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?

Might have missed it but how did the nhs even know you were seeing Jane as a private patient? Were you trying to get it paid for by the nhs?

Jane won't be able to see clients she see's on the NHS privately. It's not you per se, but no therapist would be allowed to transfer NHS patients to be private. This is common in all therapy services.

It's frustrating. I had a friend who yje NHS gave 10 sessions of therapy to. He was making good progress but felt he needed a few more sessions and the NHS said no - 10 only and if you want to go private you need to find a new therapist. Standard policy in their area and no exceptions. It was really annoying.

People saying how can the NHS dictate what OP does privately are missing the point, they have no ability or interest in dictating what patients go and do privately, but they can stipulate that their employee, Jane, doesn't transfer NHS patients to private. This is to protect patients. And it's not like working in a pizza shop where they can't tell you not to work in a supermarket on your days off. Therapists have codes of conducts they have to adhere to and need to be transparent about their care of an individual and their plans for further care.

It's a conflict of interest, because there is now a financial incentive for the NHS therapist to try and keep therapy going, not conclude treatment appropriate, to transition a client to private work, to promote dependency. It can get very messy very quickly.

OP not realising why this is and declaring they won't ever try therapy again if it isn't with Jane is kind of a sad example of why these rules need to be put in place. If OP has this sort of dependency on Jane, Jane could easily influence OP to pay for sessions indefinitely, forever, even if there is no good clinical rationale. Therapy isn't quite the same as seeing an orthopaedic consultant privately to get your hip replaced faster. The nature of your relationship is different, easier to use in a manipulative way, harder to quantify, harder to measure outcomes.

Having worked in the NHS I do find it odd that a 'letter' from Jane's boss is involved or that this was shown to you: did you give permission for your details to be passed on to her boss? Or was it a generic email saying she's not allowed to see ex-clients?

Either way, there is never 'the one' therapist. I've have several and YES it is a pain to explain your history again, but how you do this tells the therapist a great deal about what is unresolved, and it is helpful to unpack a background. Your reluctance to seek help elsewhere is not particularly... healthy? And maybe does suggest a dependence on Jane that isn't helpful in the long run.

It is nearly always the case that once you've seen a therapist through an agency or organisation, in this case the NHS, you can't see them privately. I think it's to protect both parties and prevent dependency. However, in some cases you can see the same person after six months of no contact. I saw a therapist through an agency once - publicly funded - but she left to focus on her private work. She told me that she would happily see me once six months were up. As it happened I decided not to return.

It might be worth seeing if Jane would agree to private therapy after six months.

This is a conflict of interest and not as clearcut as you state. Different NHS Trusts and different departments have varying policies around this. For some it's a never situation and for some it's allowable after a period of time has elapsed.

Yes this is the rule and it makes sense. It’s just really upset me. I would spend thousands in sessions getting to the point where my past is understood to move on with therapy for the current issues!

I’ve not seen Jane for more than 18m I think now. It doesn’t matter apparently as I still qualify for the therapy on nhs and would be seen urgently due to perinatal

I completely understand this. The reason that I don’t think I’m “dependent” on Jane is that my reasons are I’ve seen 10 therapists probably. Some I just didn’t like and so stopped seeing (this was mainly as a teen) and the rest through work programs (EAP) who I thought seemed great but I never got anywhere or improved. Jane understood me off the bat and changed my life for the positive. I enacted her strategies and I am in a better place. The issue is I need a few sessions to talk through the birth (we were doing EMDR before and I am struggling to process that trauma). Then I’d be on my merry way, I just don’t have the energy to waste money and time, get childcare etc to see therapists like my previous who were great on paper but just not for me.

I think this is the crux of the matter, you knew this was the agreement from the outset and now you want to change the rules. This is the only reason I think it’s unreasonable expectation - I understand wishing the rules were different, but they have been transparent with you from day 1. They haven’t misled you and they are not stopping you from getting therapy. This is for everyone’s protection because dependency looks different for different people, and it’s very hard to spot dependency objectively. You don’t feel dependent and Jane is trying to be accommodating but she also knows the rules and tbh it doesn’t help she is getting your hopes up here knowing it’s in her contract too!

please don’t let this put you off seeking more help if you need it. I don’t think that’s good advice for anyone and DOES suggest a level of dependency on this therapist if you believe only she can help you, this is going down an unsafe road that can lead to more harm.

I actually didn’t know the rule from the offset. I found out at the end of my second set when she decided to start working privately and I asked to see her. The enquiries began and that’s when there was lots of back and forth. I do trust her to tell me if she thought I was too dependent or that she didn’t want to see me, I’d be fine with that. I’d accept it.
I think I will seek some sort of help, I do feel my anxiety creeping up and my mood feeling off so I’ll try the perinatal team and go from there