Understanding Talking Therapies: What's Actually on Offer in Croydon (And What's Missing)

21 Aug

Your GP mentioned "talking therapies" and handed you a leaflet. Maybe you've been to the NHS website and seen the reassuring language about "evidence-based psychological therapies." Now you're trying to work out what you've actually signed up for.

If you're searching for "NHS therapy near me" or "IAPT Croydon," here's what you'll actually find.

Let me be direct about what Croydon Talking Therapies actually offers:

Low intensity CBT: 3-6 sessions, usually online or over the phone
High intensity CBT: 6-12 sessions if you score high enough on their measures
Counselling: 6 sessions maximum (provided by Care To Listen)
Group therapy: Eight weeks sharing your struggles with strangers
Guided self-help: CBT worksheets you do alone

That's it. That's the entire menu for South London's mental health provision through IAPT (Improving Access to Psychological Therapies), now rebranded as NHS Talking Therapies.

The NHS says 95% of people access services within 18 weeks. But "access" means your initial assessment, not treatment. And if you need high-intensity CBT rather than guided self-help, you'll wait longer. If you score just below their thresholds, you might not qualify at all.

What Does NHS Talking Therapies Actually Mean?

"Talking therapies" sounds comprehensive, doesn't it? Like there's a whole menu of approaches available. In reality, it's become NHS code for "cognitive behavioural therapy in various doses."

The term itself is misleading. Yes, most therapy involves talking. But so does chatting to your neighbour. The talking isn't the point - it's what happens during that talking that matters.

When Croydon Talking Therapies says "evidence-based treatment," they mean:

CBT (the main offering)
Guided self-help (CBT you do yourself)
Behavioural activation (CBT focused on activity)
Group CBT (CBT with witnesses)
Six sessions of counselling (just enough to open wounds they can't help you close)

What they don't mean is choice. What they don't mean is depth. What they don't mean is time to understand why you're here again.

Why CBT Became the Default

CBT dominates NHS provision for one reason: it fits the system's needs, not yours. As I've written about before, the NHS turned mental health into a production line - CBT is measurable, manualised, and designed to get you functional enough to return to work.

South London and Maudsley Trust, which oversees mental health services in Croydon, treats over 45,000 people annually through IAPT. That's 45,000 people getting essentially the same treatment regardless of what brought them there. The same worksheets. The same thought diaries. The same six sessions.

CBT works well for specific, surface-level symptoms:

Panic attacks with clear triggers
Specific phobias
Recent depression with obvious causes (though it won't be recent by the time you're seen)
Simple anxiety about identifiable situations

For these issues, six sessions might help. But here's what CBT can't touch: the patterns that keep bringing you back.

What Happens in 6 Sessions of NHS Therapy?

Here's what actually happens in those six sessions you waited seven months for:

Session 1: Assessment and goal-setting. You explain your entire history in 50 minutes. The therapist types while you talk.

Session 2: Psychoeducation. You learn about the CBT model. You're given your first thought diary.

Session 3-5: Technique practice. You challenge thoughts, test behaviours, fill in worksheets. The therapist checks you're doing it "right."

Session 6: Relapse prevention and discharge. You're given a folder of worksheets and wished well.

Three months later, you're back at your GP. Same anxiety, different trigger. Same depression, deeper this time. Same relationship patterns, new person.

The GP refers you back to Croydon Talking Therapies. Another assessment. Another six sessions. Another folder of worksheets you'll never look at again.

I've written more about why 8 sessions often isn't enough for complex emotional patterns. In Croydon, you get even less.

What's Missing from the Menu

Here's a pattern that CBT can't touch: someone who repeatedly ends up with critical bosses, experiencing "generalised anxiety" at every job. They get referred for CBT. They learn breathing exercises. They challenge their thoughts. But the anxiety returns with the next job.

What if the anxiety isn't the problem? What if they're unconsciously choosing critical authority figures because criticism feels familiar - like home, like love, like what they know? The anxiety is their nervous system recognising danger in patterns they keep recreating.

Six sessions of CBT couldn't touch this. How could it? The pattern is unconscious. The anxiety is the symptom, not the problem.

This is what's missing from NHS provision:

Psychodynamic therapy explores these unconscious patterns. It asks not just "how can you manage this anxiety?" but "why do you keep ending up in situations that make you anxious?"

Humanistic approaches focus on who you are beyond your symptoms, your capacity for growth that's been blocked.

Systemic therapy looks at the relationship dynamics keeping you stuck.

None of these are available through IAPT Croydon or through Mind in Croydon's NHS-funded services.

Not because they don't work - the evidence base is solid. But because they can't be delivered in six sessions, measured on weekly questionnaires, or reduced to worksheets.

When Crisis Isn't Crisis Enough

Even if you're in crisis, Croydon's Crisis Line offers "emotional support" - someone to talk to, not therapy. The Crisis Cafe in New Addington? Peer support and hot drinks, open three evenings a week.

For actual crisis intervention therapy? You need to be actively suicidal. And even then, you'll get risk management, not treatment for what brought you to crisis.

The South London and Maudsley crisis team will keep you safe. They won't help you understand why you keep ending up unsafe.

The Private Alternative

Private therapy in South London typically costs between £60-120 per session. Specialist services charge significantly more.

Expensive? Yes. But consider the real cost of staying stuck:

The relationship you'll sabotage while waiting seven months for help
The job you'll quit because the anxiety becomes unbearable
The patterns you'll pass on to your children because you never understood your own

The waiting list might be 6 weeks or 18 weeks, depending on what you need and when you ask. In that time, you'll have repeated the pattern again. The question isn't whether you can afford private therapy. It's whether you can afford to keep managing symptoms while the cause remains untouched.

What Real Therapy Offers

If you want to understand what happens when therapy goes below the surface, that work exists. Just not on the NHS.

Real therapy doesn't measure progress through weekly PHQ-9 scores - your iPhone can do that. It doesn't discharge you after six sessions because that's all the funding allows. It doesn't treat your depression as a thinking error or your anxiety as a breathing problem.

Real therapy takes time. Time to build trust. Time to notice patterns. Time to understand not just what you do, but why you do it. Time to experience yourself differently in relationship.

When we meet weekly for as long as it takes, something different becomes possible. Not symptom management. Not coping strategies. But understanding the patterns that brought you here and choosing whether to keep running them.

Making the Choice

I've written before about whether you should go private for therapy. If you're dealing with a specific phobia, recent trauma with clear symptoms, or mild depression with obvious causes, NHS provision might help.

But if you recognise yourself in any of these patterns:

You've done CBT before and you're back with the same issues
Your problems predate your current situation by years
You keep choosing the same type of person/job/situation
You can manage the symptoms but they always return
You feel like you're living someone else's life

Then you need more than what counselling Croydon NHS offers. You need more than South London IAPT provides. You need more than the NHS has decided you deserve.

Beyond the Worksheets

The NHS treats mental health like productivity problem. Get people functional. Get them back to work. Get them off the waiting list.

But you're not a productivity problem. You're a person with patterns that make sense in context, struggling with problems that have roots, dealing with symptoms that have meaning.

Your anxiety isn't a glitch to be debugged. Your depression isn't just negative thinking. Your relationship patterns aren't cognitive errors.

They're communications from parts of yourself that need to be heard, not silenced with breathing exercises. They're evidence of struggles that need to be understood, not managed with worksheets.

You deserve more than six sessions of symptom management. You deserve to understand why you keep ending up here. That understanding is available - just not from the NHS.

Luke Row is a BACP registered psychodynamic therapist in Croydon and online. I work with people who've tried managing their symptoms and are ready to understand what's underneath.