“Tailored to the Treatment”: Patients Criticize Formulaic Therapy in NHS

Qualitative research highlights the frustration of patients who felt their sessions were scripted, with many calling instead for personalization and stronger therapeutic bonds.

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Psychotherapy patients in Britain’s National Health Service say the care they receive often feels standardized, even interchangeable, rather than responsive to who they are.

A new qualitative study of National Health Service psychotherapy finds that many patients want treatment to fit them, not the other way around. The researchers asked 148 adults who had received NHS psychotherapy to describe what felt helpful, what did not, and how treatment might be improved.

According to the results, published in Psychotherapy Research, patients emphasized the value of therapy that is personal and flexible, that builds a strong relationship with the therapist, and that digs beneath surface symptoms to underlying causes. They criticized approaches that felt generic, manualized, or rushed. Others highlighted the importance of learning concrete skills and gaining agency, while warning that one-size-fits-all care risks leaving people unheard.

As the authors summarize, the analysis highlighted “the patient’s preference for personalized treatment, the importance of therapeutic alliance, [and] the demand for depth in therapy,” with patients urging “more tailored approaches and stronger therapist-patient relationships.”

The study was led by Emily Li of Yale University, together with David Kealy of the University of British Columbia, Karin Aafjes-van Doorn of Yeshiva University, Jason McCollum and John Curtis of University College London, Xiaolu Luo of the Chinese University of Hong Kong, and George Silberschatz of the University of California, San Francisco.

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11 COMMENTS

  1. Depth focused therapies are inamical to public financing. Public therapy exists to reduce symptom burden at a population level, not personal discovery or exploration.

    There are also bad manualized therapists who don’t understand that personalizing treatment is likely part of the manual and the kind of treatment given that demonstrated effectiveness to choose these treatments for public use in the first place.

    Wanting to be understood and in relationship is just not something public healthcare is good at providing. And wanting it also doesn’t mean that getting it helps show improvement in outcomes that allow public healthcare to be funded in the first place.

    Again therapy. Pick a lane. If wanting to be seen as healthcare worthwhile of public financing, the outcomes of treatments are health related and require use of faux diagnostics of invalid constructs and experiments that show marginal improvement in limited symptom domains. If you think therapy is about building a relationship and self discovery, you have to make auch better case about hey health systems should fund your practice, as it is not healthcare (I guess you would have to show self discovery improves health/wellness meaningfully to even make the attempt).

    If you conceive Psychotherapy as a treatment, it has to be a treatments for some illness. If it is not a treatmnent, why are healthcare providers and health administrators and national health systems involved with it?

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  3. I once saw a therapist who never said much beyond, “That’s cutting a little deeper.”

    Something about the way she said it told me it was scripted. A couple of years later I took a psychology class where the professor showed us a video demonstrating different therapy techniques.

    And guess what one of the “techniques” featured? “That’s cutting a little deeper.”

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        • What NHS Psychological Therapy Clients Really Want

          
          ‘Therapist responsiveness and tailoring treatment to themselves’. These are the main findings from a qualitative study of 148 NHS clients, who had psychological therapy, just published by Li et al (2025).
          Therapist responsiveness means actively listening to the client’s concerns and responding to them. In terms of the social psychology ‘Elaboration Likelihood Model of Persuasion‘, the concerns of the client can be peripherally processed, by the therapist, with effortful processing reserved for a specific identified protocol for a disorder. In the words of the title of this paper ‘It felt like I was being tailored to the treatment rather than the treatment being tailored to me’.
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          A common scenario is a single Mum living in appalling housing conditions. Her children’s asthma worsened by the mould. The Social landlord has repeatedly failed to address matters. She is severely depressed and the therapist is preoccupied with a Behavioural Activation (BA) programme. Notwithstanding, that she is too embarrassed to invite family/friends to her home.
          Effortful processing on the part of the therapist would have been discussing possible legal action against the Landlord.
          But the job of triaging clients in NHS Talking Therapies, in practice, usually falls to Psychological Wellbeing Practitioners or a social science graduate, neither of whom are trained therapists. They do not have the competence to deal with the psychological and social. The ‘PWPs’ are under pressure, with typically just 6 treatment sessions at their disposal. They may see this single Mum as unsuitable for the service or plough on with a short course of BA. However, the Mum is likely to attend only one assessment/treatment session. With regards to depression for every one person attending one session, two people go on to have 2 or more sessions [Scott (2024)]. There is an unrecognised, massive haemorrhaging of clients at triage. Comparable in scale to booked appointments for an assessment/treatment session that is not attended.
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          There is however a fundamental flaw in the Li et al (2025) paper, they state that the Improving Access to Psychological Therapies Programme (the predecessor of NHS Talking Therapies) has been ‘internationally recognised for its effectiveness in psychological care on a large scale’, citing David Clark the prime mover in the development of IAPT and Wakefield et al (2021). Neither of these sources can claim independence of the Service, the corresponding author in the Wakefield et al study was an IAPT programme director. I wrote a rejoinder to the Wakefield et al study in the British Journal of Clinical Psychology, in which my own analysis of 90 IAPT cases as Expert Witness to the Court, showed that only the tip of the iceberg recovered [Scott (2018)].
          
          Dr Mike Scott

          Hope this helps

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