NHS vs. Private Therapy
It’s been widely reported that referrals for mental health support in the UK have sky-rocketed in recent years, and that it can be incredibly difficult to access NHS services in most parts of the country. As a result, many people are turning to therapists in the private sector instead, and paying for sessions themselves.
So apart from cost, what are some of the key differences between NHS and private therapy? And what are some of the pros and cons of each option? In this post, I’ll set out to answer both of these commonly asked questions. (Please note: the information in this post only applies to the UK, although there are regional differences within this. If you’re based in another part of the world, the mental health system is likely to be very different, particularly if you’re in the US.)
NHS Therapy
How do I access therapy through the NHS?
NHS therapy services in your local area are either delivered by the NHS directly, or by an agency that has been awarded a contract to do so by the local Clinical Commissioning Group (CCG) on behalf of the NHS. This means that the types of therapy services available - and the routes to access them - can vary enormously.
You can usually be referred through your GP (if you have one), but some services will allow you to refer yourself to them. If you need specialist support, the service may have different referral pathways and criteria you’ll need to meet to be able to access them. There is usually a website that will list your local area’s services so you can see what’s available, and you should be able to find it with an internet search.
Pros of NHS therapy
In an ideal world, therapy would be free for everyone and therapists would be paid properly for their knowledge and experience. The NHS has attempted to make this something of a reality, as one of the biggest pros of NHS therapy is that sessions through these services are free at the point of use so you won’t need to pay anything towards them. This means that you can access support regardless of your financial circumstances, so if you can’t afford private therapy, you can still see a therapist.
The limited nature of the number of NHS therapy sessions available to each individual means that clients can focus on working through a specific issue, rather than jumping between several different problems. For individuals who are especially goal-orientated, this can be a significant advantage to NHS therapy, as they can identify a specific outcome that they would like from therapy, and track their progress to achieving it more easily.
The NHS have strict criteria that have to be met by therapists employed by them. This means that any therapist you work with will be registered with a membership body that’s recognised by the NHS, and that they are deemed to have sufficient training and experience to work in the NHS service.
Depending on where you are in the UK, there may be specialist services in your area that can offer you longer-term support with specific issues. For example, in Hull, there’s a specialist trauma service, an eating disorder service, and a DBT (Dialectical Behavioural Therapy) service. These services are free but they can only be accessed with a referral from a GP or a mental health service you’re already working with.
Cons of NHS therapy
One of the biggest drawbacks to NHS therapy is that there is usually a limit on the number of sessions you can have, which can be anything from 6 to 20 sessions. The number of sessions you’ll be offered will often be based on the issue you’d like support with, so if this is deemed to be a “mild to moderate” problem, it’s unlikely that you’ll be offered more than 12 sessions. If your issues are particularly complex, you may find that you’re unable to access enough sessions to work through them via NHS services unless you’re deemed eligible for specialist support.
As there is such a demand for NHS therapy, services usually have to follow strict eligibility criteria to determine who needs the support the most. Unfortunately this can reinforce the myth that you can only have therapy if you’re in crisis or at breaking point, which simply isn’t the case. Therapy can be one of the best preventative steps to maintain your mental health, and can also help to identify any issues that could have a negative impact on you early on.
Another drawback of NHS therapy is that due to demand, waiting lists are often long and it may take a while to be offered an initial assessment before you can even start having sessions. It’s common for people to reach a breaking point / time of crisis before seeking help with their mental health, which means that by the time they’re assessed for therapy, their need for support is often urgent. Having to wait for weeks, months or even years just to have an assessment can result in existing issues becoming a lot worse.
With NHS therapy, it’s unlikely that you will be given a choice of therapists or the type of therapy you have, so you might work with a therapist that you don’t particularly connect with, and / or have a type of therapy that doesn’t necessarily suit you as an individual.
The reason why the type of therapy available on the NHS is often limited to CBT (Cognitive Behavioural Therapy) is primarily due to the government IAPT (Improving Access to Psychological Therapies) programme. This scheme was commissioned as a way to make therapy easier for anyone to access, but the types of therapy on offer won’t necessarily be right for everyone. IAPT services use the NICE Guidelines as a way of deciding which therapeutic approaches will be available through the NHS, and although these therapies have a huge research base, they’re not necessarily right for everyone.
It’s also important to be aware that NHS mental health referrals will usually appear on your medical records, and although the content of any therapy sessions you attend will be treated as confidential, there will be a record of your attendance.
Private Therapy
How do I access private therapy?
If you’ve been working with a therapist in the NHS and are coming to the end of your allocated sessions, your therapist may be able to continue working with you privately if they have a private practice. Otherwise, you can search for therapists on general directories like Psychology Today and Counselling Directory, or on the websites for therapist membership bodies such as NCS, BACP and UKCP.
Friends and / or colleagues who have accessed private therapy may be able to give you some recommendations, and it’s also worth having a look at local networking groups to see if any of their members are therapists.
You can read my post that has more information about finding a private therapist here.
Pros of private therapy
Each individual looking for therapy is different, and each therapist offering therapy will also be different. I would argue that having a choice of therapist and the type of therapy you can have is one of the biggest advantages of private therapy. You have the freedom to choose who you work with, and the flexibility to change therapist if you don’t feel like it’s a good fit.
One of the biggest differences for people accessing private therapy is often the commitment to attend sessions. By choosing to invest your own money into therapy, you’ve already attached a monetary value to it, so you’re more likely to show up for your appointments and engage in the work because you’re funding it yourself. This means that private therapy is often more likely to be effective because you want to see a return on your investment so you’ve already made a choice to put the effort into it.
Therapists in private practice who have availability for new clients will usually have a minimal wait to offer an initial assessment and first session, so you can meet them and start working with them quickly. This is a big advantage if you’re in a particularly difficult place with your mental health, as it reduces the likelihood of any existing issues having time to escalate further.
Assuming that every client is going to need the same number of sessions for a particular issue is one of the biggest problems with NHS therapy. Each individual’s issues will affect them differently, and there may be lots of underlying historical concerns that need to be explored in therapy as well. This means that therapy can be a long-term process, so having no limits to the number of sessions available or the duration of therapy (months or even years in some cases) is a big advantage to private therapy.
As therapists in private practice are not part of the NHS, there won’t be any log of your request and referral for mental health support, or your attendance at sessions. This means that your choice to have therapy will remain private and confidential between you and your therapist, which often puts people’s minds at ease.
Cons of private therapy
For many people, the biggest challenge for accessing private therapy is often the financial cost. Therapists in private practice can charge anything between £40-£100 per session. This may depend on where you live and how many therapists are in the area, as well as the training, experience and specialism of the therapist. It is a significant investment, and if your financial circumstances change, it may be one that you simply can’t afford to continue to make.
Unlike many other countries, in the UK the terms “counsellor”, “psychotherapist” and “therapist” are not protected titles. This means that legally, anyone can use them, even if they have no formal training or qualifications in providing therapeutic support. There’s also no legal requirement for therapists to register with any professional membership bodies, so it’s important to do your own checks to ensure that any therapist you’re planning to work with is insured, has undertaken a supervised clinical placement with genuine clients prior to working in private practice, and that they have regular clinical supervision to ensure that they are practicing safely and ethically.
Private therapists often work in an open-ended way, which means that there is no limit to the number of sessions you can have with them, or how long you can work together. As a result of this, it can be difficult for clients to identify and focus on specific issues consistently, so the therapeutic work has the potential to drift around rather than getting to the root of the client’s problems, which won’t suit everyone.
I hope that you’ve found this post helpful in providing an insight into the differences between NHS and private therapy. If you have any questions about anything I’ve raised in this post, or you’re interested in the possibility of working with me, feel free to get in touch. You can contact me: using the form below; via email to emma@emmapooleytherapy.com, or on Facebook and Instagram @emmapooleytherapy.