insurance will accept?
- Which insurance options apply to your sessions, and what would I need to submit?
- Which licence do you hold to practise psychotherapy (for example an Approbation as a psychotherapist or a permission as Heilpraktiker für Psychotherapie)?
It also helps to call your insurer before treatment begins and ask directly what they cover for this specific professional and this kind of therapy. A short written confirmation can save you surprises later.
Asking about money is part of choosing well, and a good therapist will answer openly. If you are still deciding which kind of professional you need, Psychologist, psychiatrist, psychotherapist or Heilpraktiker may help.
More about therapy with me.
References
- Bundesministerium für Gesundheit. (n.d.). Psychotherapeutische Sprechstunde. Retrieved November 5, 2026, from https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/psychotherapeutische-sprechstunde.html
- Bundespsychotherapeutenkammer. (2017). Kostenerstattung: Patienteninformation. https://www.psychotherapeutenkammer-berlin.de/system/files/document/20170522_bptk-patienten-info_kostenerstattung.pdf
- Fünftes Buch Sozialgesetzbuch – Gesetzliche Krankenversicherung (SGB V), § 13. https://www.gesetze-im-internet.de/sgb_5/__13.html
This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.
