European Kur and spa-medicine system

1. Introduction

Version followed: the German statutory routes as the statutory insurers and their information services publish them in 2026 (GKV Vorsorge under §§ 23, 24 SGB V and Reha under §§ 40, 41 SGB V; Deutsche Rentenversicherung (DRV) medical rehabilitation under § 15 SGB VI and its Reha-Nachsorge programmes IRENA and Psy-RENA), with short comparisons to the Austrian PVA, Czech VZP, French Assurance Maladie and Italian SSN (Lombardy) routes. German sources are primary; translations of German, Czech, French and Italian terms are marked [translation: own].

The European "Kur" is not a psychotherapy. It is a group of publicly funded health-insurance and pension-insurance benefits delivered by physicians (Kurärzte/Badeärzte, rehabilitation physicians, thermal physicians) and multiprofessional clinic teams, often at state-recognised spa or climatic resorts (anerkannte Kurorte) that use natural remedies such as mineral springs or climate [source: betanet, Vorsorgeleistungen und Vorsorgekuren]. In German law the colloquial word "Kur" covers two different things: Vorsorge (prevention: to stop a health risk becoming an illness or to strengthen health) and Rehabilitation (to improve an existing illness or limitation and prevent it worsening) [source: betanet, Reha und Kur für Mütter und Väter]. Psychosomatic rehabilitation, mostly funded by the DRV, is the part of this system in which psychotherapy is central: it treats mental illnesses such as depression, anxiety disorders and eating disorders in about 195 rehabilitation facilities, typically over five to six weeks [source: DRV press release 13.10.2021].

Core idea of how change happens, as the funders frame it: a time-limited stay away from everyday burdens, with structured treatment and health education, restores health and (for the DRV) working capacity; the gains are then carried into daily life and work through structured aftercare (Reha-Nachsorge) close to home [source: DRV Psy-RENA page; DRV IRENA page]. The psychotherapist's role is to identify which route fits, support the application and medical documentation, prepare the client, coordinate during the stay where needed, and deliver or connect the client to aftercare after discharge. A psychotherapist does not deliver the spa treatments themselves (baths, mud, physiotherapy, massage); these are prescribed by physicians and delivered by licensed staff [source: betanet, Vorsorgeleistungen] [synthesis].

2. Framework

The system is a set of access routes, each with its own funder, legal basis, application and aftercare. Choose the route first, then follow its stages.

Route A. GKV medical Vorsorge (§ 23 SGB V) [source: betanet, Vorsorgeleistungen und Vorsorgekuren]

Forms: (1) ambulante Vorsorgekur ("offene Badekur" [translation: own: open spa cure]) at a recognised Kurort, accommodation self-organised; the Kompaktkur is a special form of this; (2) stationäre Vorsorge in a Vorsorgeeinrichtung (inpatient prevention facility), which requires that an illness is already present (secondary prevention).
Application: completed jointly by the insured person and the treating physician, submitted to and approved by the Krankenkasse before the measure starts; the Medizinischer Dienst (MD) usually checks necessity. Statutory grading: outpatient Vorsorge in a recognised Kurort is covered only when ordinary outpatient care is not enough, or cannot be used because of work or family circumstances; inpatient Vorsorge only when outpatient Vorsorge is not enough either. The Krankenkasse decides type, duration, start and facility by individual medical need, respecting the right to choose under § 8 SGB IX [source: § 23 SGB V].
On site: treatments (e.g. physiotherapy, massage) need a prescription from the treating physician or the local Kurarzt (Badearzt) [translation: own: spa physician].
Duration as published: usually 3 weeks (4 weeks where medically necessary; longer for children under 14 in inpatient Vorsorge). Usual interval between measures: 3 years (outpatient) or 4 years (inpatient), with exceptions only for medical necessity. The statute sets inpatient Vorsorge at usually no more than three weeks unless a longer stay is urgently medically necessary, four to six weeks for children under 14, and the 3-year (outpatient in a Kurort) and 4-year (inpatient) intervals after comparable publicly funded measures unless an earlier one is urgently medically necessary [source: § 23 SGB V].
Costs as published: for outpatient Vorsorge the person pays accommodation, meals and the Kurtaxe, with a daily insurer subsidy set by the fund's statutes (by statute up to €16 a day, up to €25 for chronically ill small children [source: § 23 SGB V]); co-payments apply for treatments; inpatient adults pay a daily co-payment; exemption is possible once the personal co-payment ceiling is reached.

Route B. Vorsorge or Reha for mothers, fathers and carers (§§ 24, 41 SGB V; Müttergenesungswerk) [source: betanet, Reha und Kur für Mütter und Väter; Kur + Reha GmbH, Informationen zur Antragstellung]

Always inpatient, only in Müttergenesungswerk (MGW) clinics or equivalent clinics with a care contract; the "ambulant vor stationär" rule [translation: own: outpatient before inpatient] does not apply.
Forms: Muster 64 (Vorsorge, § 24) completed by the physician with the parent; Muster 61 (Reha, § 41) where impairments have lasted longer than 6 months (one Beratungsstelle advises completing parts B to E only); Muster 65 for each child who needs treatment. MGW-recognised Beratungsstellen help choose a clinic and complete and submit forms.
The attest should link health problems to parenting duties; one Beratungsstelle names three areas the insurer weighs: health status (e.g. exhaustion, anxiety, mild to moderate depression, sleep disorders, somatoform complaints), parent-specific burdens (e.g. multiple burdens from work, family or caring; a child with chronic illness, behavioural problems or disability) and life circumstances (e.g. separation, bereavement, financial worries, isolation), asking for at least two context factors.
Usually 3 weeks; usual interval 4 years; daily co-payment for adults; children usually up to 12 (exceptions to 14; no limit for children with disabilities); Widerspruch (objection) within one month of a refusal.

Route C. GKV medical rehabilitation (§ 40 SGB V) – applies when no other funder (usually the DRV) is responsible; the Muster 61 "Beratung zu medizinischer Rehabilitation/Prüfung des zuständigen Rehabilitationsträgers" is used to clarify the responsible funder [source: betanet, Reha und Kur für Mütter und Väter]. Statutory conditions [source: § 40 SGB V]: outpatient Reha (in a contracted facility, including mobile Reha) when outpatient treatment is not enough; inpatient Reha when outpatient Reha is not enough (carers under § 19 SGB XI are entitled to inpatient Reha regardless); the Krankenkasse decides type, duration, start and facility by medical need, respecting the right to choose (§ 8 SGB IX), and may depart from the prescription on medical necessity only on a differing opinion of the Medizinischer Dienst, giving reasons in writing; usual length at most 20 treatment days outpatient or three weeks inpatient, longer where urgently medically necessary or where indication-specific standard durations apply; for adults, not again within four years of a comparable publicly funded measure unless urgently medically necessary; adults pay a daily co-payment to the facility.

Route D. DRV medical rehabilitation incl. psychosomatic Reha (§ 15 SGB VI) [source: DRV press release 13.10.2021; Psychotherapeutenkammer Berlin, Info Psy-RENA]

Insurance conditions apply; one published example is compulsory contributions for at least six calendar months in the last two years.
Application online or on paper, also through DRV advice centres, the service telephone, Versichertenberater or Versichertenälteste; a physician's Befundbericht (medical findings report) is required in every case.
Wunsch- und Wahlrecht [translation: own: right to state wishes and choose]: preferences for outpatient or inpatient form, place, start date and clinic are granted "nach Möglichkeit" (where possible).
Usually 5–6 weeks; full-day outpatient Reha has no co-payment; inpatient Reha carries a daily co-payment for at most 42 days per calendar year.
After discharge: Reha-Nachsorge (IRENA, Psy-RENA and others), found via nachderReha.de.

Route E. Aftercare (Reha-Nachsorge, DRV)

Psy-RENA (psychosomatic aftercare): for people who completed DRV medical Reha with a mental-health diagnosis in the discharge report (dependence on alcohol, medicines or drugs excluded: separate aftercare exists); started within four weeks of discharge on application, or on the clinic's recommendation; delivered by DRV-approved medical or psychological psychotherapists in practices and counselling centres; up to 25 weekly 90-minute group sessions (8–10 participants), a 50-minute intake and closing session, up to 5 coordination units of 20 minutes, and in exceptions 12 individual sessions; no extension; also by video, plus a smartphone app for depressive disorders [source: DRV Psy-RENA page; Psychotherapeutenkammer Berlin, Info Psy-RENA (2018)]. Timing differs between documents: the Chamber flyer gives four weeks after discharge; the DRV Fachkonzept Psy-RENA (December 2017) requires the start within three months of the end of Reha and completion within 12 months [source: DRV, Fachkonzept Psy-RENA]; the current DRV page names no window. Confirm the window that applies with the DRV or the discharging clinic [uncertain].
IRENA (intensified aftercare): delivered only by inpatient and full-day outpatient Reha facilities; services from at least two of three fields (I movement therapy and physiotherapy; II clinical psychology, occupational therapy, clinical social work; III information, motivation, education, nutritional medicine); up to 24 weekly appointments of 90 minutes (more for neurology and obesity), groups of up to 10, medical intake and closing, no extension, digital form as individual sessions [source: DRV IRENA page].

Other European systems (for clients insured there or moving between systems)

Austria (PVA): medical rehabilitation (inpatient, outpatient, tele-rehab), RehaJET (occupational rehabilitation, 4 weeks), Gesundheitsvorsorge in contracted Kuranstalten, and Gesundheitsvorsorge Aktiv (GVA, 22 days inpatient, for musculoskeletal conditions, with a "Mentale Gesundheit" [translation: own: mental health] module among its options). Application by the treating physician on the official form; the PVA decides; do not book before written approval; admission within six months of approval; income-graded daily co-payment; no entitlement to a yearly repeated stay [source: PVA brochure, Medizinische Rehabilitation und Gesundheitsvorsorge, July 2026].
Czech Republic (VZP): lázeňská léčebně rehabilitační péče [translation: own: spa therapeutic-rehabilitative care] is proposed by the registered GP, the recommending outpatient physician or the hospital physician and confirmed by the insurer; length and repetition are set per indication in the Indikační seznam (indication list) attached to the public health-insurance law; some indications have admission deadlines after surgery, diagnosis or discharge. Whether mental disorders are listed [uncertain: not verified] [source: VZP, Potřebujete se léčit v lázních?].
France: a prescription links the condition to one of 12 orientations thérapeutiques, one of which is "affections psychosomatiques" [translation: own: psychosomatic disorders]; the cure must last 18 days; the patient sends the insurer's prise-en-charge questionnaire; usually one cure per calendar year; a thermal physician supervises under a forfait de surveillance médicale; transport and accommodation are means-tested [source: France Assos Santé, Fiche C.9.6].
Italy (Lombardy page): an SSN prescription from a GP, paediatrician or relevant specialist; the SSN covers one cycle per calendar year, of 12 days within at most 60 days, with self-declaration that no cycle was used that year; national ticket rules and exemptions; categories listed are rheumatic, ENT, respiratory, dermatological, gynaecological, urinary, vascular and gastrointestinal (no psychiatric category on that page) [source: Regione Lombardia, Cure termali e terme].
Hungary: publicly subsidised medicinal-bath treatment on physician prescription [uncertain: secondary, unverified].
International bodies: the International Society of Medical Hydrology and Climatology (ISMH) and the World Federation of Hydrotherapy and Climatotherapy (FEMTEC) are the scientific and federative bodies of spa medicine [uncertain: secondary, unverified].

Criteria for moving between stages [synthesis, built on the sources above]

Clarify → apply: the problem and goals fit a route; outpatient options alone are insufficient or the client needs distance from everyday burdens; physical and eating-related screening done; the client wants it.
Apply → prepare: written approval received (never start before it).
Stay → aftercare: discharge report (Entlassungsbericht) received; aftercare recommendation acted on within the published window (Psy-RENA: within four weeks).
Aftercare → ending: aftercare completed or ended; ongoing psychotherapy needs reviewed.

3. Guiding principles

Know which funder you are dealing with. Practical meaning: GKV routes aim at health and prevention; DRV routes aim at working capacity and "Stabilisierung Ihrer Erwerbsfähigkeit"; write and plan to the funder's aim [source: DRV IRENA page; betanet].
Medical responsibility stays with physicians for medical questions. Practical meaning: the Befundbericht, Vorsorge forms and spa prescriptions are signed by physicians. Contract (Vertrags-) psychotherapists may themselves prescribe GKV rehabilitation of a psychotherapeutic kind (psychosomatic Reha and psychiatric rehabilitation, RPK) for patients with a mental or behavioural disorder, with the conditions set out in 4.15 [source: G-BA Rehabilitations-Richtlinie; KVB, Psychotherapeutinnen und -therapeuten dürfen Rehabilitations-Maßnahmen verordnen (2026)]. Otherwise your contribution is a supporting report, information and coordination.
Approval before departure. Practical meaning: tell clients never to book or travel before the written decision; Austrian PVA costs are generally not covered for stays begun without approval [source: PVA brochure; betanet].
Context matters as much as diagnosis. Practical meaning: for parent routes document at least two context factors linking illness to family burdens [source: Kur + Reha GmbH].
The stay is one episode in a longer treatment. Practical meaning: plan aftercare before admission and act on it within the published windows [source: Psychotherapeutenkammer Berlin, Info Psy-RENA] [synthesis].
No dual roles in aftercare. Practical meaning: a client may receive outpatient SGB V psychotherapy during Psy-RENA, but not from the same therapist; choose whether you are the Psy-RENA provider or the outpatient therapist [source: Psychotherapeutenkammer Berlin, Info Psy-RENA].
Physical safety and eating-disorder caution. Practical meaning: spa treatments, exercise and nutrition modules are medical interventions; screen and route all clearance questions to the physician; give no diet, fasting, exercise, temperature or duration instructions [synthesis].
Consent for body-based treatments. Practical meaning: clients may decline or stop any touch-based application (massage, physiotherapy) and can ask for adaptations; touch is never sexual [synthesis].
Health claims are attributed. Practical meaning: describe benefits as the funders frame them (prevention, rehabilitation, working capacity); a Kur is not a treatment for cancer or other physical disease [synthesis].
Client autonomy and the right to object. Practical meaning: support Widerspruch where the client wants it (one month for parent routes) and respect a decision not to go [source: betanet, Reha und Kur für Mütter und Väter].

4. Intervention inventory

The procedures below are the psychotherapist's tasks around the Kur and Reha system. Clinic treatments are delivered by the clinic team and are not listed as therapist interventions. Example language is illustrative throughout.

4.1 Route clarification (Vorsorge, Reha or aftercare; which funder)

Purpose / when: when a client asks about a "Kur", is exhausted or not improving in outpatient therapy, faces long sick leave, or is a parent or carer under heavy family burden.
Steps: (1) Clarify the aim: preventing illness (Vorsorge, §§ 23/24 SGB V) or treating an existing illness with functional limitations (Reha, §§ 40/41 SGB V or DRV). (2) Ask about employment and pension contributions: work-related illness or threat to working capacity points to the DRV; one Beratungsstelle notes that such cases can be refused under §§ 24/41 [source: Kur + Reha GmbH]. (3) Ask about parenting or caring duties (MGW route). (4) Ask about previous Vorsorge or Reha in the last 3–4 years (published intervals) [source: betanet]. (5) Note insurance country for clients insured in Austria, Czechia, France or Italy and point them to that system's route (Section 2). (6) Agree who does what: GP or specialist, you, an MGW Beratungsstelle or DRV advice centre.
Example language (illustrative): "'Kur' can mean several different things here. Is the main goal to recover before you become ill, to treat what is already wearing you down, or to keep you able to work? The answer decides who pays and which form we use."
Watch for / working: the client can name the route, the funder and the next person to contact; watch for a wish to escape a crisis (acute suicidality, acute psychosis, active substance dependence) that needs acute care rather than a Kur [synthesis].

4.2 Medical and physical-safety screening before referral

Purpose / when: before any application, because spa treatments (baths, heat or cold applications, mud, inhalation, exercise and physiotherapy) are medical interventions [synthesis].
Steps: (1) Ask the client to discuss fitness for the stay and for spa applications with the treating physician; the Kurarzt on site prescribes the applications [source: betanet]. (2) Flag to the physician, without assessing them yourself: cardiovascular disease, blood-pressure problems, pregnancy (clinics have different rules, often by week of pregnancy; a physician should confirm that the pregnancy allows the stay [source: betanet, Mütter und Väter]), epilepsy, diabetes, regular alcohol use, recent surgery, and all regular medicines [synthesis]. (3) Never advise on medicines; route questions to the prescriber [synthesis]. (4) Specific contraindications for individual spa applications [uncertain: not verified]: leave these to the Kurarzt.
Example language (illustrative): "Before we apply, please ask Dr. X whether the stay and the treatments there are safe for your heart and with your tablets. I am not the right person to judge that, and the spa doctor will check it again on arrival."
Watch for / working: physician confirmation documented; watch for clients minimising symptoms to be approved, and for heat-, cold- or exertion-related complaints during the stay, which go to the clinic physician at once [synthesis].

4.3 Eating-disorder and body-image screening

Purpose / when: before any stay with nutrition, weight, exercise or fasting-type modules (e.g. IRENA field III nutritional medicine, obesity programmes, PVA GVA "healthy nutrition") [source: DRV IRENA page; PVA brochure], and for every client whose history includes restriction, purging, compulsive exercise or ARFID [synthesis].
Steps: (1) Ask about current and past anorexia, bulimia, binge eating, ARFID, orthorexic patterns and compulsive exercise; a brief validated screener such as the SCOFF can be used as published (items not reproduced here) [synthesis]. (2) Ask about pregnancy and breastfeeding, diabetes with insulin or sulfonylureas, underweight, older age and adolescence; these need explicit physician clearance for any diet or weight module [synthesis]. (3) If positive, tell the referring physician and the clinic in the application so the clinic can choose suitable modules; eating disorders themselves are an indication for psychosomatic Reha [source: DRV press release 13.10.2021]. (4) Agree with the client that no weight goal will be set in therapy [synthesis].
Example language (illustrative): "Some clinics offer nutrition or weight programmes. Has food, weight or exercise ever taken over your life, or does it now? If so, I want the clinic to know so they can plan around it."
Watch for / working: clinic informed; watch during and after the stay for new restriction, compensatory exercise, body checking or a sense of "failing" a nutrition module; refeeding and electrolyte risks after restriction, and the criteria for them, belong to physicians [synthesis].

4.4 Supporting the GKV Vorsorge application (§ 23 SGB V)

Purpose / when: a client with a health risk or a beginning illness for whom outpatient care is not enough.
Steps: (1) Explain the forms: ambulante Vorsorgekur at a recognised Kurort (self-organised accommodation, treatments prescribed by the Kurarzt) versus stationäre Vorsorge (an illness must already be present) [source: betanet]. (2) The client and the treating physician complete the application; it must be approved before the start [source: betanet]. (3) Offer a short psychotherapeutic statement on request (see 4.7). (4) Encourage the client's own short letter describing their situation; betanet recommends a medical statement on therapeutic necessity and goals plus a personal letter [source: betanet]. (5) Check practical points: co-payment exemption at the burden ceiling, Haushaltshilfe for children under 12 if travelling alone to inpatient Vorsorge, a person needing care can accompany with a note on the application [source: betanet].
Example language (illustrative): "Write half a page in your own words: what your day looks like, what you have already tried, and what you hope to be able to do afterwards. Insurers read that alongside the doctor's form."
Watch for / working: a complete application leaves the practice; watch for clients who expect a Kur to replace psychotherapy, or who experience a refusal as a judgement of their suffering [synthesis].

4.5 Supporting a Mutter-, Vater- or carer-Kind-Kur (§§ 24, 41 SGB V; Müttergenesungswerk)

Purpose / when: a parent or carer whose health problems are tied to family burdens; always inpatient in MGW or equivalent clinics [source: betanet, Mütter und Väter].
Steps: (1) Refer to an MGW Beratungsstelle, which helps choose a clinic, complete forms and, with the parent's consent, submit them and track deadlines [source: Kur + Reha GmbH; betanet]. (2) The physician completes Muster 64 (Vorsorge) or Muster 61 (Reha, impairments over 6 months), plus Muster 65 for each child needing treatment [source: Kur + Reha GmbH]. (3) Help the parent name at least two context factors from the three areas health, parent-specific burdens and life circumstances, and link them to the symptoms [source: Kur + Reha GmbH]. (4) Clarify children's ages, school release, and Haushaltshilfe for a child who stays at home [source: betanet, Mütter und Väter]. (5) Plan for pregnancy questions early [source: betanet, Mütter und Väter].
Example language (illustrative): "The form asks how your health and your family situation hang together. Let us put that in concrete words: what do you carry every day, and where does your body or mood show it?"
Watch for / working: parent can state their goals and the child's; watch for guilt about "taking time out", partner conflict about the stay, child-protection concerns (which follow your usual safeguarding duties, not the Kur process) [synthesis].

4.6 Supporting a DRV psychosomatic rehabilitation application

Purpose / when: a working-age client with a mental illness that endangers or reduces working capacity, especially with long sick leave or repeated relapses.
Steps: (1) Check basic insurance conditions with the client or a DRV advice centre (e.g. the published example of six months' compulsory contributions in the last two years) [source: DRV press release 13.10.2021]. (2) The client applies online or on paper, or through a DRV advice centre, the service telephone, Versichertenberater or Versichertenälteste [source: DRV press release]. (3) A physician's Befundbericht is required in every case; offer a psychotherapeutic report for the physician or as an enclosure (4.7) [source: DRV press release] [synthesis]. (4) Use the Wunsch- und Wahlrecht: discuss full-day outpatient vs inpatient, location, start date and a specific clinic (e.g. one with trauma, eating-disorder or language expertise) and write the reasons into the application [source: DRV press release] [synthesis]. (5) Explain duration (usually 5–6 weeks) and co-payment (none for full-day outpatient; daily for inpatient, at most 42 days a year) [source: DRV press release].
Example language (illustrative): "Psychosomatic rehab is run by the pension insurer, and its question is: what do you need to stay able to work, or get back to it? We can say which clinic would suit you and why."
Watch for / working: a decision arrives; watch for fear that Reha leads to a pension or job loss; give the facts neutrally (the DRV reports that about 15 percent receive a reduced-earning-capacity or old-age pension two years after psychosomatic Reha) [source: DRV press release] and explore what the client wants [synthesis].

4.7 Writing a psychotherapeutic report or statement for an application

Purpose / when: when the physician, the client, the MGW Beratungsstelle or the funder asks for supporting information, or in a Widerspruch.
Steps [synthesis, guided by betanet's advice to state therapeutic necessity and goals]: (1) Obtain the client's written consent to release information and agree the content with them. (2) State diagnoses (ICD-10/ICD-11 as used in your setting) and course. (3) Describe functional limitations in everyday life, family and work concretely (what the client can no longer do, since when). (4) Name context factors (for parent routes, at least two linked to family burdens) [source: Kur + Reha GmbH]. (5) List outpatient treatment so far and why it is not sufficient alone. (6) State specific, checkable goals for the stay. (7) Name requirements for the clinic (e.g. trauma-sensitive setting, eating-disorder expertise, language) and safety-relevant points (suicidality history, crisis plan) [synthesis]. (8) State your plan for continuation after discharge. (9) Keep it factual, short and free of information the funder does not need.
Example language (illustrative, for the report): "Despite 20 outpatient sessions, the patient remains unable to complete household and childcare tasks without help. A residential setting away from daily burdens is indicated to consolidate stabilisation; outpatient therapy will resume after discharge."
Watch for / working: the client recognises themselves in the text; watch for exaggeration under pressure to secure approval, and for content that could later affect work-capacity assessments; discuss this openly with the client [synthesis].

4.8 Supporting an objection (Widerspruch)

Purpose / when: after a refusal the client wants to contest.
Steps: (1) Note the deadline (one month for the parent routes) [source: betanet, Mütter und Väter]. (2) Read the refusal's reasons with the client. (3) Provide a supplementary report addressing those reasons (4.7); ask the physician to update theirs. (4) For parent routes, involve the MGW Beratungsstelle, which supports objections "in den meisten Fällen" [source: Kur + Reha GmbH]. (5) If a GKV application was forwarded to the DRV, betanet recommends contacting the DRV and clarifying that Vorsorge was requested [source: betanet, Mütter und Väter]. (6) Mention Beratungshilfe for clients who cannot afford legal advice [source: betanet, Mütter und Väter].
Example language (illustrative): "The letter says outpatient options are enough. Let us answer exactly that: what has been tried, and what happened."
Watch for / working: objection sent in time; watch for demoralisation and self-blame [synthesis].

4.9 Preparing the client for the stay

Purpose / when: after approval, in the weeks before admission [synthesis].
Steps [synthesis]: (1) Agree two or three personal goals and write them down for the admission interview. (2) Describe what to expect as the clinic publishes it (individual and group therapy, movement, relaxation, health education; for DRV clinics a focus on work). (3) Discuss separation from family and practical arrangements (employer must be told promptly about dates and any extension [source: betanet, Mütter und Väter]; Haushaltshilfe). (4) Make a written crisis plan the client can show the clinic. (5) For clients with trauma histories: explain that they can decline or stop any touch-based application, ask for a different therapist or for a chaperone, and tell staff which situations trigger them; touch is never sexual and intimate areas are not part of these treatments [synthesis]. (6) Prepare for group settings and shared rooms. (7) Agree whether and how you stay in contact; with consent, offer the clinic a short handover. (8) Plan aftercare before departure (4.11).
Example language (illustrative): "If a massage or a bath treatment feels wrong, you can say stop at any moment and ask for something else. That is your right, not being difficult."
Watch for / working: client arrives with written goals and a crisis plan; watch for anticipatory anxiety, avoidance (wanting to cancel) and unrealistic hopes of a cure in three to six weeks.

4.10 Coordination during the stay

Purpose / when: the client is in a clinic and outpatient therapy is paused or continued by agreement [synthesis].
Steps [synthesis]: (1) With consent, share relevant history with the clinic psychotherapist. (2) Agree whether you have any contact during the stay; avoid parallel treatment that confuses the plan. (3) If the client contacts you in crisis, route them to the clinic team and its physician on site. (4) Ask the clinic to send the discharge report to the physician and, with consent, to you.
Example language (illustrative): "While you are there, the clinic team is your first contact. Tell them what you would tell me."
Watch for / working: clear roles; watch for splitting between clinic and outpatient therapist and for early discharge requests.

4.11 Activating aftercare after discharge (Reha-Nachsorge)

Purpose / when: within days of discharge from DRV Reha; Psy-RENA can be applied for within four weeks or recommended by the clinic [source: Psychotherapeutenkammer Berlin, Info Psy-RENA].
Steps: (1) Read the discharge report with the client: diagnoses, recommendations, work-capacity statement, aftercare recommendation [synthesis]. (2) If Psy-RENA was recommended, help find a provider via nachderReha.de [source: DRV Psy-RENA page]; if no local group forms within three months, up to 12 individual sessions are possible in justified exceptions [source: Psychotherapeutenkammer Berlin, Info Psy-RENA]. (3) If IRENA was recommended (often for combined physical and psychological needs), it is delivered by Reha facilities [source: DRV IRENA page]. (4) Decide whether you continue as outpatient SGB V therapist; a Psy-RENA provider cannot be the same therapist [source: Psychotherapeutenkammer Berlin, Info Psy-RENA]. (5) Translate clinic skills into weekly practice goals [synthesis]. (6) Mention the travel-cost allowance and absence of co-payment for Psy-RENA [source: Psychotherapeutenkammer Berlin, Info Psy-RENA (2018)].
Example language (illustrative): "What was the one thing from the clinic you most want to keep? Let us make it a weekly step, and sort out the aftercare group this week."
Watch for / working: aftercare starts in time; watch for the post-discharge dip (return of symptoms on facing work and family), loss of structure, and early return to work under pressure.

4.12 Delivering Psy-RENA as a DRV-approved provider

Purpose / when: for psychological or medical psychotherapists approved by the DRV; approval requires Reha experience or a qualification seminar, suitable group rooms, but no statutory-insurance licence [source: Psychotherapeutenkammer Berlin, Info Psy-RENA (2018)].
Steps: (1) Intake session (50 minutes): review the discharge report and agree aftercare goals. (2) Up to 25 weekly 90-minute group sessions, closed or semi-open, 8–10 participants, aimed at practising and maintaining self-management skills learned in Reha in daily life and work, and at strengthening communication, social competence, problem-solving and conflict skills [source: DRV Psy-RENA page; Info Psy-RENA]. (3) Use up to 5 coordination units of 20 minutes for crisis intervention, talks with relatives, the Reha-Fachberatung or the company physician, on documented need [source: DRV Psy-RENA page; Info Psy-RENA]. (4) Closing session (50 minutes). (5) Video delivery is possible; a smartphone app exists for depressive disorders [source: DRV Psy-RENA page]. (6) No extension. The DRV Fachkonzept Psy-RENA (December 2017 version) adds [source: DRV, Fachkonzept Psy-RENA]: (a) three guiding principles: individualisation, occupational orientation and transition to self-directed activity; (b) group themes: coping with demands of work and social life (time pressure, reliability, concentration, endurance); stress management (setting priorities, realistic expectations); problem-solving and social competence (declining tasks, asking for help, standing up to supervisors and colleagues); working in a team; coping with unemployment and job search (self-concept, interviews, whether to disclose illness); leisure, recovery and balancing family and work roles; (c) methods: role-play, skills training, exchange between participants, practical activity planning and self-management techniques, with the emphasis on practice and solutions; (d) individual setting only if no group is available within 45 minutes' travel or the wait exceeds three months (8 sessions of 50 minutes, extendable by 4 with reasons); (e) a break of more than six weeks counts as discontinuation, and participants can be excluded after three unexcused absences; (f) each group session is documented per person, and a final report (Abschlussdokumentation) on goals, interventions, course, work capacity and recommendations goes to the DRV with the invoice, is discussed with the client and copied to the treating physician. Check the current version of the concept with the DRV before relying on these details [uncertain]. The weekly session structure used in the example below (review of the week, one theme, practice, transfer task) is the writer's synthesis [synthesis].
Example language (illustrative): "Each week we check what you tried at home or at work, practise one skill together, and you take one small step into the next week."
Watch for / working: attendance, achieved transfer tasks, stable or returning working capacity; watch for participants deteriorating (who need a crisis contact or a change of treatment), and for group conflicts about work and sick leave.

4.13 Advising clients insured in other European systems

Purpose / when: clients insured in Austria, Czechia, France or Italy, or moving between systems [synthesis].
Steps: (1) Austria: the treating physician submits the PVA form; wait for written approval; admission within six months; GVA includes a mental-health module [source: PVA brochure]. (2) Czechia: the GP, recommending specialist or hospital physician submits a proposal; indication list sets eligibility and length [source: VZP]. (3) France: a physician prescribes one of 12 orientations (including affections psychosomatiques); 18 days; insurer form; one cure per year [source: France Assos Santé]. (4) Italy: SSN prescription; one 12-day cycle per year [source: Regione Lombardia]. (5) Hungary and cross-border coverage [uncertain: not verified]; refer to the client's insurer.
Example language (illustrative): "Your insurer at home decides this, not a German fund. Your doctor there will need to file the request."
Watch for / working: client has the right contact; watch for paying privately for an unapproved stay.

4.14 Integrating the experience and monitoring after return

Purpose / when: in the outpatient sessions after discharge [synthesis].
Steps [synthesis]: (1) Debrief: what helped, what was hard, what was new about the body (rest, movement, touch, water). (2) Monitor mood, sleep, eating, body image and alcohol use for the first months. (3) Ask specifically about adverse experiences during the stay (injury, exhaustion, boundary violations, distressing treatments); pass physical effects to the physician, and report professional misconduct through the appropriate channels with consent. (4) Review the relapse-prevention plan and the timing of any future application (published intervals).
Example language (illustrative): "Was anything at the clinic upsetting or harmful, even if it seems small now? I would rather hear about it."
Watch for / working: gains maintained over months; watch for disappointment, idealisation of the clinic, eating changes, and delayed trauma reactions to body-based treatments.

4.15 Prescribing psychotherapeutic GKV rehabilitation as a contract psychotherapist

Purpose / when: for psychotherapists with a statutory-insurance licence whose client has a mental or behavioural disorder and needs psychosomatic Reha or psychiatric rehabilitation (RPK) funded by the Krankenkasse [source: G-BA Rehabilitations-Richtlinie; KVB 2026].
Steps [source: KVB 2026, summarising the Rehabilitations-Richtlinie]: (1) Confirm the indication is a mental or behavioural disorder; for indications covered by the Psychotherapie-Richtlinie (e.g. depressive episodes, anxiety disorders) no separate consultation is required, for other ICD-10-GM Chapter V diagnoses consult the treating physician first. (2) In every case check for somatic causes that need medical clarification. (3) Collect existing medical information (further rehabilitation-relevant diagnoses, earlier medical treatment, risk factors, other medical services including medication) and obtain it from the physician if missing. (4) If the responsible funder is unclear, use Teil A of Muster 61 to ask the Krankenkasse whether it or another funder (such as the DRV) is responsible. (5) Prescribe on Muster 61 Teile B to D, documenting the impairments that justify Reha, treatments so far, limitations of activity and participation, relevant personal and environmental factors (for § 41 SGB V, parent-specific factors) and medical risk factors. (6) Plan aftercare and your own role after discharge (4.11) [synthesis].
Example language (illustrative): "I can fill in the Reha prescription myself. Before I do, I need a short note from your GP about your physical health and medication."
Watch for / working: a complete Muster 61 reaches the Krankenkasse; watch for physical complaints that have not been medically assessed, and for prescribing outside the indications above, which belongs to the physician [synthesis].

5. Handling problems

The statutory sources describe access rules, not clinical difficulties; unless a source is named, the guidance below is [synthesis].

Refusal or forwarding to another funder. Read the reasons; respond with a targeted supplementary report within the deadline (one month for the parent routes) [source: betanet, Mütter und Väter]; involve the MGW Beratungsstelle or a DRV advice centre; if a GKV request is forwarded to the DRV, clarify which benefit was requested [source: betanet, Mütter und Väter]. Language (illustrative): "A refusal is a decision about paperwork, not about how much you are suffering."
Ambivalence and fear of consequences (job, pension, custody). Separate facts from fears: give the published facts on duration, co-payment and Entgeltfortzahlung (continued pay usually applies; the employer must be told promptly) [source: betanet, Mütter und Väter]; explore the worst-case belief; respect a decision not to apply.
Expecting a cure. Reframe the stay as one step; write goals that are achievable in 3–6 weeks and plan aftercare before departure.
Non-adherence before admission (forms not returned, cancelling). Break the application into small tasks with dates; involve the Beratungsstelle, which can handle correspondence with consent [source: Kur + Reha GmbH]; explore avoidance as part of the clinical picture.
Crisis during the stay. The clinic team and its physician are responsible on site; your role is to redirect and, with consent, inform them. Suicidal statements follow current risk-assessment practice and the clinic's emergency procedures.
Overwhelm or trauma reactivation through groups or body-based treatments. Remind the client of the right to stop or decline any application and to ask for a different therapist or setting; ask the clinic team to adapt the plan. Hands-on treatments remain with licensed clinic staff; a psychotherapist does not add touch to therapy unless their own professional code allows it and they hold the training. Report any sexualised or boundary-violating behaviour by staff through the clinic's complaint route and, with consent, the relevant professional body.
Eating, weight and body image problems emerging. If nutrition, weight or exercise modules trigger restriction, compensatory exercise or shame, inform the clinic physician and ask for the module to be stopped or adapted; after discharge, screen again and refer to specialised eating-disorder care where indicated. Never give diet, fasting, exercise or weight advice.
Physical adverse effects (dizziness, palpitations, exhaustion, skin reactions, injuries). These go to the Kurarzt or clinic physician at once and, after return, to the treating physician; do not interpret them as "healing reactions".
Post-discharge dip. Normalise it, shorten the gap to aftercare (Psy-RENA within four weeks [source: Psychotherapeutenkammer Berlin, Info Psy-RENA]), increase session frequency temporarily, and review the return-to-work plan with the physician and, via coordination units in Psy-RENA, the company physician [source: DRV Psy-RENA page].
No aftercare group available. Psy-RENA allows up to 12 individual sessions in justified exceptions if no group forms within three months [source: Psychotherapeutenkammer Berlin, Info Psy-RENA]; IRENA in digital form is delivered as individual sessions [source: DRV IRENA page]; otherwise continue outpatient SGB V therapy.
Role conflict. If you are the client's outpatient therapist, do not also deliver their Psy-RENA [source: Psychotherapeutenkammer Berlin, Info Psy-RENA]; refer to another provider.
Rupture over the discharge report. Clients may disagree with diagnoses or the work-capacity statement. Read it together, separate the client's experience from the report's functions, and help them raise factual corrections with the clinic or the funder.
Pressure from the insurer to apply for Reha. If a physician or the Medizinischer Dienst judges earning capacity to be at risk or reduced, the Krankenkasse can ask a sick-pay (Krankengeld) recipient to apply for Reha within 10 weeks (§ 51 SGB V); if no application is made in time, Krankengeld stops at the deadline and resumes from the day a later application is made. The pension insurer can treat a Reha application with no prospect of success as an application for a reduced-earning-capacity pension, which ends Krankengeld and can have lasting financial effects. Objection and court action against the request are free, and while they run an application is usually not required [source: betanet, Krankengeld > Keine Zahlung]. Refer the client to an independent social-law adviser (e.g. EUTB, a social-welfare association or a lawyer, with Beratungshilfe where needed) before they decide.
Clients from other systems paying privately. Advise waiting for written approval; PVA costs are generally not covered for stays begun without it [source: PVA brochure].

Sources

Statutory, insurer and institutional sources:

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