Is Counselling Only For the Rich?
Disclaimer: I use therapy and counselling interchangeably throughout this article. I believe they have slightly different meanings in the medical community so please bear with me.
I recently was lucky enough to go through therapy for four months. I had been wanting to attend therapy for a couple of years. I first self-referred myself with the NHS who eventually reached out after some time - roughly two weeks I think. We scheduled a phone call during which a psychologist from Homerton University Hospital called me to ask why I was self-referring. I told her that I had been asking myself lots of questions recently about my life choices, my place in society, my relationships with others, and that some of that overthinking was deteriorating my personal life and my professional life to a certain extent.
After a few follow-up questions, she went on to say that unfortunately, they work with people suffering from depression, intense anxiety, and other conditions, but that it sounded like I could greatly benefit from counselling. This meant that they could not help me at this time, but were happy to send me information about my counselling options.
I was happily surprised when I received a long email full of detailed services such as The Caravan Drop in Counselling Service in central London, the City and Hackney Wellbeing Network and the Centre for Better Health (lots of these were in or near Hackney in London where I was living at the time). I studied this list extensively and I learned very positive things about all these options. First, I found out that there are many different price ranges, from free or £5 a session for those who are unemployed and receiving benefits all the way to £100 session therapies.
I also recently learned that many other charities and organisations offer therapy with prices based on what you can afford, often targeted to specific ethnic groups or minorities. What became clear quite quickly though was the direct link between the price and the wait time: the more you are willing to pay, the less you will have to wait (with more expensive therapies starting immediately). Being lucky enough to earn a living that disqualified me from most of these options, and not keen about the idea of paying £60+ weekly for therapy, I put a pin in that plan.
Fast forward to a year later, in the middle of a pandemic. Like many I am sure, I felt my mental health deteriorating through lockdown. I was very anxious, slept horribly, and this amongst other symptoms was greatly impacting my general wellbeing, as well as those around me. At that point I made the decision to start counselling remotely with a private therapist (which I realise is an opportunity not offered to all - I feel extremely lucky). This went on for four months.
A friend once told me that “you go into therapy with an idea of what it’s going to be about, but cannot begin to imagine the extent to which it will be different“. I could not agree more. I went through quite a few drastic life-altering events in these four months, maybe in part due to the therapy that I went through. What I am left with is a better understanding of myself and of human psychological mechanisms. I also learned a lot about my relationship with my parents, with others and with myself. My sleep is back to normal and I feel a lot less anxious than I used to. While I decided to cut the counselling to what my therapist judged to be “relatively short”, he also told me that a therapy so early in life (at 24-25 years old) can be extremely important and he recommended that I come back to it later on.
I would recommend therapy to my worst enemy. Perhaps it would lead to us becoming great friends. I had no idea where it could lead me. If it were up to me, I like to believe that I would want to have therapy be mandatory, at least in some parts of life. Maybe 6 months in your 20s. Another 6 months later on. I am led to believe however, that therapy is a lot more effective if you have the headspace for it. To be able to dig deep within yourself requires a high level of motivation, which is likely to depend on whether the decision to undergo therapy is one’s own decision, or decided for them (such as being court-mandated, or as a family recommendation). This feels largely confirmed by my experience, where I ended things after four months because I did not feel motivated enough anymore.
I attended 15 sessions over the course of these four and a bit months, which set me back £1,200 (I am lucky enough to have now been mostly reimbursed by my health insurance, even though I self referred). That works out to roughly £300 a month which, let’s be realistic, is not the kind of disposable income available to many. With rent prices in cities increasing drastically in the last decade, millennials complaining that they are struggling to put any money on the side on a monthly basis, starting salaries being excruciatingly low, particularly in cities like London where the job market is extremely competitive, and few of us being offered private health insurance through work, it is hard to believe that many have the opportunity to spare £300 a month for counselling.
I believe this to be a tremendous problem. Many of us are suffering from mental health problems, and this has been accentuated with the current pandemic. As I experienced, I believe therapy can be a great way to get at some of the reasons behind such problems, which is a great first step towards getting better. I think however that the NHS currently does a good job at helping those with major mental health issues such as chronic depression, insomnia, deep anxiety, etc. In order to be qualified to receive this kind of free treatment though, the threshold is such that you have probably been suffering a great deal for some time.
Where I believe there is also lots of value (in a way which I do not think is greatly appreciated) is in understanding yourself, the reasons for the way that you are. Counselling might help you become the person that you are longing to be. It might help you get rid of that feeling of inadequacy. It’s finally someone you can talk to about that feeling you have which never dared tell your parents, your friends. Are you torn about your career choices? You might be making choices to satisfy your parents, not yourself. Do you ever wonder why you are afraid of conflict? It might be a behaviour which you inherited as a child. Ever wondered why some of us suffer from eating disorders related to one’s conception of body image? This might be a result of (not so) innocent comments throughout one’s life. All of these questions could find answers through counselling.
Unfortunately, the less fortunate ones will struggle to attend a therapy which can help them explore those parts of human psychology and themselves. What kind of (additional) inequality could that create in society between the rich and the less rich?
Is counselling for the rich? Definitely not. But they might be the only ones to be able to reap the benefits of it. You should consider it, if you are lucky enough to be able to.
Written by Raphael Lenain
Raphael lives in London, where he works for a startup in healthcare. In his free time he likes to cook feasts for his friends, DJ and even produce music. He is also a big fan of the outdoors, and is always up for a good walk. On Saturday mornings, you might find him at the farmers market, or cycling around Hackney.