Sexual abuse can traumatise victims and deeply hurt them physically and emotionally. But what does trauma actually mean?

In psychology, trauma is defined as an experience that exposes a person to an enormous threat, either directly or through observation. Those affected by it usually experience feelings of intense fear, helplessness or terror during this time. In addition to sexual abuse and other experiences of violence, natural disasters or accidents can also traumatise people.

Victims of sexual abuse often find it difficult to come to terms with what they have experienced. This can cause them to immediately suffer stress, psychological problems or illness, or even years later. A particularly large number of affected people develop what is known as post-traumatic stress disorder (PTSD). Symptoms of PTSD include sleep disorders and flashbacks. Flashbacks are memories of traumatic events and are usually experienced as a mental reliving of the trauma that they have no control over. PTSD can also cause depression, anxiety or personality disorders, sexual problems and addiction.

Some consequences are less obvious and people suffer in a way that is less noticeable, such as by being withdrawn or having little self-confidence. That does not mean that their experiences are any less traumatic. The consequences of traumatic experience can also mean that people find it difficult to maintain healthy relationships or do not meet their full potential educationally or at work.

In particularly severe cases of violence, a dissociative disorder may occur. Dissociation is in fact a natural psychological reaction to protect a person from feeling psychologically overwhelmed during a traumatic experience. It allows people to "disconnect" from what they have experienced. However, severe and especially prolonged traumatic experiences can cause sufferers to have persistent dissociative experiences. For example, they may feel temporarily detached from their own thoughts and feelings, and even their own bodies. Or they may not remember what they were doing at a particular time.

People sometimes go on trips that last several days and then can't remember them afterwards. There are also more serious forms of dissociative disorder that can occur as a result of a very severe violence experience. In these cases, a person's personality splits into multiple identities. You can find more information under „Organised sexualised and ritual violence“ in the „Useful information“  section.

Psychotherapy treats mental illnesses as well as physical illnesses with an important underlying psychological element. This includes the psychological consequences of sexualised violence.

Psychotherapy is based on scientifically recognised methods. Unlike psychiatrists, who are medical doctors, (psychological) psychotherapists do not prescribe medicines. Psychotherapy takes place in a one-on-one conversation between the patient and the psychotherapist. This also includes exercises and, in the case of children, also games. There are various types of psychotherapy.

Therapy methods are also called guideline therapies ("Richtlinientherapien"). They are scientifically recognised methods for the treatment of all mental disorders and are covered by health insurance.

Psychotherapists usually specialise in one specific method. These include behavioural therapy, depth psychology-based psychotherapy and analytical psychotherapy, as well as systemic therapy for adults. You can find out more about these different methods on the „Wege zur Psychotherapie“ (Paths to psychotherapy) website. 

The different methods are offered in the form of individual and group therapies. Other specific therapy methods for trauma patients, such as trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing (EMDR), can also be used. In EMDR, the processing of traumatic experiences is supported by eye movements. Other types of therapy include conversational psychotherapy, Gestalt therapy and body-oriented therapy. These are not covered by health insurance, but there are other funding agencies that may cover the costs. During an initial psychotherapy consultation session you can find out whether you need psychotherapy and, if so, which type of therapy is best for you and your situation and how the costs can be covered.

Victims and survivors can also benefit from services other than psychotherapy. There are specialised advice and counselling centres that employ people with psychotherapy skills who can provide psychological support. These advice and counselling services are usually free of charge and may be easier to access than psychotherapy. There are various ways: Some people find their way to psychotherapy via an advice and counselling centre. For others, an advice session is sufficient or direct psychotherapy is the first step.

Anyone who has experienced sexual abuse or is close to an affected person may suffer from symptoms that psychotherapy can help with.

It can help a person come to terms with the experience of violence immediately after an event. But therapy can also help if the sexualised violence happened a long time ago. 

Psychotherapy for adults

Psychotherapy can help you if you suffer from sleep problems or experience flashbacks. Flashbacks are memories of traumatic events and are usually experienced as a mental reliving of the trauma that people have no control over. Or if you are no longer able to do everyday chores that used to be easy, or if your work has become difficult for you. Perhaps talking to family or friends is no longer helpful, or your relationships are suffering because you are not feeling well? The people around you are worried about you or you yourself are plagued by fears and worries? If you feel that you need support, psychotherapy may be an option for you.

Psychotherapy for children and adolescents

Children and adolescents react to experiences of violence in many different and very individual ways. Young children in particular often exhibit behaviours that they had already grown out of. Some might start sucking their thumbs again, wet themselves or want to sleep in bed with their parents. They cannot bear being away from their parents. For some children, the psychological stress is expressed in the form of physical complaints such as stomach aches and headaches. Children and adolescents may also experience permanent mood changes after experiences of violence. They may withdraw completely and prefer not to see anyone at all. Others throw tantrums and are very irritable. Situations and requests that they had previously easily coped with can suddenly trigger anxiety and feelings of being overwhelmed. Often they start doing badly at school, or occasionally suddenly do much better. Sometimes young people in particular hurt themselves to feel that they are even alive or to relieve the extreme tension they feel.

Sie können sich komplett zurückziehen und möchten am liebsten niemanden mehr sehen. Andere bekommen leicht Wutanfälle und sind reizbar. Situationen und Anforderungen, die sie zuvor wie selbstverständlich bewältigten, können in ihnen plötzlich große Ängste und Gefühle von Überforderung auslösen. Häufig kommt es auch zu auffälligen schulischen Leistungseinbrüchen, seltener zu -steigerungen. Manchmal verletzen insbesondere junge Menschen sich auch selbst, um zu spüren, dass sie überhaupt lebendig sind, oder um die extreme Anspannung in ihrem Inneren zu verringern. 

These symptoms do not have to be the result of an experience of violence, they can also have other causes. However, psychotherapy can be useful when children or adolescents are experiencing distress or have trouble in their daily lives in their interactions with others, at school or at their training place. Child and youth psychotherapists, incidentally, treat children and young adults up to the age of 21.

Seek advice!

You can also discuss with your family doctor or a specialised advice and counselling centre for sexualised violence whether therapy might be right for you Psychotherapists in private practice also offer special initial consultation hours, where you can describe your situation and get advice.

It is possible that a psychotherapist behaves inappropriately and that you feel you are not being treated properly. In such cases, the "Ethikverein" ethics association provides confidential, free and, if required, anonymous advice.

For example:

• If you have problems or conflicts during therapy;
• If you feel insecure, hurt or mistreated;
• If the therapy was discontinued for a reason you do not understand;
• If ethical guidelines may have been violated;
• If you are looking to make a formal complaint or would like mediation.

You can find more information about the "Ethikverein" association here.
 MYou can find out more about your rights as a patient in the "Wegweiser" guide of the Federal Chamber of Psychotherapists (BPtK).

As a psychotherapy outpatient you generally attend weekly appointments in a psychotherapy practice.

The advantage of outpatient therapy is that you, the patient, can immediately apply what you have learned and go about your daily routine as usual. Once you are in therapy and your relationship with your therapist is stable, you can usually attend sessions on a long-term basis and the therapy can be adapted to individual needs and stress levels.

Before starting the therapy itself, you will attend initial consultation sessions. Adults can have up to six appointments, and children or people with a mental disability up to ten appointments.

These sessions can all be attended in the same practice or in different practices. These initial psychotherapy consultation sessions ("psychotherapeutische Sprechstunden") are designed to determine whether therapy is an option for you. They have to be attended before you start therapy unless you have been treated in a hospital or rehabilitation clinic in the last twelve months.

During the initial consultation sessions you can talk about your psychological symptoms and how they affect your everyday life. The psychotherapist will also give you information about the different psychotherapy methods and forms of treatment and answer your questions.

You will not always be able to immediately start psychotherapy. Sometimes, a psychotherapist will not be able to offer you a place straight after the initial consultation. Do not let that discourage you! You can use the initial consultation session to find out whether therapy would be suitable for you and what the right form of therapy for you might be.

At the end of the initial consultation you will be provided with written information about what type of help is recommended for you – such as guideline psychotherapy, hospital treatment, counselling or a self-help group. This written recommendation is important. If you urgently require guideline psychotherapy, you are entitled to be assigned a therapy place by the appointment service offices (TSS).

If you are in a severe crisis, your psychotherapist will offer you more appointments or make a referral immediately after the initial consultation.

This is called acute treatment. It is intended to help people overcome a severe psychological crisis. Acute treatment usually consists of twelve appointments of 50 minutes each. In the case of children and adolescents, their caregivers can usually be provided with three additional appointments of 50 Minutes each. During the acute treatment you will also discuss what the next steps may be. For example, your psychotherapist might talk to you about whether outpatient or (partial) inpatient psychotherapy might be an option for you.

This treatment does not need to be applied for with health insurance. If the psychotherapist is unable to offer acute treatment after the initial consultation, you will be given a written recommendation. People with statutory health insurance can submit this recommendation to the appointment service office (TSS) of the National Association of Statutory Health Insurance Physicians (KBV). You should then be provided with an appointment for acute treatment within two weeks. You can find out more about acute treatments on the "Wege zur Psychotherapie" (paths to psychotherapy) website of the Federal Chamber of Psychotherapists (BPtK).

If, after the initial consultation, you know that you want to start psychotherapy, you will then attend two to four psychotherapy trial sessions of 50 minutes each. The German term for the trial sessions is "Probatorik" or "probatorische Sitzungen"

Children and adolescents with mental disabilities are entitled to up to six trial sessions. These sessions are covered by health insurance and do not have to be applied for.

The purpose of the trial psychotherapy sessions is for the patient and therapist to get to know each other. They allow you to figure out whether a relationship of trust can be established. A relationship based on trust is an important foundation for therapy. You should therefore pay special attention to how you feel during these trial sessions. You should also ask any questions you may have. Do you feel well taken care of? Can you talk about anything that is on your mind? If not, you can go to a different practice where you feel more comfortable.

The sessions are also there for the psychotherapist to make sure they can offer the right treatment for you. The therapist will draw up a treatment plan and discuss it with you during these sessions.

Short-term and long-term therapy differ in terms of duration and the application procedure with the health insurance company. It is common that you start out with short-term therapy.

A short-term therapy consists of two parts, each with twelve sessions of 50 minutes each. If the first twelve sessions are not enough, you can request an extension of twelve additional sessions. It is also possible to turn short-term therapy into long-term therapy if necessary.

Depending on the method used, long-term therapies can last between 36 and 300 therapy hours. In very serious cases, additional sessions can be applied for and have to be justified. For people with mental disabilities, additional therapy hours can be requested if caregivers are to be included in the therapy.
You can find out more about outpatient treatment on the "Wege zur Psychotherapie" „(paths to psychotherapy)“ website of the Federal Chamber of Psychotherapists (BPtK).

To find a therapy place, you can get in touch with psychotherapists and medical specialists in your area. Some of them are registered under "Finding help".

You can also find links to the websites and search engines of the Associations of Statutory Health Insurance Physicians and psychotherapist associations ("Psychotherapeutenkammern"), where you can find more databases. For the costs to be covered by statutory health insurance companies, the psychotherapists need to hold a health insurance licence ("Kassenzulassung"). If you want to undergo psychotherapy, you can contact the following professions and points of contact:

• Psychological psychotherapists
• Psychological child and youth psychotherapists
• Medical specialists in psychiatry and psychotherapy
• Medical specialists in child and youth psychiatry and psychotherapy
• Medical specialists for psychosomatic medicine and psychotherapy
• Medical specialists with the additional official "psychotherapy" title
• Psychiatric outpatient departments in hospitals for psychiatry and psychotherapy for adults as well as for Children and adolescents 
• University outpatient clinics at university psychology departments  
• Outpatient clinics at training institutes for psychotherapists

The National Association of Statutory Health Insurance Physicians (KBV) also has an appointment service office (TSS) for people with statutory health insurance. The office can be contacted around the clock, either over the phone (116117) or online, and can arrange an initial psychotherapy session for you. If you have already been to an initial psychotherapy session and you have a certificate stating that acute treatment or guideline psychotherapy is necessary for you, the appointment service office must try to find a therapy place for you.

The waiting time must be no longer than four weeks for an appointment for a trial session if guideline psychotherapy was recommended for you, and no more than two weeks if acute treatment was recommended. You are not entitled to choose either a particular practice or a date/time for your appointment. If you want to make an appointment with a particular practice, you should call them directly to make an appointment. Advice and counselling centres can also help you in your search. They are usually part of a local network and often know therapists who specialise in trauma therapy.

Psychotherapists with statutory health insurance approval ("Kassenzulassung") cannot always offer a therapy place within the foreseeable future, especially to people with statutory health insurance.

If the appointment service office (TSS) of the National Association of Statutory Health Insurance Physicians (KBV) cannot refer you to a therapist, you can make an application to your health insurance company for treatment in a private psychotherapy practice.

This is conditional on the psychotherapist having an official license to practice and the necessary expertise (behavioural therapy, depth psychology psychotherapy, psychoanalytic psychotherapy or systemic therapy for adults). However, the psychotherapist does not need to hold a health insurance licence ("Kassenzulassung"). This is called the cost reimbursement procedure ("Kostenerstattungsverfahren"). In practice, however, many applications for reimbursement are rejected by health insurance companies. This is also the case if the insured person can prove that the psychotherapy is necessary and cannot be postponed and that attempts to obtain treatment from a healthy insurance-certified psychotherapist have failed.

If you have to wait longer for a therapy place, you also have the option of contacting a specialised advice and counselling centre. They often provide victims and survivors with help and support over longer periods of time. They also often offer therapy services you can attend until you find therapy place. Talking to other victims and survivors in a self-help group can also help and offer relief.

Statutory health insurance covers the costs for standard therapies, namely behavioural therapy, depth psychology therapy, analytical psychotherapy and systemic therapy for adults.

These come in the form of individual or group therapy. For these costs to be covered, it is important that your psychotherapist holds a health insurance licence ("Kassenzulassung").

In order for psychotherapy to be paid for by health insurance, an application must first be submitted to and approved by the insurance company. The application procedures differ based on whether you need acute treatment, short-term or long-term therapy. Your psychotherapist will know exactly what you need to do, and when, and will usually prepare the application for you. Most of the time, you just need to read through the application and sign it.

For patients with private health insurance , the costs are covered in accordance with the insurance contract.

You can find out more about the application process and cost coverage by health insurance companies here.

Victims and survivors of sexual abuse may be entitled to psychotherapy under the Victim Compensation Act (OEG) via the sexual abuse fund (FSM) and the recognition and compensation services of the churches. In some cases, the statutory pension or accident insurance covers the costs. You can find more information under "Financial assistance".

Statutory health insurance covers the costs for standard therapies, namely behavioural therapy, depth psychology therapy, analytical psychotherapy and systemic therapy for adults.

These come in the form of individual or group therapy. For these costs to be covered, it is important that your psychotherapist holds a health insurance licence ("Kassenzulassung").

In order for psychotherapy to be paid for by health insurance, an application must first be submitted to and approved by the insurance company. The application procedures differ based on whether you need acute treatment, short-term or long-term therapy. Your psychotherapist will know exactly what you need to do, and when, and will usually prepare the application for you. Most of the time, you just need to read through the application and sign it.

For patients with private health insurance , the costs are covered in accordance with the insurance contract.

You can find out more about the application process and cost coverage by health insurance companies here.

Victims and survivors of sexual abuse may be entitled to psychotherapy under the Victim Compensation Act (OEG) via the sexual abuse fund (FSM) and the recognition and compensation services of the churches. In some cases, the statutory pension or accident insurance covers the costs. You can find more information under "Financial assistance".

Inpatient treatment usually means that a patient is admitted to a clinic, where they remain day and night. This means that they can get immediate help in case of a crisis.

Inpatient treatment may be necessary if the mental illness is particularly severe and if, for example, outpatient treatment does not make things better. Or if the mental illness escalates and the person can no longer cope with everyday life or go to work for a prolonged period.

However, there is a risk that a person falls back into their old patterns of thinking and behaviour after returning home. Because after spending time in the clinic they are once again confronted with everyday life and its challenges. The time at the clinic should therefore also be used to prepare the patient for the time after they get discharged. In 2018, so-called inpatient-equivalent treatment ("stationsäquivalente Behandlung") was introduced in addition to inpatient treatment. It is like normal inpatient treatment, but takes place in the person's home.

Semi-residential and day-care treatment means the patient spends the day in the clinic and goes home in the evening. The advantage of this is that the patient receives thorough care while at the same time spending time at home, which can make returning to everyday life after treatment easier.

The treatment consists of various therapeutic models.

These include:

• Individual or group psychotherapy
• Medical care
• Drug therapy
• Occupational therapy
• Creative therapy methods such as art therapy or music therapy
• Body-therapy methods
• Relaxation techniques
• Psychoeducation
• Physiotherapy
• Sports and exercise therapy

Various professionals from the fields of medicine, psychotherapy, physiotherapy and health and nursing care work together as a team to provide these therapies.

To be admitted into a clinic as an inpatient or for day-care treatment you usually need a referral from a psychotherapist or doctor.

The following people can make such referral:

• Family doctors
• Psychotherapists
• Child and youth psychotherapists
• Medical specialists in psychiatry and psychotherapy
• Specialists in neurology
• Medical specialists in child and youth psychiatry and psychotherapy

Prior to admission, many clinics meet up with the potential patient to discuss whether the treatment is necessary and whether the clinic can provide the right treatment. The following facilities offer inpatient or semi-residential hospital treatment:

• Specialist clinics for psychiatry and psychotherapy/li>
• Specialist clinics for child and youth psychiatry and psychotherapy
• Specialist clinics for psychosomatic medicine and psychotherapy
• General hospitals with psychiatric, psychotherapy or psychosomatic wards
• Psychosomatic or psychotherapy rehabilitation clinics

Are you looking for a hospital or outpatient clinic near you? You can find several points of contact under „Finding help“.

In certain cases, the statutory health insurance companies cover the costs of inpatient or semi-residential hospital treatment.

​​​​​​This is the case when

• the patient has an illness that they cannot be treated for as an outpatient,
• a crisis necessitates inpatient treatment;
• outpatient treatment has not led to improvement.

The treatment is prescribed by family doctors, attending specialists or (child and youth) psychotherapists.

Semi-residential and inpatient rehabilitation treatment must be applied for. A pension insurance fund (such as "Deutsche Rentenversicherung") covers the costs if you are in employment. You will need to apply for medical rehabilitation. Doctors or psychotherapists can help you with the application. If you are not employed and are therefore not covered by a care funder, the application must be submitted to the health insurer. If the health insurance covers the costs, your doctor or psychotherapist can apply for medical rehabilitation.

Would you like to find out more about covering the costs of treatment? More information is available in the "Wegweiser" guide of the Federal Chamber of Psychotherapists (BPtK).

If you would like to find out more about psychotherapy, this information may be useful:

You want to do therapy

• The "Wege zur Psychotherapie" (paths to psychotherapy) website offers many practical tips and background information all about psychotherapy.

You are a parent of a victim and would like information

• The "Mutig fragen, besonnen handeln" (Brave questions, calm actions) brochure explains to parents how to deal with sexual abuse.
• The "Psychotherapie für Kinder und Jugendliche – Informationen für Eltern" „(Psychotherapy for children and adolescents – information for parents) guide offers help and advice on your way to psychotherapy.

You work with adolescents

• The "Gefühle fetzen" (Feelings are cool) website of the Federal Chamber of Psychotherapists (BPtK) helps young people find out what is going on with them and their feelings.

You work with refugees

• The "Ratgeber für Flüchtlingseltern" (Guide for refugee parents) helps refugee families with a traumatised child, as well as professionals who support the parents.