to think the NHS is hindering my recovery?

[Postpartumproblemo]

I saw a therapist through the NHS last year, I had two referrals. On the first I was diagnosed with OCD (after years of anxiety/depression and seeing loads of private therapists through work and never understanding what is wrong with me) and I opened up to my therapist, Jane. After I was discharged I realised I wasn’t coping with the tools I was given and felt I may have been discharged too early, I referred myself again and they agreed I needed to be seen again and that it made sense to see Jane since she began my therapy. I had to wait 9 months and saw her and it was life changing - we tried a different approach which worked and it truly made me a better, happier person able to cope with the world.

I wanted to continue once I was discharged and knew Jane worked privately. I knew I was “well” but felt regular therapy would be beneficial in managing the OCD. Perhaps I am too Americanised through TV, but people seem to have regular therapy. NHS said no and that Jane would be depriving the NHS of a client if she did, so that was that.

I since had a baby and a hugely traumatic experience where I lost control (I almost died as did baby) and it has majorly triggered my OCD. I emailed Jane via her private clinic to ask if I could see her again. However, NHS says no because I’m their client, but NHS also says I’m not allowed to see Jane again as we will be “too close”.

Is this not ridiculous? I now won’t seek any therapy. It took so much of me to explain my trauma to Jane, to go through my life history which is very complicated and takes a lot of time. Jane remembers all family members, events, I don’t need to go through my past to get to the point. Yet I’m not allowed to ever see her again? If she quit the NHS then yes I’d be able to but I know she values working for them and is high up now.

I feel majorly let down by the service and at a loss. I’d understand if Jane thought I was becoming dependent but she even has documented that I am not and the difficult history is the reason she is best suited, but the NHS response is that there are no allowances and I should re-refer and see someone else, but there is a year waiting list.

Is this not stupid?

I'm not entirely sure that's how it works... I work for the NHS and I also see patients privately. They only get a limited number of appointments on the NHS so that's not something I am "depriving NHS of".. I mean, it's cost-saving if anything. There is nothing in my contract that stipulates I can't see patients privately only that I can't have personal relationships with them until they are at least two years post discharge.
Are you quite sure that Jane just doesn't want you as a client? Who in NHS told you that you can't see her?

Yes, I can’t see how they can stop you. Surely it’s between you and Jane if she sees you privately. As for “depriving the NHS…” most places aren’t exactly short of patients.

It’s very weird, OP.

This perfectly sums up my thoughts. After working for years in the NHS (not in MH) I have never heard the NHS not allow private treatment. Private treatment clears more space for others to be treated on the NHS which is a huge help. I've seen patient change between NHS and private then sometimes back to the NHS for years.

It sounds to me that it may be actually Jane who is trying to stop it. She may feel you are too dependent on her.

My experience with the NHS is that they want you to go back to the same place/person.
I had therapy on the NHS for depression/ptsd last year, and realised I needed more in September, but didn't feel that the type of therapy was what I currently needed.
I asked for a GP appointment, explaining that I was struggling and needed different therapy t what I'd had and was told a GP would phone.
Apparently in such a situation sending a text telling me to contact the person I'd already had therapy with was considered appropriate, and they wouldn't refer me elsewhere. Hence I haven't had any more.
I'm not convinced that texting that information was appropriate with the information I'd provided, even if I had stated I didn't want to go back there. It certainly did worse than nothing for my depression.

In my personal experience, cutting off all contact with nhs and paying to find your own solution is hugely beneficial (totally offsetting the cost). I found contact with the toxic pit of hell that is the nhs to be catastrophic. The amount I paid to private doctors was hugely beneficial and worth not having a fancy holiday (for example).

there are some areas where nhs works. Where it doesn’t, patients have the choice to pay and find another way. If many people took out private health cover it would hugely benefit their health and the nations health as the nhs is a disintegrating disaster.

I’m certain, it was written by her boss. I don’t know if it’s different that she works for Therapy in County as a company which is in the NHS. It says if I move outside of the area I can see her but as long as I am in the town I am in, then I can’t. It is stupid and makes no sense. She stayed in touch and made it clear that she would happily see me privately but the official letter said no but I can go back via the referral with Therapy in County

I kind of see the NHS perspective as I am allowed more appointments and qualify, the issue is they don’t usually allow you back to the same person after 2 admissions (which I’ve had) to prevent dependency (this is in the official handbook I was given on day 1). Jane is very high up and takes 4 patients a year in the NHS now so it would be a long wait even if I was able to see her.

Jane did say that if she felt I was dependent and didn’t want to see me anymore then she would have communicated it by email / with an excuse. Instead she set up a therapy hour long call to ask what is happening, how things are going and went back through the official guidelines, she did say she would speak with her manager to see if there’s a chance I’d be able to go privately since time has passed. We’re the same age and I feel like we got on well. I like her and I am not dependent and am fully self aware so I am certain she isn’t trying to fob me off - I’ve seen the evidence of the policies. I am just so annoyed by it.

Look on the BACP website and contact Jane directly. She'll either take you on as a private client or won't. Mi don't see how the nhs can have any control over this.

I’m sorry, this is very frustrating for you but it seems the NHS in your area is adamant and that your energy would be best directed at finding a new therapist. Perhaps Jane could recommend someone.

That might put Jane in a difficult position. She has a contract that vetoes seeing ex clients and would have to say no. She has been clear that she can’t.

She meant that if op saw Jane privately, she would be depriving an NHS patient of a therapy session. But you are correct, there is no shortage of NHS pts requiring therapy.

But she won't be. Jane has a contract with the NHS for a specific number of hours/episodes of care. If the OP sees her privately, that has nothing to do with her NHS work. She will still have to deliver the same care hours to the NHS and her appointment with OP will be in her private practice time.

@SoNiceToComeHomeTo
The nhs limits the number of sessions it offers so how can they say no, you can't carry on in a private capacity with the same therapist?
It seems way too controlling.

Gently, YABU

The reason you can't arrange to see Jane privately after seeing her in her NHS clinic is that the rule is in place to protect vulnerable people from exploitation. Otherwise it would open the door to NHS therapists influencing their clients to carry on but pay privately. People who might not really be able to afford it might become dependent on that specific therapist and feel they 'need' to keep seeing them. It might affect the work done under the NHS, because instead of delivering treatment with an end date, the patient and therapist might presume that this end date (which is set for a good reason: to preserve resources, to adhere to an evidence based protocol with a set dose, to ensure dependency isn't promoted: the NHS is very much 'let's get you to a place where you can manage your own mental health' unless you have a severe mental illness like schizophrenia, psychosis etc.).

Jane won't go against what her employer says and put her job at risk to see you privately. Depending on her modality she will have her own code of ethics, however even if it doesn't explicitly state that NHS therapists can't see patients privately after their NHS treatment ends, she may well feel herself it's inappropriate, have discussed it in supervision, and have recognised it's a conflict of interests and not in your best interest.

It may be possible for them to make an exception to 'only two treatments with one therapist' and for Jane to accept you back for treatment under the NHS for this new presenting problem, you can always try, but in general I would say gently that it's lovely you've had such a positive experience with Jane, but I wouldn't discount that you will likely find another therapist who is equally as good, who may have different fresh perspectives, who can help you just as Jane did. After all a therapist can only do so much, it's what the client does with that support and info that makes the difference. And if you benefited form Jane's support before, that is because you did the work. So I would say telling yourself you won't ever try therapy again because it isn't with Jane is a bit unfortunate and a potential sign of that dependency that therapists try to avoid promoting.

Not unusual though. I had the same working for an EAP. They don't want therapists using the service to get private clients.

Sounds like Jane doesn't want you as a client. I seen private patients and NHS patients. I can tell the NHS patients where I am but if they find me of their free will that's their choice....I just used to inform my boss.

Use the summaries from Jane to find a new private therapist. There are other good ones like her out there. Jane is not the "cure" - your progress is down to you taking responsibility and engaging a programme of treatment that any good psychologist can provide. You can bring forward the work you have already done with a new person.

If Jane's private therapy is not funded by the NHS I don't see how they can dictate who she sees?

This is the first I’ve heard that the NHS is short of mental health patients.

I had no problems switching from seeing my therapist on the NHS to private. I don’t see how the NHS can have any say in what a private patient does.

I've declined clients as a manager on behalf of my team before, where I think the relationship is draining the staff member or too close to maintain professional boundaries. Sometimes when the staff member wants me to, and sometimes myself as a decision for their well-being.

We would also not allow nhs patients to then be seen privately. It could be seen as promoting private business through your nhs role and a breach of care standards/conflict of interest.

Find someone new. You may find a fresh new perspective.

Jane has said she’s not allowed to continue and shown a letter from her boss. I believe her. Upsetting for OP to have it suggested that her trusted therapist is lying.

This was my thought.

I have seen multiple types of drs on the nhs and then seen them privately both via nhs then private and privately then on nhs.

Its an odd policy to refuse a private patient

They can put it in her contract which the therapist has to agree.

If you can afford private therapy then it really is worth trying to find another therapist who you can see for as long as you need.