Is Affordable Counselling Cutting Psychotherapy’s Throat?

WinningCompetion-300x167Psychotherapy is a profession in crisis. If you work in the NHS, you will know this already. Despite Government commitments to do more, therapy posts have been cut and health care providers are paying less and using more volunteers. If you are in private practice you will be well aware how hard it is to make money, particularly if you are just starting out. More practitioners are competing for the finite number of clients who can afford £50 or more a week to spend on their psyche.

The financial situation of therapists was highlighted last week in the election campaign for the position of Chair of UKCP. Martin Pollecoff, who is positioning himself as the change candidate, pointed out that the profession is prone to hold the “wonderful 1970s idea that if you did the right thing then a higher power would take care of the money”1. Psychotherapy needs to sell itself, says Pollecoff, and he is pledging to make this a priority if UKCP members elect him as Chair.

It is welcome to see a senior psychotherapist be so honest about the problem and offer a solution. Unfortunately, our financial concerns as a profession usually get expressed in forum threads that bemoan the situation but offer few answers. A prime example of this was a discussion on CAPPPchat (, a forum for therapists in private practice in South West England. The spark was an advertisement from a low cost Bristol counseling service, Affordable Talk (, recruiting therapists to work Friday evening and weekends at £15 an hour. The consensus was that this was “minimal wage for anti-social hours”:  too low to cover supervision; insufficient to attract therapists with the necessary training and experience; and, overall, reflective of a devaluing of the profession.

Presumably Affordable Talk thought they were offering an opportunity to Bristol therapists to work a few more hours to the benefit of less well off clients. Sex Therapy Bristol approached Affordable Talk for comment. They declined, stating that this was “not a debate/discussion that we wish to enter into”. Whatever Affordable Talk’s intention, the thread revealed that a lot of therapists in private practice are concerned about what they earn per hour and believe that services offering low cost therapy might undercut their private practices.

So does low cost counselling undercut more expensive private practice work? Providing concessions to less well off clients is a longstanding tradition in psychotherapy. But low cost services are something different. They sell themselves to a less well off demographic rather than offer a portion of their time pro bono. They can do so because therapists who work for them are ready to accept a lower hourly rate.

To identify why they would do that, we have to look at how prices are set in psychotherapy. Unlike other professions, our hourly rate is not set by results. Rather our price is determined by our qualifications, our experience and what we think we are worth. Some therapists who work for low cost counselling services may be doing so out of altruism, but others do so because their labour is judged by the market and themselves to have a lower value: they have a lower level of training and less experience. None of this means that they are not excellent therapists, but we are not a profession that determines price by clinical outcomes.

The service that so upset therapists on CAPPP chat, Affordable Talk, is the low cost affiliate of Talk in the Bay, a commercial counselling service based in Cardiff ( Sessions at Talk in the Bay start at £45 compared to £25 at Affordable Talk. No business will undercut its own products unless it believes there is a different market that wants something cheaper. So the CAPPP chat commentators are both wrong and right: Affordable Talk is not a threat to private practitioners who charge £45 an hour. It is a cheaper product aimed at a market that can only bear £25 an hour.

However, in the terms by which psychotherapy sets price, it is likely to be delivering therapy using staff who are less qualified, less experienced and whose time is valued less by the market and by themselves. This conclusion is supported by the fact that the therapists listed on Talk in the Bay’s website are a different team. That does not mean that the low cost team is less able or effective. Outcomes in psychotherapy do not set price. However, the different teams will reflect differences in experience, training and individual expectation of earnings.

However, we should nonetheless be concerned about the extent to which the growth of such services as Affordable Talk reflects a wider devaluing of the profession. It is no coincidence that the proliferation of charities and other organisations offering affordable therapy has taken place in parallel to the huge increase in the training of therapists. It is important to understand that it is a symptom of a wider problem within the profession rather than a cause in itself.

Psychotherapy as a service profession has failed to understand market forces and use them to its advantage. We have preferred to let the money, as Martin Pollecoff reminds us, take care of itself. Unlike doctors, accountants and solicitors, our services are not required by everyone. There are only so many of the financially secure but worried well to go round. We face a zero sum game in which any expansion is at the expense of our peers. The only strategies to address this are either to increase the size of the market by promoting what we do, or putting up barriers to entry to restrict the numbers who train and qualify. Psychotherapy has done neither.

Not since the counter culture of 1960s and 70s has psychotherapy actively promoted itself as an activity that can be life enriching as well as problem solving. Instead, different approaches to therapy have sought to advance the interests of their specialism at the expense of others. This tendency has been exacerbated by the splits within the profession. The limited number of clients able to pay the fees of senior professionals has forced them to use teaching and supervision to supplement their income. Even greater benefits came to those who had the creativity and ego to establish their own approaches and become the established leaders in promoting, training and supervising new ways of working. What has developed is a de facto pyramid scheme where the rewards go to those who lead the profession as writers, teachers, supervisors and therapists. This has encouraged the creation of more courses that continue to churn out more therapists, most of whom will never make a decent living.

Government policy exacerbated this situation by attempting to make therapy a commodity that can be accessed by all. The profession has supported this development for reasons that included more jobs training more therapists. The result has been a further increase in the number of therapists, many of whom will be pushed into private practice as Government policy flipflops from investment in services to austerity cuts. Rather than ensure that trainings are restricted as a barrier to entry, psychotherapy has lowered those hurdles.

So what do you do with all the new practitioners that the therapy training industry produces? One answer has been to set up low cost counselling services that offer lower wage hours or volunteer placements to the host of underemployed trainees and graduates. Low cost counselling is a result of the problem of oversupply of therapists; a symptom rather than a cause.

If private practice psychotherapy wants to get more clients, it needs, as Martin Pollecoff, says, to sell itself. We cannot do anything about the number of practitioners now in the market, but we should be watchful of moves to expand the profession further. The priority for those of us in private practice and the professional organisations that represent us is to educate the public about the differences in what we offer.  Low cost counselling is a good thing, but it is not deep psychotherapy practiced by highly qualified professionals who have spent years studying and honing their skills.

Psychotherapy can be radical and transformative, not only personally but politically too. R.D. Laing was arguably the last British psychotherapist to successfully take that message and apply it publicly to society. In recent years those who lead the profession have been content to back the commoditised, quick fix approaches that have suited Government and to benefit from the proliferation of training courses. The benefits and value of long term, deep psychotherapy is what we need to sell to the public if we want to assure our economic future. Low cost counselling is not cutting the throat of psychotherapy. Rather it is the profession itself that is committing suicide by not paying attention to promoting its collective interests.

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