Psychotherapy | "I was shocked"

Protest against fee cuts in the healthcare system in Hamburg. Photo: IMAGO/BREUEL-BILD In mid-July, the black-red coalition decided on far-reaching cuts to statutory health insurance. Accordingly, in the future, expenses may only increase as much as the health insurance premium income. In the next three years, spending is to be limited even more. The so-called extended evaluation committee also decided to reduce the fees for psychotherapists by a flat rate of 4.5 percent. A court initially suspended the cut. For Johanna Thüker, chairwoman of the Association of Psychological Psychotherapists, this is not a reason to give the all-clear.

Psychotherapy is needed by people whose everyday life, well-being or ability to act is severely impaired for a long period of time by a mental illness. If the symptoms of the disease cannot be managed on your own or with general advice, such therapy is medically indicated. Depression, anxiety disorders, obsessive compulsive disorders, psychosomatic complaints are among these illnesses, as well as trauma-related disorders and severe stress reactions. Even without cuts in fees, the real demand is already higher than the offer. According to figures from 2024, around 18 million people in Germany are affected by mental illness, and around five million are considered seriously mentally ill and in urgent need of treatment. In 2025, the Central Institute for Statutory Health Insurance recorded around 15 million treatment cases per year (psychotherapy and psychiatry). The particularly critical areas include the care of children and young people as well as those in rural and structurally weak regions. Access to psychotherapy for poorer or homeless people or those with little education is also problematic. Psychiatric and psychotherapeutic care should actually complement each other, but they differ in terms of waiting times and fundamentally the focus. Psychotherapy is more behavioral and conflict-oriented; it relies on talk therapy and the processing of behavioral patterns and trauma.Psychiatry operates in a medical-biological manner; it is primarily about diagnosis and drug therapy as well as crisis intervention. Practitioners in psychotherapeutic care can be psychological psychotherapists who have completed a degree in psychology and are licensed to practice medicine - that is, they have a permanent state license to practice their medical profession in Germany. This job title is also protected. ugh

The much-noticed reduction in fees for psychotherapists has stopped for the time being. Still, there can be no talk of breathing a sigh of relief, right?

No, you can't really talk about breathing a sigh of relief. It is a good and important signal that the Berlin-Brandenburg State Social Court has initially suspended the fee cuts of 4.5 percent. However, the final verdict has not yet been made. And many colleagues are unsure whether repayments will be made if it is subsequently discovered that they were legitimate. In addition, the ruling of the State Social Court is based on a paragraph in the Social Security Code V, which protects the appropriate remuneration of psychotherapeutic services. However, this rate has now been deleted with the Contribution Rate Stabilization Act. (The sentence in § 87 read: “The evaluations for psychotherapeutic services must ensure an appropriate level of remuneration per unit of time,” editor’s note). How this will affect further case law and thus our fees is currently unclear. And then the aforementioned law also comes with further cuts: the short-term therapy flat rate is no longer applicable, psychotherapeutic services are to be budgeted for and future fee increases are reduced by being linked to the basic wage rate.

How did you experience the cuts in the spring? Did you also protest yourself?

Personally, I was shocked because I didn't think it was possible for the evaluation committee to make such decisions. That was the case for many people. But we as an association reacted immediately, joined forces with other associations and of course demonstrated. The largest joint demonstration was on April 15th with around 4,000 people in Berlin. At that point it was no longer “just” about the 4.5 percent fee cuts, but also about reacting to the Finance Commission’s proposals.

What are the consequences of the announced fee cuts?

The across-the-board cuts of 4.5 percent were/are already negative because they can lead practices into financial difficulties. Short-term cuts in the current financial year in particular are not so easy to absorb for smaller practices and especially for smaller practices with personnel costs. The so-called budgeting will have the most fatal impact on patient care. This de facto leads to a limitation in the number of psychotherapy sessions overall and thus to longer waiting times. This effect is exacerbated when practices that cannot survive economically due to the total cuts close and it becomes more difficult to generate new blood.

The psychologist Dr. Johanna Thünker is chairwoman of the Association of Psychological Psychotherapists (VPP) in the Professional Association of German Psychologists (BDP e.V.). She answered the questions in writing.

What needs to happen in the healthcare system so that patients can get a treatment place more quickly? According to a media report, it currently takes an average of 14 weeks for someone to get a place for therapy.

According to the Federal Chamber of Psychotherapists, the national average for waiting times is 21 weeks with extreme fluctuations. In the Ruhr area and very rural areas it can easily be 1.5 years, while in large cities it is often much faster. In order to shorten waiting times, we need demand planning (i.e. calculation of checkout seats) that is based on real needs. We also need better networking between the different care systems in order to make the care of mentally ill people more efficient. We consider it particularly clumsy and fatal - both in terms of human suffering and the monetary consequences - if a case in the future has to become acute before psychotherapy can be carried out. The current motion for a resolution goes in this direction, which wants to make exceptions to the above-mentioned restrictions, but only in serious or urgent cases. Many moderate cases would not be severe at all if treated early. But it's not just the fee that is still up for debate, but also the billing of those with statutory health insurance. If the therapist has more than a certain number of patients in the future, all hours beyond that will be paid noticeably less.

How should budgeting be implemented?

That's not entirely clear yet. The most likely option is a limit on hours per checkout seat. Psychotherapy cannot actually be remunerated at any low level because there are several rulings by the Federal Social Court that currently ensure a minimum remuneration. The background to these judgments was that, firstly, psychotherapy is time-bound - a therapy session can be carried out in 50 minutes, we cannot work faster, as you might be familiar with in medical practices - and secondly, our remuneration was far below that of other specialist groups. However, it is not yet clear to what extent our remuneration will continue to be protected after the deletion in the Social Security Code V or whether we are threatened with new, lengthy legal disputes.

Can you actually find anything good about the new healthcare reform?

There is currently no health care reform. The so-called contribution rate stabilization law is a pure savings law.

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