Private Therapy vs NHS: How to Choose the Right Option

When you decide to seek therapy in the UK, one of the first questions is: NHS or private? Both have genuine merits and limitations. Neither is universally "better"—the right choice depends on your circumstances, needs, and what's available in your area.

This guide compares the options honestly, helping you make an informed decision about where to access mental health support.

NHS Therapy: What's Available

IAPT Services

The main NHS psychological therapy service is IAPT (Improving Access to Psychological Therapies), known locally by various names: Talk Therapies, Talking Change, Talking Therapies, and others.

What IAPT offers:

• Treatment for anxiety disorders and depression
• Primarily CBT and related approaches
• Typically 6-12 sessions
• Self-referral in most areas
• Free at point of use

IAPT represents a significant investment in mental health access. It helps many people with mild-to-moderate anxiety and depression.

Secondary Mental Health Services

For more complex or severe presentations, secondary services offer:

• Psychiatric assessment
• Community mental health teams
• More intensive therapy options
• Crisis support

Access is typically via GP referral and involves assessment to determine eligibility.

Specialist Services

Some areas have specialist NHS services for:

• Eating disorders
• PTSD and trauma
• Personality disorders
• Perinatal mental health

Availability varies significantly by location.

NHS Advantages

Cost

The NHS is free at point of use. If finances are a significant concern, this alone can make NHS services the right choice. Private therapy typically costs £50-£150 per session—potentially £2,000-£6,000 for a course of treatment.

Accessibility

IAPT services are widely available and usually allow self-referral. You don't need to navigate finding a therapist or assessing credentials—the service does that for you.

Evidence-Based

NHS services generally offer NICE-recommended, evidence-based treatments. You're unlikely to receive an approach that lacks research support.

Medical Integration

NHS services can coordinate with other medical care—GPs, psychiatrists, other specialists. Information sharing (with consent) supports joined-up care.

Structured Approach

For some people, IAPT's structured, protocol-driven approach works well. It's predictable, skills-focused, and goal-oriented.

NHS Limitations

Waiting Times

This is the major issue. IAPT targets starting treatment within 18 weeks, but many services struggle to meet this. Waits of 3-6 months are common; some areas face longer delays.

If you're struggling now, waiting months for support can feel impossible.

Limited Duration

IAPT typically offers 6-12 sessions. This works for some presentations but is insufficient for complex, long-standing difficulties. If you need longer-term support, IAPT may not meet your needs.

Limited Approach

IAPT primarily offers CBT and related approaches. If you'd benefit from psychodynamic, person-centred, or other modalities, NHS options are limited.

Severity Thresholds

Secondary services have eligibility criteria. You might be "too complex" for IAPT but "not severe enough" for community mental health teams—the so-called "treatment gap" where people fall between services.

Limited Choice

You typically can't choose your therapist. The service assigns you based on availability. If you don't connect with your therapist, options for switching may be limited.

Postcode Lottery

Service quality varies enormously by area. Some regions have excellent, well-resourced services. Others are struggling with demand and underfunding.

Specific Issue Limitations

IAPT is designed for anxiety and depression. If your primary concern is relationship problems, identity questions, life meaning, or complex trauma, IAPT may not be well-suited.

Private Therapy: What's Available

Individual Therapists

The majority of private therapy in the UK is delivered by individual practitioners working from dedicated therapy rooms, shared spaces, or home offices.

You'll find therapists offering:

• All major modalities (CBT, psychodynamic, person-centred, integrative, EMDR, and many others)
• Both short-term and long-term work
• Specialisations in specific issues
• Flexibility in approach

Counselling Services

Organisations like Relate offer private counselling with fee structures, sometimes including sliding scales.

Private Clinics

Larger private psychology and psychiatry practices offer multi-disciplinary teams, sometimes including psychiatry, psychology, and various therapeutic modalities.

Online Platforms

Services like BetterHelp, Talkspace, and Spill offer therapy via apps and platforms, typically at lower cost than traditional private therapy.

Private Therapy Advantages

Access

No waiting lists (typically). Most private therapists can offer an initial consultation within days or weeks rather than months.

If you need support now, private therapy delivers faster access.

Choice

You choose your therapist based on:

• Therapeutic approach
• Specialisation in your concerns
• Personality fit
• Practical factors (location, availability)

This choice significantly affects outcomes.

Duration

Private therapy has no predetermined ending. You can work as long as needed—whether that's 8 sessions or ongoing support for years.

Modality

Every therapeutic approach is available privately. If you want psychodynamic exploration, Gestalt awareness, EMDR for trauma, or anything else, you can find it.

Flexibility

Private therapists can adapt to your needs rather than following protocols. The work can go where it needs to go.

Continuity

You maintain the same therapist throughout, building a consistent therapeutic relationship.

Confidentiality

While all therapy is confidential, private therapy creates no NHS records. For some people—those worried about insurance implications, professional registration, or simply privacy—this matters.

Private Therapy Limitations

Cost

The obvious barrier. Private therapy typically costs £50-£100 per session in most areas, higher in London (£80-£150). Over months of weekly sessions, this adds up significantly.

Some therapists offer sliding scales or reduced fees. Training institutions offer lower-cost therapy with supervised trainees. But cost remains a genuine barrier for many.

Quality Variation

Anyone can call themselves a therapist in the UK. While professional registration (BACP, UKCP, BPC) indicates training and accountability, unregistered practitioners exist. You need to assess credentials yourself.

No Medical Integration

Private therapists generally aren't linked into your NHS medical care. Coordination requires you to facilitate it.

Finding Requires Effort

You have to research, contact, and assess potential therapists yourself. This takes time and energy when you're already struggling.

No Regulation Guarantee

Unlike doctors or nurses, therapists aren't required to be registered. Due diligence is essential.

Making the Decision

Consider NHS If:

• Cost is a major concern: Private therapy isn't viable financially
• Your need isn't urgent: You can wait for treatment
• You're dealing with anxiety or depression: IAPT is designed for these
• You prefer structured approaches: CBT's protocol-driven style appeals
• You want minimal decision-making: You'd rather be assigned than choose

Consider Private If:

• You need help now: Waiting months isn't manageable
• You want to choose your therapist: Therapeutic fit matters to you
• Your issues are complex or long-standing: Brief intervention won't suffice
• You want a specific approach: Modality preference exists
• IAPT wouldn't suit your concerns: Relationship issues, identity questions, complex trauma

Consider Both If:

• You can start private while waiting for NHS: Get immediate support, then transition
• You need medication alongside therapy: NHS psychiatry plus private therapy
• Private covers gaps: Use NHS for core treatment, private for additional support

Practical Steps

Accessing NHS Services

1. Self-refer to IAPT: Search "talking therapies [your area]" or ask your GP for the local service name
2. Complete initial assessment: Usually by phone or online
3. Wait for treatment allocation: The painful bit
4. Begin treatment: Typically starting with guided self-help or group interventions

If your needs are complex, ask your GP about secondary mental health services.

Finding Private Therapy

1. Check directories: BACP, Counselling Directory, Psychology Today
2. Verify registration: Check they're registered with BACP, UKCP, BPC, or HCPC
3. Review credentials: Training, specialisations, experience
4. Have consultations: Most offer brief initial conversations
5. Assess fit: Do you feel comfortable? Does their approach make sense?

Assessing Affordability

If private therapy is a stretch:

• Ask about reduced fees: Many therapists offer sliding scales
• Consider training placements: Qualified trainees supervised by experienced therapists at lower cost
• Explore low-cost services: Some organisations offer reduced-fee therapy
• Check employee benefits: EAP programmes provide free sessions
• Consider frequency: Fortnightly sessions halve the cost

Frequently Asked Questions

Can I do both NHS and private therapy simultaneously?

Generally yes, though it's worth informing both parties. Having two therapists working on the same issues can be confusing, so consider different focuses.

Is private therapy better quality?

Not automatically. Good NHS therapy exists; poor private therapy exists. Quality depends on the individual therapist, not the funding source.

How do I know if NHS therapy would suit my issues?

IAPT works best for mild-to-moderate anxiety and depression without significant complexity. If your concerns are primarily relationship-focused, trauma-related, or about identity and meaning, private therapy likely suits better.

What if I can't afford private and NHS has long waits?

Options include: low-cost training placements, charity counselling services, university counselling (if applicable), employee assistance programmes, or online platforms (cheaper than traditional private therapy).

Will NHS therapy go on my medical record?

Yes, though access is limited to healthcare professionals involved in your care. This rarely causes problems but matters to some people.

What about online therapy platforms like BetterHelp?

These offer lower cost and immediate access but have limitations: less control over therapist matching, typically text-based or brief video sessions, and variable quality. They may suit some people as a first step.

Finding Your Path

Neither NHS nor private therapy is universally better. The right choice depends on your specific situation: what you're struggling with, how urgent your need, your financial circumstances, what approaches suit you, and what's available locally.

If you can access both, that's ideal—immediate private support while waiting for NHS, or NHS core treatment supplemented by private. If you can only access one, that's okay too. Both pathways help people.

I work privately in London and online, offering individual therapy for a range of concerns. If you're weighing your options and would value a conversation about what might suit you, I offer a free initial phone consultation. I'm happy to help you think through the decision, even if private therapy isn't the right answer for you.

What matters most is that you access support that works for you—whatever funding route gets you there.