Discourse Revived from the Dead
The current state of psychotherapy care for adults with autism in Germany presents several challenges and developments that require attention.
**Wait times and access:** Long waiting lists for psychotherapy are a common issue in Germany, with an average waiting period of around five months. Some patients may not receive a response or may be told that no new patients are being accepted. Finding therapists who speak English and are covered by public health insurance (Gesetzliche Krankenversicherung, GKV) can be particularly difficult, making access more challenging for some autistic adults. A procedure called “Kostenerstattung” allows reimbursement for therapy by non-GKV affiliated licensed therapists if attempts to find a publicly covered therapist fail, but this requires documented proof of effort and approval from the health insurer.
**Specialized centers and care quality:** Specialized centers for autism care in Germany tend to have shorter waiting times and provide longer appointment durations. These centers can offer better tailored care to autistic adults, as their staff is highly knowledgeable about autism. However, many autistic adults still experience barriers such as misunderstandings by healthcare staff or insufficiently adapted communication strategies, leading to anxiety and less effective care.
**Diagnosis rates and challenges:** Diagnosing autism in adults is becoming more recognized but still faces hurdles. Misdiagnosis or late diagnosis can lead to comorbidities such as anxiety, depression, and self-harm behaviors. Gender differences in diagnosis also exist, with females often diagnosed later or under-recognized, which impacts therapy access and outcomes.
**Therapeutic options and innovations:** Cognitive behavioral therapy (CBT) remains a core psychotherapeutic approach, but the accuracy of diagnosis is critical to tailoring effective treatment. There is interest in integrating Artificial Intelligence (AI) and Machine Learning (ML) into psychotherapy to improve diagnostics and personalized treatment plans. However, many German psychotherapists have mixed attitudes toward AI, partly due to fears of professional replacement and knowledge gaps. Education and emphasizing the irreplaceable human qualities of therapists are expected to help acceptance.
It is worth noting that specialized clinics do not diagnose autism in two-thirds of cases, leading to identity crises. Autism spectrum disorders are often over- or under-diagnosed. Psychotherapy remains the primary option for treating autism, but many doctors and therapists lack sufficient knowledge about these disorders. There are only twelve specialized centers for adults with autism in Germany, with very long waiting lists.
In addition, medications are the mainstay of therapies for brain diseases, but outpatient psychotherapy is also recommended for many of these diseases. However, only 1.3 percent of statutory health insurance (SHI) expenditure is spent on outpatient psychotherapies.
The Berlin symposium of psychotherapists attracted significant interest, with 900 participants, but criticism included the increasing fragmentation of billing systems and lack of transparency, as well as insufficient consideration of vulnerable groups in training and continuing education.
Mental disorders, including those associated with autism, are at the forefront in terms of the number of healthy life years lost. The suicide rate is high among people with autism, and their life expectancy is shortened in Germany. People with autism are inadequately treated, with only twelve specialized centers for adults and long waiting lists.
The federal government has drastically reduced funds in the area of psychosocial support for refugees in 2024, affecting not only psychotherapies but also counseling and language and cultural mediation. People with reduced earning capacity most often have a mental disorder.
In conclusion, adults with autism in Germany face long wait times and limited availability of specialized psychotherapists, though specialized centers improve access and quality. Diagnosis can be late or missed especially for some groups, impacting therapy options. While traditional therapies like CBT dominate, there is cautious optimism about AI-supported innovations. Navigating the public insurer system is complex but offers financial coverage for therapy. However, there is a need for increased funding, more specialized centers, and improved education for healthcare professionals to better serve this vulnerable population.
[1] German Federal Ministry of Health (2021). "Psychotherapie in Deutschland." Retrieved from
- The integration of Artificial Intelligence (AI) and Machine Learning (ML) into psychotherapy could potentially enhance diagnostics and personalized treatment plans for autistic adults, addressing some challenges in mental-health care.
- The shortage of specialized centers for autism care and the long waiting lists for psychotherapy in Germany impact the health-and-wellness of autistic adults, particularly when it comes to their mental health.
