Psychotherapy Part 2: Public or Private


  • Public Sector help in the UK is free:
    • it can be difficult to access
    • it can be recorded on your medical records
    • it can involve long waiting lists
    • help can be very time-limited
    • it can be restricted to establishment-approved therapy models
    • it sometimes requires psychiatric diagnosis
    • it offers you little or no choice over the type of therapy or the therapist
    • it can be variable across NHS Trusts
    • it can offer you additional support e.g. psychiatry, social services
    • It can sometimes put you in touch with other service users and groups
  • Private sector help falls into two groups:
    • Private Clinics:
      • often very expensive
      • can be paid using health insurance
      • usually offer a limited range of therapies e.g. CBT, EMDR, Psychodynamic
      • can be attended for as long as you consider appropriate
    • Private individual therapists:
      • offer the greatest choice and flexibility
      • fees are variable
      • qualifications and experience vary
      • support is restricted to contact with one person
      • you get to choose who you work with, the type of therapy you want, and for how long
      • it does not appear on your medical, insurance or employment records
      • it is also not restricted to psychiatric or clinical problems, and can address all emotional, psychological and personal development needs


Public Sector Help

Some forms of counselling and psychotherapy may be available via your local NHS Trust or GP surgery, free of charge.  This tends to come with a waiting list, limited numbers of sessions the service will offer, and a limited range of therapies, many of which are not made clear to patients.  Therapies tend to be offered only for clinical problems, and any involvement you have with Mental Health services entered on to your medical record, including diagnoses and other sensitive information.

Very broadly, psychotherapies and helping methods fall into two categories:

  1. Symptom-focussed models that focus on specific clinical or psychiatric problems, symptoms and diagnoses divorced from their social context or causes
  2. Relationship- or process-based models that use a variety of methods to address life difficulties and clinical problems that arise out of social contexts by building a trusting relationship with the patient over time

Typically, the NHS in the UK offers a mix of both symptom-focussed and relationship-based help, with the vast majority of it being the former as it is much cheaper to train practitioners in such models and deliver them in short modules of ten or twelve sessions, for example.  CBT (Cognitive Behavioural Therapy), and CBT-related therapies now dominate NHS psychological help, with counselling and much more limited relationship-based psychotherapy offered in the form of, for example, psychodynamic or systemic approaches. EMDR is a symptom-focussed technique that is sometimes available in some NHS Trusts, usually used for treating symptoms of psychological trauma.

Relationship-based psychotherapies also enable you to address and overcome the detrimental psychological and emotional effects of trauma but with an emphasis on building a trusting relationship with the therapist over time.  Symptom-focussed techniques (CBT, EMDR etc) don’t consider the therapeutic relationship a significant factor in therapeutic change, focussing instead on trying to change problematic thinking and behaviours in the patient rather than considering the wider influences upon the person’s mental state.  Relationship-based psychotherapies, by contrast, (psychodynamic, Gestalt, Existential Analysis, Person-Centred, Transactional Analysis to name a few) generally consider the quality of the patient-therapist relationship, the unique patient history and other environmental influences to be crucially important in the treatment and change process.  As such, they usually involve more sessions, requiring long-term and in-depth training for practitioners, and are thus much more expensive to provide for public service facilities.

The NHS is the most effective route to prescription psychiatric medication, hospitalisation, ECT (Electro-Convulsive Therapy) and psychiatric diagnosis if this is what you consider best for you.  However, it is important to understand the implications of these choices fully before committing yourself to that direction.  Psychiatric medications and treatments are typically not curative as stand-alone treatments, they sometimes come with significant detrimental effects, and some psychiatric diagnoses can be very stigmatising for some individuals, remaining on your medical record for life.  They can sometimes, however, allow you access to periods of short-term stability (via medication or in-patient care, for example) and treatment in some cases (but can also exclude you from services, depending on the specific diagnosis you receive).  If in doubt try to learn as much as you can about other patients’ experiences, and the scope and service provision in detail of your local NHS Trust specific to any diagnosis prior to making a decision about this route.


Private Sector Services

Private Services break down into two broad categories: Private Centres, Clinics and Hospitals and Private Individual Practitioners.  Private Hospitals will tend to be considerably more expensive for therapeutic help than private individuals.  This does not mean that they provide better quality help, support or treatment, however.  Running costs of facilities and the exclusive nature of private services tend to command higher fees, which can often be prohibitively high.  It is important that you look into costs prior to arranging a meeting or assessment.  One advantage of a Private Service may be that your private health insurance may cover some or all of the costs.  Check with your insurance company if in doubt.

Some private practitioners and private clinics can charge you £160 or more per 50 minute session for little more than simple CBT, and £350 per hour for assessment of your needs.  Research any facility or practitioner’s services thoroughly before making a commitment.


Private Individual Practitioners

Private practitioners tend to offer the best range of choices, quality, anonymity and flexibility with the best value for money.  Fees, experience and qualifications are usually well-publicised on practitioner websites, giving you enough information to make an informed decision prior to contacting the practitioner.

Some advantages of private psychotherapy, analysis and counselling are:

  • You can normally get immediate access to help and be seen without delay
  • You have control over the therapist you work with and the therapeutic orientation of the work (the type of therapy)
  • You can be seen outside normal working hours
  • Different formats and frequencies for therapy can be offered in a private setting
  • You have control over the duration of the therapy rather than being restricted to a limited number of sessions
  • Private psychotherapy is not restricted to the treatment of clinical or psychiatric conditions, but can also be used for various aspects of personal, spiritual and professional development
  • Private psychotherapy and any psychiatric diagnostic labels or other sensitive information will not appear as part of your medical record and no information about you shared with anyone else without your consent.  By contrasts, information contained in medical records can sometimes affect applications, insurance policies etc.
  • A wider range of therapies and ways of working are available privately, moreso than those typically offered in the NHS or private clinics


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