Cognitive Therapy Worldwide: Germany Approves Psychotherapies, CBT included

In the U.S., psychologists and other mental health care providers practice whatever type of therapy they prefer. But in Germany, things are a little different. There’s an emphasis on evidence-based therapy (therapy that has been demonstrated to be effective in clinical trials) – including Cognitive Behavior Therapy (CBT).

Here’s how Germany’s handling mental health care. This info was provided to us by Dr. Michael Linden:

  • Psychotherapies have to be licensed in Germany, similar to drugs. Required are at least three controlled clinical studies for a minimum of five different areas of mental health.
  • A second board has to decide whether a certain form of psychotherapy is efficacious enough to be reimbursed.
  • Cognitive behavior therapy has been licensed and is reimbursed by all insurance companies, i.e. private or social health insurance. Every person in Germany can get up to 80 sessions of CBT without direct costs.
  • There are about 20,000 psychotherapists in outpatient care and approximately a similar number in institutions. About 40% are cognitive behavior therapists. They treat about 300,000 patients per year.
  • There are about 75,000 to 100,000 inpatients per year who get cognitive behavior therapy.

In other words, Germany is providing evidence-based CBT treatment, and reimbursement for treatment, to almost 400,000 total patients per year. 

It’s phenomenal. We have no idea when the U.S. government is going to catch up… we have boards to regulate food, drugs, medical procedures – but no board that evaluates the efficacy of mental health procedures. We need national guidelines about therapies that are recommended, based on clinical trials. Also, private insurance companies should take note – evidence-based care actually saves everyone money in the long run, since it is clinically demonstrated to help people get better.

2 replies
  1. Kevin Benbow
    Kevin Benbow says:

    My understanding is that the UK is also going in this direction. Perhaps some could clarify that for me. . . . . .

    In a recent clinical supervisor’s meeting we had a rather spirited discussion along these lines. I found it both amazing and a little disappointing to find that I was viritually the only one who advocates for an evidence based, empirically supported approach to treating mental illness. My colleaugues are all of the persuasion that DSM diagnosis is only useful tor reimbursement. My response was that DSM diagnosis is useful for determining which research based protocols can be applied.

    I even made the statement that once research reaches a “critical mass” the pendulum will violently swing back from the current fad driven approach to psychotherapy and those who take an atheoretical stance will find themselves on the outside looking in when it comes to reimbursement and practice.

  2. CT Today
    CT Today says:

    The UK does seem to be moving in the direction of evidence-based mental health care, and recently launched a pilot program to increase access to evidence-based therapists, including Cognitive Behavior Therapists.

    There’s a great article called After Freud that talks about CBT being the most well-researched psychotherapy, and one that is increasingly favored in Britain… might be interesting to share with your colleagues.


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