1. Unlike in America, in Germany everybody is a member of a health- insurance company (an HMO), that means, no one will directly pay for his or her treatment (with a few exceptions). That means, there is no chance for most of the psychotherapists to survive financially without having the right to be reimbursed from the insurance companies.
2. Physicians traditionally have a very strong influence in the health-care system in general and in the field of psychotherapy/psychiatry. Their work is legally based. There are a few psychologists as well with certain trainings, either in behavior therapy or psychoanalysis. These are the only two schools which are officially acknowledged in Germany.
3. Physicians and these psychologists can cover only about 50% of the people deserving psychotherapy. So there are "exceptions" for therapists like me (or family-therapists or psychodramatists etc.). We get paid from our clients and they will get back the money from their insurance compamies. But we have to label our treatment as either psychodynamic or behavioral and we are officially not allowed to do Gestalt-therapy. (I'm talking only about out-patients. There is a slightly different situation in clinics etc.)

Gestalt!: That doesn't seem like a very stable situation, certainly untenable for Gestalt therapists.

Thomas: The physicians are in a very strong position and want to cover the field of psychotherapy and psychiatry on their own. That means, if nothing changes, they will push away the psychological psychotherapists. That is why we need a law to protect our work. And hopefully this law will allow other schools to become acknowledged within the health-care system. This last point is very important for me.

Gestalt!: It sounds as if there are some who don't share your convictions.

Thomas: Well, yes. There are others among Gestalt therapists who think all this law stuff is a waste of time and energy and that we will have to make too many compromises. Personally, I don't think so. It's relatively clear how this law will look. It's not a good law for us, but better than nothing. And that's what we have been demonstrating for.

Gestalt!: Yes, and that is what got our attention - the fact that therapists were actually marching to demonstrate something, actually confronting, it would seem, the coallition between government and managed care. This is a fascinating development, and one that is echoed in our country by a united objection among mental healthcare professionals to the intrusion by the insurance industry into, and some would say destruction of, good mental health care. How was the turn out for your demonstrations?

Thomas: There were about 4.000 Psychotherapists- quite impressive. There will be a new effort from the gouverment now; nobody can say as of yet if this effort will result in a solution. To put it in one sentence: psychotherapeutic work for Gestalt therapists in Germany has become increasingly difficult.