# What drives psychotherapists' willingness to treat individuals with spinal cord injury? A cross-sectional study from Germany

## TL;DR

This study explores why some psychotherapists in Germany are willing to treat people with spinal cord injuries, finding that factors like preparedness and home visit policies play a role.

## Contribution

The study identifies specific modifiable and non-modifiable factors influencing psychotherapists' willingness to treat individuals with spinal cord injuries in Germany.

## Key findings

- Therapists who agreed to home-based therapy were more willing to treat individuals with spinal cord injuries.
- Older age and higher emotional response were linked to lower willingness to treat this population.
- Training and preparedness can be improved to increase access to mental healthcare for individuals with spinal cord injuries.

## Abstract

Individuals with spinal cord injury (SCI) have a higher prevalence of mental health problems than the general population but face significant barriers to accessing outpatient psychotherapy. Understanding the factors that influence therapists' willingness to treat this population is critical for improving mental healthcare equity.

We conducted a cross-sectional online survey among licensed outpatient psychotherapists in Southern Germany. All therapists registered with the Association of Statutory Health Insurance Physicians who had an email address or an online contact form were invited to participate. In total, 677 complete datasets were analyzed in this study. Using logistic regression, we examined the associations between therapists' self-reported willingness to accept a hypothetical therapy request from an individual with SCI and nine potential influencing factors, including personal, emotional, and organizational variables.

Six variables were significantly associated with the therapists' willingness. Therapists who agreed to provide home-based therapy had higher odds of being in the willing group [OR = 2.28, 95% CI [1.50, 3.46], p < 0.001], as did those who reported a stronger feeling of preparedness [OR = 1.83, 95% CI [1.51, 2.21], p < 0.001] and greater field experience [OR = 1.34, 95% CI [1.11, 1.61], p = 0.002]. In contrast, older age [OR = 0.83, 95% CI [0.74, 0.92], p < 0.001], higher levels of emotional response [OR = 0.82, 95% CI [0.68, 0.99], p = 0.040], and workload concerns [OR = 0.73, 95% CI [0.55, 0.95], p = 0.020] were associated with lower odds of being in the willing group.

Willingness to provide psychotherapy for individuals with SCI is associated with both modifiable (e.g., training, preparedness, home visit policies) and non-modifiable (e.g., age) factors. These findings highlight the importance of disability-specific education and structural adjustments to reduce access barriers. Although the present study was limited to Southern Germany, reports from other countries, such as Australia and Switzerland, document a low uptake of psychotherapy among individuals with SCI, suggesting that this may represent a broader challenge across healthcare systems. Our results thus contribute to a better understanding of provider-side barriers in Germany and may stimulate further international research into disability-inclusive mental healthcare provision.