German situation of psychotherapy

Legislation

In 1999 a psychotherapists' (not psychotherapy!) law was passed which made psychotherapist a licenced health profession with similar rights and duties as physicians but limited allowances (restricted are prescribing of medication or other medical interventions as physical therapy, referal to other doctors, referal to a psychiatric clinic).

Training

The psychotherapists' law requires a postgradual training after a university degree which contains the following elements:
- 600 hours of theory lessons, including the chosen psychotherapy approach, mental disorders, interventions and some information about the other psychotherapy approaches accepted by the camber of psychotherapists
- 1200 hours of practicum in a psychiatric institution
- 600 hours of practicum in a different psychiatric or psychotherapeutic/ outpatient institution
- 120 hours of self-experience
- 600 hours of treatment in the chosen approach under supervision (every 4. session = 150 hours)

The training is conducted at institutes which have to be privately paid, training is not publicly funded. The structure of those institutions can be university integrated, non-profit-organisation or profit-related institution.

Subgroups of licenced psychotherapists

The profession of licenced psychotherapists can be devided into several groups with different qualification requirements:

1. according to their target group: There are the psychotherapists for adults and psychotherapists for children and adolescents.
a) Psychotherapists for adults: They have to be psychologists on master's level (or former diploma).
b) Psychotherapists for children and adolescents: They can either be the above or a have a degree in the educational field. Here the requirements differ from region to region. In some areas it can be at bachelor's degree, different fields of study are accepted.

2. according to their professional background: There are psychological and medical psychotherapists.
a) Psychological psychotherapists have a psychology degree and the above described postgradual training.
b) Medical psychotherapists have a medical degree and undergo a similar training but require less hours of theory and treatment.

Important institutions

a) The chamber of psychotherapists regulates and monitors the professional competencies and qualities. Membership of licenced psychotherapists is mandatory. It's science board decides on which psychotherapeutic approaches are scientifically proven, so that a psychotherapist trained in that approach can obtain the official licence. Here, five psychotherapeutic approaches have been accepted so far as scienticially proven: cognitive-behavioral, psychoanalytic, psychodynamic, client-centered and systemic.

b) The second important actor is the national licence board for any medical intervention (Gemeinsamer Bundesausschuss, short: GBA) which decides on which intervention is scientifically and cost-effective enough to be payed by public ensurance as regular
Ironically, only three out of five have been accepted: cognitive-behavioral, psychoanalytic and psychodynamic. Client-centered approach was denied by the board because the studies submitted were seen as unsufficient scientific evidence. A request from systemic approach is currently under review. Lately, there has been an initiative from different methods on common ground to form a union of humanistic approaches. A new request to the board was made in 2013 but has not yet been revised.

The consequences of this gap between licenced psychotherapists in an approach accepted by the GBA and one not accepted are that there is almost no training institutes in the later two approaches. Non-GBA-accepted licenced psychotherapists can practice psychotherapy but will not be able to have a practice where their patients can get publicly financed treatment.

"Non-licenced" psychotherapists
Besides licenced psychotherapists there is a huge amount of psychotherapeutically trained professionals which do not meet the criteria required by psychotherapists' law. For them it is possible to obtain a legal permission to treat patients/clients by a "health practicioner" licence in the area of psychotherapy (Heilpraktiker für Psychotherapie). It is granted by the federal bureaus of health. The licence can either be given after a theoretical exam or when proving relevant qualification level (as a psychology degree which contained the subject of clinical psychology). Anyone who obtained the health practicioner's licence can have a private practice (not funded by public ensurance but privately paid by clients). They are not allowed to call themselves psychotherapists but can include the term "psychotherapy" in their professional description. Practioners have a very broad spectrum of psychotherapy training, ranging from technically only theoretical to ECP-Level.

Numbers and facts

Public ensurance pays 80€ for a psychotherapy session. For regular short term treatment public ensurance grants 25 hours of therapy. In cognitive-behavioral therapy a long-term therapy means 45 hours, psychodynamic approaches need more hours. Therapists have to write a report which is revised by an expert to get the grant from public ensurance.
There are around 22000 licenced psychotherapists, 50% have their own practice (mostly public ensurance based). The other ca. 50 % of work in institutions.
There are also around 22000 professionals with the "health practictioner" permit.

Psychotherapists's law reform

The new grand coalition government annouced a law reform by the end of the term in 2017. In November 2014 the federal chamber of psychotherapists voted in favor of a university psychotherapy training similar to the German structure of medicine: After a university degree follows a five-year professional on-the-job training (which will inclued a trainee salary) specialising in a modality. Contents of the university degree, especially how much psychology and psychotherapy contents will be included, are currently being developed. By the end of 2016 the ministry of health will have published the first draft of the new law.

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