'Stressful experience': How hard is it to find an English-speaking therapist in Germany?

With the ongoing anxieties posed by Covid-19 and previous lockdowns, mental health issues are stubbornly on the rise in Germany.

For expats, the pandemic has brought with it isolation, culture shock and homesickness, as well as the stresses of day-to-day life under lockdown. Meanwhile, travel restrictions in and out of Germany have made it harder than ever for those living abroad to return home to see family and friends.

According to one Berlin-based therapist, all of these factors have led to a spike in the number of expats seeking a therapist under lockdown. With the difficulties that come with navigating the system, however, support in English is not always easy to come by.

Restricted access

Last year, charity German Depression Aid revealed that, while demand for mental health services has increased in the wake of the pandemic, these same services are becoming harder to access.

In a recent study, 79 percent of people with depression said the lack of structure under lockdown had made life harder for them. At the same time, around 50 percent of people struggling with mental illness said their access to therapy had been restricted due to Covid-19.

READ ALSO: Germany grapples with mental health impact of Covid-19

The problem seems to be particularly bad for non-German speakers, who - even in normal times - often struggle to find therapists in Germany who work in their native language. 

Photo: picture alliance/dpa/SOPA Images via ZUMA Wire | Jesus Merida

Eva Schmidt-Mayer, a Berlin-based psychotherapist who works in both German and English, says expats are struggling more than ever to find therapy in the wake of the pandemic. As one of the rare therapists who accept public insurance, she currently receives inquiries for English-speaking therapy on a daily basis, but doesn't have the capacity to meet all of the requests. 

“It must be very hard for people to find someone,” she said. “I have more queries from English speakers than German speakers, and for the expats the demand seems to have risen enormously since the pandemic.”

So, why is it so difficult to find an English language therapist in Germany, and why do so few of them accept public insurance? 

READ ALSO: How foreigners in Berlin are turning to a black market in mental health for treatment

“More unpaid expenditure of time”

With an ever-expanding international community in Germany and a strong tendency for German professionals to speak English, the pool of therapists offering English-language services is by no means small – especially in the major cities.

Online directory Therapie.de lists around 600 English-speaking therapists currently working in Berlin, 150 in Frankfurt, around 230 in Hamburg, and 240 in Munich.

However, if you search for English-language therapists who accept state insurance such as TK or AOK as payment, the pool narrows – and filtering by those with available spaces narrows it even further.  

According to Schmidt-Mayer, the difficulties in finding an English-language therapist in Germany are – like many aspects of life here – rooted in bureaucracy.

To receive reimbursements for therapy from a state insurer in Germany, the therapist must be fully accredited as a psychotherapist or psychiatrist under German law, which means having studied the relevant subject for at least five years in higher education. In addition to this, the patient must also be able to be able to prove their need for ongoing therapy.

Photo: picture alliance/dpa | Friso Gentsch

The level of paperwork involved in proving the patient's need and the uncertainty of getting a repayment at the end of it make it a “quite a risk” to accept English-language patients, Schmidt-Mayer added.

“For me, it is connected to more unpaid expenditure of time, as the reimbursement process has become quite complex and usually the English-speaking patients are not able to fill the forms and write the letters,” she explained.

“The insurance companies have also begun to consistently deny the first application, so people have to write oppositions which have to be legally correct. It’s impossible for English speakers, and even difficult for German natives.

“It means I have to invest quite some time without payment before I can even start the therapy. Meanwhile a lot of patients give up as they do not have the capacity, so for me economically it is quite a risk.”

“A stressful experience”

Laura Hermann, a British expat who lives in Göttingen, sought English-language therapy after suffering a bereavement in early 2020.

Unable to find anyone covered by state insurance in her local area, she broadened her search to nearby towns and found a therapist 30 miles away in the town of Nordheim. This therapist had a six-month waiting list just for an initial assessment, with a further six-month wait for a possible appointment.

“I knew I couldn’t possibly wait that long,” she said. “But luckily my husband found a private psychotherapist in Staufenberg – 35 miles away – who speaks English. She is suitably accredited for my state insurance to make an exception and pay her up to the standard rate of treatment.”

In spite the lucky find, Hermann describes the entire process as “a pretty stressful experience”.

Photo: picture alliance/dpa | Wolfgang Kumm

“I attended my initial assessment with [the therapist], which I had to pay for privately. She was then able to submit a written report to my state insurers arguing my case and making a recommendation for the length of therapy required,” Hermann explained.

“I wasn’t able to make any further appointments until the insurers had decided on my case, and it ultimately went to an external reviewer who did decide the insurers should cover my treatment, but only half of the sessions that had been requested.”

READ ALSO: What are the main reasons internationals in Germany turn to therapy?

How to find an English-speaking therapist

With the bleak reports of rejected insurance claims and year-long waiting lists, it would be easy to get discouraged when looking for an English-speaking therapist.

Nevertheless, it’s by no means impossible to find one if you’re in need of support. Online therapist directories such as Therapie.de allow you to search by region, language, payment method, therapy type and availability, so you can narrow down lists of therapists that you think would be a good fit.

READ ALSO: Explained: How to receive help for a mental health issue in Germany

After finding someone with availability (and the right qualifications), you should contact your insurance provider to tell them you are planning to start therapy. With their agreement, you can generally have up to six assessment sessions with an accredited therapist without needing a doctor’s referral.

If you want to continue therapy after this, your therapist will need to write to your insurance company to argue your case. At this point, you’ll probably need a doctor’s referral, which you can get by visiting your local GP (or Hausarzt), and discussing your mental health concerns.

Consider switching insurance

If your current insurance is causing issues, Schmidt-Mayer suggests trying out some of the smaller state insurance companies, who are often more open to reimbursing the costs of psychotherapy.

“You should talk to the new insurance transparently before the change to explain that you’re switching explicitly for this reason, so that the application is accepted quickly after you switch,” she said. “But of course, it is still a lot of paperwork to be done in a time of need.” 

Photo: picture alliance/dpa/Ukrinform

Throughout the process of securing counselling, Hermann says her insurance company – one of the smaller state insurance providers – was “fantastic”.

“They even waived the need for a doctor’s referral,” she said.

Of course, if this still sounds like too much hassle, there’s always the option of paying for therapy privately – if you can afford it. 

Fees per 'therapy hour' (50 minutes) can range anywhere from €50 to €120, with most therapists pricing themselves at around the €100 mark, making long-term therapy prohibitively expensive for many.

In times of urgent need, these fees can sometimes be reduced - so it's usually worth contacting your preferred therapist to discuss your circumstances and what you can afford. 

If you're open to bearing your soul via Zoom, online therapy could also be a viable option. In the aftermath of the pandemic, most therapists are now happy to provide online therapy sessions, meaning that people in more remote areas can also find an English-speaking therapist in a city like Berlin - or even in their home country - without having to travel there regularly.

Websites like It’s Complicated list nearby therapists based on their speciality, price, availability – and also contain info on whether they are open to online sessions – so if you’re happy to pay out of your own pocket, this could be a good place to start.

Finding the right therapist can be a long journey, but with the right approach, it's still possible - even in extraordinary times. 

READ ALSO: Germany grapples with mental health impact of Covid-19