Tag Archives: Therapy Costs

How Do My Results Compare With IAPT / NHS Therapy?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

(Spoiler alert – very well!)

This essay came about because of two things happening around the same time.

Firstly, I was questioned as to whether private therapy was good value compared to the NHS – “The NHS has got to be doing it cheaper, hasn’t it!” was what was said to me. And there certainly wasn’t a question mark at the end of her sentence.

I looked it up, as to be honest I thought it would be around my charge of £30 to £60 per hour session.

I was rather annoyed and disgusted to discover that it costed £95 a session for “low intensity work,” and around £175 for “high intensity.” I can deliver either.

But never mind the cost, what about the quality, was my next thought…..

 

The second thing that happened was that a blog I follow (which looks at the application of statistics to therapy, amongst other things)  published an article on the measured recoveries made by clients given therapy in the NHS. It’s here(link).

Quite frankly I found the results shocking.

So will you, and I reproduce the bare bones of the NHS/IAPT results below .

For comparison,  I have worked out my own matching statistics, and show those in blue, together with some thoughts on the discrepancies.

It is recognised that the primary characteristic of a high-quality counsellor/psychotherapist is the ability to enable clients to maintain engagement, i.e. to help them to keep coming until they have what they need. This can be measured by:

A. The proportion of those entering therapy who have a managed/planned ending. In my service, it is 82%, compared with the NHS at 58%.

B. The proportion of clients who have had a managed ending that show demonstrable improvement (using recognised psychological tests). In my service it is 98%, compared with the NHS at 51%, and of course the NHS is starting from a lower percentage anyway (51% of 58%, rather than my 98% of 82%).

That’s the bottom line really, but if you want a further breakdown, I’ve put some of the calculations below.

Why is the difference so stark? – Well, here are a few guesses.

  • The NHS/IAPT controls what therapies are available there, and how they are practised – the process is carefully “manualised” and there is little flexibility in the approach.
  • The whole idea of “low intensity” and “high intensity” therapy seems to me to be missing both the point, and the research, actually.
  • With me, my approach is tailored differently for every client. A psychiatrist that one of my client’s sees occasionally said that he felt that I was delivering “A Bespoke Service.” Unsurprisingly, I liked that.
  • Although I do do some pro-bono work, client’s have to be able to pay for my services, and that does mean that I get a greater level of readiness and commitment, and ability to engage with the world.
  • The NHS is all about seeing as many patients as they can, regardless of staff readiness and morale (sorry, but it’s true, and it isn’t the fault of individual therapists). I try my best to put people off from coming if they are not ready, I really do NOT want to see someone who isn’t ready to work with me.
  • I run my life around the delivery of a high quality service, including lots of meditation, down-time, reading, learning, and no late nights, excess alcohol, etc etc. I didn’t become a therapist as a career move, I became a therapist because it was very clear to those in the volunteer service I was helping at, and clear to the therapists I attended in my own personal therapy, that I had a natural ability to do it well, and the commitment to do the required training.

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More Detailed Statistics Follow (for the Strong-Willed Only):-

  1. The journey from referral – 30% of IAPT referrals don’t enter treatment [I’m afraid I have no way of capturing this data for my own clients, as I rarely hear from people who decide to go elsewhere,  or nowhere.]
  2. The journey from entering therapy – 45% of IAPT clients that enter therapy don’t complete. [17% of my clients do not complete a course of six sessions,  or where they have decided to have more than six sessions then cancel what turns out to be their last session.  In these cases, having no closing data from testing, I cannot say definitely whether the client has met the standards for significant improvement or recovery. In some cases, I think it likely that the client feels that the process is not helpful to them, but decide not to talk to me about it and thereby come to a managed ending.. But some also leave suddenly,  having made good progress,  because they find it difficult to do endings,  or because they intend to return at some point, but haven’t needed to so far.]
  3. The outcome at therapy ending for all clients – 53% of IAPT clients do NOT achieve  recovery [the lower the number the better for this one. I use the CORE-OM test, an internationally recognised test for assessing risk, health, improvement and recovery. My percentage of completing clients who do NOT achieve recovery is 18%.]
  4. The outcome at therapy ending for clients that were at case level at the start – 51% of those clients achieve recovery (reach a point on psychological tests which are below the scores of a clinical population) in IAPT therapy [for my clients,  83% achieve recovery, and 98% have measured significant improvement in their symptoms. For my clients the main limiting factor is the budget in these cases. Often their employer will only pay for six or eight sessions and the client is would have to pay for further sessions with me once this number has been reached. These clients may well go on to other agencies – I often recommend local or online resources to clients who have finished but who would benefit from further sessions .]

Can I Have A Free Trial Session?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Only if you don’t want to come for another session!

Many therapists, particularly when newly qualified, will offer a free first session so you can see how you can get along. My way is to insist on payment for the first session, usually in advance, with a guarantee of a refund of that payment if either of us doesn’t want to continue for any reason at all after having attended for the first session.

Yes, if you come to the first session, you are welcome to leave, having had a full session, and with a refund, if you decide for any reason that you do not want to continue.

So, what’s the difference? In practice very, very few clients fail to show up for the first session if they have paid in advance. This is very much to their own benefit, as if they just vanish without attending or paying, they are not going to come back and give therapy a chance to make a difference in their lives. And it has been proven over and over that therapy can make a huge difference in their lives. So I don’t want to discourage them from having that opportunity to better themselves.

It’s true that most clients who come for the first session will continue for a course of sessions, be that six sessions – my suggested course – or longer. And the overwhelming majority of those clients will come to feel that the experience offers extraordinary value for money. But if they don’t want to return I am delighted to offer a refund. In a way it could be argued that I’m paying these clients not to return!  Why? – because I only want to work with clients who really, really want to work with me.

Of course,on occasion, I believe that I am not the right therapist for a client. Obviously they get a refund, and suggestions as to other therapists who may be more suitable. Sometimes, I want the client to think hard about their motivation and expectation of therapy before coming for a course of sessions. In those cases I will insist on giving a refund immediately. If the client then decides they want to return for a course (and it has to be said that most do), they will pay me for the first session too.

Therapy is Cost-Effective

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Here’s a good subject to start the blog off on the revamped website.

A few years ago (2009) I came across an interesting bit of research. Personally, I have no doubt it’s accurate. Here’s an extract:

Research by the University of Warwick and the University of Manchester finds that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Chris Boyce of the University of Warwick and Alex Wood of the University of Manchester compared large data sets where 1000s of people had reported on their well-being. They then looked at how well-being changed due to therapy compared to getting sudden increases in income, such as through lottery wins or pay rises. They found that a 4 month course of psychological therapy had a large effect on well-being. They then showed that the increase in well-being from an £800 course of therapy was so large that it would take a pay rise of over £25,000 to achieve an equivalent increase in well-being. The research therefore demonstrates that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Governments pursue economic growth in the belief that it will raise the well-being of its citizens. However, the research suggests that more money only leads to tiny increases in happiness and is an inefficient way to increase the happiness of a population. This research suggests that if policy makers were concerned about improving well-being they would be better off increasing the access and availability of mental health care as opposed to increasing economic growth

A fuller description of the research is still up on the Warwick University website. That would be four lots of six sessions I suspect, today. You can do a great deal of work in that time.

Actually clients have told me that having a significant amount of therapy actually helped them make more money as well – promotions at work, greater self-confidence, that sort of thing. Sort of having your cake and eating it too, I suppose.