Who seeks psychodynamic psychotherapy in community-based practices? Patient characteristics examined in a large sample of applications for reimbursement of psychotherapy in Germany

This study examined the demographic characteristics of patients using outpatient psychodynamic psychotherapy and compared them to the general population. A second aim was to explore clinical and biographical features of the users. We extracted data from a random sample of 983 applications for reimbursement of psychodynamic psychotherapy in community-based practices in Germany. These applications contain information for the health insurer but also additional written reports for an expert reviewer. Census data for comparison were obtained from the Federal Statistical Office of Germany. Men, older people, and migrants were underrepresented, while the unemployed were overrepresented compared to the general population. A third of the reports described a patient's experience of physical and/or sexual violence. Twenty-six percent of the reports mentioned that the parents had separated, and a third of these patients were younger than 5 years at that time. Suicidal ideation was reported for a fifth of the patients. About 5% were reported to present with self-harming behaviour and 14% with violence towards others. It was mentioned that the patients were consuming dangerous amounts of alcohol in 9%. The most frequent diagnosis group was affective disorders, followed by neurotic disorders, whereas only few had a substance use diagnosis or a psychotic disorder. In summary, men, migrants, older people, and patients with substance abuse and psychotic disorders are likely underrepresented in outpatient psychotherapy in Germany, indicating unequal access to mental health care despite the universal coverage of its costs. Patients in outpatient psychodynamic psychotherapy often present with severe clinical problems.