The National Heath Service plays a big part of life in the UK. Love it or hate it - it's significant. For much of the time (and for the time being) seeing a professional and undergoing medical procedures is free. Counselling, too, is free within the NHS. How wonderful this is! Free health care is something special. With it being free, why would somebody in the UK pay to see a private, independent psychotherapist? Great question.
Waiting lists
Ah, waiting lists. It's difficult to know how long the average person in the UK waits to see a counsellor. Not only does it depend on the area of the UK one lives, the NHS doesn't readily hand over data regarding waiting times. However, staggeringly, it's published [1] that there are currently over 11,000 trans people waiting for an appointment with the NHS gender identity clinic, which is meeting people for initial sessions who joined the list in 2018 - that's four years of waiting!
And waiting for therapists in private practice? We can fill up and be unavailable, so there can be a waiting list. However, the majority of independent psychotherapists are full time and so will be seeing clients regularly and on rotation. The selling point of seeing a private professional is that you can fly in as free as a bird!
Amount of Sessions
In private practice, the client - that's you - has control of how many sessions you want. Have one. Have 98. Have three a year or three a week. As long as your therapist stays available and willing, you can see them.
In contrast, and mainly because of that waiting list mentioned before, NHS counsellors are restricted to how many sessions they can offer. A standard is eight sessions, though this can be raised if the counsellor makes a claim to advocate for the client to stay for longer. Whether eight sessions is enough for a person is another question (but, of course, eight may very well be enough).
Assessments
Speaking of making claims and advocating, the NHS counsellor is bound by the service they work for. In reality, this means they generally must keep tabs on their own work to keep themselves employed and to keep the service funded: It is standard practise for an NHS counsellor (as well as any public funded counsellor) to assess you, the client, on arrival. Counsellors often use what is known as a CORE-10 score. Questions about mental health and functionality and support are asked and scored out of 10. The process is repeated during the last appointment so that therapy is measurable and therefore justifiable.
Private practitioners may or may not choose to keep tabs and measure progress regarding therapy, which is totally fine and should be agreed upon together with the client. Although generally private practice is less clinical and medical than the NHS, which can be a winning factor for people who don't want to be poked and prodded.
Some people have no problem being assessed, questioned and measured and others detest this. What do you prefer?
Modality of Therapy
Of course, you may be wondering about what is actually offered in the NHS. Counsellors aren't just counsellors who are counsellors. Psychotherapists (who are technically different to counsellors) come in many shades and shapes. All trained and specialised in different modalities - or types - of therapy. Currently in the UK, Cognitive Behavioural Therapy (CBT), Counselling for Depression (CfD) and Eye Movement Desensitisation and Reprocessing (EMDR) are hot, trendy and most funded. It's common that one's GP would choose which type of therapy is best and send them off to the relevant professional trained in either of the three modalities above just here. Is it fair for me to say: "you get what you're given"?
Over in the private field, there are more than 30 types of therapies offered with counsellors each promoting themselves. Surfing what's available could be great - or a total pain in the a** if you are don't have the time or are not feeling good and just want to see anyone soon.
Understandably decision fatigue may bring someone who is new to therapy to never start therapy privately. The NHS may be doing some people a favour.
The Therapist
Yet despite the volume of modalities of therapy available in the private field, there is one thing I cannot downplay. When seeking therapy independently it's key that you are able to engage with therapy with the individual who is right for you! Countless studies point to the therapeutic relationship being the factor that creates successful therapy, so you want to meet with the right person for you, whatever 'right' means for you. Getting what you're given, or rather who you're given, in the NHS simply may not work for you.
Price
And, price. A factor too, naturally. Being in the NHS, seeing NHS counsellors is free for the client. Private practitioners, being independent, are paid for by either the client or somebody on behalf of the client, like health insurances or employee assistance programmes (EAP). Venturing towards the private practitioner can be inaccessible due to the fees.
Fortunately, the NHS is available as a free, albeit slow and strictly managed route, and the UK has numerous free emergency helplines like Samaritans and Childline (see Loud Lamb's resource page) which are available round the clock when independent counsellors are either unavailable or inaccessible.
NHS Therapy or Private Practice? There are pros and cons for both.
But, what do you want? What can you afford to wait and pay? Do you want to choose your therapist and modality?
Which is better for you?
Written by Lily Llewellyn
November 7th 2022
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