A very good question indeed, especially now when, since 2007 there is a marked difference in the how accessible psychological help is through the NHS.Â My general advice would always be to talk to your GP first and find out about your local services. It may be that your difficulties could be well addressed with their help. The following considerations might help you make an informed choice:
Length of therapy
In the current economic climate, it is important to remember that all organisations, including the NHS, need to be cost-effective and so the majority of psychological help within Primary Care will be short term. If you feel you may need a longer time, then that would be an important consideration as all therapy requires you investing your trust and opening up to build a good working relationship.
Is there the right service for you?
If your problems map out well onto what a service was set up to help with then you have a good chance of being helped effectively. For some people that match may be more difficult. For example, if your problems are fairly complex and long-standing, you may not be offered a brief therapeutic input from a short-term service, as long standing problems do not tend to respond well to brief therapy and, importantly, would be outside of the serviceâ€™s remit.
A recent survey by Mind concludes that patients are still waiting too long for counselling and other forms of therapies, despite wide recognition of their benefits. 54% of patients have waited more than 3 months for treatment. While things are getting better overall Â in this respect, there may still be some time you have to wait for an assessment of your needs and then for the treatment itself. Your GP should be able to advise you on what the local waiting times are for you to be able to make an informed decision.
Another aspect to consider is the choice of therapist, both in terms of your personal “fit”, i.e. how well you feel you can work together, and also in terms of type of therapy offered by your practitioner. My advice would be to go with your gut instinct and to do so sooner rather than later. All good therapists will welcome your feedback and, if you don’t quite click, will help you find a person you can do good work with.
How much say you have
The recent survey by Mind reports most people were not offered a choice of treatment within the NHS. However, you might want to be involved in making important decisions regarding your treatment, for example how long it should last or what type of treatment you would prefer or who your therapist is. That might be easier to achieve if you pursued an independent route as these issues tend be largely pre-determined by organisational constraints. Organisations and services are obliged to make treatment decisions based on their remit, i.e. what type of service they have been commissioned to deliver andÂ adhere to NICE treatment guidelines, which may or may not reflect your treatment preference.
Some people prefer to keep their personal therapy private. An independent therapist is able to offer a confidential service where no information is shared with third parties without your explicit wish and instruction- the only exception to this would be duty of care should there be an immediate and serious danger to somebodyâ€™s safety or a court order requesting information.
Last but not least the physical environment in which you engage in therapy is important as it will either help you feel at ease and open up to do good work -or not. Generally speaking, if the premises are used specifically for therapy it is easier to make the space feel safe, confidential, inviting and private. Where the room has many functions over the course of the week (i.e. a community venue/ counselling room/ group meeting), the right balance is more difficult to strike and can detract from your experience of therapy. It is also good if you can get to therapy easily- either on public transport or being able to drive and park nearby. And if there is somewhere peaceful nearby, where you can go and gather your thoughts before and/or after the session, this would be a real bonus!
So all in all, a consideration of free options is the best starting point and your GP should be able to discuss these options with you. There are some excellent option available on the NHS if your needs fit within the service remit. There are also some other considerations which may influence your decision and these can include the level of your choice about the therapist, the type of treatment and its length, waiting time and the environment for your therapy.