Private Therapy vs NHS in London: What You Need to Know (2026)

If you are considering therapy in London, one of the first decisions you face is whether to go through the NHS or seek private treatment. Both options have real strengths, and neither is universally better than the other. The right choice depends on your circumstances — your budget, your timeline, and the kind of support you are looking for.

In my 14 years as a therapist, I have worked with many clients who tried the NHS route first, others who came to me directly, and quite a few who used both at the same time. In this article, I want to give you a clear, honest comparison so you can make an informed decision.

How long are NHS waiting times for therapy in London?

They are long, and in many boroughs they are getting longer. The median wait for community mental health services in England is approximately 45 days from referral to first contact, but this figure masks enormous variation. NHS England data shows that around 16,500 people are currently waiting 18 months or more for mental health treatment, and the 90th percentile waiting time — meaning the point at which 90% of patients have been seen — stands at 251 days. That is more than eight months.

In London specifically, demand has surged since the pandemic. Many NHS Talking Therapies services (formerly IAPT) report wait times of 8 to 16 weeks for an initial assessment, with further waits before treatment begins. For specialist services — complex trauma, eating disorders, personality disorders — waits of six months to over a year are common.

This is not a criticism of NHS staff, who do remarkable work under enormous pressure. If you are in crisis, the NHS has urgent pathways. But for ongoing, planned therapy, the timeline can be frustrating.

What type of therapy does the NHS offer?

The NHS primarily offers Cognitive Behavioural Therapy (CBT), an evidence-based approach focused on changing unhelpful thought patterns and behaviours. It works well for many people, particularly for anxiety, depression, and phobias. You may also be offered guided self-help, computerised CBT, or other structured approaches like interpersonal therapy (IPT). Treatment is typically time-limited — most courses run between 6 and 16 sessions.

What the NHS generally does not offer is a wide choice of therapeutic approach or therapist. You will usually be allocated to whoever is available, and switching can be difficult. The system is designed to deliver standardised treatments at scale, and personalisation is limited by resources.

What does private therapy offer that the NHS does not?

Private therapy gives you three things that the NHS system struggles to provide: choice, speed, and flexibility. You choose your therapist, your therapeutic approach, and how long you continue for. There is no waitlist, no discharge after a set number of sessions, and no restriction on what you can bring to the room.

In my practice, I work as a gestalt therapist — an approach that focuses on your present-moment experience rather than following a structured programme of techniques. The therapeutic relationship itself is central to the work. This kind of open-ended, experience-based therapy is rarely available through the NHS, but it can be profoundly effective for relationship difficulties rooted in attachment patterns, identity questions, life transitions, grief, or a general sense of being stuck.

You also have continuity. You see the same therapist every week, and that consistency allows for deeper trust and more meaningful work. NHS services, particularly in overstretched areas, sometimes involve seeing different practitioners or being moved between teams.

How much does private therapy cost in London?

Private therapy fees in London typically range from £70 to £150 or more per session, depending on the therapist’s experience, location, and specialism. Central London practices tend to be at the higher end, while therapists in outer boroughs or those working exclusively online may charge less.

At my practice, I charge £120 for a 50-minute in-person session at 85 Wimpole Street (W1G 9RJ) and £100 for a 50-minute online session. I know that therapy is a significant financial commitment, and I take that seriously. I believe that if you are investing in your mental health, you deserve to know exactly what you are paying for and what you can expect in return.

To put it in context, a weekly session at £100 to £120 comes to roughly £400 to £480 per month. The difference between this and other monthly expenses is that therapy addresses something that affects every area of your life: your relationships, your work, your sense of self.

Can I use both NHS and private therapy at the same time?

Yes, you absolutely can, and many people do. There is no rule that prevents you from seeing a private therapist while you are on an NHS waiting list, or even while you are receiving NHS treatment. In fact, this is one of the most practical strategies I see.

Some clients come to me because they cannot wait months for NHS treatment. They start private sessions for immediate support, then decide whether to take up the NHS offer when it arrives or continue privately. If you’re not sure what that first step looks like, I’ve written a guide to what to expect in your first therapy session. Others use the NHS for medication management while doing deeper therapeutic work in private sessions.

I would simply recommend being transparent with all your providers, so that your care is coordinated rather than contradictory.

Do I need a GP referral for private therapy?

No. You can contact a private therapist directly — find someone whose approach suits you, get in touch, and book. No GP involvement needed.

For NHS Talking Therapies, you do not need a GP referral either. Since 2008, self-referral has been available in England. You can find your local service on the NHS website and refer yourself online or by phone. Many people do not realise this, which adds an unnecessary step and further delay.

Will private therapy appear on my medical records?

No, and this matters to more people than you might expect. Private therapy is entirely confidential and is not recorded in your NHS medical records. Your GP will not be informed unless you specifically ask your therapist to write to them, and no record of your treatment will appear on any centralised health database.

This matters for people in professions where mental health disclosures can have career implications — the military, law enforcement, financial services, aviation — and for anyone who simply values their privacy. What you discuss in a private therapy room stays there, subject only to standard safeguarding exceptions (such as serious risk of harm).

NHS treatment, by contrast, is recorded in your medical records and accessible to other healthcare professionals. For most people this is not a problem, but if privacy is important to you, private therapy offers a level of confidentiality the NHS cannot match.

Does health insurance cover private therapy in the UK?

Some policies do. Insurers like Bupa, AXA Health, Aviva, and Vitality offer mental health cover in certain plans, though cover may be limited to a set number of sessions or require pre-authorisation. Check your policy or call your insurer to ask about outpatient mental health cover.

Employee Assistance Programmes (EAPs) are another option — many UK employers offer 4 to 8 free sessions. These can be a useful starting point, though you may not have much choice over your therapist.

How do I decide which option is right for me?

Here is my honest perspective, based on 14 years of working with clients across both systems.

Consider the NHS if: you are comfortable with CBT or a structured approach, you can manage the waiting time, you are on a tight budget, or you need medication alongside therapy (GPs and NHS psychiatrists can prescribe; private therapists cannot).

Consider private therapy if: you want to start quickly, you want to choose your therapist and approach, you need more than 6 to 16 sessions, you value privacy, you have tried CBT and found it was not right for you, or you’re working with long-standing patterns like perfectionism and burnout that need more than a short course.

Consider both if: you are on an NHS waiting list and need support now, or you want NHS medication management alongside private therapeutic work.

There is no wrong answer here. The most important thing is that you get the support you need, through whatever route makes that possible.