Private therapy or the NHS: how to choose in London

Deciding to see a therapist is often the hardest step. Then comes a practical question that can feel surprisingly confusing: go through the NHS, pay privately, or both? The two routes work quite differently, and each suits different situations. Here is how they compare in London, based on the latest NHS figures.

What the NHS offers

The main NHS route for common problems such as anxiety and depression is NHS Talking Therapies. It is free, and in England adults can usually refer themselves online without seeing a GP first. It is generally for people aged 18 and over (16 and over in some areas), and people usually need to be registered with a GP.

The service treats low mood and depression, including postnatal depression, as well as anxiety, panic, social anxiety, phobias, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). It also supports people coping with long-term physical conditions. Guided self-help is often offered first. Other options include cognitive behavioural therapy (CBT), counselling, interpersonal therapy and couples therapy, depending on the area. Sessions can be in person, by video, by phone or as an online course.

Treatment is short and structured. According to the NHS, a course of CBT usually lasts between 5 and 15 sessions, and in 2025–26 people who finished a course had about nine on average. Patients are usually allocated a therapist rather than choosing one. If a person needs an interpreter, NHS guidance says one should be provided free of charge.

Some problems, including eating disorders, bipolar disorder, psychosis and drug or alcohol problems, usually need a GP referral to specialist mental health services.

NHS waiting times

NHS England’s standard is that 75 per cent of people should start treatment within six weeks of referral and 95 per cent within 18 weeks. In 2025–26, 89 per cent of people who finished a course of Talking Therapies had started within six weeks. The figure has been falling: in August 2026 it was 83 per cent.

These figures measure the time to the first treatment session, and only for people who completed a course. Some people wait longer between the first appointment and the start of regular sessions. For specialist community mental health services there is no national waiting time standard, and some people wait many months.

Anyone who needs urgent help can call NHS 111 and choose the mental health option, go to A&E, or call 999 if a life is at risk. Samaritans can be reached free, day and night, on 116 123.

What private therapy offers

The main differences are choice and time. A person can choose their therapist, the approach, and the language they want to speak in. A first appointment is often possible within days. There is no fixed number of sessions, so therapy can be short and focused or continue for months or years, depending on what is needed, and the person sees the same therapist throughout.

No GP referral is needed: a person contacts the therapist directly. Many people use private therapy for issues that don’t fit a short structured course, such as relationship difficulties, life changes, long-standing patterns or a general sense of being stuck.

How to check a private therapist

In the UK the titles “psychotherapist”, “counsellor” and “therapist” are not protected by law, so anyone can use them. Some titles are protected: “practitioner psychologist”, “clinical psychologist” and “counselling psychologist” can only be used by people registered with the Health and Care Professions Council (HCPC).

Many psychotherapists and counsellors belong to registers accredited by the Professional Standards Authority, such as those of the British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP). Membership is voluntary, but it means the therapist has met training standards and follows a code of ethics with a complaints process. Registers can be checked online. It is also reasonable to ask about the therapist’s training and experience, fees, session length and cancellation terms before starting.

How much private therapy costs

Fees vary widely. According to BACP, more than half of the therapists listed in its directory charge between £40 and £60 a session. In London fees are usually higher, especially in central London and for therapists with specialist training or long experience. Some therapists offer a free introductory call or reduced rates.

Some private medical insurance policies cover therapy, usually as an add-on, with a limit on sessions and often only with a GP referral. Conditions that existed before the policy started are often excluded, so it is worth checking the policy wording. Many employers also offer an Employee Assistance Programme with a few free counselling sessions, which can be a useful starting point.

Confidentiality and medical records

NHS Talking Therapies records are part of NHS care, and services usually let the GP know that a person has been in contact. Local services publish privacy notices explaining what is shared.

A private therapist keeps their own notes, which are not part of the NHS record. The GP is not informed unless the client asks for that. Confidentiality in therapy is not absolute, however, whether private or NHS: it may be broken where there is a serious risk to the client or others, a safeguarding concern, or a legal requirement such as a court order. Under data protection law, people can ask to see the records held about them.

Medication

Psychotherapists and psychologists don’t prescribe medication. If medication might help, a person can see their GP, who can prescribe or refer to a psychiatrist. Many people combine medication from their GP with therapy, either on the NHS or privately.

Using both

There is nothing to stop someone seeing a private therapist while on an NHS waiting list, or while getting medication or other help from the NHS. Some people start privately because they don’t want to wait, then decide whether to take up the NHS place when it comes. It helps to tell each professional about the other, so that care is joined up.

The NHS may suit someone who is comfortable with a short, structured course, can wait, or needs to keep costs down. Private therapy may suit someone who wants to start soon, choose their therapist or language, or work on something that needs more time. Both routes can help. What matters most is getting support in a way that works for the person.