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Burnout and exhaustion

There is a point at which rest stops working.

The weekend is no longer enough, a holiday lasts three days, and the morning already begins tired. If you have arrived there, this is no longer about better time management.

Recognising it

When rest stops working

First the energy goes, then the patience. People who once liked their work suddenly hear themselves talking cynically about colleagues, patients, customers or pupils, and are startled by it.

Then, almost always, comes the shame. No longer functioning feels like personal failure, particularly for people who could always rely on themselves to manage. So they keep working, and the gap between what is still possible and what is being asked grows wider.

The body usually speaks up before that: sleep that does not restore, one infection after another, headaches, a pounding heart, a stomach that will not play along.

Getting clear on it

First look at what it actually is

Burnout is not a mental illness in its own right; it describes a state. In ICD-10 it sits under Z73 as a problem related to life-management difficulty, not as a diagnosis. That is not a technicality; it is the reason we look closely at the beginning.

Behind what feels like burnout there is often something treatable with a clear name: a depressive episode, an exhaustion-related depression, an anxiety disorder, a chronic stress reaction, a sleep disorder, sometimes undiagnosed ADHD, sometimes a physical cause. And sometimes it really is mainly the work situation.

I work as a licensed psychotherapist (Psychologische Psychotherapeutin), not as a burnout coach. The difference shows exactly here: I assess before I treat. And if a medical work-up is part of it, I tell you so.

Treatment

What the treatment looks like

How it works

  1. Diagnostic assessment

    In the first appointments we clarify what is actually there and what needs to be checked medically: thyroid, blood count, sleep, and more if needed.

  2. Relief first

    Before anything else is possible, the load has to come down. It is the most uncomfortable step and usually the one that works fastest.

  3. Understanding your own part in it

    Perfectionism, taking on responsibility, the difficulty of saying no, a sense of self-worth that hangs on performance. Without this part, the exhaustion reliably returns after you go back.

  4. Rebuilding regulation

    Sleep, breaks, movement, switching off. Not as a programme, but as whatever your system needs right now in order to wind down.

  5. Planning the return

    Going back to work is part of the treatment, not what comes after it. We prepare conversations, work out boundaries and decide what has to change. A pause without change only postpones the problem.

Public sector

For civil servants

Teachers, police officers and other civil servants are among the occupational groups with the most days lost for mental health reasons, and are often better placed here than they think.

Through Beihilfe (the reimbursement scheme for German civil servants) and your private supplementary insurance, treatment in a private practice is possible, billed under the German fee schedule for psychotherapists (GOP) in conjunction with the fee schedule for physicians (GOÄ).

For psychotherapy, most Beihilfe offices require prior approval. Your Beihilfe office determines the exact scope; I tell you in advance which services will be charged and prepare the necessary paperwork.

Practicalities

Costs and practicalities are settled beforehand.

Fees and reimbursement
  • Individual therapy, 50 minutes Billed under the German fee schedule for psychotherapists (GOP), at 2.3 times the standard rate. The amount depends on which services the session involves. Self-payers: 167.58 €. 134.06–167.58 €
  • Who pays Private health insurance, Beihilfe and self-payment. People with statutory insurance via Kostenerstattung, the reimbursement route under § 13 (3) SGB V. Private · Beihilfe · self-pay
  • Duration For exhaustion without an underlying depression, often 12 to 25 sessions. If a depressive episode underlies it, we plan for more and review how it is going regularly. 12–25 sessions
  • Setting The first appointment takes place at the practice in Frankfurt. Further appointments at the practice or by video, at the same rates. Practice or video
  • Languages German, English and Farsi, even for the things that are hard to say. Deutsch · English · فارسی

All amounts are per session and are known before the first appointment. Whether Beihilfe or an insurer covers them depends on your Beihilfe office and your insurer; I prepare the paperwork for it.

Common questions

What people ask before the first appointment

Is burnout a diagnosis?
Not in the strict sense. In ICD-10, burnout is classified under Z73, as a problem related to life-management difficulty, not as an illness. For billing with an insurer an actual diagnosis is therefore needed, and that comes out of the assessment. In most cases something is then found that has a name and is treatable.
Can you write me a sick note?
No. A sick note (Arbeitsunfähigkeitsbescheinigung) is issued by your doctor: as a psychotherapist who is not a physician, I am not permitted to certify unfitness for work. What I can do: give a professional assessment of the situation, discuss with you what makes sense, and, if you wish, coordinate with the medical practice treating you. If time off is coming, the decisive question is not how long it lasts, but what changes by the time you go back.
Do I have to tell my employer?
No. Your employer learns neither a diagnosis nor the fact that you are in treatment. With a sick note, only the unfitness for work is reported, not the reason. Whether, when and whom you tell is your decision, and we can go through conversations like that together beforehand.
Wouldn't a holiday be enough?
If three weeks of holiday change the state for good, it was probably exhaustion and not yet burnout. The hallmark is precisely that rest stops working. Then it is not about more time off, but about what produces the exhaustion and keeps it going.
I am a civil servant. How does the billing work?
Through Beihilfe and your private supplementary insurance, billed under the German fee schedule for psychotherapists (GOP). For psychotherapy most Beihilfe offices require prior approval; I prepare the paperwork for that.
I have statutory insurance. Is it still possible?
Yes, via Kostenerstattung under § 13 (3) SGB V, or as a self-payer. For Kostenerstattung you need a PTV 11 form from a psychotherapeutic consultation appointment, a Konsiliarbericht (a doctor's report confirming that physical causes have been checked) and documented rejections from practices that bill the statutory health insurers, usually three to five, with dates. I prepare the application with you, in German, English or Farsi. I cannot promise approval; around half of first applications are refused, and an appeal is often part of the process.
A beginning

Three lines are enough.

Tell me roughly what it is about. I will get back to you within two working days. If I am not the right person for you, I will say so and suggest someone better suited. The practice opens on 1 November 2026; you can request appointments for the first weeks from now on.

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In a crisis please do not wait for me: call 112, where you can speak English, or go to the emergency department of the nearest psychiatric hospital. Telefonseelsorge, 0800 111 0 111, counsels in German.