Organizational framework for psychotherapy

  1. Statutory health insurance
  2. Private health insurance and aid
  3. Confidentiality and data protection

Psychotherapy is a treatment that in some cases requires only a few sessions, but often extends over a longer period of time. Depending on how intensively you have to work on a problem, the psychotherapeutic treatment can take several years.

For a fruitful therapeutic process, it usually makes sense for the sessions to take place as regularly as possible. That is why psychotherapists arrange – if possible – fixed, constant appointments with their patients.

The organisation of the psychotherapeutic practice also requires that the patients keep their appointments, which are set up exclusively for them. If a patient does not come to the agreed appointment, the therapist has no other patients sitting in the waiting room who he could treat instead. Even if appointments are cancelled at short notice, the therapist cannot assign this appointment elsewhere. Appointments on which the patient does not appear may not be invoiced to the health insurance fund, as the fund only pays for services rendered. So the therapist has a loss of earnings during this time.

Therefore, most therapists make arrangements with their patients to cancel appointments (at least 48 working hours before the agreed appointment) and pay a fee for missed hours (legally secured under the term “provision fee”).

Psychotherapy at the expense of health insurance companies can be carried out by psychotherapeutically qualified psychological psychotherapists, child and adolescent psychotherapists and certain specialists (e.g. specialists in psychotherapeutic medicine). The health insurance funds only pay for certain psychotherapeutic procedures whose effectiveness has been proven. In individual cases, there are differences between statutory and private health insurance.

Statutory health insurance

Preliminary talks and assumption of costs

Every insured person has the right to have two “psychotherapeutic consultation hours” and four preliminary talks with one – if necessary with several – psychotherapists at the expense of the health insurance company. Additional payments or private billing are not necessary or permitted.

During the preliminary talks, the psychotherapist gets a first insight into the possible causes of the problems and clarifies the treatment options. The trial sessions also serve to check whether the patient and therapist can talk to each other and work together, i.e. whether they fit together. A therapist who is spontaneously and consistently unsympathetic is unsuitable for psychotherapeutic cooperation.

If both have agreed to start therapy, the patient, with the help of the therapist, applies to his health insurance company for reimbursement. The therapist writes a report in which he explains the planned treatment. This report is sent in anonymous form to an expert who then recommends or advises the health insurance company not to pay for the treatment. A certain number of meetings shall be authorised; if necessary, a request for continuation may be made at a later date.


In my practice there are the following possibilities of therapy:

short-term therapy

(psychoanalytically or depth-psychologically founded)

up to 24 meetings

Psychotherapy based on depth psychology

50 – 100 meetings

Analytical Psychotherapy

160 – 300 meetings

Analytical group therapy   

120 – 150 meetings

Depending on the procedure, the sessions take place once to three times a week.

The therapy is invoiced with the help of the insurance card via the Association of Statutory Health Insurance Physicians.

Private health insurance and aid

In the case of the aid and some private health insurances, the implementation and assumption of costs are basically very similarly regulated.

With most private insurances, however, the agreed tariff is important: many tariffs only reimburse a very limited number of psychotherapeutic sessions, e.g. 20 sessions per year.


The therapist charges the patient directly for the therapeutic services, e.g. at the end of the quarter. The patient is obliged to pay the bill immediately. The patient submits the invoice to his insurance company or to the reimbursement allowance.

Per session of 50 minutes of individual psychotherapy are usually charged about 92.51 euros (2.3 times GOÄ rate), in addition there are some other services that the therapist will explain in detail when he calculates them.

Confidentiality and data protection

All contents of the therapeutic discussions are treated strictly confidentially. The mere fact that someone is under treatment is treated confidentially. That is, in extreme cases, when a patient tells me that he has committed a murder, this falls under absolute secrecy. However, if a patient tells me that he is going to commit murder now, this is not covered by confidentiality, but I am obliged to contribute to averting damage from third parties, and first and foremost of course from the patient himself.

The same applies if a patient comes to a therapy session drunk and he tells me he will drive a car afterwards.

For information to third parties the written consent of the patient is always required!

The report to the expert on the assumption of costs is anonymised with the statutory health insurance funds; this is not the case with aid and private health insurance.

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