It’s time to talk about money

This selection of infographics and text is taken from the 2021 CTUK report here.

The demographics of the therapy sector revealed a familiar picture of 79% women, ages clustered between 35-65 years with 28% describing themselves as disabled, higher than the UK national average of 18%.

There has been only a small shift in income patterns during the pandemic, with many therapists continuing to earn low weekly wages. The survey reported that 30% earn between £0-99, with over half earn less than £400 per week (gross income) which is the median earning for employed people in the UK.

This is partly explained by the high percentage of people working part-time (51%). This in turn is partly explained by the high level of disabled workers in the sector at 28%, 34% of whom work part-time higher than national average of 23% disabled workers who work part-time.

The very high levels of part time work convey a mixed picture of insecure income linked to insecure patient numbers. For many this is a situation of involuntary underemployment in private practice, supplemented by by temporary work such as Employee Assistance Programmes (EAPs) and short term contracts within IAPT. However there is also a common practice of working part time in order to practice safely and manage the levels of distress experience in the consulting room. The IAPT model for example, and the digitalisation of therapeutic work all increase the intensification of work with high case loads up to 8 clients per day. Traditionally the sector has recommended a maximum working hours but there is now only a weaker set of BACP guidance that outlines the ethical issues, creating de facto a system where there is no standard maximum case loads (Therapy Today, October 2019 Volume 30 Issue 8).

There is a very high percentage of people at 63% working on a self-employed basis where weekly incomes are significantly lower and more insecure. There is also a relatively high percentage of respondents who are not working at all in the sector (5%) with 30% earning the main bulk of their income outside of counselling and psychotherapy.  This is a very high percentage of counsellors and psychotherapists who have to subsidise their work through work outside of the the sector or from family incomes. Connected to this 51% of respondents went into debt while training and 30% in debt while working.

Low earnings also relate to the widespread use of unwaged work within the sector. 36% of respondents work unwaged, a system that has traditionally been part of most training courses, and is a way of gaining sufficient clinical hours for membership of the psychotherapy and counselling professional bodies. The honoraries in our survey worked across the range of public and private mental health employers, including services set up to respond to the Covid-19 impact on healthcare workers. Although the  largest section of unwaged work was relatively low at 1-4 hours per week this is likely to underestimate the real cost to counsellors and psychotherapists who will in addition have to attend supervision for these clients and, if clients are not seen in the same location on the same day, consist of working for free across a number of days and therefore reducing the possibility of maintaining paid work in other jobs.

Unsurprisingly then,14% of respondents receive income based welfare benefits with 4% accessing food banks while training and 3% while working as counsellors/psychotherapists. As a result of these financial realities, a high level of 30% of respondents cannot see a future earning a living as a counsellor or psychotherapist.

The data in context

There is no workforce data or monitoring of working conditions for those working for non-NHS providers in the UK’s mental health sector. Such data as does exist is for workers directly employed by the NHS, but, given that 63% of respondents are self employed this only gives us a partial picture of what is happening in services. This lack of data is compounded by the reluctance of staff to talk about their working conditions, in part because of insecurity but also fear of victimisation within the profession.  

This CTUK survey, and previous surveys carried out by www.thefutureoftherapy.com, show a clear prevalence of low waged, unwaged and precarious work in counselling and psychotherapy. It is important to understand that the UK is a low wage economy defined as earning less than two-thirds of median hourly pay. The introduction of the minimum wage and the National Living Wage in 2016 has done much to decrease the percentage of people earning below minimum wage rates but in the UK the insecurity of income is the key characteristic. Low pay in relation to hourly earnings fell to 16.2% in 2019, the lowest since the ONS data collection began in 1997 with a UK average of £15 per hour.  But although the percentage of people in the UK on low hourly pay is 14%, the percentage on low weekly pay is 28% indicating the significance of low numbers of paid hours/clients for counselling and psychotherapy incomes.

Despite the ‘future of work’ debates the image of self-employment – in the case of therapy principally related to private practice – continuously underestimates the insecurity of income that self-employed workers face. The ONS reports that self-employed workers on average earn £240 per week – approximately half the average income of their employed equivalents.

What the data shows is that the counselling and psychotherapy sector exhibits the precarious characteristics of the UK labour market such as wage insecurity, while underlining its specific characteristics, such as the scale of self-employed and unwaged therapeutic work. It is this financial landscape that must now inform the current professional debates and negotiations about the future of therapy.

To download the CTUK report for free click here.

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